Cervical Cancer Update – Including When and How Often You Should Screen

…..CCervical Cancer Updateervical cancer in the United States has been dramatically reduced over the past 30 years due to the widespread testing of cervical cells with the use of the Pap smear.  The cervical screening program is constantly evolving as more studies mature the guidelines.  The American College of Obstetrics and Gynecology (ACOG) in November of 2012 issued a new Practice Bulletin, which gives new guidelines to improve cervical cancer screening, based on the latest studies.  This will be a short summary of these guidelines:

  • The cervical cancer screening program begins at age 21 regardless of the onset of sexual activity.
  • With women 30 to 65 years of age, cervical cancer screenings should not be performed as often as annually.  Annual well woman exams are still recommended and extremely important!
  • For women ages 21 to 29, Pap smears should be done every 3 years.
  • For women ages 30 to 65, Pap smears should also be done every 3 years.
  • Co-testing (Pap smears and HPV testing) should not be performed with women 21 to 29 years of age.
  • Co-testing should occur every 5 years with women 30 to 65 years of age.
  • With adequate screening history, cervical screening can be stopped after age 65.
  • After a hysterectomy in which the cervix has been removed, screening can be stopped.
  • Any woman who has received the HPV vaccine should be screened by the same guidelines.

…..As always, all of this information should be discussed with your health care provider who will establish an individual plan for you.  Remember all recommendations may be modified based on the individual’s personal history.

-Dr. P

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Crucial Tdap Vaccination Recommendations for Pregnant Women

…..Let us now summarize the Tdap vaccination recommendations as advisCDC_09[1]ed by the CDC (Centers for Disease Control and Prevention) and the American College of Obstetricians and Gynecologists:

  • Pregnant women should receive the Tdap vaccine with each pregnancy, and the ideal timing is during 27 to 36 weeks of the pregnancy.
  • With the preceding plan, there is an increased likelihood of optimal protection against pertussis for the pregnant woman and her infant during the first few months of the baby’s life.
  • All women during each pregnancy should receive the vaccine whether or not she has received the vaccine in the past.
  • If the pregnant woman has not received the vaccine during the pregnancy, it should be administered immediately after delivery.
  • To date there is no data to suggest increased fetal, maternal, or pregnancy risks with the vaccine, but the safety should be closely monitored under the direction of the Food and Drug Administration.
  • Although not part of the new immunization schedule recommendations, experts are advising vaccinations for the new baby’s father, siblings, and other caretakers.  This is part of the cocooning strategy.  Even grandma and grandpa should consider vaccination.

…..As always, discuss all your concerns with your caring medical professional so you can obtain the best care possible for you and your family!

-Dr. P

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The New Outbreak of Pertussis in Babies


Little Baby M.O.
Over the past decade, there has been a large increase in the incidence of pertussis (whooping cough) in the United States, with over 40,000 cases being reported in 2012.  What is of great concern is the large number of infants being affected.

The CDC (Centers for Disease Control and Prevention) reports that most pertussis hospitalizations and deaths occurred among children under 3 months old.  Babies do not receive their first pertussis vaccine until two months of age, and they are not fully protected until after their third shot, which comes at about six months.  Over the first six months of life our babies are at a high risk of getting very sick if they develop this bacterial infection.

In order to combat this new outbreak of pertussis, in January 2013, the CDC released a new immunization schedule.  This recommended that a dose of Tdap vaccine be given to all women during each pregnancy whether or not she had received the vaccine previously.  This was a change from their previous recommendations which suggested that the vaccine be given only to pregnant women who had never received this vaccine.

-Dr. P

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Are You at a High Risk for Lung Cancer?

Last week, I spent the day attending a conference at the Icahn School of Medicine at Mount Sinai in New York City.  It was called Lung Cancer Screening: A Paradigm Shift in Primary Care.  The main focus was on the changing thoughts and new protocols for screening for lung cancer in high risk patients.  Of course I looked at the course through my OB/GYN glasses, and here are some of the points I took home:lungs brown and pink

  • Lung cancer is the #1 cancer killer in the United States, and it is now found as often in women as it is in men.
  • Therefore, for women in the United States, lung cancer is the #1 cancer killer, and its numbers are greater than breast, ovarian, and uterine cancer combined.
  • Smoking and exposure to passive smoke are the main causes of lung cancer.
  • Finding lung cancer at an early stage and having it removed can give an overall cure rate of 80% at the Stage 1 level.
  • Low-dose lung screening CAT scans can pick up these early cancers, and the radiation exposure can be low, thus decreasing the radiation exposure risks.
  • With the new thoracic laparoscopic surgical techniques, post-op pain and recovery time have been greatly reduced.

The questions that need to be resolved are many.  When do you start the screening process?  In the high risk patient, do you screen yearly?  How do you define who is the high risk patient?  How are the scans paid for?

I left the conference more determined than ever to try to help my patients stop smoking and to help the younger ones not to start.  If you do smoke and have been smoking for a while, please speak to your health care providers to see if these new developments may be of help for you.  The lung cancer screening protocols are evolving so keep your eyes and ears open!

-Dr. P

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Postmenopausal Women – Preventing Your Urinary Tract Infections


…..
Postmenopausal women are at an increased risk for urinary tract infections (UTIs) because of a decrease in their estrogen levels.  This lower hormone state is associated with specific physical and physiologic changes that increase this risk:Postmenopausal Women – Preventing Your Urinary Tract Infections

  • Thinning of the mucosa of the vulva (vaginal tissue)
  • Changing of the normal bacteria that usually inhabit the vagina, especially a decrease in lactobacillus colonization
  • An increase in the pH of the vagina
  • Vaginal colonization of E. coli.

…..There have been multiple studies which have found a decrease in these UTIs with the use of estrogen intravaginal creams.  There are many variations on the types of estrogen used and many commercial products available.

…..If you are in the menopausal time of your life and suffer from recurrent UTIs, ask your medical professional about the possible use of a vaginal estrogen preparation.

-Dr. P

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Another Way to Reduce Your Risk of Developing Breast Cancer

Pink Breast Cancer RibbonSome women at a high risk for breast cancer may reduce their chance of developing invasive breast cancer with the use of the medication called tamoxifen.  Chemoprevention is the use of a medication to reduce cancer, and it may be considered in a patient who is at high risk of developing breast cancer.

In a high risk population, the risk reduction with the use of tamoxifen has been reported to be 49%, and this has resulted in the FDA approving tamoxifen as the first drug for breast cancer prevention.  In addition, studies have also found that another medication, called raloxifene, to be of benefit in menopausal women.  Of course there can be serious side effects with these medications, so their use may be limited.

If you are at a high risk of developing breast cancer, start a discussion with your medical team about the possible use of chemoprophylaxis!

-Dr. P

Read more about tamoxifen in my post: How Does Tamoxifen Treat Breast Cancer?

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Some Points You May Not Know About HPV

Let us continue our HPV informational journey with a few essential points:

  • HPV infections are almost exclusively acquired from sexual exposure.Some Points You May Not Know About HPV
  • The virus has been detected in multiple sites on both the male and female genital areas.
  • The cervix is the most common site for the infection.
  • Transmission between the mother and infant has been documented, with exposure during the delivery being suggested as the most common cause of the fetal infection.  This is considered a vertical form of transmission.  Some studies suggest a vertical transmission rate of about 25% with almost all neonatal infections cleared by the first year of life.

-Dr. P

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What Other Issues Can HPV Cause?

It was not until the early 1980s that the association HPV Researchbetween the human papillomavirus (HPV) and genital tract infections became apparent.  A German research physician had isolated the HPV 16 and implicated its role in the development of cervical cancer, so a new scientific journey had begun.

We now know that the persistence of an HPV infection is necessary for the development of cervical cancers, and it is implicated in the majority of other genital tract infections in both men and women.  It is time to start our journey to a better understanding of a virus that affects so many of us!

Click here to continue to: Some Points You May Not Know About HPV

-Dr. P

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Two Reasons Why You Should Not Drink Alcohol During Pregnancy

Water Pouring from Bottle…..Alcohol is a teratogen!  A teratogen is a drug or any other substance that can affect the development of an embryo and can lead to birth defects or other developmental problems.  Fetal alcohol syndrome (FAS) is a constellation of physical, behavioral, and cognitive abnormalities in children resulting from a mother drinking alcohol during a pregnancy.

…..The Centers for Disease Control and Prevention report that the rates for FAS in the United States range from 0.2 to 2 cases per 1000 live births.  A less severe form of this problem, called fetal alcohol spectrum disorders (FASD), might be 3 times this rate.

…..There is always the question about how much alcohol will cause a problem.  Will low levels of alcohol consumption during pregnancy cause harm?  What do low levels of alcohol mean?  Will a small amount be OK?

…..It is important to remind ourselves that FAS and FASD are entirely preventable.  These syndromes are not seen if a pregnant woman does not drink alcohol during her pregnancy.  It is for this reason that the Surgeon General of the U.S. and the American College of Obstetricians and Gynecologists direct health care clinicians to advise patients to abstain from alcohol completely during pregnancy.

-Dr. P

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Exercising During Pregnancy – Is it Safe?

…..Obstetrical health professionals have always told their patients that regular, moderate exercise during pregnancy is beneficial and safe for both the mother and fetus.  It is generally agreed that exercise can reduce the common discomforts of pregnancy.  Exercise may even help decrease the risks of gestational diabetes and even preeclampsia.

…..young woman exercising in a parkThe Department of Health and Human Services recommends 2 1/2 hours of moderate aerobic exercise per week.  I have always suggested walking a 1/2 hour daily while trying not to get overheated or out of breath.  If you are able to carry on a regular conversation during your walk, then you are probably not overdoing it.  The problem is not knowing how much is overdoing it, and the guidelines are vague.

…..Should elite athletes continue vigorous programs during their pregnancy?  Should overweight or inactive women begin some exercise regime during their pregnancy?  Once again, relating to these questions, the problem is that detailed studies with direct answers are scarce.

…..However, new studies are now being undertaken at the Johns Hopkins Bayview Medical Center that may give some direct answers.  Recently, two articles were published from their program which showed that even inactive healthy women can exercise moderately during their pregnancy without problems.  They also showed that athletes may continue vigorous exercise safely.  Their very scientific research continues, and finally, we may have the answers for our patients.

…..Lastly, common sense should always be used: pregnancy is not the time to begin activities that may increase your risk of injury.  That means no kickboxing!

-Dr. P

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How Does Tamoxifen Treat Breast Cancer?

…..Science HealthTamoxifen is a common endocrine treatment for both early and advanced breast cancer in pre- and post-menopausal women.  Some breast cancer cells are stimulated to grow in the presence of the estrogen hormone.  The estrogens bind to special areas in the cancer cells called estrogen receptors, and once the estrogens are attached, the cancer cells’ growth is enhanced.  These breast cancers are called estrogen receptor positive.

 …..Tamoxifen breaks down in the body into a compound that also binds to the estrogen receptor in the cancer cell, but it does not stimulate the cancer cell to grow.  Since the binding site is filled, any available estrogen cannot attach to the cancer cell and stimulate its growth.

…..After the diagnosis and treatment of a breast cancer that was estrogen receptor positive, many patients would be placed on 5 years of tamoxifen treatment, and this would reduce the recurrence of the disease.  New studies may cause oncologists to change the protocol to 10 years of tamoxifen treatment due to the findings of better long-term outcomes.  There are currently ongoing studies which should shed more light on the possibility of modifying the protocols.

…..I would like to touch upon two other points.  As with all medications, tamoxifen can have side effects.  Endometrial cancer is increased with the use of tamoxifen, and so oncologists follow patients closely for this potential problem.  Lastly, another group of medications, called aromatase inhibitors, is now being used more frequently with these patients, but worldwide tamoxifen remains widely used.

-Dr. P

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Hysterectomies in This Day and Age

.Surgery….A hysterectomy is the surgical removal of the uterus.  There are many reasons to have this surgical procedure, and the decision to undergo a hysterectomy must never be made lightly.  Today, the decisions are becoming more complicated as the surgical techniques change and more options are available.

…..The first laparoscopic hysterectomy was performed about 25 years ago, and this changed gynecological surgery forever.  The instruments used were very basic, the technique was new, and acceptance was gradual.

…..In 2008, only about 20% of hysterectomies performed in the USA were being performed with a laparoscopic technique, but by 2012 the number had risen to about 40%.  This minimally invasive route includes the robotic and the conventional laparoscopic procedures.  The refinement of instruments and robotic technology continues the march to an even larger percentage of hysterectomies being performed by the minimally invasive approaches.

…..Remember, before undergoing any surgery, do your research into the indication for the surgery and the type of procedure.  Check into the surgeon’s experience and background, and always ask many questions before any decisions are made!

-Dr. P

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Should You Take Depression Medications During Pregnancy?

MH900390528…..The decision to use any medication during a pregnancy is always made with great care after thorough evaluation by the patient and her health care providers.  Selective serotonin reuptake inhibitor (SSRI) use during pregnancy has always been controversial and now even more so due to recent articles on the subject.  Here are some important points:

  • Depression and anxiety are common in women of childbearing age, and many of these women are being treated successfully with medications, especially the SSRIs.
  • Stopping any antidepressant medication before or during a pregnancy can bring about a depressive relapse, especially in women with a history of severe depression.
  • Fetal and maternal well-being is paramount in balancing the risks and benefits of antidepressant treatment in pregnancies.
  • SSRIs seem to work by boosting serotonin levels in the brain, resulting in mood regulation.
  • Prozac (fluoxetine) was the first SSRI antidepressant approved by the FDA, hitting the market in 1988.  It quickly became one of the most prescribed medications in the United States.
  • Prozac, Celexa (citalopram), and Zoloft (sertraline) are three SSRIs that have been used in pregnancies.

-Dr. P

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A Way to Help Determine the Status of Your Weight

Weight control is a major concern for most of us.  As menopause approaches, many women experience an increase in their weight, with about 70% being overweight.  Body mass index (BMI) is a commonly used calculation that quantifies where our weight is, and when using this classification, about 50% of perimenopausal and menopausal women are considered obese.

Using a person’s height and weight, body mass index can be calculated, giving us a guide to where we stand with regards to our weight.  A BMI of 24 to 29 is considered overweight, and over 30 is obese.  Let us look at where some weights fall:

  • At 5 ft. 1 in. a BMI of 24 to 29 corresponds to a weight of 130 to 150 lbs.
  • At 5 ft. 1 in. a BMI of 30 corresponds to a weight of 160 lbs.
  • At 5 ft. 6 in. a BMI of 24 to 29 corresponds to 155 to 180 lbs.
  • At 5 ft. 6 in. a BMI of 30 corresponds to a weight of 185 lbs.

Remember that this BMI number is not an exact measurement of body fat but it alerts us to where our weight status lies and gives us an indication of our risks for developing the complications of obesity.  These include diabetes, hypertension, heart disease, and many other medical conditions.

BMI Chart Larger

-Dr. P

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One Possible Way to Decrease Your Chance of Developing Alzheimer’s Disease

One Possible Way Decrease Alzheimer’s Smaller BlogI recently came upon an article which touched upon a walking program that could decrease the chance of developing Alzheimer’s disease.  Some studies have suggested that by walking about a mile each day, you can dramatically decrease your risk.

It seems that this decreases the mental losses by improving Reduce Alzheimer's Diseasethe blood flow to the brain and therefore keeping the brain cells healthier.  So one of the easiest exercises available to all, again shows great benefit.

Let us then begin a review of this exercise!

  • There are very few medical conditions that prevent us from walking.  Of course, always check with your medical professional before starting a new program.  Beginning at a slow pace in a safe area is a perfect way to start.
  • Good walking footwear is important, and replacement every 6 months or when the cushion of the heal wears is a must.
  • You should start with a few minutes of a mild warm-up with mild stretching.

-Dr. P

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Breast Cancer – Early Detection Can Save Your Life

…..October is Breast Cancer Awareness Month, and hopefully we are all aware of the high risk of breast cancer that surrounds us.  We know that 1 in 8 women will develop breast cancer in their lifetime, and all of us have someone close who has suffered with this cancer.  In my own family, we lost Mary Ann’s mom, who was my wife’s mother, to this terrible disease.

…..Early detection saves lives, and it is all of our responsibility to encourage the special women whom we love to practice good breast health, which should include:

  • Monthly self breast examsBreast Cancer Pink Ribbon Patch
  • At a minimum of once a year, breast exams from your health care provider
  • Yearly mammograms starting at age 40
  • Special follow-up programs if there is a strong family history of breast cancer

…..As a gynecologist, breast health has been a daily and major part of my professional life.  I encourage all of my patients to be their own best advocates when it comes to breast health.  Do your self-exams.  Do the recommended breast studies.  Once the studies are done, get the results and understand what the results are.  Do the follow-up studies and follow-up consults that are advised.  If there is a problem, see the breast specialists.  Get second opinions if there is ever a doubt.  Let us all work together to defeat this foe!

-Dr. P

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What Factors Place Adolescents at an Increased Risk of Developing STIs?

Young women are at a high risk of acquiring STIs (sexually transmitted infections) and of developing the serious complications of untreated chlamydial and gonococcal infections.  Almost half of all STIs occur in teenagers and young adults between the ages of 15 and 25.  Physical and behavioral factors place the sexually active teenager at an increased risk to develop these infections.

Physically, the cervix is more vulnerable to these infections because it has not fully developed, exposing more susceptible cells to the infections.  Since the young woman may be coming into contact with these infectious agents for the first time, her immune defenses are not strong.

Behavioral risk factors include having multiple new sexual partners and not using condoms or not using condoms properly.  The U.S. Department of Health and Human Services has a goal to increase the simultaneous use of both condoms and hormonal contraception (birth control pills).  This combination of methods is highly effective in preventing a pregnancy and preventing the acquisition of STIs.  Yet currently, some studies reveal that only about 5% of adolescent females are using this practice.

-Dr. P

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The Concern of Getting the Flu Shot During Pregnancy – FAQs Answered

…..Let me give you some information to cover some of the questions that patients frequently ask.  This information is from the American College of Obstetrics and Gynecology, the American Medical Association, and the Society for Maternal-Fetal Medicine. It is from the form given to obstetricians to give to thSyringe for Flu Concern Patch Blog Post Paint3eir patients.

…..If you get vaccinated during your pregnancy, your unborn starts to get some protection during this period. This also gives the newborn a degree of protection in the first few months of life when their vaccinations have not been begun.

…..Safety, of course, is the main concern of all mothers. Flu vaccines have been given safely to millions of pregnant women for more than 50 years and are endorsed by the above medical societies.

…..The question of mercury in some of the vaccines is always a concern. Thimerosal, a type of mercury, is a type of preservative used in trace amounts in some vaccines and has not been shown to be harmful to a pregnant woman or her unborn child.  Also, it does not cause autism. Again, this is from the above mentioned medical societies. Remember, if you are still concerned about being given preservatives during your pregnancy, there are single-dose flu vaccines that are mercury-free, so speak to your medical professional.

…..Lastly, you must begin the discussion about the flu vaccine with your caregiver now. Ask all your questions, become informed, and let us all be protected… and you cannot get the flu from the flu vaccine!

-Dr. P

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Why Should You Get a Flu Shot Each Year?

…..The influenza vaccine comes in two types:

  • Inactivated, or killed vaccine, which is given by injection with a needle
  • Live, or attenuated (weakened) vaccine, which is sprayed into the nostril

…..The influenza viruses are always changing, and so each year scientists try to determine which viruses are going to cause the flu that year. In other words, a new vaccine is put together each year to prevent the flu for that season. It is for this reason that an annual vaccination is recommended.  After a person receives the vaccine injection, it takes about two weeks for the protection to develop, and the protection lasts for about a year.

Why Should You Get a Flu Shot Each Year

…..Some inactivated influenza vaccines contain a preservative called thimerosal while some vaccines are thimerosal-free. This has been a concern for many, but it has been shown not to be harmful to a pregnant woman or her baby, according to the American College of Obstetrics and Gynecology.

…..The U.S. Department of Health and Human Services recommends that all people 6 months of age and older should get the flu vaccine. Vaccination is especially important for people at a higher risk of severe influenza, including their close contacts.  Some of these close contacts can be healthcare workers and children younger than 6 months.

…..You should get the vaccine as soon as it is available for the new season. Even though most influenza occurs from October through May, the flu season can occasionally come earlier, so get the protection as early as possible.

-Dr. P

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All Pregnant Women Should Be Immunized for the Flu

…..A few days ago, the influenza vaccine for the 2012-2013 flu season arrived in myAll Pregnant Women Should Be Immunized for the Flu office.  In the United States, this season is considered to be October through May.  We have already begun to arrange the vaccination for all of our pregnant patients.  As a result, it seems to be the appropriate time to have our review of influenza immunization during pregnancy.

…..The American College of Obstetricians and Gynecologists recommends that every pregnant and non-pregnant woman receive an inactivated influenza vaccine.  It appears that the most effective way to increase the influenza immunization rates among pregnant women is for the physicians to directly recommend the flu shot to patients.  The live, attenuated influenza vaccine is contraindicated for pregnant women, but the inadvertent vaccination of a pregnant woman with the live vaccine has not been shown to be harmful.  Therefore it is not an indication for pregnancy termination.

…..Why should we get vaccinated? Influenza, the flu, is a contagious disease caused by the influenza virus, which can be spread by coughing, sneezing, or with nasal secretions.  Anyone can get the flu, but the rates of infection are highest among children.

…..The symptoms usually last only a few days and include fever, chills, cough, sore throat, headache, muscle aches, runny nose, and fatigue.  Young children, older people, pregnant women, and people with medical conditions that have them in a weakened state can become much sicker and need to be hospitalized.  So by taking the flu shot you can protect yourself and those around you.

-Dr. P

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What Is Most Likely to Happen if You Are Diagnosed with Lyme Disease?

…..When Lyme disease has been diagnosed because you have the “bull’s eye” rash from a tick bite or a positive blood test, your medical team will usually prescribe an antibiotic regimen.   Depending upon your history of allergies, two of the most common treatments are amoxicillin (500 mg three times a day for 14 to 21 days) or doxycycline (100 mg twice a day for 14 to 21 days).

Bull's Eye Rash (Tick)

…..Intravenous antibiotic treatments are not often needed, but they are needed when the Lyme infections are more serious. These would include infections around the brain and spinal cord (meningitis) or heart (carditis).

…..I would like to leave you with two interesting facts about Lyme disease. If for some reason you get the infection and do not obtain treatment with an antibiotic, you have about a 10-15% risk of developing Lyme arthritis, and this needs to be treated with a different antibiotic plan.

…..Even after treating Lyme disease and having no blood tests pointing to an active disease, about 10-20% of people will not feel well for months, having complaints of being exhausted and joint pain. Antibiotics do not seem to be the answer for this frustrating condition.  The passage of time is the ultimate treatment.

…..Enjoy the rest of your summer and always check your clothes and body for ticks after working or playing outdoors in a grassy area. Then take a shower, which removes the ticks off your body and prevents those troublesome bites!

-Dr. P

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You Found a Tick on Yourself – What Are the Next Steps?

Once you have discovered that a tick is on your body, you remove it with a tweezers.  Try to detach it at the base of the tick’s attachment.  If it is removed within 24 to 48 hours, it is unlikely that it has infected you with Lyme disease. Also, it is important to remember that only 1 in 20 people bitten with an infected tick will develop the disease.  Not every deer tick carries the Borrelia burgdorferi bacteria, with usually 1 in 5 being carriers in high risk areas.Tick Removal Display Image

The Infectious Disease Society of America does not recommend antibiotics for everyone who has been bitten by a tick. If the rash of Lyme disease develops, then antibiotics are advised.

The rash is the easily noticed circular “bull’s eye” target-like rash. This rash can begin anywhere from 1 to 4 weeks after the bite. It starts out being the size of a quarter and can widen to 6 to 9 inches as the bacteria spread out. If your anxiety of developing the disease is great, many doctors will treat you with doxycycline if you do not have an allergy to the medication.

Find out more in: What is Most Likely to Happen if You Are Diagnosed with Lyme Disease?

The blog post preceding this one: This Little Surprise in Your Garden Can Cause a Big Problem

-Dr. P

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This Little Surprise in Your Garden Can Cause a Big Problem

Two days after working in the garden, I was taking a shower, and on my shoulder I found a dark raised lump that looked like an apple seed. Of course I panicked, took a nail clipper, grasped the bottom of the “seed,” and then pulled it off. It was a tick! I put it down next to the sink and it started to walk. Again I panicked, crushed it, and flushed it down the toilet.Garden M.O. USENext, the ever-calm OB/GYN doctor quietly called his wife to let her know what happened and to check the rest of my body for ticks. Surely you know that is not the manner in which I spoke. Thank God I was smart enough many years ago to have found a calm and cool wife who then helped me check for any other ticks, and none were found.

The next morning, again while taking a shower, on my abdomen I found another dark spot. This time it was much smaller, black, and I did not notice it the morning before. It was another tick.

Later that day, I went to see my personal physician, who happens to be one of my dearest friends. He is an expert on Lyme disease and took care of me. This story has prompted me to write about this problem and get some basic information to my friends.

Over 30,000 new cases of Lyme disease are diagnosed each summer, and 90% occur in 10 states.  New York is one of those states. This disease is an infection caused by the bacteria called Borrelia burgdorferi, which enters the body from an infected deer tick’s bite.

While the tick is attached to us, it begins to suck blood from the victim, and at this time, it regurgitates the bacteria into the person’s system. Most of the infections in humans are caused from the bites of immature ticks called nymphs, which are the size of poppy seeds. The disease can also be transmitted from the bite of an adult deer tick, but because they are larger, they are more likely to be discovered before having time to transmit the disease.

Continue to: You Found a Tick on Yourself – What Are the Next Steps?

-Dr. P

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Is the Stress in Your Mind Causing Stress on Your Hair?

…..Continuing our discussion on hair loss in women….

…..Remember how our mothers always told us that stress could cause so many problems and make us feel terrible?  As always, our mothers were right.  For women, a severe illness, psychological stress, or having a baby are inciting stressful events that can cause physical effects.  One of these effects is hair loss.Hair Loss  Patch Blog Post 2

…..Usually 90% of our hair is in the growth phase, with 10% in the resting phase.  Keep in mind that some hairs are always shedding in the resting phase, and it is usually a small and regular amount.

…..Telogen Effluvium (TE) is a condition of diffuse hair loss that is caused by an identifiable stressful life situation; three of those situations were stated above.  In TE, 70% of hairs are in the growth phase and 30% in the resting phase.  This results in about 3 times as many resting phase hairs being shed daily.  The hair loss is gradual and diffuse and may be similar in appearance to the loss associated with the female patterned hair loss called androgenic alopecia (AGA).

…..With TE, a woman usually is aware of shedding, but with AGA, the loss is gradual, and shedding is not usually a complaint that is presented.  Also with TE, the loss may not become apparent for several months after the stressful event.

…..To treat TE, you must first identify and resolve the stress the body has been subjected to.  With pregnancy or an acute illness, the hair loss is usually self-limiting with complete recovery within 6 months after having the baby or recovering from the illness.  When TE is caused from psychological stress, since the treatment and recovery can take some time, the hair recovery can also involve a prolonged period.

-Dr. P

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Add Vitamin D to Your New Year’s Resolutions

…..The new year comes with all the resolutions we promise to keep.  Weight loss is
always the one we want to accomplish.  I wish to remind you again to continue your vitamin D supplements if you were found to be needing them.  Every day I read about theNew Year importance of this vitamin and appreciate its newer roles we have discovered.  Remember that it has an important place with our immune system, cancers, diabetes, and heart health; so speak to your family doctor or me at your next visit.

-Dr. P

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Unraveling the Urinary Tract Infection (UTI)

…..UTIIn my practice, urinary tract infections are among the most common problems that I see.  It is estimated that 60 to 70% of all women will experience a UTI in their lifetime and that half will have a first time infection by the time they are 35.

…..Most women know they have a “bladder infection” because of the symptoms they experience.  These symptoms include:

  • Pain with urination
  • Increased urgency to urinate, with many times passage of just a few drops of urine
  • Increased frequency of urination
  • Pain, pressure, and/or fullness in the lower abdomen

…..If the infection of the urinary tract system has risen above the bladder and into the kidney, the symptoms change.  The patient appears to be sicker with more severe symptoms, which include:

  • Tender flank pain over the area of the kidneys
  • Fever and chills
  • Nausea and vomiting

…..Although the diagnosis of a UTI is usually made by a patient’s complaints, dipstick urine tests are commonly used to help confirm the diagnosis.  These tests look for certain markers in the urine that point to a UTI.  Dipstick urine tests are not totally conclusive.

…..The standard to confirm a UTI is the urine culture and sensitivity test at the laboratory.  This test will diagnose the bacteria causing the infection, and it will also provide the susceptibility of the bacteria to certain antibiotics.  The disadvantage of this test is the cost and the 48 hours it takes to get back the information.

…..There are many risk factors in pre-menopausal women for a UTI.  A few of these are:

  • Frequent or recent sexual activity
  • Past history of a UTI
  • Increased number of vaginal deliveries
  • Obesity
  • Diabetes

-Dr. P

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Vitamin D – Is Your Serum Sufficient?

…..I hope everyone has survived the earthquake and Irene; my home lost power for five days, and it was not easy without the lights.  Today we will finish up our discussion of vitamin D.

Vitamin D Serum

…..Vitamin D2 and D3 are changed in the liver to 25-Hydroxyvitamin D.  That is the last time you will see that tough word since I will refer to it as 25(OH)D.  This is what is measured in the blood, and it determines if we need to have extra vitamin supplementation.  Vitamin D insufficiency is usually defined as a serum 25(OH)D level of 30 to 32 ng/ml.

…..In regard to calcium absorption, most studies suggest that with a 25(OH)D level of at least 20 ng/ml, there will be maximum absorption.

…..The daily recommendation for vitamin D is 600 IU for healthy non-pregnant women under 70 years of age and 800 IU for women older than 70 years.

…..Extra vitamin D should be added if the level is below 30 ng/ml.  As a general rule of thumb, an extra 1000 IU per day of vitamin D3 will increase the 25(OH)D levels by 6-10 ng/ml.  The levels should be checked after a three month trial.

…..Lastly, some studies point to problems if the 25(OH)D levels are greater than 50 ng/ml, so always check levels after adding extra vitamin D.

-Dr. P

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Do You Have an Increased Risk for Vitamin D Deficiency?

…..I cannot believe how fast the summer always seems to go.  As August slips away, enjoy as much time as you can surrounded by family and friends.  Now let’s go over who is at an increased risk for vitamin D deficiency.

…..People at an increased risk are those who have:

  • Obesity
  • Dark skin pigmentationTall Green Tree
  • Decreased sun exposure
  • Low intake of vitamin D
  • Poor absorption of ingested vitamin D
  • Been using antituberculosis and anticonvulsant medications, which increases breakdown in the liver of the vitamin
  • Kidney and renal disease
  • Osteoporosis and osteopenia

-Dr. P

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Vitamin D – More Important Than You May Think!

…..This past year has seen the discovery of vitamin D deficiency in a large portion of our population.  In my office, we never measured the value before but now I speak about low vitamin D many times a day. Today you will be given some basic points, and over the next few blogs you will have a good understanding of the situation.

  • Vitamin D is important to maintain bone health.
  • Some studies have reported that being low on vitamin D can be related to heart problems, cancer, diabetes, and autoimmune disease.  However, few true clinical trials have been taken.
  • Too much vitamin D should be avoided because of possible harm and lack of beneficial evidence.
  • The best measurement for the deficiency is the value of 25(OH)D in the blood.  The supplementation of the vitamin should be given to reach a target 25(OH)D value.

…..This is a start of your vitamin D education!

Vitamin D Benefits

-Dr. P

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Aspirin to Prevent Preterm Labor

One Viable Method to Prevent Preterm LaborPreterm birth rates continue to rise in the United States and are a major cause of neonatal morbidity and mortality.  Low-dose aspirin has been researched as a possible inexpensive and safe medication to help reduce the incidence of preterm birth.

Aspirin helps by reducing uterine contractility and inflammation.  Many medical issues such as the fetus being too small for gestational age, preeclampsia, placental insufficiency, and spontaneous labor may be reasons to consider protocols to help prevent preterm births.  In these instances, the effects of aspirin may be very helpful.

Many studies have shown a decrease in preterm births in patients taking low-dose aspirin prior to and during pregnancy.  It can be especially helpful to those with a history of a previous pregnancy loss.

The possibility of decreasing the incidence of preterm labor is very exciting.  Additional research is necessary to fully observe and understand all of the effects of low-dose aspirin on pregnancy.  Always remember to speak to your health care provider to discuss your particular concerns and to see if low-dose aspirin can be beneficial to you!

-Dr. P

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