When Should Young Women Start Getting Pap Smears?

5461276006_df3a5a44b8_zCervical cancer was once the number one cancer killer, but with the introduction of the Pap smear almost 60 years ago, this cancer has become increasingly rare.  The guidelines for cervical cancer screening are always evolving, and the American Society for Colposcopy and Cervical Pathology (ASCCP) has been at the forefront of these changes.

The relationship between high-risk HPV (human papillomavirus) and the development of pre-cervical and cervical cancer has been well established.  Thankfully, most HPV infections are short-lived and not detected within 1-2 years.  Only a small percentage of infected women will go on to develop a high-grade cervical abnormality or cervical cancer.

More than 80% of all women will develop a genital HPV infection by the time they reach the age of 50.  HPV infections are the most common in young women, and again, these infections are cleared by most young women in less than two years.

We now have a good understanding of the natural history of HPV infections and the development of cervical cancer and the pre-cancers.  ASCCP’s guidelines advise that cervical cancer screening should begin at age 21 regardless of the age of sexual initiation.  Since most of the infections in the young will regress, starting a screening program at an earlier age may result in many unnecessary treatment interventions.

Remember to always discuss your particular concerns and develop your individual screening program with your healthcare professional.

-Dr. P

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Healthy and Creative Recipes from Lexi’s Clean Kitchen

I have come to discover Alexis Kornblum’s wonderful website, Lexi’s Clean Kitchen, and her creative cooking.  From her healthy food section, I would like to start a series that provides nourishing recipes.  You can expect to find gluten-free, dairy-free, paleo-friendly, refined sugar-free, soy-free, and vegan-friendly recipes.  Each time, a dinner, snack, dressing, drink, or treat will be featured.

First up is Roasted Garlic Chicken and Veggie Primavera.  The dish has roasted garlic, delicious olive oil, Himalayan sea salt, a hint of spice, and fresh parmesan cheese.  Flavor heaven.  Here is the link to the recipe: lexiscleankitchen.com/2014/07/11/healthy-food-friday-zucchini-roasted-garlic-chicken-and-veggie-primavera

RoastedGarlicChickenVeggiePrimavera7

For dessert, you are having Nutella Swirl Pumpkin Muffins.  These muffins are spongy, moist, loaded with pumpkin, and hold a hint of sweet.  lexiscleankitchen.com/2014/10/03/healthy-food-friday-nutella-swirl-pumpkin-muffin

Nutellaswirlpumpkinmuffin9-Dr. P

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What Could Happen if You Smoke During Pregnancy?

We all know that cigarette smoking is a health hazard.  In pregnancy, smoking spreads that hazard to the baby as well as the mom.  The CDC (Centers for Disease Control and Prevention) provides us with the following information:

  • It is reported that 10% of women smoke during the last 3 months of pregnancy
  • 50% of women who smoke before a pregnancy will quit during the pregnancy
  • 50% of women who stopped smoking during a pregnancy will go back to smoking after their baby is born
  • Smoking increases the difficulty to become pregnant
  • Smoking increases the risk of spontaneous miscarriages
  • Smoking also increases the risk of a premature birth
  • This action increases nicotine and decreases oxygen to the developing fetus
  • The baby’s placenta may not work as well in mothers who smoke
  • Smoking increases the risk of certain birth defects, including cleft lip and cleft palate

If you smoke, please try to stop for your health and the health of your baby.

Cigarette Blog

-Dr. P

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How Probiotics Can Be an Enormous Benefit to Your Health

The business associated with the use of probiotics is huge around the world.  It promises to use live and good bacteria to decrease/replace the bad bacteria that can build up in the colon.  Probiotics are live bacteria that are mostly found in foods and supplements.  They have the potential to provide beneficial health effects for the person ingesting the bacteria.

probiotics-4

The human gastrointestinal tract, especially the colon, is populated by a large amount and assortment of bacteria, called the intestinal flora.  This flora develops over the first two years of life and evolves over time based on health, diet, genetics, and many other factors.  This good natural bacteria and added probiotics seem to work in a variety of ways:

  • Natural good bacteria and probiotics prevent the growth of bad bacteria by not allowing a place for it to grow and competing for the nutrients.
  • They lower the acidity of the intestine, creating an unwelcome environment for the bad bacteria.
  • They increase the production of mucin.  Mucins are the proteins that bind to form the gel-like mucous, made by the epithelial cells that line the intestines.  This produces a chemical barrier which limits the damage of inflammation.

You should open a discussion with your health care provider about the benefits of probiotics, especially the next time an antibiotic is needed.  Antibiotics can affect the natural flora of the intestine so a probiotic review may be perfect.

Probiotics 2

-Dr. P

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How Can Uterine Fibroids Affect Your Pregnancy?

How Can Uterine Fibroids Affect Your PregnancyAbout 5% of all women have a uterine fibroid and this is the most common of the noncancerous gynecological tumors.  Since fibroids can increase risks during a pregnancy, the health care provider follows a pregnant woman with fibroids carefully.

One of the complications can be that the baby is in a position other than head-down near the time of delivery.  This can affect the type of delivery advised.  Other possible complications associated with fibroids and pregnancy can be pain, preterm delivery, premature rupture of the membranes, and other difficulties.

Because of the great hormonal changes during pregnancy, fibroids can shrink or grow at this time.  The changes occur mostly in the first 3 months of the pregnancy.  More pregnancy complications have been found when a fibroid is larger than 10 cm.

If you have fibroids and are pregnant, start early discussions with your health care providers about the risks to be concerned about and how is the best way to be followed during your pregnancy.

-Dr. P

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What Are the Risks of Delaying Childbirth?

Over the past 50 years, more women are delaying childbirth for many reasons.  Now obstetrical teams are seeing an increase in first births for woSmiling young doctor holding a beautiful newborn baby.men aged 40 to 44.  Pregnancies can progress beautifully with these women but increased risks have been associated with later motherhood.  Some of these risks include:

  • Abnormal fetal chromosomes
  • Diabetes during the pregnancy
  • High blood pressure before and during the pregnancy
  • Preterm labor and delivery
  • Increased chance of twins

The age of the father is also of concern here.  Advanced paternal age is often thought of as being 40 or older at the time of conception.  There are studies suggesting that advanced paternal age can be associated with a higher risk for autism spectrum disorders and some gene abnormalities.

If you or your partner is in this age group and are considering a pregnancy, begin a discussion with your health care provider.

-Dr. P

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A Simple Exercise That Burns More Calories Than Walking

Young women in the officeI have always advised my patients that walking is a great exercise.  A pair of sneakers and comfortable clothes is all you need to get started.  Taking the stairs instead of the elevator has been another of my common suggestions, and as the colder weather quickly approaches, maybe we should consider starting a stair climbing program.

Most of us have access to stairs, either at home, work, or the mall.  A great way to begin is climbing the stairs one at a time at your own pace, either holding on to the rail or keeping your hands free.  You are using more muscles and burning more calories than walking.  It is a vertical exercise, so it is good for muscle strengthening, cardiovascular work, and weight loss.  Once you are up the stairs, you must come back down since the descent also has great benefits.

As always, do not start an exercise program unless you have discussed it with your health care provider.  Stair climbing can be an easy addition to your exercise program and who knows where it will take you!

-Dr. P

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A Tool to Measure Your Risk of Developing Breast Cancer

A Tool to Measure Your Risk of Developing Breast CancerMany women who are at an increased risk of developing breast cancer are not aware of their risk.  If you are at an increased risk, a pharmacologic preventive therapy (chemoprevention) is a consideration you should discuss with your health care provider.  It has been reported that the agents used can reduce the risk by 50%.

The Gail Breast Cancer Risk Assessment Tool is one of the models that has been developed to quantify a woman’s risk of developing breast cancer.  By answering a series of questions about lifestyle, obstetric and gynecological history, and family history, a 5 year and lifetime risk can be calculated.  If there is a moderate to high risk, lifestyle and pharmacologic interventions should be considered.

Tamoxifen (Nolvadex) and Raloxifene (Evista) are two agents that may be discussed to help in the reduction in breast cancer.  There are risks and benefits to both medications, which need to be considered.

-Dr. P

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Don’t Only Be Aware in October

As October quickly comes to a close, the breast cancer awareness campaign will also come to an end.  It is imperative that our fight against breast cancer should not be at the forefront of our minds only in October but be there day by day, all year long.  All of us have someone close who has suffered with this cancer, so all of us must encourage the women in our lives to pursue proper breast health.  Don’t hold back today; speak to someone dear to you about breast cancer and you may save a loved one’s life!Mother and Daughter Face To Face

-Dr. P

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A Healthy Exercise for Beautiful Autumn

The fall season is full of pumpkins, mums, scary costumes, and beautiful crisp clean air!  It is a perfect time to get started on an outdoor walking program.  Join a friend or relative and begin your walking exploration of your neighborhood and make this fall the getting in shape season for you.Autumn Leaves, Berries and Pinecones

-Dr. P

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The Vegetable from the Fountain of Youth

“If you’re looking for the Fountain of Youth, kale may just be it!” Tom Gatto, a registered dietician, updates us on the nutritional powerhouse called kale. His discussion includes nutrient density, how to prepare it, and which vitamins, minerals, and antioxidants it contains and how they enhance our health.

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What Makes You at Risk for Hepatitis C?

…..Recently, the newspapers have been full of articles concerning the hepatitis C virus (HCV) and a new medication that reportedly cures people with the chronic type of the disease.  It is a very expensive drug, but the results have been wonderful; so I think it is time to give a little review of this disease.Hepatitis C Risk Factors 2

…..Hepatitis C is a contagious disease that is usually transmitted through blood contact with an infected person.  When first getting the disease (acute HCV), there may be no symptoms or only mild flu-like symptoms.  Most people do not even know that they have the disease, and most will go on to develop the chronic HCV, which is a long-term illness.

…..Of those with the chronic illness, about 25% will develop a severe liver disease such as cirrhosis or cancer.  At this time, baby boomers seem to be at the highest risk for the chronic version of this disease.  This will include the population born between 1945 and 1965.

…..The risk factors include:

  • Having a blood transfusion before 1992
  • Being on kidney dialysis
  • Sexual contact with an infected partner
  • Obtaining a tattoo or body piercing with an unclean instrument
  • Being exposed as a health care worker
  • Injecting drugs

…..Since baby boomers are many times more likely to have chronic HCV than other age populations, a screening blood test should be considered for this age group.  Feeling tired seems to be the most common symptom of the disease, so talk to your health care professional to see if a test should be considered for you!

-Dr. P

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An Alternate Way to Remove Those Ticks!

…..Last weekend, I was reminded that we are deep into another summer that is full of the problems with ticks.  At the end of a great summer day, I watched as my daughter checked her little ones for ticks.  She keeps them away from the bushy areas, but at bath time the checking takes place.

…..I recently learned about a different way to help remove a Ticks 4 Green Cotton Ballstick.  Take a cotton ball and put liquid soap on it.  Cover the discovered tick with the cotton ball and rub the soap on the tick for a few seconds.  Usually the tick will dislodge on its own and be stuck to the cotton ball as you take it away.

…..Hopefully you will not need to try this method but keep it in the back of your mind.  Enjoy the summer!

concept

…..For my instructions on removing a tick with tweezers: You Found a Tick on Yourself – What Are the Next Steps?

-Dr. P

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Concerned About Mercury Consumption During Pregnancy? The FDA Has Relaxed Its Stance

Two fresh sea bream on wooden board with herbs and lemonThe Food and Drug Administration of the United States has recently drafted new guidelines, reassuring pregnant women and nursing mothers that they should include more seafood in their diets.  This is because the health benefits far outweigh the risk of the mercury content.

The new suggestions advise eating 8 to 12 ounces of seafood a week, which means 2 to 3 meals per week.  The FDA also suggests that young children should also be eating fish 2 to 3 times per week in portions that are appropriate for their age.

Some important facts:

  • Fish are loaded with the types of omega-3 fatty acids that are high in DHA, which is important in brain and eye development.
  • The FDA suggests that women and children should consume fish low in mercury.  These include canned light tuna, salmon, tilapia, catfish, cod, shrimp, and pollock.
  • Four fish to avoid because of their high levels of mercury include shark, swordfish, tilefish from the Gulf of Mexico, and king mackerel.
  • Almost all fish contain trace amounts of mercury.  Mercury in high amounts can harm the brain and nervous system.

-Dr. P

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Herpes Information Made Simple

…..A few times a week a new case of genital herpes presents to my office, and the patient always experiences great psychological and physical pain and stress.  The classic presentatioBeautiful Woman with Pencil and Folder Isolated on White.n of HSV (herpes simplex virus) is a painful group of vesicles and ulcers.

…..The infections are classified as primary, non-primary first episode, or recurrent.  The primary infection is the most painful and may be associated with tender lymph nodes as well as a fever and body aches.  If not treated, these primary lesions can last 2 to 6 weeks.  Recurrences vary in their frequency; however, 50% of patients will have one within 6 months.  These recurrences are generally milder with fewer lesions and a much shorter course.

Herpes, Type 1 and Type 2

…..HSV is a DNA virus classified into two subtypes, 1 and 2, based on various proteins making up the virus.  HSV-1 is primarily the cause of herpes of the mouth and in the past was said to be the cause of infections above the waist.  It can also be responsible for genital infections, and these infections are becoming more common, especially among young women.

…..HSV-2 is almost always a genital infection.  The virus is spread through direct contact with mucosa (moist tissue like the vagina and lips/mouth) or damaged, irritated skin.  Incubation of the virus lasts for about a week, and the virus then reproduces in the superficial layers of the skin, causing inflammation and damage.  During the first infection, the virus enters the nerve cells and becomes dormant.  The virus can reactivate and cause ulcerative disease or shed without any symptoms.

…..Let me leave you with a few facts:

  • In the US, 20% of women have had an HSV-2 infection
  • Most infections are spread by those who are unaware of having HSV
  • Recurrent disease is more common in those with type 2, compared to those with type 1

Methods of Herpes Treatment

 …..For now we will finish our discussion of herpes.

…..During a symptomatic outbreak, the treatment consists of supportive measures such as oral and topical pain medications and special genital hygiene.  An antiviral medication can be added to decrease the viral shedding and the duration of the painful ulcers.  These medications should be started at the onset of the symptoms.

…..Acyclovir and valacyclovir are the two most common antivirals used and have a long history of safety in pregnancy.  There are some patients who experience frequent attacks, and a daily treatment of these medications can greatly suppress the episodes and therefore decrease the chance of spreading to a sexual partner.

…..In the future we will have a discussion of herpes and pregnancy, but for now I am going to get a donut.

-Dr. P

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Urgent Care

I am happy to announce a new program called urgent gynecological care.  This means that immediate appointments are now available 6 days a week.  In gynecology offices, when a patient calls to make an appointment, many times she cannot see her OB/GYN for a few weeks or even months.  This can have a negative impact on her health if immediate attention is needed.  Call us and we will be happy to set up an appointment.

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Polycystic Ovary Syndrome in Young Women – Signs You May Have It

…..P??????????????????olycystic ovary syndrome (PCOS) is a common endocrine problem in young women, and it often goes undiagnosed in the adolescent population.  The patients are frequently presented with menstrual irregularity and signs of androgen excess, which includes unwanted excess hair growth and acne.  These are the symptoms that usually lead the patients to visit their health care professional.  The weight of the young women can range from normal to elevated, and with obesity, the androgen affects can be more advanced.

…..To make the diagnosis of PCOS, certain criteria need to be met.  The most common guideline requires 2 of the following characteristics:

  • Signs of androgen excess
  • Irregular menses (probably secondary to problems with ovulation)
  • On a sonogram exam of the pelvis, the ovaries are found to have many small cysts (polycystic ovaries)

…..PCOS can have metabolic consequences with major effects on the glucose metabolism, affecting up to 25% of these young women.  There are different ways to screen for this abnormality, from obtaining fasting levels of glucose and insulin to a full glucose tolerance test.  Elevated weight levels, monitored by determining the BMI, increases the risk of developing these metabolic problems.

…..Next time we will review management for the young PCOS patients.

-Dr. P

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A Vitamin That May Reduce the Risk of Uterine Fibroids

…..It seems that every day there is a study revealing the importance of having a normal level of vitamin D.  A new report even points to an association between fibroids and vitamin D.  Uterine fibroids are benign tumors of the uterine smooth muscle, and this affects approximately 30 to 40% of all women.  It is one of the leading causes for a hysterectomy in the United States.  In the laboratory it has been shown that an active metabolite of vitamin D can inhibit the growth of fibroid tissue.

…..AA Vitamin That May Reduce the Risk of Uterine Fibroidspproximately 1000 women ages 35 to 49 years old were enrolled in a study where the vitamin D level was obtained, and the fibroid status was determined by ultrasound screenings of these premenopausal women.  The group with normal vitamin D levels had a 30% lower risk of fibroids as compared to those with vitamin D insufficiency.

…..More research needs to be done to confirm these findings but it seems that sufficient vitamin D may be associated with a reduced risk of uterine fibroids.  As always, speak to your health care provider before beginning any new vitamin supplement program.

-Dr. P

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Hair Loss – Its Cycle, Most Common Causes, and the Effect of Stress on It

Hair Loss 7…..I would like to start a discussion of hair loss in women.  This is a common condition for many women.  By age 50, 50% of women will suffer from this problem.  Another term for significant hair loss is alopecia, and affected women can suffer great anxiety and stress.

…..There are two types of alopecia: scarring and non-scarring.  Scarring alopecia can be found in discoid lupus erythematosus and other conditions.  The scar formation destroys the hair follicle, thus causing the hair loss.  These patients should see a dermatologic specialist as soon as possible.  On the other hand, in non-scarring alopecia, the hair follicles are not permanently destroyed, and so the hair loss may be reversible.

What Cycle Does Your Hair Bear Throughout Your Life?

…..Let us start with the hair growth cycle.  There are three phases of this cycle: anagen (growth phase), catagen (transitional or resting phase), and telogen (testing or shedding phase).

…..In the anagen phase, the hair grows, and 80 to 90% of all hair follicles are included in this phase.  This growth pattern can last for 2-3 years, and the length of time is genetically determined.

…..The catagen phase lasts only for 2-3 weeks.  In this resting phase, only 1 to 3% of the scalp follicles are included.

…..The last phase is the telogen phase.  This is when hair is shed usually at a normal rate of 75-100 hairs per day, and it lasts for about 3-4 months.  So it is important to remember that it is natural for some hair loss every day!

Why Is Hair Loss Harrowing You?  What is the Cause?

For most patients, a careful history of their hair loss will give a good indication of the cause.  There are many questions to be considered; the following are some of them:

  •  Is the loss diffuse or is it in a specific area?  If it is in a specific area, it is important to delineate the location.
  • Hair care techniques and the products used can provide important Hair Loss 4information.  Are chemical straighteners being used?
  •  Are cornrows part of a new style of yours or have they been used for some time?  Traction alopecia has been seen with the cornrows hairstyle.
  • During a physical exam, the scalp should be carefully inspected.  Is there any scaling, inflammation, or reddish areas?

…..In the areas of the hair loss, if there are hair follicles then you are dealing most likely with non-scarring alopecia.  If there are no follicles then this could be scarring alopecia, and this patient should be sent to a dermatologist, who will consider a biopsy.  The hair should be evaluated for its length, thickness, and fragility.  Lastly, a pull test could be performed, which will help determine if active shedding is taking place.

Women: Your Most Common Cause of Hair Loss

…..The most common cause of hair loss in women is androgenetic alopecia (AGA), which is also known as female pattern hair loss.  This is a genetic disease that can be inherited on many genes, but it does not affect everyone who carries the genes.  By menopause, 40% of all women will be affected in some way.  It is identified as a gradual onset of diffuse hair loss.

…..The problem’s basis is the male hormone found in all women.  It attaches to sites on the hair follicles and affects the follicles that are genetically susceptible.  These follicles have a shortening of the growth phase, and the hair from these follicles are short and thinner than normal ones.

…..Again, hair loss in women is generally diffuse, and there is usually a preservation of the frontal hairline.  This is distinct from male pattern hair loss, with frontal peak and top loss.  AGA’s onset is usually gradual with no specific bare areas.  There does not appear to be an increase in shedding because the hair growth does not become less but is only affected.

…..At the medical exam, the scalp should be examined for redness, signs of infection, and scarring.  A family history should be taken to look for a similar condition in other family members.  Usually, there is not an endocrine cause for this problem, but if general hirsutism accompanies the finding, then a full hormonal investigation should be started.

…..The only FDA-approved treatment is the topically applied vasodilator called Minoxidil (Rogaine).  It comes in an over-the-counter preparation of 2% and 5% foam or liquid, which are all effective.  There seems to be better results with the 5%, but there may be an increased chance of local irritation.  How it specifically works is uncertain but there seems to be an increased growth phase, and the hairs grow longer and stronger.  Remember, the treatment is 2x per day and forever.  When you stop, the hair you gained will be lost.  Lastly, you may not see any results for 3-4 months, so patience is needed.

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

?????????

…..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.

.…..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.

Four Reasons Why Your Hair Could Be Losing

…..Now we will close our discussion of hair loss in women with a few more causes.

…..Traction Alopecia is hair loss from excessive pulling at the hair roots over a prolonged period of time.  The loss occurs where the hair is pulled in one direction, for example, by a ponytail or a cornrow pattern of braids.  The treatment is usually just discontinuing the particular hairstyles, and in time, the problem resolves.

…..Tinea Capitis is caused by a fungal infection of the hair shaft.  It is most common in children.  However, it can be found in immunocompromised adults such as AIDS patients and patients receiving chemotherapy.  The presentation is usually a round patch of hair loss associated with pruritis and scaling.  The diagnosis is made with cultures and the examination of scrapings along the border of the lesion.  The usual treatment is oral antifungals.

…..Trichotillomania is classified as an impulse control disorder.  It involves compulsive and repetitive pulling or plucking of the hair, which leads to noticeable hair loss.  Patients have described feeling tension before pulling out the hair, and the tension is relieved after the hair is pulled out.  This condition is usually managed by a trained mental health professional.

…..Anagen Effluvium involves an acute loss of scalp and body hair when the growth phase of hair is disrupted.  This occurs mostly with patients on chemotherapy.  Because 80 to 90% of hair is in the growth phase, this hair loss is dramatic and diffuse.  The loss usually begins 1-3 weeks after the chemotherapy is started, and the hair returns typically 3-6 months after the treatment is finished.  The initial hair that returns may differ from the patient’s usual hair, but these changes are mostly temporary.  Permanent hair loss from this condition is usually rare.

…..I hope this information on hair loss in women has been enlightening and helpful.

-Dr. P

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Some Solutions to Your Recurrent Yeast Infections

Yeast CellsRecurrent vaginal yeast infections (Candida vulvovaginitis) is a common problem for many women, leading to frequent visits to their health care providers.  By definition, four or more occurrences of this vulvovaginitis within 12 months indicate a recurrent infection, which can lead to much frustration for the suffering patient.

Candida is a microorganism that is normally found in the vagina along with bacteria.  There is usually a natural balanced mix of yeast and bacteria in the vagina.  When the balance is disrupted, there can be an overgrowth of yeast, which is the infection.  Vaginal cultures can be obtained in these patients to check for certain species of yeast that can be resistant to standard treatments.

Fluconazole (brand name Diflucan) is used in one of the advised treatment regimens.  This is an antifungal agent that is generally well tolerated but can be associated with headaches, nausea, and abdominal discomfort.

Using this medication, there have been rare cases of serious liver reactions and low blood sugars.  This may happen in patients using medications to lower their blood sugar.  For the recurrent infections, one treatment plan is fluconazole 150 mg orally every 72 hours for 3 doses, followed by the medication once a week for 6 months.

If the cause of the recurrence is thought to be one of the more resistant species of Candida, intravaginal boric acid capsules taken once a day nightly for 14 days may be a consideration.

As always, this information should only be the start of your journey to treat this common problem.  You must have a good discussion with your health care provider concerning any medication and treatment regime that is being considered.

-Dr. P

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Osteoporosis – Are You at Risk and How Do You Treat It?

…..Many menopausal women suffer from osteoporosis.  Osteoporosis is the thinning of bones which causes them to become weak, brittle, and more susceptible to fractures.  Women have an increased risk of osteoporosis throughout their lifetime.  Risk factors include:

  • Low body weight
  • Smoking history
  • Fair skin
  • Menopausal state

…..There are various methods of prevention and treatment for osteoporosis.  There are medications such as the bisphosphonates (Fosamax) and selective estrogen receptor modulators (Evista).  Supplements such as calcium and Vitamin D are important additives.  Helpful lifestyle Osteoporosis Treatment Preventionchanges include the cessation of smoking, decreased alcohol use, and weight-bearing exercises.

…..Evista is a medication used to treat osteoporosis in the selective estrogen receptor modulator class.  It mimics the beneficial effects of estrogen by increasing bone density.  Many studies have also shown that Evista decreases the risk of certain types of breast cancer.  The side effects of Evista are hot flushes, leg cramps, and infrequent blood clots or strokes.

…..Speak to your health care provider to see if Evista can be of benefit for you to treat osteoporosis and prevent breast cancer.

-Dr. P

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These Signs May Imply You Have Hypothyroidism

The thyroid gland is one of the largest endocrine glands in the body and is located in the lower portion of the neck.  It is the site where the thyroid hormones are made, and these hormones have many significant functions.  Hypothyroidism (underactive thyroid function) is the most common of the possible thyroid problems and is seen more in women.  Some signs of this condition can be fatigue, cold intolerance, low heart rate, weight gain, dry skin, and coarse hair.

A boredomlow body temperature can be an early sign of a thyroid that is not producing a sufficient amount of hormones.  A person’s body temperature is a measure of the body’s ability to generate and eliminate excess heat.  The thyroid hormone has a direct effect on the basal metabolic rate, which can affect our body temperatures.  The average body temperature should be 98.6 F during the mid-afternoon.

If you are experiencing any of the above symptoms or if your mid-afternoon temperature is below average, then you should speak to your health care provider about the possibility of a thyroid condition.

-Dr. P

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Avoid the Metabolic and Reproductive Consequences of PCOS

Polycystic ovary syndrome (PCOS) is very common, but many times it is underdiagnosed and a misunderstood disorder in young women today.  Symptoms of PCOS may include irregular periods, increased facial and body hair, alopecia, acne, and multiple cysts of the ovaries.

IAvoid the Metabolic and Reproductive Consequences of PCOSt is important to diagnose PCOS due to its potential metabolic and reproductive consequences.  PCOS can increase the risk of heart disease, obesity, high blood pressure, diabetes, liver problems, and obstructive sleep apnea.  PCOS may also increase the risk of having difficulties conceiving.

There are various treatment modalities available for PCOS patients, so speak to your health care professional if you have any of these signs or symptoms.

-Dr. P

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Some Risks When You Use Oral Contraceptives

It has been a common thought that when using a medication for a particular problem, always try to use the lowest dose possible so potential side effects would be decreased. In terms of oral contraceptives, the dosage of these medications has been gradually reduced over the years in order to decrease the risks of abnormal blood clotting and breast concerns. Now the new very low dose oral contraceptive formulas are being reviewed due to their potential effects on long-term bone health when used in young women.

Oral Contraceptives RisksBone mass increases greatly in young women. It is an important buildup which can have great effects later on in life.

Osteoporosis is a common problem especially in older women, and it is a condition of low bone mass, increasing the possibility of fractures. Recent studies have indicated that young women who have been on the very low dose oral contraceptives may have a decrease in the buildup of their bone mass, setting them up for potential problems as they grow older.

As always, before beginning any medication, you must have a good discussion with your health care provider about that medication. When considering an oral contraceptive, ask questions about the various dosages available so the best choice can be made.

-Dr. P

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A New Way to Treat Your Hot Flushes

…..FlamesA new medication, called Brisdelle (paroxetine), has been approved by the FDA as the first non-hormonal treatment for moderate to severe hot flushes (vasomotor symptoms).  This is a common problem in perimenopausal and menopausal women.

…..Brisdelle contains the same ingredient as Paxil, but at a much lower dosage.  At this dosage, this medication is not indicated to treat any psychiatric condition but solely is for the hot flushes.

…..Many perimenopausal women suffer from severe hot flushes daily.  Brisdelle has been proven to decrease these attacks significantly.  It is reported to be a safe, non-hormonal option, and one capsule at bedtime is the advised treatment.

…..Pregnancy and some medications may prevent you from trying this medication.  As always, before starting a new medication, review your current medications with your medical provider.  So speak to your health care professional about the various treatments for menopausal symptoms and perhaps this new medication may be right for you.

-Dr. P

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Non-Invasive Prenatal Testing – When Should You Consider This?

Non-Invasive Prenatal Testing…..Let us return to our review of non-invasive prenatal testing for abnormalities of the fetal chromosomes.

…..This testing is supported by the professional societies, including the American College of Obstetrics and Gynecology.  It is not a testing program that is offered to all pregnant women at this time, and there are certain indications for considering this program.  Now in what circumstances should it be considered?  Here are some:

  • If the mother’s age will be 35 years or older at the baby’s birth
  • Abnormal sonographic findings of the fetus that may point to an increased risk of fetal chromosome abnormalities
  • History of a past pregnancy with chromosomal abnormalities
  • Abnormal testing results in the current pregnancy that suggest chromosomal problems

…..The testing is a simple blood test of the mother, and it can be taken in the first or second trimester and as early as 10 weeks gestation.  It does not replace chorionic villus sampling (CVS) or amniocentesis, and these are the tests to consider if there is a positive non-invasive test result.

…..If there is a positive result, genetic counseling is the next step, and probably the invasive tests will be offered.  Also, remember that this test is intended to detect trisomy 21, 18, and 13, and to give information about the X and Y chromosome.  It does not eliminate the chance of other chromosome problems that may be present.

-Dr. P

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Prenatal Genetic Testing – A New, Non-Invasive Procedure!

…..Prenatal Genetic TestingPrenatal genetic testing is used to determine the risk of a fetus having an abnormal chromosome.  Finding the fetus with an abnormality at the 21, 13, or 18th chromosome at an early fetal age and with a non-invasive technique has been the quest of many investigators over the past 50 years.  Every decade seems to bring a new and exciting way to help the pregnant woman determine the health of the baby she is carrying.

Now the pace of new developments in the science of prenatal genetic testing is moving at a rate that was unimaginable just a few short years ago.  A non-invasive fetal diagnosis now appears to be practical because cell-free fetal DNA can be found in the mother’s blood and can be used for genetic testing.  These new techniques will gradually replace the invasive procedures such as chorionic villus sampling or amniocentesis.

…..With all the new advances, the testing and counseling for genetic fetal evaluation is evolving, so it is important to discuss these new frontiers with your medical team.

-Dr. P

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Urgent Gynecological Care

…..I am excited to tell you about a new service offered here at our practice.  We realize that women have become very busy with commitments to family, work, and community.  The pressures of career demands, managing a household, taking care of the children, and day-to-day responsibilities can make life hectic at times.  This can make scheduling urgent doctor’s visits a hassle.

Urgent Gynecological Care

…..Therefore, I am happy to announce a new program called urgent gynecological care.  This means that immediate appointments are now available 6 days a week.  In gynecology offices, when a patient calls to make an appointment, many times she cannot see her OB/GYN for a few weeks or even months.  This can have a negative impact on her health if immediate attention is needed.

…..Call us and we will be happy to set up an appointment.  I am looking forward to caring for your special need.

-Dr. P

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Rejuvenate Your Life with This Simple Exercise

Everyone is always telling us to exercise, and we all know that the simplest program of all is walking.  There are many studies that confirm the substantial benefits of walking, and these include heart health, weight loss, stronger bones, and just feeling happier.  I have often advised my patients to try to walk about a half hour per day and explained that the distance at first is not important.

Young Woman Standing with Arms Stretched OutAs your conditioning improves, the distance over that time will increase and you will be surprised at how much better you feel.  Some helpful tips:

  • Start with a warm-up for the first few minutes to get the muscles going.
  • Like our mothers always told us, try to stand up straight and gently move those arms.
  • The proper shoes and socks are important.  I have always asked for the advice of the professionals at our local runner’s store.
  • Take those long steady steps so that the senior shuffle stays away from our door.

As always, if there are any questions about your health, speak to your health professional before beginning a program.  I am looking forward to saying hi as we pass on the streets of our neighborhood!

-Dr. P

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Should Pregnant Women Get the Flu Shot?

.Syringe….It is time to bring up the flu vaccine again!  October is the start of the flu season, and it can run all the way into the spring.  The flu vaccines are available now, and remember, it takes about two weeks to produce the protective antibodies after receiving the vaccine.

…..Pregnant women who get the flu have an increased risk to develop serious complications from the infection, resulting in hospitalizations.  Also, with the new moms’ vaccinations, protection is also increased for their infants who are susceptible to influenza-related respiratory illnesses.  Let us review a couple of points:

  • In the past there was concern about trace amounts of a preservative called thimerosal, which was in some flu vaccines.  There are thimerosal-free vaccines now, and the U.S. Centers for Disease Control and Prevention have concluded that the thimerosal used in the vaccine is safe.
  • Patients with egg allergies need to discuss this with their medical practitioner before receiving the vaccine.

…..Over the past few years, more pregnant women have received the flu vaccine, with the percentage reaching about 50%.  Let us try to raise that number this year and get better protection all around!

…..For more information, view two of my other posts about the flu: Why Should You Get a Flu Shot Each Year? and The Concern of Getting the Flu Shot During Pregnancy – FAQs Answered

-Dr. P

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Why Finding Out if You Have Cancer Genes Is Imperative

…..Breast cancer and Lynch syndrome genes are carried by over one million people in the United States, and these two conditions are associated with the most common hereditary gynecological cancers.  At present, only a very small percentage of the women who carry these genes have been identified.  Therefore, the protocols that can be used to decrease the risk of dying from the cancers that these genes can cause are not being instituted.

…..GenesOur family history will be the first indication that these genes may be a part of our genetic pool, and this can lead to testing for our carrier status.  If identified, the cancer screening tests start earlier for the individual carrier and for their relatives in future generations.

…..We must remember that, based on family history, about ten percent of women are at an increased risk for a gynecological cancer.  Due to the increased risk of breast, ovarian, colorectal, and prostate cancer, which is determined from the family history, a more intense and earlier testing program may be needed.

…..A woman with a first degree relative with breast cancer has an increased risk for developing that cancer, and it is greater if that cancer was found in that relative before the age of 50.  A first degree relative is a parent, brother, sister, or child.

-Dr. P

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An Important Action to Take to Prepare for Future Medical Conditions

…..Every day there is another story on the daily news about a genetic breakthrough concerning a medical condition.  Be it about an increased risk for developing a cancer or an inherited condition affected by a specific lifestyle, genetic technologies are advancing rapidly.  This will lead to a more personalized medical care based on an individual’s personal risk.Family Portrait

…..Before stepping into this new world of high-tech genetics, we must not forget about the low-tech importance of obtaining our family’s medical history.  Most of us feel that our family history is important but some studies have shown that only about 30% of us will actively collect information about family health conditions.  It is important to be armed with this information so when you visit your health professional, the best care can be obtained.

…..Therefore, at your next family party when you are having coffee with your great Aunt Mary, get her to tell some good family stories, and begin the collection process for your family’s medical history.

-Dr. P

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A New Birth Control Option That May Suit You

Smiling Woman…..Earlier this year, the FDA approved a new IUD (intrauterine device) for the first time in over 10 years.  It is marketed under the name Skyla, and it is a hormone-releasing system similar to another FDA approved IUD.  However, it uses a lower amount of hormone called levonorgestrel, which is a synthetic progesterone, and it is constructed with a smaller frame and inserter.  Here is some more information:

  • This new IUD is used as a contraceptive and can help control heavy menstrual bleeding.
  • Because of its smaller size, it may enable an IUD to be available to women who would normally have difficulty with the placement of an apparatus like this, for instance, someone who has not had children or women who have had Caesarian births.
  • The hormone system produces a local affect inside the uterus, which usually decreases the menstrual bleeding.  Because of the lower dose of hormones used as compared to another similar IUD, this  one provides continuous pregnancy protection for 3 years as compared to 5 with the higher amount of hormones.  In addition, the lower hormone level may be associated with a slightly greater bleeding pattern.
  • It is a latex-free product.

…..It is good to have a new option for women seeking a continuous birth control method.  Please speak to your health care professional, because with its smaller size and lower hormone level, this may right for you.

-Dr. P

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Preterm Births – Ways to Prevent This Large Problem

Preterm births continue to be a large problem in the United States, leading to many problems for these children.  It is the leading cause of infant mortality in our country.  Prevention is always the goal, and today, measuring the cervical length with a transvaginal sonogram may help identify patients who are at a higher risk for preterm births.Stethoscope on Pregnant Belly

Once identified, these patients may benefit from close follow-up plus the progesterone treatments and cervical surgery that are available.  Here are some more details:

  • The cervix may begin to shorten long before preterm labor or before the preterm rupture of membranes occur.
  • The cervical length usually can be measured with the use of a transvaginal sonogram.
  • A shortened cervix found before 20 weeks of pregnancy markedly increases the risk of preterm birth.  Progesterone treatments and cervical surgery, called a cerclage, may reduce the risk significantly.
  • Women with a history of a preterm birth, multiple gestations, or a previous cervical surgery are at a higher risk of early delivery and so may benefit from cervical length measurements.

As always, a dialogue with your health care provider is the first step in receiving the best medical care.  For the prevention of a preterm birth, taking the measurement of the cervical length may be part of that discussion.

For more information, check out: Preterm Births – Information You Should Be Aware Of

-Dr. P

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Are You Concerned About the Morning Sickness Associated with Pregnancy?

Waking Up Morning Sickness M.O.…..Morning sickness is a common problem affecting many women during early pregnancy.  To try to help with the symptoms, most medical professionals will advise eating several small meals during the day, eating low fat, bland foods, and trying to avoid smells that seem to increase the nausea.  Over my many years in practice, I often also advised popcorn, the insides of Italian bread, and ginger pops.

…..If this conservative management does not help, there is a recent FDA (U.S. Food and Drug Administration) approved treatment that may be of help.  Diclegis is the first medicine approved for this problem in over 25 years.  This combination of two substances was marketed many years ago as Bendectin, and it was removed from the market after a safety scare that was proved to be a false alarm.  However, the manufacturer stopped producing it because defending it in court was too costly.

…..Diclegis is a combination of two active ingredients, doxylamine and vitamin B6, and the FDA has granted  Diclegis a Pregnancy Category A status, meaning that controlled studies have not shown an increased risk to an unborn baby during pregnancy.  For the past few years, the American College of Obstetricians and Gynecologists has recommended this combination as a first-line treatment for morning sickness.

…..There is a set protocol on how to start and use Diclegis.  Drowsiness and sleepiness are the most common adverse effects reported by users.  These symptoms can be severe, so great caution is necessary.  As with all medications, you must have a thorough discussion with your health care provider before entertaining the use of this or any medication.

-Dr. P

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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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A New Medication to Help a Painful Menopausal Symptom

.
MH900370730In February 2013, the FDA (Food and Drug Administration) of the US approved a new drug for the treatment of dyspareunia (painful sexual relations), caused by the thinning of the vulva and vaginal tissues in the menopausal time of life.

The drug is called Osphena (ospemifene), and it acts as a tissue selective estrogen protagonist and antagonist.  This means that in some tissues, like the uterine lining and the vulva/vagina tissues, the ospemifene stimulates the tissue like estrogen, and in other tissues it acts like an anti-estrogen.

  • This is a medication in the same family as tamoxifen, which is used in breast cancer treatment and prevention protocols.
  • Dyspareunia is decreased because ospemifene has been shown to stimulate the vaginal mucosal tissue.
  • Osphena is an oral tablet which is taken daily.
  • It is contraindicated in patients with estrogen dependent cancers, a history of stroke or blood clots, or a cardiac history.
  • With this medication, there has been a reported increase in hot flushes.
  • This new medication may appeal to women who are not interested in using estrogen vaginal treatments or systemic hormone replacement therapy.

If you are suffering with this menopausal problem, speak to your health care professional because help is available, and this new medication may be an answer for you.

-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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