A Lively Holiday Season

central-park-142894_640It has been a while since I added to my blog.  The holiday season is a very full time with lots of enjoyable get-togethers with family and friends.  Also during this season, I am enrolled in a fellowship program in Anti-Aging, Regenerative, and Functional Medicine.

Last week, we met to review a metabolic and functional approach to endocrinology.  We discussed bio-identical hormones in great depth.  It is now possible to give hormone replacement with hormones that have the exact same chemical structure as the hormones our bodies make.

During this special season I wish all of you many hours surrounded by those you love.  Those hours should be filled with giggles, smiles, and many hugs.

-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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Emergency Contraception – Continuing the Conversation

The side effects of these treatments include nausea and vomiting along with irregular vaginal bleeding.  Some patients will complain of breast tenderness, abdominal pain, dizziness, and headaches.

These types of emergency contraception have been used woman-509973_640successfully when initiated up to 72 hours after intercourse.  This was the findings with the initial studies.  However, more recent findings indicate that they are still moderately effective when used up to 5 days after intercourse.

Lastly, we should mention the use of the copper IUD for emergency contraception.  This has been used since 1976 (when inserted within 5 days after unprotected intercourse).  One advantage of this treatment is that the IUD can be left in and serve as a long-term treatment for contraception.  Sometimes this treatment may not be as easily available to the patient, and the placement of the IUD may not be easily accomplished in a patient who is young and has not had a baby before.

-Dr. P

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What’s Emergency Contraception All About?

…..Lbeautiful-15767_640et us get back to our discussion of emergency contraception.  The research on emergency contraception began in the 1960s, and the first treatment protocols arrived in 1974.

…..The two most common protocols are the progesterone only pill (Plan B) and the estrogen and progesterone pills.  Plan B consists of only one pill, and the second regime of estrogen and progesterone is a two-dose treatment 12 hours apart.  Both of these treatments are available over-the-counter for women 17 or older.  For women under 17, a prescription is necessary.

…..There is no clear reason for how the emergency contraception works.  A few explanations have been promulgated:

  • Inhibition or delay of ovulation
  • Interference with sperm transport or penetration of the egg
  • Thickening of cervical mucous
  • Impairment of ovarian hormone production

…..Remember that emergency contraception is effective only before a pregnancy has occurred.  If a pregnancy has already been established, studies have shown that the emergency contraception does not harm the developing fetus nor increase risks to the ongoing pregnancy.

…..To be continued!!!!!!

-Dr. P

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The Availability of Emergency Contraception

With the mornings crisp and clear, it is certain that fall is in full swing.  As I have mentioned before, since my life has always revolved around the school year, this is my time for new projects.  Our anti-aging/bio-identical hormone program is being updated, and the new treatment options are becoming available for our practice family.  I promise to keep you informed.

Today I want to begin to update you on emergency contraception.  This is a therapy to prevent pregnancy after unprotected or not totally protected intercourse.  It is not an abortion, and it does not cause an woman-593141_640abortion if you are already pregnant.  Most people call this treatment the Morning After Pill or Plan B, but regrettably, these phrases are not known or used as much as they should be.

With half of all pregnancies unintended and 40% of these pregnancies ending in abortion, it is imperative that this treatment is more known.  Women seeking this treatment are typically under 25, and the common indication is a broken condom, missed oral contraceptive pills, or a failure to use any birth control at all.  It should not replace our normal contraceptive methods, but should be available and used when necessary to prevent an unintended pregnancy.

-Dr. P

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A Fresh September Start

I hope all our families have survived the first week of school.  It seems my life has centered around the school schedule.  September has always been a new beginning in my mind, and each year our office embarks on new programs and plans.  Last year we put much energy into the Aquebogue office.

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Later this week, Mary Ann and I will fly to Dallas for a national symposium, the Bio-Identical Hormone Replacement Symposium, on anti-aging medicine and bio-identical hormone replacement therapy.  We have been providing this service for some time, and it will be good to speak to the national experts so we can provide the latest treatments in this ever-evolving field.  Over the next few weeks, I will bring you up-to-date information on the new developments.

-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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Methods of Herpes Treatment

…..I hope this finds all of my friends doing well.  For now we will finish our discussion of herpes.

…..DuSciencering 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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Herpes, Type 1 and Type 2

…..The weather on Long Island continues to be perfect beach weather; I hope everyone is taking the time to enjoy the outdoors, spending wonderful times with family and friends.

…..Let’s get back to our review of the herpes simplex virus (HSV).  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 interesting factsH2:

  • 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

-Dr. P

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Herpes Information Simplified

…..Welcome to my new blog!  I will try to bring you women’s health news in clear, straightforward language that hopefully will make you better informed.

…..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 presentation 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.

…..At our next visit, we will review the different subtypes of HSV and the current treatments.  Until then, remember to wear sunblock daily to protect yourself from the damaging sun.

-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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