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

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

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

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

Gonorrhea – A Condition Which Often Lacks Symptoms

…..teenage depression - teen woman sitting thinkingNext in my series about sexually transmitted infections in adolescents, we will be discussing gonorrhea.

…..Gonorrhea is a common STI in the adolescent and young adult population (15 to 25).  There are about 750,000 cases each year, with women having a slightly higher rate than men.  We should use the same targeted screening that is used for chlamydial infections (with all women under 25 being tested).  The same risk factors are associated with gonorrhea and chlamydia, and with both, more than 50% of women are asymptotic.

…..When there are symptoms, they may include vaginal discharge, pelvic pain, or pain with urination.  Again, if there is a delay in diagnosing and implementing the treatment of an infection, severe pelvic problems can develop.

…..There are specific antibiotic protocols for treatment that are available.  These days, consideration must be made for antibiotic resistance, which has been developing.  Lastly, with all persons found to have gonorrhea, there should be testing for HIV, syphilis, and chlamydia.

-Dr. P

You May Experience This Common Complication of Early Pregnancy

…..I would like to begin a review of one of the most common complications of early pregnancy, vaginal bleeding.  This is the number one reason patients will have an emergency visit in the first trimester, and it is a cause of great anxiety to patients and theirYou May Experience This Common Complication of Early Pregnancy families.  There are a few important facts you should be aware of:

  • About 15% of recognized pregnancies will end in miscarriage
  • 80% of miscarriages occur in the first trimester
  • Trauma, smoking, excessive alcohol use, and advanced maternal age increase the risk of first trimester bleeding
  • 25% of pregnant women will report first trimester bleeding or spotting
  • 8% of pregnant women report heavy vaginal bleeding
  • Of the patients who report bleeding, 75% will have 1 episode, 20% will have 2 episodes, and 10% will have 3 or greater episodes
  • The amount of bleeding is the most significant predictor of an impending miscarriage
  • Again, advanced maternal age is a significant risk factor for first trimester bleeding and subsequent miscarriage; 50% of pregnancies in women over 40 result in a miscarriage, with abnormal chromosomes in the fetus being a primary factor
  • For women under the age of 35, the rate of a spontaneous miscarriage is 2%.

-Dr. P

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

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

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

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

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