Turner Syndrome – A distinctive group of woman

 

Turner syndrome

Women with Turner Syndrome (TS) are a distinctive group of women who require specialized medical and obstetrical/gynecological care. TS is found in approximately 1 in 2,500 pregnancies and is the result of the loss or partial loss of an X chromosome. Normally women’s chromosomes are 45XX and with TS it will be 45X. Because of this missing chromosome women with TS can look slightly different and can have an array of possible medical conditions such as:

  • cardiovascular disease which could be the result of a congenital anomaly
  • osteoporosis
  • hypothyroidism
  • abnormal lipids
  • diabetes

Pediatricians and pediatric endocrinologists usually follow these patients closely during childhood and adolescence, initiating estrogen to begin puberty and normal development. Conception and pregnancy offer unique conditions which will require individualized intense care by a team of specialists and preconception counseling is a must. Because of the higher risks for various medical conditions, TS patients need to be followed carefully throughout their lives.

-Dr. P

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Are you at your mental best? No? Maybe you need a cup of coffee and a nap.

Most of us have a downtime in our day approximately 7 to 8 hours after we awaken so that means between 2 and 4 pm we may not be at our mental best. The benefits of an afternoon nap are well known with 10 to 20 minutes being the most ideal. We arise from the nap with increased mental sharpness. You can increase this mental boost even greater by having a pre-nap cup of coffee. The caffeine will kick in just about the time you get up and perhaps your thinking will be even sharper. It seems there is another benefit to having that extra cup of coffee!

Getting ready for college life


It is already mid-August and many families with a college student are about to start on a new adventure. Whether the young adult is going to a commuter school and living at home or attending an away college and living in a dorm, there are many changes about to hit family dynamics and the college students lives. Long discussions should now begin about forming healthy habits that will be important for now, and more importantly, for the future. I always advise living the way your grandmother taught you. Here are some of Grandma MaryAnn’s suggestions.

Grandma MaryAnn says you must:

  • Get your sleep – It is important to get at least seven to eight hours of sleep every night. During sleep your body may be resting, but your brain is busy processing all the information it was exposed to during the day. Sleep helps your immune system to stay strong and prevent colds and other infections you are constantly exposed to. If possible, shut off all your electronic devices 30 to 40 minutes before going to sleep; the light from the screens can affect chemicals in your brain that enhance getting to sleep.
  • Eat well – Food is your body’s fuel. In order to work hard and think clearly, you need to eat the fruits, nuts and vegetables that we all know are the right stuff. Starting with a healthy breakfast will get the brain ready for the day. Healthy snacks are a must. The crash after the candy bar will be tough to handle.
  • Exercise – Exercise needs to be a part of your regular schedule because it decreases stress, keeps your mind sharp, and is fun. You should think of it as an investment in yourself.

I wish all the students a great year, and remember to call your Mom and Grandma as often as you can because with loving words from your biggest supporters, there is nothing you can’t handle.

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A gentle way to remove a tick

We, here on the Island, are in the middle of tick season and it is reported that there is an above average tick infestation this year. If you do come in contact with a tick, there is always the time honored tweezer method to grasp and remove it.

Another method is to take a cotton ball and put a liberal amount of liquid soap on it. Cover the tick with the soap-soaked cotton ball. Rub for a few seconds and usually the tick will release and be attached to the ball. This simple method is perfect for children and upset adults.

As always, prevention is the best medicine. Please check out the 8 best ways to avoid being bitten by a tick.

Ticks Poster 1 Rev5

-Dr. P

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Another reason to encourage weight control in adolescents

kid-scale

Obesity is a known risk for high blood pressure, diabetes, heart disease and colon cancer. A recent study out of Israel found that obese or overweight 17- and 18-year-olds can have an increased risk of developing colon and rectal cancer, and the risk may be increased as high as 50%! We now have another reason to encourage good eating and exercise habits for our children. The earlier these healthy life style habits begin, the better.

-Dr. P

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Experiencing Hot Flashes?

hot-flashes

A common complaint of the majority of menopausal women is the hot flash. It is also called hot flushes or night sweats, and the medical term used would be vasomotor symptoms (VMS). Most women will relate a feeling of great heat that overtakes their entire body, and this can last up to 5 minutes. These flashes can begin a few years before menopause and can last for many years after. There is great variability as to the number and intensity of these flashes, but most women who experience these hot flashes all consider them a problem that is disruptive to their lives. The exact cause of these flashes is not completely known, but the decrease in estrogen in menopause plays the main role.

Read more about menopause hot flashes and menopause.

-Dr. P

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Decreasing Hormones. Decreasing Menstruation.

As a woman ages, her ovarian function begins to decrease, and as the follicular activity starts to wane, the production of estrogen and progesterone goes down.  The decrease in these hormones will eventually lead to no more menstrual cycles, and menopause is defined as 1 year of no menstrual bleeding.  This is a natural part of every woman’s life as the 50’s approach and the average age of menopause is 51 to 52.  With our ever increasing life spans, women may spend 30 to 40 years in this postmenopausal state.

menstrual

-Dr. P

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Zika Update: A New Way to Test for This Infection

Blood sample positive with Zika virusThe CDC (Centers for Disease Control and Prevention) recently updated its guidelines concerning the testing of pregnant women who have a possible Zika virus infection or exposure.  It must always be noted that most people with the Zika virus infection are either asymptomatic or have mild clinical symptoms.  Mild clinical symptoms can be an acute onset of a fever, a rash, joint pain, and/or conjunctivitis.

There is new data suggesting that the virus can be detected in the blood and urine for 2 weeks after the infection begins.  This testing of the urine and blood for the virus should be performed for:

  • Symptomatic pregnant women in less than 2 weeks after the symptoms begin
  • Asymptomatic pregnant women in less than 2 weeks after a possible exposure

After this 2-week window, blood testing should begin for the Zika virus IgM antibody, which the body makes in response to a new Zika virus infection.  If this is found to be positive, there was definitely an infection and close fetal evaluation should begin.

As always, you should discuss the Zika virus problem with your health care provider so you can get the best possible care.

-Dr. P

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How to Exercise When Your Routine Is Being Snowed On

HowExSnow57039413 2If you are on a regular walking program as part of your exercise plan, the recent snowstorms may hold you back for a while.  It may be time to revisit your stairs at home or at work to continue staying in shape.

Try to vary your ascent by speed and the number of steps taken.  Before you begin each climb at home, you may want to add stretching and doing a plank or push-ups.  Before your descent, consider 10 jumping jacks.  Also, always remember to speak to your health care provider before beginning any exercise program!

-Dr. P

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What I Learn from the Anti-Aging Medicine Conferences

Last week, Mary Ann and I attended the World Congress on Anti-Aging Medicine in Las Vegas.  This is a meeting we attend annually, and each year we return with new and exciting information.

My focus was again on bio-identical hormone replacement therapy and I am never disappointed with my time spent with the world leaders in this field.  The overall philosophy of this branch of medicine is to help our patients prevent disease and to maintain function throughout their lives, long into old age.

-Dr. P

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What Are the New Breast Cancer Screening Guidelines for Average-Risk Women?

Nurse Assisting Patient Undergoing MammogramThe American Cancer Society (ACS) recently updated their breast cancer screening guidelines for women who are at an average risk of developing the disease.  It was published in the October 20, 2015 issue of JAMA (Journal of the American Medical Society).

Here are the recommendations:

  • Women with an average risk of breast cancer should undergo regular screening mammograms starting at age 45
  • Starting at 40, have annual screenings if the woman desires
  • For women aged 45 to 54, the screenings must be annual
  • For women over 55, mammograms every 2 years or annually if the women desires
  • Screen as long as the overall health of the women is good or if her life expectancy is 10 years or greater
  • For average-risk women at any age, ACS does not recommend clinical breast exams for breast cancer screening

These recommendations have refueled the debate over what are the best guidelines, and these differ from the other major health organizations.  It can be confusing, but I think it opens more discussions between women and their health care providers concerning the best way to screen for breast cancer for each individual.  Please continue to speak to your health care provider about your breast health and come up with a plan best suited for you.

-Dr. P

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Are You Prepared for This Summer’s Tiniest Villains?

I was working in my garden, and guess what I discovered yesterday, once again?  I spotted another tick on myself!  Because of this, I thought it would be a great time to discuss ticks all over again – what they do, what you should do if you find one on yourself, and all about Lyme disease.

Are You Prepared for This Summer’s Tiniest Villains-742474_1280Over 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, it begins to suck blood from the victim, and at this time, it regurgitates the bacteria back 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.

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.

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 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 withTick Removal Display Image 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.

An Alternate Way to Remove Those Ticks!

I recently learned about a different way to help remove a tick.  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.

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 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!

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-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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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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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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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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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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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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Treatment for Lichen Sclerosus

To finish up our review of lichen sclerosus, I want to leave you with some important points:

  • woman smiling in the parkPruritus is the most common symptom, occurring in 99% of women, vulvar irritation occurs in 60%, and vulvar burning and painful sex in 30%
  • High potency corticosteroids are the treatment of choice with 80% experiencing complete remission
  • Clobetasol 0.05% ointment is the medication most often prescribed
  • Ointments are used instead of lotions because of less irritation, and there are rarely any adverse effects with long-term use
  • The treatment protocol usually entails a few months of daily use, followed by a gradual decease, then followed by use as needed

Find about more about lichen sclerosus in: Could You Have Lichen Sclerosus?

-Dr. P

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This Past Stormy Month and a Conference

I cannot believe a month has passed since I wrote my last blog; it has been an interesting month.  First, I hope all of my friends in the New York area are getting back to normal after Sandy.  On Long Island where I live, the damage along the coast has been devastating, and the strength of my neighbors has been heroic.  Mary Ann and I just returned to our home after 2 weeks when the electric came back on.  We were very lucky with only tree damage, so no complaints in our home.This Past Stormy Month and a Conference

We participated in a wonderful conference in Atlanta concerning Female Sexuality.  It concentrated on many aspects of the sexual experience with a major focus on vulva, vaginal, and pelvic pain.  We must become more open about these problems, and it is my hope to help relieve these concerns with many of my patients in the future.

-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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Urgent Facts About Chlamydia, a Common STI

…..Sexually transmitted infections in adolescents continued…

…..CChlamydia Infohlamydia is one of the most common infectious diseases in the United States, with somewhere between 1 to 3 million cases each year among women ages 15 to 45. The most affected group is between ages 15 and 19, followed by 20 to 25 as the second most affected group.

…..One problem in finding this infection is that less than half of the most affected women are screened for Chlamydia trachomatis. The Center for Disease Control (CDC) guidelines suggest a yearly screening for chlamydia on all sexually active women who are 25 and younger, and testing should be performed for women over 25 if they have a new sexual partner or multiple partners. Women should also seek testing if they experience abdominal or pelvic pain, vaginal discharge, painful intercourse, pain with urination, or irregular bleeding.

…..Testing usually entails a speculum exam with a Q-tip swab of the cervix. If the speculum exam is a problem for the adolescent, then a vaginal swab can be performed. The patient can even collect a vaginal swab test privately if necessary.

…..After a woman is treated, reinfection is common, and having a treated infection does not provide immune protection against future infections. It is therefore advised that a repeat test be performed a few months after a treated infection.

…..If there is a delay in treatment of this infection, then there is an increased chance of developing an infection of the pelvis, called pelvic inflammatory disease (PID), which can lead to infertility. Some studies suggest that PID can develop in up to 30% of women with their first chlamydial infection.

…..There are many antibiotic treatment plans suggested by the CDC, and they all are very successful. The adolescent and her partner should avoid intercourse for 7 days after both partners have been treated.  Ideally, the patient should refer for testing any sexual partner that she encountered within the last 1-2 months.

-Dr. P

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How a Sonogram Can Determine if Your Pregnancy Is Normal or Abnormal

…..OHow a Sonogram Can Determine if Your Pregnancy is Normal or Abnormalver the last 30 years, ultrasound has changed dramatically in how we evaluate early pregnancy.  Transvaginal sonography has allowed us to assess early gestation with better clarity.

…..The gestational sac is the first visible sign of a normal
intrauterine pregnancy.  This should be seen with the transvaginal sonogram by 5 weeks after the last menstrual period. The earliest embryonic structure is the yolk sac, and likewise, this can be seen as early as the end of the 5th week.  Evaluating the yolk sac is important because it can point to problems in a pregnancy. If it is not present at this early time, or if the shape is irregular or large, this can be the first sign of a nonviable pregnancy.

…..Near the 6th week from the last menstrual period, the embryo should be seen attached to the yolk sac, and fetal heart activity should be noted between the 6th and 7th week. When the gestational sac is approximately 2 cm, an embryo should be seen, and if it is not identified at this time, a blighted ovum is confirmed.

…..There are specific sonographic signs of a problem pregnancy:

  • A small gestational sac around the embryo
  • If the embryo does not increase in size by 1 mm per day
  • A fetal heart beat at a rate of less than 120 beats per minute after 7 weeks of gestation.

…..Let us end this review on a positive note. If a patient has no abnormal symptoms, normal fetal heart activity, and 7 weeks of gestation has been reached, then there is a 99% chance of a successful pregnancy.

-Dr. P

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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

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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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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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Women: Your Most Common Cause of Hair Loss

…..More about hair loss in women…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.

-Dr. P

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What Cycle Does Your Hair Bear Throughout Your Life?

…..I would like to continue our review of hair loss in women.  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).

What Cycle Does Your Hair Bear Throughout Your Life…..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!

-Dr. P

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Don’t Lose from Hair Loss

…..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.

Don't Lose from Hair Loss

-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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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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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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