Why Testing for Thrombophilia Before Using Birth Control Is Important

Raquel Goldstein, RPA-C, MS, is a physician assistant at Dr. Polcino’s office. Today she speaks about thrombophilia’s effect on a woman using birth control. Since about 10% of women will carry thrombophilia, it is important to be informed about this genetic trait and what is recommended if it is identified.

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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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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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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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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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Exercising During Pregnancy – Is it Safe?

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

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

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

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

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

-Dr. P

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How Does Tamoxifen Treat Breast Cancer?

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

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

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

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

-Dr. P

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

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

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

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

-Dr. P

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Evaluating Your First Trimester of Pregnancy – The HCG Hormone’s Role

…..LEvaluating Your First Trimester of Pregnancy – The HCG Hormone’s Roleet us now start to review how early pregnancy (the first trimester) is evaluated, especially in the case of bleeding.

…..The embryo produces a hormone called hCG very early in the pregnancy, and later the placenta also produces this hormone.  Repeating or checking the levels of the hCG every 2 to 3 days is helpful when trying to assess the viability of an early pregnancy and to see if it is normal.  At a certain hCG level (between 1200 to 1500), a pregnancy should be visualized by a transvaginal sonographic exam.  When serial hormone levels are being followed, it is important to use the same laboratory or else there may be different test kits used at the specific lab, and so the results may not be accurate.

…..The hCG level should have a minimum rise of 50% every 2 days, and some practitioners consider a rise of 66% to better reflect a normal pregnancy.  I was taught that the levels should double every 3 days, and this is the formula I have always used.

…..All pregnancies are different, and there is some variability in the rise of hCG in normal pregnancies.  There are also some specific circumstances that affect this hormone’s levels:

  • If the woman is dehydrated when a test is taken, and on the repeat test she drinks more, the test can be affected
  • The level of hCG, which rises so dramatically early in the pregnancy, will begin to level off at about 8 weeks
  • In twins and other multiple pregnancies, the numbers can have great variability especially if there is a problem with one of the pregnancies

-Dr. P

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Four Reasons Why Your Hair Could Be Losing

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

Four Reasons Why Your Hair Could Be Losing…..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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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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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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