Mom was right after all! I talk about the importance of breakfast, including what problems it can prevent and the positive impact it can have on our children.
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Some women at a high risk for breast cancer may reduce their chance of developing invasive breast cancer with the use of the medication called tamoxifen. Chemoprevention is the use of a medication to reduce cancer, and it may be considered in a patient who is at high risk of developing breast cancer.
In a high risk population, the risk reduction with the use of tamoxifen has been reported to be 49%, and this has resulted in the FDA approving tamoxifen as the first drug for breast cancer prevention. In addition, studies have also found that another medication, called raloxifene, to be of benefit in menopausal women. Of course there can be serious side effects with these medications, so their use may be limited.
If you are at a high risk of developing breast cancer, start a discussion with your medical team about the possible use of chemoprophylaxis!
Read more about tamoxifen in my post: How Does Tamoxifen Treat Breast Cancer?
Let us continue our HPV informational journey with a few essential points:
…..Alcohol is a teratogen! A teratogen is a drug or any other substance that can affect the development of an embryo and can lead to birth defects or other developmental problems. Fetal alcohol syndrome (FAS) is a constellation of physical, behavioral, and cognitive abnormalities in children resulting from a mother drinking alcohol during a pregnancy.
…..The Centers for Disease Control and Prevention report that the rates for FAS in the United States range from 0.2 to 2 cases per 1000 live births. A less severe form of this problem, called fetal alcohol spectrum disorders (FASD), might be 3 times this rate.
…..There is always the question about how much alcohol will cause a problem. Will low levels of alcohol consumption during pregnancy cause harm? What do low levels of alcohol mean? Will a small amount be OK?
…..It is important to remind ourselves that FAS and FASD are entirely preventable. These syndromes are not seen if a pregnant woman does not drink alcohol during her pregnancy. It is for this reason that the Surgeon General of the U.S. and the American College of Obstetricians and Gynecologists direct health care clinicians to advise patients to abstain from alcohol completely during pregnancy.
.….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!
…..The decision to use any medication during a pregnancy is always made with great care after thorough evaluation by the patient and her health care providers. Selective serotonin reuptake inhibitor (SSRI) use during pregnancy has always been controversial and now even more so due to recent articles on the subject. Here are some important points:
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.
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.
I 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 the 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!
…..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.
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.
…..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:
…..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 their families. There are a few important facts you should be aware of:
…..The influenza vaccine comes in two types:
…..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.
…..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.
…..More about hair loss in women…
…..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.
…..In 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:
…..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:
…..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:
…..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.
…..This is a start of your vitamin D education!