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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Gonorrhea – A Condition Which Often Lacks Symptoms

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

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

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

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

-Dr. P

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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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Some Points You Should Know About Bleeding in Early Pregnancy

…..Let us end our review of vaginal bleeding in early pregnancy with a few points:

  • Early pregnancy bleeding often stops on its own, and the Some Points You Should Know About Bleeding in Early Pregnancycause is not always determined.
  • Vaginal bleeding is a common problem, and observing vaginal sonograms and hCG blood levels is helpful to determine the cause of the bleeding and to assess the chance of a successful pregnancy.
  • If the bleeding continues past the third month of the pregnancy, there is an increased chance of problems later on in the pregnancy, such as early rupture of the membranes and preterm (early) delivery.
  • This type of bleeding is a cause of great fear and anxiety for a couple, and emotional support from the medical team, family, and friends is imperative!

-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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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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What Are Common Causes of Bleeding in the First Trimester of Pregnancy?

…..There are a few common causes of bleeding in the first trimester:What Are Common Causes of Bleeding in the First Trimester of Pregnancy

  • Spontaneous abortion
  • Ectopic pregnancy
  • Subchorionic hemorrhage
  • Gestational trophoblastic disease (less common)

…..When we speak about miscarriages (spontaneous abortions), there are a few terms which are frequently used.  An ultrasound and an examination will usually confirm the diagnosis:

  • Threatened abortion (when vaginal bleeding occurs before 20 weeks of gestation, there is a viable pregnancy, and the woman has a closed cervix)
  • Inevitable abortion (if there is a dilated cervix)
  • Incomplete abortion (when a portion of the pregnancy has passed)
  • Complete abortion (when all of the pregnancy tissue (products of conception) has passed)

…..Gestational trophoblastic disease is a much less common cause of vaginal bleeding early in a pregnancy.  Some signs of this condition would be a pregnancy size larger than would be expected (based on routine dates), very high levels in a blood pregnancy hormone test (hCG), and severe nausea and vomiting.  Here are some common terms that are encountered:

  • Complete hydatidiform mole: A partial mole is formed when a sperm fertilizes an egg that has no nucleus.  This is the most common type of this condition.  On a sonogram, there may be many ovarian cysts seen or many cysts within the uterus.
  • Partial mole: This arises when two sperm fertilize an egg.  On a sonogram, there may be a sac with a fetus.

-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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The Concern of Getting the Flu Shot During Pregnancy – FAQs Answered

…..Let me give you some information to cover some of the questions that patients frequently ask.  This information is from the American College of Obstetrics and Gynecology, the American Medical Association, and the Society for Maternal-Fetal Medicine. It is from the form given to obstetricians to give to thSyringe for Flu Concern Patch Blog Post Paint3eir patients.

…..If you get vaccinated during your pregnancy, your unborn starts to get some protection during this period. This also gives the newborn a degree of protection in the first few months of life when their vaccinations have not been begun.

…..Safety, of course, is the main concern of all mothers. Flu vaccines have been given safely to millions of pregnant women for more than 50 years and are endorsed by the above medical societies.

…..The question of mercury in some of the vaccines is always a concern. Thimerosal, a type of mercury, is a type of preservative used in trace amounts in some vaccines and has not been shown to be harmful to a pregnant woman or her unborn child.  Also, it does not cause autism. Again, this is from the above mentioned medical societies. Remember, if you are still concerned about being given preservatives during your pregnancy, there are single-dose flu vaccines that are mercury-free, so speak to your medical professional.

…..Lastly, you must begin the discussion about the flu vaccine with your caregiver now. Ask all your questions, become informed, and let us all be protected… and you cannot get the flu from the flu vaccine!

-Dr. P

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Why Should You Get a Flu Shot Each Year?

…..The influenza vaccine comes in two types:

  • Inactivated, or killed vaccine, which is given by injection with a needle
  • Live, or attenuated (weakened) vaccine, which is sprayed into the nostril

…..The influenza viruses are always changing, and so each year scientists try to determine which viruses are going to cause the flu that year. In other words, a new vaccine is put together each year to prevent the flu for that season. It is for this reason that an annual vaccination is recommended.  After a person receives the vaccine injection, it takes about two weeks for the protection to develop, and the protection lasts for about a year.

Why Should You Get a Flu Shot Each Year

…..Some inactivated influenza vaccines contain a preservative called thimerosal while some vaccines are thimerosal-free. This has been a concern for many, but it has been shown not to be harmful to a pregnant woman or her baby, according to the American College of Obstetrics and Gynecology.

…..The U.S. Department of Health and Human Services recommends that all people 6 months of age and older should get the flu vaccine. Vaccination is especially important for people at a higher risk of severe influenza, including their close contacts.  Some of these close contacts can be healthcare workers and children younger than 6 months.

…..You should get the vaccine as soon as it is available for the new season. Even though most influenza occurs from October through May, the flu season can occasionally come earlier, so get the protection as early as possible.

-Dr. P

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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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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 the rest of 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!

-Dr. P

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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 a 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 with 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.Tick Removal Display Image

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.

Find out more in: What is Most Likely to Happen if You Are Diagnosed with Lyme Disease?

The blog post preceding this one: This Little Surprise in Your Garden Can Cause a Big Problem

-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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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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Is the Stress in Your Mind Causing Stress on Your Hair?

…..Continuing our discussion on hair loss in women….

…..Remember how our mothers always told us that stress could cause so many problems and make us feel terrible?  As always, our mothers were right.  For women, a severe illness, psychological stress, or having a baby are inciting stressful events that can cause physical effects.  One of these effects is hair loss.Hair Loss  Patch Blog Post 2

…..Usually 90% of our hair is in the growth phase, with 10% in the resting phase.  Keep in mind that some hairs are always shedding in the resting phase, and it is usually a small and regular amount.

…..Telogen Effluvium (TE) is a condition of diffuse hair loss that is caused by an identifiable stressful life situation; three of those situations were stated above.  In TE, 70% of hairs are in the growth phase and 30% in the resting phase.  This results in about 3 times as many resting phase hairs being shed daily.  The hair loss is gradual and diffuse and may be similar in appearance to the loss associated with the female patterned hair loss called androgenic alopecia (AGA).

…..With TE, a woman usually is aware of shedding, but with AGA, the loss is gradual, and shedding is not usually a complaint that is presented.  Also with TE, the loss may not become apparent for several months after the stressful event.

…..To treat TE, you must first identify and resolve the stress the body has been subjected to.  With pregnancy or an acute illness, the hair loss is usually self-limiting with complete recovery within 6 months after having the baby or recovering from the illness.  When TE is caused from psychological stress, since the treatment and recovery can take some time, the hair recovery can also involve a prolonged period.

-Dr. P

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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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Why Is Hair Loss Harrowing You?

…..Hair loss in women continued…Why is Hair Loss Harrowing You

…..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 information.  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 it’s length, thickness, and fragility.  Lastly, a pull test could be performed, which will help determine if active shedding is taking place.

-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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The Availability of Emergency Contraception

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

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

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

-Dr. P

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A Fresh September Start

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

maple-leaves-228164_640

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

-Dr. P

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Vitamin D – Is Your Serum Sufficient?

…..I hope everyone has survived the earthquake and Irene; my home lost power for five days, and it was not easy without the lights.  Today we will finish up our discussion of vitamin D.

Vitamin D Serum

…..Vitamin D2 and D3 are changed in the liver to 25-Hydroxyvitamin D.  That is the last time you will see that tough word since I will refer to it as 25(OH)D.  This is what is measured in the blood, and it determines if we need to have extra vitamin supplementation.  Vitamin D insufficiency is usually defined as a serum 25(OH)D level of 30 to 32 ng/ml.

…..In regard to calcium absorption, most studies suggest that with a 25(OH)D level of at least 20 ng/ml, there will be maximum absorption.

…..The daily recommendation for vitamin D is 600 IU for healthy non-pregnant women under 70 years of age and 800 IU for women older than 70 years.

…..Extra vitamin D should be added if the level is below 30 ng/ml.  As a general rule of thumb, an extra 1000 IU per day of vitamin D3 will increase the 25(OH)D levels by 6-10 ng/ml.  The levels should be checked after a three month trial.

…..Lastly, some studies point to problems if the 25(OH)D levels are greater than 50 ng/ml, so always check levels after adding extra vitamin D.

-Dr. P

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Do You Have an Increased Risk for Vitamin D Deficiency?

…..I cannot believe how fast the summer always seems to go.  As August slips away, enjoy as much time as you can surrounded by family and friends.  Now let’s go over who is at an increased risk for vitamin D deficiency.

…..People at an increased risk are those who have:

  • Obesity
  • Dark skin pigmentationTall Green Tree
  • Decreased sun exposure
  • Low intake of vitamin D
  • Poor absorption of ingested vitamin D
  • Been using antituberculosis and anticonvulsant medications, which increases breakdown in the liver of the vitamin
  • Kidney and renal disease
  • Osteoporosis and osteopenia

-Dr. P

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Vitamin D – More Important Than You May Think!

…..This past year has seen the discovery of vitamin D deficiency in a large portion of our population.  In my office, we never measured the value before but now I speak about low vitamin D many times a day. Today you will be given some basic points, and over the next few blogs you will have a good understanding of the situation.

  • Vitamin D is important to maintain bone health.
  • Some studies have reported that being low on vitamin D can be related to heart problems, cancer, diabetes, and autoimmune disease.  However, few true clinical trials have been taken.
  • Too much vitamin D should be avoided because of possible harm and lack of beneficial evidence.
  • The best measurement for the deficiency is the value of 25(OH)D in the blood.  The supplementation of the vitamin should be given to reach a target 25(OH)D value.

…..This is a start of your vitamin D education!

Vitamin D Benefits

-Dr. P

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Methods of Herpes Treatment

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

…..DuSciencering a symptomatic outbreak, the treatment consists of supportive measures such as oral and topical pain medications and special genital hygiene.  An antiviral medication can be added to decrease the viral shedding and the duration of the painful ulcers.  These medications should be started at the onset of the symptoms.

…..Acyclovir and valacyclovir are the two most common antivirals used and have a long history of safety in pregnancy.  There are some patients who experience frequent attacks, and a daily treatment of these medications can greatly suppress the episodes and therefore decrease the chance of spreading to a sexual partner.

…..In the future we will have a discussion of herpes and pregnancy, but for now I am going to get a donut.

-Dr. P

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Herpes, Type 1 and Type 2

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

…..Let’s get back to our review of the herpes simplex virus (HSV).  HSV is a DNA virus classified into two subtypes, 1 and 2, based on various proteins making up the virus.  HSV-1 is primarily the cause of herpes of the mouth and in the past was said to be the cause of infections above the waist.  It can also be responsible for genital infections, and these infections are becoming more common, especially among young women.

…..HSV-2 is almost always a genital infection.  The virus is spread through direct contact with mucosa (moist tissue like the vagina and lips/mouth) or damaged, irritated skin.  Incubation of the virus lasts for about a week, and the virus then reproduces in the superficial layers of the skin, causing inflammation and damage.  During the first infection, the virus enters the nerve cells and becomes dormant.  The virus can reactivate and cause ulcerative disease or shed without any symptoms.

…..Let me leave you with a few interesting factsH2:

  • In the US, 20% of women have had an HSV-2 infection
  • Most infections are spread by those who are unaware of having HSV
  • Recurrent disease is more common in those with type 2, compared to those with type 1

-Dr. P

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Herpes Information Simplified

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

…..A few times a week a new case of genital herpes presents to my office, and the patient always experiences great psychological and physical pain and stress.  The classic presentation of HSV (herpes simplex virus) is a painful group of vesicles and ulcers.

…..The infections are classified as primary, non-primary first episode, or recurrent.  The primary infection is the most painful and may be associated with tender lymph nodes as well as a fever and body aches.  If not treated, these primary lesions can last 2 to 6 weeks.  Recurrences vary in their frequency; however, 50% of patients will have one within 6 months.  These recurrences are generally milder with fewer lesions and a much shorter course.

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

-Dr. P

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Aspirin to Prevent Preterm Labor

One Viable Method to Prevent Preterm LaborPreterm birth rates continue to rise in the United States and are a major cause of neonatal morbidity and mortality.  Low-dose aspirin has been researched as a possible inexpensive and safe medication to help reduce the incidence of preterm birth.

Aspirin helps by reducing uterine contractility and inflammation.  Many medical issues such as the fetus being too small for gestational age, preeclampsia, placental insufficiency, and spontaneous labor may be reasons to consider protocols to help prevent preterm births.  In these instances, the effects of aspirin may be very helpful.

Many studies have shown a decrease in preterm births in patients taking low-dose aspirin prior to and during pregnancy.  It can be especially helpful to those with a history of a previous pregnancy loss.

The possibility of decreasing the incidence of preterm labor is very exciting.  Additional research is necessary to fully observe and understand all of the effects of low-dose aspirin on pregnancy.  Always remember to speak to your health care provider to discuss your particular concerns and to see if low-dose aspirin can be beneficial to you!

-Dr. P

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