It is already mid-August and many families with a college student are about to start on a new adventure. Whether the young adult is going to a commuter school and living at home or attending an away college and living in a dorm, there are many changes about to hit family dynamics and the college students lives. Long discussions should now begin about forming healthy habits that will be important for now, and more importantly, for the future. I always advise living the way your grandmother taught you. Here are some of Grandma MaryAnn’s suggestions.
Grandma MaryAnn says you must:
Get your sleep – It is important to get at least seven to eight hours of sleep every night. During sleep your body may be resting, but your brain is busy processing all the information it was exposed to during the day. Sleep helps your immune system to stay strong and prevent colds and other infections you are constantly exposed to. If possible, shut off all your electronic devices 30 to 40 minutes before going to sleep; the light from the screens can affect chemicals in your brain that enhance getting to sleep.
Eat well – Food is your body’s fuel. In order to work hard and think clearly, you need to eat the fruits, nuts and vegetables that we all know are the right stuff. Starting with a healthy breakfast will get the brain ready for the day. Healthy snacks are a must. The crash after the candy bar will be tough to handle.
Exercise – Exercise needs to be a part of your regular schedule because it decreases stress, keeps your mind sharp, and is fun. You should think of it as an investment in yourself.
I wish all the students a great year, and remember to call your Mom and Grandma as often as you can because with loving words from your biggest supporters, there is nothing you can’t handle.
We, here on the Island, are in the middle of tick season and it is reported that there is an above average tick infestation this year. If you do come in contact with a tick, there is always the time honored tweezer method to grasp and remove it.
Another method is to take a cotton ball and put a liberal amount of liquid soap on it. Cover the tick with the soap-soaked cotton ball. Rub for a few seconds and usually the tick will release and be attached to the ball. This simple method is perfect for children and upset adults.
As always, prevention is the best medicine. Please check out the 8 best ways to avoid being bitten by a tick.
Obesity is a known risk for high blood pressure, diabetes, heart disease and colon cancer. A recent study out of Israel found that obese or overweight 17- and 18-year-olds can have an increased risk of developing colon and rectal cancer, and the risk may be increased as high as 50%! We now have another reason to encourage good eating and exercise habits for our children. The earlier these healthy life style habits begin, the better.
A common complaint of the majority of menopausal women is the hot flash. It is also called hot flushes or night sweats, and the medical term used would be vasomotor symptoms (VMS). Most women will relate a feeling of great heat that overtakes their entire body, and this can last up to 5 minutes. These flashes can begin a few years before menopause and can last for many years after. There is great variability as to the number and intensity of these flashes, but most women who experience these hot flashes all consider them a problem that is disruptive to their lives. The exact cause of these flashes is not completely known, but the decrease in estrogen in menopause plays the main role.
Read more about menopause hot flashes and menopause.
As a woman ages, her ovarian function begins to decrease, and as the follicular activity starts to wane, the production of estrogen and progesterone goes down. The decrease in these hormones will eventually lead to no more menstrual cycles, and menopause is defined as 1 year of no menstrual bleeding. This is a natural part of every woman’s life as the 50’s approach and the average age of menopause is 51 to 52. With our ever increasing life spans, women may spend 30 to 40 years in this postmenopausal state.
A recent small study of menopausal women with frequent hot flashes may show a relationship between these flashes and an increased chance of developing heart disease. Frequent hot flashes meant that the women experienced these flashes 5-6 times per day.
In the study, changes were seen in the vessels of the cardiovascular system. This again points to the importance of menopausal women having regular visits with their health care professionals to assess their cardiovascular health!
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.
The business associated with the use of probiotics is huge around the world. It promises to use live and good bacteria to decrease/replace the bad bacteria that can build up in the colon. Probiotics are live bacteria that are mostly found in foods and supplements. They have the potential to provide beneficial health effects for the person ingesting the bacteria.
The human gastrointestinal tract, especially the colon, is populated by a large amount and assortment of bacteria, called the intestinal flora. This flora develops over the first two years of life and evolves over time based on health, diet, genetics, and many other factors. This good natural bacteria and added probiotics seem to work in a variety of ways:
Natural good bacteria and probiotics prevent the growth of bad bacteria by not allowing a place for it to grow and competing for the nutrients.
They lower the acidity of the intestine, creating an unwelcome environment for the bad bacteria.
They increase the production of mucin. Mucins are the proteins that bind to form the gel-like mucous, made by the epithelial cells that line the intestines. This produces a chemical barrier which limits the damage of inflammation.
You should open a discussion with your health care provider about the benefits of probiotics, especially the next time an antibiotic is needed. Antibiotics can affect the natural flora of the intestine so a probiotic review may be perfect.
…..Let us now summarize the Tdap vaccination recommendations as advised by the CDC (Centers for Disease Control and Prevention) and the American College of Obstetricians and Gynecologists:
Pregnant women should receive the Tdap vaccine with each pregnancy, and the ideal timing is during 27 to 36 weeks of the pregnancy.
With the preceding plan, there is an increased likelihood of optimal protection against pertussis for the pregnant woman and her infant during the first few months of the baby’s life.
All women during each pregnancy should receive the vaccine whether or not she has received the vaccine in the past.
If the pregnant woman has not received the vaccine during the pregnancy, it should be administered immediately after delivery.
To date there is no data to suggest increased fetal, maternal, or pregnancy risks with the vaccine, but the safety should be closely monitored under the direction of the Food and Drug Administration.
Although not part of the new immunization schedule recommendations, experts are advising vaccinations for the new baby’s father, siblings, and other caretakers. This is part of the cocooning strategy. Even grandma and grandpa should consider vaccination.
…..As always, discuss all your concerns with your caring medical professional so you can obtain the best care possible for you and your family!
Over the past decade, there has been a large increase in the incidence of pertussis (whooping cough) in the United States, with over 40,000 cases being reported in 2012. What is of great concern is the large number of infants being affected.
The CDC (Centers for Disease Control and Prevention) reports that most pertussis hospitalizations and deaths occurred among children under 3 months old. Babies do not receive their first pertussis vaccine until two months of age, and they are not fully protected until after their third shot, which comes at about six months. Over the first six months of life our babies are at a high risk of getting very sick if they develop this bacterial infection.
In order to combat this new outbreak of pertussis, in January 2013, the CDC released a new immunization schedule. This recommended that a dose of Tdap vaccine be given to all women during each pregnancy whether or not she had received the vaccine previously. This was a change from their previous recommendations which suggested that the vaccine be given only to pregnant women who had never received this vaccine.
…..Postmenopausal women are at an increased risk for urinary tract infections (UTIs) because of a decrease in their estrogen levels. This lower hormone state is associated with specific physical and physiologic changes that increase this risk:
Thinning of the mucosa of the vulva (vaginal tissue)
Changing of the normal bacteria that usually inhabit the vagina, especially a decrease in lactobacillus colonization
An increase in the pH of the vagina
Vaginal colonization of E. coli.
…..There have been multiple studies which have found a decrease in these UTIs with the use of estrogen intravaginal creams. There are many variations on the types of estrogen used and many commercial products available.
…..If you are in the menopausal time of your life and suffer from recurrent UTIs, ask your medical professional about the possible use of a vaginal estrogen preparation.
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!
Let us continue our HPV informational journey with a few essential points:
HPV infections are almost exclusively acquired from sexual exposure.
The virus has been detected in multiple sites on both the male and female genital areas.
The cervix is the most common site for the infection.
Transmission between the mother and infant has been documented, with exposure during the delivery being suggested as the most common cause of the fetal infection. This is considered a vertical form of transmission. Some studies suggest a vertical transmission rate of about 25% with almost all neonatal infections cleared by the first year of life.
It was not until the early 1980s that the association between the human papillomavirus (HPV) and genital tract infections became apparent. A German research physician had isolated the HPV 16 and implicated its role in the development of cervical cancer, so a new scientific journey had begun.
We now know that the persistence of an HPV infection is necessary for the development of cervical cancers, and it is implicated in the majority of other genital tract infections in both men and women. It is time to start our journey to a better understanding of a virus that affects so many of us!
When a pregnant woman “breaks her water” usually it is the start of an exciting time of her pregnancy because labor has started or is about to begin. This is fine if the pregnancy is near the due date, but if the water breaks and the pregnancy is not near the due date, then there is a problem. Preterm premature rupture of membranes (PPROM) is a bad problem and is a leading factor in premature births.
About 12% of births in the US are preterm
Most pregnancies last about 40 weeks
Babies born between 32 and 37 weeks are considered preterm, and babies born before 32 weeks are considered early preterm
About 5% of births in the US are complicated by PPROM
Since the most common outcome of PPROM is delivery of the baby within 1 week of the water breaking, information about this potential complication must be available to everyone.
Weight control is a major concern for most of us. As menopause approaches, many women experience an increase in their weight, with about 70% being overweight. Body mass index (BMI) is a commonly used calculation that quantifies where our weight is, and when using this classification, about 50% of perimenopausal and menopausal women are considered obese.
Using a person’s height and weight, body mass index can be calculated, giving us a guide to where we stand with regards to our weight. A BMI of 24 to 29 is considered overweight, and over 30 is obese. Let us look at where some weights fall:
At 5 ft. 1 in. a BMI of 24 to 29 corresponds to a weight of 130 to 150 lbs.
At 5 ft. 1 in. a BMI of 30 corresponds to a weight of 160 lbs.
At 5 ft. 6 in. a BMI of 24 to 29 corresponds to 155 to 180 lbs.
At 5 ft. 6 in. a BMI of 30 corresponds to a weight of 185 lbs.
Remember that this BMI number is not an exact measurement of body fat but it alerts us to where our weight status lies and gives us an indication of our risks for developing the complications of obesity. These include diabetes, hypertension, heart disease, and many other medical conditions.
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!
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.
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.
…..Over 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.
…..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:
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%.
…..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 their 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!
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.
…..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.
…..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.
…..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.
…..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:
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:
…..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.