A Tool to Measure Your Risk of Developing Breast Cancer

A Tool to Measure Your Risk of Developing Breast CancerMany women who are at an increased risk of developing breast cancer are not aware of their risk.  If you are at an increased risk, a pharmacologic preventive therapy (chemoprevention) is a consideration you should discuss with your health care provider.  It has been reported that the agents used can reduce the risk by 50%.

The Gail Breast Cancer Risk Assessment Tool is one of the models that has been developed to quantify a woman’s risk of developing breast cancer.  By answering a series of questions about lifestyle, obstetric and gynecological history, and family history, a 5 year and lifetime risk can be calculated.  If there is a moderate to high risk, lifestyle and pharmacologic interventions should be considered.

Tamoxifen (Nolvadex) and Raloxifene (Evista) are two agents that may be discussed to help in the reduction in breast cancer.  There are risks and benefits to both medications, which need to be considered.

-Dr. P

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A Healthy Exercise for Beautiful Autumn

The fall season is full of pumpkins, mums, scary costumes, and beautiful crisp clean air!  It is a perfect time to get started on an outdoor walking program.  Join a friend or relative and begin your walking exploration of your neighborhood and make this fall the getting in shape season for you.Autumn Leaves, Berries and Pinecones

-Dr. P

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The Vegetable from the Fountain of Youth

“If you’re looking for the Fountain of Youth, kale may just be it!” Tom Gatto, a registered dietician, updates us on the nutritional powerhouse called kale. His discussion includes nutrient density, how to prepare it, and which vitamins, minerals, and antioxidants it contains and how they enhance our health.

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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?

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…..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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Avoid the Metabolic and Reproductive Consequences of PCOS

Polycystic ovary syndrome (PCOS) is very common, but many times it is underdiagnosed and a misunderstood disorder in young women today.  Symptoms of PCOS may include irregular periods, increased facial and body hair, alopecia, acne, and multiple cysts of the ovaries.

IAvoid the Metabolic and Reproductive Consequences of PCOSt is important to diagnose PCOS due to its potential metabolic and reproductive consequences.  PCOS can increase the risk of heart disease, obesity, high blood pressure, diabetes, liver problems, and obstructive sleep apnea.  PCOS may also increase the risk of having difficulties conceiving.

There are various treatment modalities available for PCOS patients, so speak to your health care professional if you have any of these signs or symptoms.

-Dr. P

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Urgent Gynecological Care

…..I am excited to tell you about a new service offered here at our practice.  We realize that women have become very busy with commitments to family, work, and community.  The pressures of career demands, managing a household, taking care of the children, and day-to-day responsibilities can make life hectic at times.  This can make scheduling urgent doctor’s visits a hassle.

Urgent Gynecological Care

…..Therefore, I am happy to announce a new program called urgent gynecological care.  This means that immediate appointments are now available 6 days a week.  In gynecology offices, when a patient calls to make an appointment, many times she cannot see her OB/GYN for a few weeks or even months.  This can have a negative impact on her health if immediate attention is needed.

…..Call us and we will be happy to set up an appointment.  I am looking forward to caring for your special need.

-Dr. P

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A New Birth Control Option That May Suit You

Smiling Woman…..Earlier this year, the FDA approved a new IUD (intrauterine device) for the first time in over 10 years.  It is marketed under the name Skyla, and it is a hormone-releasing system similar to another FDA approved IUD.  However, it uses a lower amount of hormone called levonorgestrel, which is a synthetic progesterone, and it is constructed with a smaller frame and inserter.  Here is some more information:

  • This new IUD is used as a contraceptive and can help control heavy menstrual bleeding.
  • Because of its smaller size, it may enable an IUD to be available to women who would normally have difficulty with the placement of an apparatus like this, for instance, someone who has not had children or women who have had Caesarian births.
  • The hormone system produces a local affect inside the uterus, which usually decreases the menstrual bleeding.  Because of the lower dose of hormones used as compared to another similar IUD, this  one provides continuous pregnancy protection for 3 years as compared to 5 with the higher amount of hormones.  In addition, the lower hormone level may be associated with a slightly greater bleeding pattern.
  • It is a latex-free product.

…..It is good to have a new option for women seeking a continuous birth control method.  Please speak to your health care professional, because with its smaller size and lower hormone level, this may right for you.

-Dr. P

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The New Outbreak of Pertussis in Babies


Little Baby M.O.
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.

-Dr. P

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Two Reasons Why You Should Not Drink Alcohol During Pregnancy

Water Pouring from Bottle…..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.

-Dr. P

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Preterm Births – Information You Should Be Aware Of

Baby Looking UpWhen 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.

-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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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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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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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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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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