Thursday Series: Things I've learned from my patients today; Honesty
February
28 ,
2008
Today I had to do the surgeons least favorite thing. I needed to take a patient back to surgery for a complication that resulted from a surgery that was done about a month ago.
When I had to tell her about what had happened, I had to consider the typical dilemma. Of course she needed an explanation, but how complete should I be when telling her? Does she really need to know every detail? What if I make myself look bad, will she ever trust me again?
Well, the best policy is honesty, and it is so much easier to simply tell the truth. I reviewed with her the entire procedure, where the problems occurred and what needed to be done to fix it. I answered her questions in detail, and we went through diagrams and reviewed everything. She agreed to the second procedure, which thankfully was a success.
When I went to speak with her husband in the waiting room after the surgery, he told me, "I just would like to tell you how much my wife appreciated your honesty and completeness. She felt so comfortable knowing that you were up front with all of the details that made her feel confident that she was in capable hands. I wanted to tell you this when she wasn't around because I didn't want to embarrass her."
I learned how much people appreciate honesty. If you want their confidence, they want to know that you can be trusted. We can all consider this in all of our relationships.
Wednesday Series: Little known big topics in GYN; There is a solution to wetting yourself every time you sneeze!
February
27 ,
2008
There is a saying among gynecologists that refers to the prevalence of urinary incontinence among women. That is that if you want to know how frequent this problem is among women, well, it is as frequent as the amount of times you ask about it! This saying recognizes the fact that so many women, suffer from leaking urine, usually when they cough, sneeze or strain.
Unfortunately, it seems that many women suffer in silence, doctors may not ask about it, or the women think it is normal. You should know that most women with urinary incontinence can get relief, and with relatively mild interventions.
Sometimes a medication is all that is needed, but there are also minor surgical procedures that can be done as an outpatient that can provide good relief. The surgery consists of placing a small sling (usually a thin strip of specially designed synthetic material) underneath the urethra (that is the hole where the urine comes out) in the vagina. This is through a tiny incision and usually does not require a stay in the hospital. The recovery time is not too long, and the relief is hopefully lifelong.
So talk to your doctor, and stop suffering in silence!
Tuesday Series: Breast health tidbits; Breast cancer prone personalities?
February
26 ,
2008
Today's discussion breast health discussion is meant to dispell a bad myth. There is a myth that has been circulating, that soem people may be prone to cancer because they are "just that type of person". People usually won't say it publicly, because they don't want to insult anyone, but there is no denying that it can sometimes be whispered behind closed doors.
Well now we finally can quote pretty good scientific evidence that there is no such thing as a personality type that is somehow prone to developing breast cancer.
In a study titled "Personality Factors and Breast Cancer Risk: A 13-Year Follow-up" published in the Journal of the National Cancer Institute in January 2008 they studied various personality traits and the risk of developing breast cancer. According to their findings, "None of the personality factors were statistically significantly associated with an increased risk of breast cancer, with or without adjusting for the medical risk factors."
So let's stop perpetuating this myth. Breast cancer can strike anyone, regardless of what type of person they are. Take care of yourself (i.e. stop smoking, lose weight, exercize...), check your breasts each month, see your doctor yearly, get mammograms as recommended, and report anything suspicious to your doctor.
Monday Series:GYN and alternative medicine:Yogurt for yeast infections
February
25 ,
2008
So I'm sure lots of you have heard that if you want to prevent yeast infections you should eat yogurt. Does it really work? How would it work?
Well, the theory goes that the species of bacteria that live in a healthy vagina are a type of bacteria called lactobacillus. When they are plentiful in the vagina, they manage to keep the yeast under control and everything is fine. When for some reason the lactobacilli are not plentiful enough, the yeast take over and - so does the itching, burning, and discomfort of a yeast infection.
Well yogurt has tons of lactobacilli, so maybe by eating yogurt you can restore the balance and get rid of the yeast! Maybe the L. acidophillus in the yogurt will help promote the growth of healthy bacteria in the vagina?
Well the studies are not really enough to prove it, but there is some support for this in the medical literature. See "Use of Probiotics in Humans:An Analysis of the Literature" in Gastroenterology Clinics September 2005. In that review they seemed to bring some pretty good evidence that yogurt actually does help a bit.
Given the general health benefits of a good lowfat yogurt, with calcium, protein and the possible "probiotic" benefit, why not try it? It even tastes good!
Sunday series:GYN controversies; Hormone replacement therapy
February
24 ,
2008
For those of you that are following along with our Sunday series, I'm sure your sitting at the edge of your seats, waiting for this next installment.
I left you wondering if it mattered when a woman starts hormone replacement (HRT). If a woman waits for years after menopause, and then she starts HRT, is her risk higher than someone who starts HRT right away with menopause?
Well, as physicians have pondered this question, the data from the famous WHI study was revisited, and lo and behold, The longer a woman waited after menopause to start HRT, the higher the risk was for coronary and vascular disease! This means that it might not be such a bad idea to start hormone replacement right away when the symptoms are the worst. But think twice before you start it years later, because that is when the risk is the highest.
Saturday Series: GYN News; Home births
February
23 ,
2008
On February 6, ACOG, the American College of Obstetricians and Gynecologists released a policy statement regarding home births. For the full statement, click here.
It should not be surprising that the advocates of home births have come out in full force and attacked this statement. The primary accusation being that ACOG is simply out for money. I would like you to look at this very popular blog post by amygeekgirl on blogher.com.
The post is so full of false and dangerous assertions that I am not sure where to begin.
Bloggers like amygeekgirl are doing nothing less than putting women and children in danger. Let us look at some of the "data" she brings in order to support her claims. She brings a study in the British Medical Journal from 2005 which claims to show that home births are safe. This despite the fact that the rate of neonatal deaths in the study was 1.7/1000 in low risk women. The data for low risk women in the same year who delivered at hospitals is difficult to figure out, because the government data doesn't have a category called "low-risk" women.
Therefore, in order to compare the results of the study with a comparable group of "low-risk" women who delivered in a hospital, we would have to take an equal number of "low-risk" women, have them deliver in a hospital and see what the outcomes are. We can't simply take the hospital records of an equal number of women who "happened" to deliver in a hospital, because, this would include high risk women as well.
So we are left with assumptions about rates of neonatal death among "low-risk" women in hospitals that can not be proven. The study quoted simply had no comparison group at all. Indeed, a careful look at the numbers in the CDC report would lead one to believe that the neonatal mortality rate of the home birth women actually was higher than the rate of the women who gave birth in the hospital, but this cannot be proven either, because the comparison group simply doesn't exist. Bottom line is that all the study proves is that the neonatal death rate among low risk women that attempt home birth is 1.7/1000. While interesting, it doesn't tell me if those numbers would have been any better or worse had they labored in a hospital.
Next she brings in Denmark, Sweden, the UK and the Netherlands as examples of developed countries where home births are common to prove that home birthing is safe. Well, in three out of those four countries, the neonatal mortality rate according to the WHO was actually higher than the US rate! Only in Sweden was the rate lower, so what does that prove?
Now here's the real sneaky thing. The first strategy that the home birth advocates use is to somehow make it seem as if having a midwifery birth and a home birth are somehow synonymous. The like to make it seem as if there is some kind of war going on between the midwives and the doctors, and we're somehow fighting over this giant pot of money.
The fact is that midwives have brought great and positive changes to hospitals across the country. The overwhelming majority of these midwives wouldn't even think about practicing outside a hospital or at least in accredited birthing center. Most obstetricians, myself among them, have been working together with midwives for years, and we have long recognized the value of a good midwife in the care of a woman in labor.
This is the real tragedy of what people like amygeekgirl are doing. They plant these ideas in peoples' minds that have nothing to do with reality. Every woman in labor should have the labor that she wants and deserves. Most hospitals today can accommodate midwives, and will respect your plans and wishes. Hospitals are not what they used to be. If you don't think your getting good treatment from your doctor, midwife, or hospital, please feel free to go to the next hospital down the street. But please don't forget safety, please don't allow your emotions to get in way of doing the right thing.
Friday series: 15 minutes to better health; Breakfast!
February
22 ,
2008
So we've now added calcium, Iron and fiber to our diet in our "15 minutes" series, so why not add an entire meal! According to many surveys, breakfast is the most skipped meal of the day. This is despite the fact that it is also the most important! Now let's see why it is so important for our health.
1) There is good evidence that "breakfast eaters" are less likely to be overweight than "non-breakfast eaters" (Journal of American Dietetic Association April 2007)
2)People who eat breakfast are more likely to consume milk which we know is a great source of calcium (Journal of American Dietetic Association November 2006)
3) People who eat breakfast are more likely to get more fiber in their diet (Journal of American Dietetic Association June 2005)
So maybe you're getting the hint, it doesn't take long to eat a proper breakfast. So why not take this simple step toward better health?
Thursday Series: Something I've learned from my patients today; How great my job is!
February
21 ,
2008
I just saw a very mature young woman today, who said something I'm sure I'll remember for a very long time.
Here's a little background about her story. I first met her about a year ago in the ER when she was 14 years old. She was in terrible pain, crying and curled up in her Mom's arms. Her belly was distended, and she was vomiting violently. To make a long story short, she was diagnosed with a hemorrhagic ovarian cyst that was bleeding into her abdomen.
I took her to the operating room, and removed the cyst, and also about one and a half liters of blood from her abdomen. She was remarkably better after the surgery, and I earned her trust talking about her love for turtles.
More than a year later, she is now 15 years old, and is doing well in high school. She came to see me for an unrelated problem.
At the end of our conversation, I asked her how she was doing in school, her grades, extracurriculars etc...She says, "I've been working hard, because I know that I have to do well if I'm going to be a doctor someday!"
"So you plan on being a doctor?" I asked.
"Ever since the surgery last year, I decided, that if a doctor can make someone feel so much better like you did for me, that is what I want to do with my life."
I could hardly hold myself back from crying. From this one statement, I feel like everything I've done has been worth it, every single bit, and then some.
Wednesday Series: Little known big topics in GYN; Smoking and abnormal pap smears
February
20 ,
2008
Welcome back to our Wednesday series, our next little known big topic is smoking and abnormal pap smears.
I cannot tell you how many times I've been asked, "what can I do to make sure my pap smears are normal?" Every women wants to know what is in her control, and how she could improve her health. But the pap smear always seems mysterious and uncontrollable.
Well, it has been very well established that smoking is a risk factor for abnormal pap smears and cervical cancer. Stopping smoking can definitely decrease your risk, and can help you start getting normal pap smears again.
The mechanism is thought to be that smoking decreases your body's ability to fight off the HPV virus which causes cervical dysplasia and abnormal pap smears. When you quit smoking, your immune system can better fight off the virus.
So go ahead, speak with your doctor about how to get help kicking the habit. Kick the habit, and get normal pap smears again.
Tuesday series, Breast health tidbits: Obesity and breast cancer risk
February
19 ,
2008
When I discuss breast health with my patients, I have noticed that some risk factors for breast cancer seem more "popular" than others. It is no secret that a family history of breast cancer is important, and the effects of smoking on breast cancer risk is catching on in popularity. Everyone seems to know that your age is crucial when assessing your risk for the disease. However, it has struck me as surprising that so few of my patients seem to be aware that obesity also plays a very important role.
According to some studies*, a woman with a BMI (Body Mass Index - a method of including both weight and height to determine whether someone is proper weight for his/her height - for more about the BMI see below**) over thirty has twice the risk of breast cancer. This is especially concerning because it may be a risk factor for getting breast cancer at a younger age.
The mechanism, is assumed to be the fact that obese women have more of the hormone estrogen circulating in their body. It is known that too much estrogen can cause breast cancer.
It has been shown that diet and exercise can reduce that risk. So not only is a proper well balanced diet important for your cardiovascular health, it is important to prevent breast cancer as well. So you can now add one more good reason to the long list of reasons to stay in shape.
*Predictors of Breast Cancer Development in a High Risk Population American Journal of Surgery October 2006
** BMI = [Weight in pounds ÷ Height in inches ÷ Height in inches] x 703. For example: A person who weighs 210 pounds and is 6 feet tall would have a BMI = 210 pounds divided by 72 inches divided by 72 inches multiplied by 703 = 28.5.
Monday series; GYN and alternative medicine: Accupuncture for painful periods?
February
18 ,
2008
Menstrual cramps and dysmenorrhea have always been serious problems for many women, and the strategies to deal with them are many. We can use pain medications of all sorts, we can try to delay or eliminate even the monthly periods, or various other methods to treat the problem. However, a new study done in Germany brings a new method into our armamantarium, acupuncture.
According to a study published in the most recent issue of the American Journal of Obstetrics and Gynecology, when provided together with traditional treatment, "Additional acupuncture in patients with dysmenorrhea was associated with improvements in pain and quality of life as compared to treatment with usual care alone and was cost-effective within usual thresholds."
This study supports yet another use for an interesting mode of treating pain which comes from a discipline not generally considered "scientific." Acupuncture has been used succesfully in many types of chronic pain with varying degrees of success, but now women with severe pain associated with their periods can consider acupuncture, when used together with their doctor's recommended treatment, to be an effective method of controlling their pain.
Sunday Series: Gyn controversies Hormone Replacement
February
17 ,
2008
So last week I left you hanging. We were wondering why so many gynecologists are still prescribing hormone replacement for menopausal symptoms if studies seem to show that it increases the risks of breast cancer and heart disease.
Well, to make a long story short, we need to look at the WHI study that we quoted last week a little more carefully. It turns out that the average woman in the study was in her late 50's early 60's and had been postmenopausal for a while. They were then asked to start taking hormones, and they were randomized to a hormone group and a placebo group. It is among these women that the risks were increased.
But for us gynecologists, most women that ask for treatment for hot flashes, night sweats etc... are not like this at all! They usually are going through menopause right now! They also are younger, like in their late 40s early 50's, so do the study findings apply to them as well? Does the risk of breast cancer and heart disease also apply to the women that are sitting in the office asking for treatment?
Stay tuned for more next week, as we continue to analyze this most important GYN controversy!
Just yesterday the Agency for Healthcare Research and Quality, part of the U.S. Dept of Health and Human Services released an astounding report: The proportion of U. S. women having their babies delivered by Cesarean section jumped to nearly 1 in 3 in 2005.In 1995, the proportion had been 1 in 5!
According to the AHRQ; about 1.3 million women gave birth via Cesarean section in 2005 -- a 38 percent increase over the 800,000 Cesarean sections performed in 1995.
Of course, the pundits and commentators all had to say their piece:
"It's because of malpractice liability concerns!", say the doctors.
"It's because the hospitals want to make more money!" say the health care industry skeptics.
Although there may be some truth to many factors, one thing that I have noticed in my own practice seems to go unmentioned. That is the factor of patient demand. I cannot tell you how many times patients have walked into my office asking for a c-section. I usually try to ascertain and understand their motivations, but it is not as easy as you might think. Some people think it is safer, some think that it is less risky to the baby, some want the convenience, some are afraid of labor, some are concerned about the integrity of their female anatomy. Bottom line is though, most of the above concerns do not usually justify doing a surgical procedure.
However, there is no question that patient demands do influence the cesarean section rate. Any doctor will much more easily do a cesarean section when his or her patient is asking for it, even if the indications for the c-section might not be that solid.
I wonder if there is a way we could study how much of an influence this factor has had on the c-section rate. Even more interesting, I wonder, why are women today asking so often to avoid vaginal deliveries?
Friday series: 15 minutes to better health! Fiber
February
15 ,
2008
If you're following our 15 minutes to better health each weekend, you've now added adequate calcium, vitamin D, and Iron to your diet. This week let's talk about fiber.
Fiber is a very important part of our diet that comes mostly from plants. It is not really digestible, but it is very important for many reasons. It gives bulk to your food, causing you to feel full, it allows for more slow and steady absorption of nutrients like sugars, it nourishes the healthy bacteria that line the colon, and it gives bulk to the stool.
Eating a diet that is high in fiber and low in fat can help keep your digestive system healthy. A fiber-rich diet also may help prevent cancer, heart disease, and other serious health problems.
Good sources of fiber include fruits, vegetables, beans, and whole grains. Whole-grain products include whole wheat, whole oats, whole rye, and whole-grain barley. Buckwheat, popcorn, brown rice, and wild rice also are whole-grain products. To choose whole-grain food items, read the package label. The words "whole" or "whole grain" will be shown before the name of the grain.
Doctors recommend that you should eat 25 grams of fiber each day.
If you have any suggestions for this 15 minutes to better health series, please comment, I'm looking forward to hearing from you!
Thursday Series; Something I've learned from my patients today; Emotional strength
February
14 ,
2008
Today I had an amazing patient. I had done a surgery for her to repair a pelvic floor defect a little over one year ago. The surgery included the placement of an artificial mesh to provide strength to the pelvic floor.
Unfortunately, her body rejected the mesh, and she needed two additional surgeries, several months apart in order to repair it. Needless to say, the ordeal was significant, and she suffered a lot.
I saw her recently for routine follow up six months after we finally finished eveything, and Thank God she was doing very well. She had lost >30 lbs (weight had been s erious problem for her), and she looked happy and satisfied.
When I asked her how things were going, she told me that her husband was suffering from cancer, which had started during her surgical ordeal. Despite all this, she said, "I have a husband, we are alive, we have a house, and we have our garndchildren!"
Walking into her exam room was the best lesson I learned today. No matter what life may throw at you, you can still look forward to a better tommorrow, and you can still find things to be happy about today.
Wednesday Series: Little known big topics in gynecology; The IUD
February
13 ,
2008
The IUD is a form of birth control that is very safe and very convenient. But it is also the most underutilized. Indeed, a survey published in Contemporary obgyn magazine in June of 2007 stated that only 1.3% of people who use birth control use the IUD.
Why does this matter? Why do I think that the IUD is underused?
Well, the IUD has several major advantages over almost every form of birth control. The fact is that most forms of birth control require you to do something every day, every week or so on. The IUD cannot be forgotten! Once it is in, it is in.
We are all familiar with friends who got pregnant, that "one time" they forgot their pill, or that time they left the diaphragm at home or the condom slipped off etc... The IUD eliminates this problem.
In case you think it is dangerous or causes infections, this is simply not true. The data supports a very good safety profile for an IUD, and they do not cause infections. It is true however, that if you get a sexually transmitted infection, that it may be worse if the IUD gets infected as well.
This is true, but we all should know how to prevent ourselves from getting sexually transmitted infections in the first place.
Tuesday Series: Breast Health tidbits, Does the breast self exam work?
February
12 ,
2008
Most women should be familiar with the recommendation that they perform a breast self examination every month. Most doctors, including me, instruct their patients to examine their breasts once a month for new changes and suspicious lumps.
But does it help? Can women really find and detect breast cancer on their own? In 2002 a study done in China was published and it caused a big stir. 266,064 women were divided into two groups one that was taught to do regular breast self-examination and another group was not. During 10 to 11 years of follow-up, there was no difference between the two groups in breast cancer deaths. In fact more benign breast lesions were diagnosed in the self-examination group leading to more unnecessary procedures.
The results of this study were supported by some scientists, but disputed by others. Doctors have still not stopped recommending breast self examination though, and it still remains a basic part of the recommended surveillance for breast cancer.
But why?
I think we still recommend breast self examinations because of simple common sense. How could we not expect women to be the most familiar with their own breasts? Who could we trust more than the patient herself? I certainly know from my own experience how attuned many women are to changes in their own bodies. Maybe it is not scientifically proven, but don't stop checking. You may be fortunate enough to save the most important life in the world, your own.
Monday Series: GYN and herbal medicine, a cure for HPV?
February
11 ,
2008
Our next installment of alternative medicine and gynecology will focus on the supposed "natural cure" for HPV - Human papillomavirus. This is the virus that causes cervical dysplasia and cervical cancer.
I decided to discuss this topic after several patients of mine inquired about it, so I owe it to them to do a little research.
There are several products out there that one can find that are being marketed as "herbal" or "natural" remedies for HPV. The following are some of them:
This is by far not an exhaustive list, if you decide to google HPV and natural cures you will probably find many more.
This is a great opportunity for us to learn a little bit about HPV. The overwhelming majority of people, especially young people with HPV infection will never develop cervical cancer. Even those who develop dysplasia, it will usually get better in its own. However, it is extremely important that anyone diagnosed with HPV to get regular pap smears and follow up with her doctor, just in case she does develop severe disease in order to prevent cancer.
Any one of the manufacturers of these products can certainly bring thousands of "testimonials" from patients who got better on their herbal products, because of course, that is what would have happened whether they were taking this treatment or not! However, only a clinical trial with thousands of patients using scuientific controls in a blinded trial can truly prove effectiveness. This is the fallacy of all "testimonials" when it comes to medical treatments. This is simply not a way to prove anything.
Just imagine if I tried to "prove" to you that spending an afternoon in Chicago is a cure for the flu. After all, I know hundreds of people who have had the flu, spent an afternoon in Chicago, and they got better!
Deborah Kotz in her blog On Women writes about how health websites that are focused on alternative medicine are more than 15 times more likely than traditional medical sites to contain gross errors. This was based on a study recently published in the journal Cancer.
Use your discretion and don't be fooled into wasting your money. Much more importantly, NEVER use these products as a replacement for following your doctor's instructions. The sellers of these products won't be able to treat you when you get cancer because you ignored your doctor.
Bottom line, if you truly want to reduce your risk for cervical cancer, stop smoking, use condoms all the time, have sex with one partner who is faithful to you, get the HPV vaccine, and visit your doctor regularly for pap smears and follow his/her instructions if you have an abnormal pap smear.
Sunday Series: Gynecologic Controversies; Hormone Replacement, Heart Disease, and Cancer risk
February
10 ,
2008
We'll probably have to spend the next few Sundays on this topic. The HRT - Hormone Replacement Therapy debate is probably the biggest controversy to hit the Gynecology world in its' history, so I think the best way to tackle it would be to divide our discussion into several parts.
First, a little history. It has long been known that the best way to treat the symptoms of menopause has been to use hormone replacement. Not every menopausal woman has terrible symptoms, but for those who suffer from hot flashes, night sweats, mood changes, etc., it has long been recognized that replacement the estrogen with hormone pills provides much needed relief.
However, in 2002 the early results of the Women's Health Initiative (WHI) study was released to much public fanfare. The headlines screamed, "Hormone Therapy increases the risk of breast cancer stroke and heart disease!" All the health reporters for the popular newspapers trumpet this as if it sounded the death knell for this previously popular treatment.
Meanwhile, in 2007 the following is published in 2007 in the journal menopause:
"It seems that many ob/gyns, particularly those who are male and older, remain skeptical of the results of the 2002 Women's Health Initiative (WHI) study regarding hormone replacement therapy (HRT) and continue to prescribe the therapy, particularly for vasomotor symptoms, vaginal dryness, and osteoporosis."
Power ML, Schulkin J, Rossouw JE. Evolving practice patterns and attitudes toward hormone therapy of obstetrician-gynecologists. Menopause. 2007;14:20-28.
So are these obgyns old fashioned and ignorant? Did they read the study? How could they ignore the fact that this treatment may be dangerous? Well stay tuned next Sunday for the next installment of Gynecologic Controversies, and you may learn something surprising. In the meantime, I would love to hear your hormone replacement stories and ideas.
Gynecology News: Saturday Series
February
09 ,
2008
Saturdays will now be devoted to interesting news items in the world of Obstetrics and Gynecology. I'm dropping the politics idea because it is so hard to pin down what the candidates opinions are on such specific issues. There's so much interesting stuff out there, I hope you'all can bring my attention to items in the news if you see something you'd like to discuss.
Check out this article in New York times of Feb 4, 2008. Just fascinating! More babies born in the US in 2006 than in any year since 1961! 4,265,996 babies!
Don't you wonder why that might be? The times reporter was looking at housing costs, size of houses and other possibilities. Maybe it is a resurgence of religion? the article does show higher fertility rates among people who identify themselves as religious.
Some would suggest that access to abortion is declining, others say it is the increase in illegal immigration, as immigrants tend to have larger families. Still others claim that it is just a blip, but not really a new trend, and it will go down again soon.
I don't have any idea for sure, but I can tell you the feeling i get from my patients. I think it is because we are a family oriented society. We love our families and we live to raise and nurture our families. This is true about all aspects of our society, both religious and secular left and right. We love to bring new children into the world, because overall we are proud of who we are.
I would love to hear your ideas about the baby boom. Please tell us what you think.
Friday series: 15 minutes or less to better health! Iron
February
08 ,
2008
It's time for our Friday series again "15 minutes or less to better health." Last weekend our blog readers have conquered getting enough calcium and Vitamin D in their diet, and today we will focus on Iron. Iron deficiency is a major health problem, easy to fix and can definitely be solved in much less than 15 minutes a day.
Iron is a crucial nutrient for our health. Its most important function is as the major building block of red blood cells. According to the CDC, Iron deficiency is the most common nutritional deficiency in the United States. Our high carb diet leaves many of us nutritionally deficient in Iron. The deficiency becomes most apparent in people who have increased needs for Iron. This includes children, pregnant women, and women of chilbearing age.
Iron deficiency can cause many symptoms including:
Fatigue
Poor work and school performance
Slow cognitive and social development during childhood
Increased susceptibility to infection
So, it is important, to make sure you get enough Iron in your diet, or to take supplements if necessary. Foods that are high in Iron include meats, beans, spinach, and some seafood. See the CDC here for specific foods and the amounts of Iron they contain.
If you cannot get it in your diet, then take supplements. For women the general guidelines are for ages 9-13, 8mg/day; ages 14-18, 15 mg/day; for ages 19-50, 18 mg/day; and over 50, 8 mg/day. For more on iron deficiency see the CDC website.
Next Friday, we will discuss Vitamin C, and why it is important, and how it is related to Iron.
Thursday Series: Something I've learned from my patients today; medical terminology!
February
07 ,
2008
Thursdays will be devoted to what may be our most interesting topic, "Something I've learned from my patients today."
The most fascinating thing about being a doctor, is the privilege to be able to meet and interact with so many interesting people. Since people usually come for to me for help, I sometimes start to think of myself as a teacher, until I get reminded that I have a lot to learn. A doctor that doesn't learn from his patients, is a doctor that doesn't listen to his patients. Every Thursday I will bring a real patient encounter (with no identifying characteristics - to hide people's identity) which taught me something special. I think even non-doctors will be able to apply these lessons to their professional and personal lives.
A patient came to see me for follow up after a surgery that we did several weeks ago. When her surgery was done, I had purposefully left a type of packing we surgeons call a sponge in the wound and gave her husband instructions on how to remove it the next morning. I called the next morning to find out how everything was doing, and her husband said, she was doing fine and he had removed the sponge.
Well, I asked her during the post-op visit, how it went when her husband removed the sponge the morning after surgery, and she gave me the most incredulous look. Somehow she appeared simultaneously horrified and humored, it was a look that is difficult to describe. "What the Hell! A sponge?" my husband said, "S--T, this is like a giant coral reef!"
She then laughed and said to me, "when you said a sponge, my husband and I were thinking about a little kitchen sponge."
The lesson to be learned was simple. Sometimes we get so caught up in our own world, that we forget that we have a unique system of medical terminology that non-medical people don't understand. This can lead to all sorts of misunderstandings, sometimes humorous, but sometimes it may even be dangerous.
I think we can all use this lesson in our daily lives. Don't just assume that everyone around you knows what you're talking about. You may think you speak the same language, but make sure your words are truly understood as you intend them to be.
Wednesday series: Little known big topics in Gynecology; Prolapse
February
06 ,
2008
Welcome to the AskMyGyn.com Wednesday blog series! There are many gynecologic problems that women suffer from that are big hot topics that are discussed all of the time. But then there are those lesser known and lesser discussed problems that somehow seem to fall through the cracks. So I decided to devote Wednesdays to discussing these "little known big topics" in gynecology.
Today's topic is vaginal prolapse. This refers to an entire group of problems that occur when the vagina and the organs nearby begin to drop because of a weakness of the tissue that is supposed to support the vagina. Different types of prolapse include cystocele, rectocele, enterocele, and uterine prolapse.
Vaginal prolapse is extremely common, affecting approximately 10-30% of all women ages 40 and up. It can occur in younger women as well, but the risk generally increase with time. It can cause significant discomfort including pelvic pressure, urine incontinence, painful intercourse, constipation, and difficulty performing normal life functions like heavy lifting, exercise, or more.
You'd think that something this serious and common would be more well known, but it seems to be often "swept under the rug". I'm not sure why, but many women tend to attribute the problem to getting older and they don't seek treatment or tell their doctors about it during their annual visits.
The symptoms of this problem include all of the things mentioned above, often a woman will feel a "bulge" down there, especially when lifting or straining, and may experience pressure, pain, incontinence or pain with sex.
Vaginal prolapse can be treated with medication such as an estrogen cream, kegel exercises, a device called a pessary, or occasionally surgical repair. If you think you may be suffering from vaginal prolapse, tell your doctor! He/she may be able to help.
Tuesday Series: Breast Health Tidbits; Coffee and breast cysts, fact or fiction?
February
05 ,
2008
Fibrocystic breasts are a very common cause of breast tenderness and pain in adolescent and young women. Fibrocystic breasts refers to the lumpy/stringy masses that are very commonly found in young women's breasts. Often, the pain gets worse with your period. Luckily, for most women it is not a big deal, but it can be very bothersome for others.
So you've probably heard that if you have this problem, you should avoid caffeine, right? Doctors, women's health providers, mothers and friends all seem to say that if you want to stop the pain, cut down on the coffee and chocolate! Is it true? Does caffeine really cause fibrocystic breast disease and pain?
Well, I wish I had the answer, but I really don't. As a physician, I have seen many women and girls who complain of this problem who swear that their symptoms got better when they stopped drinking coffee. It's hard to deny what people say they have experienced first hand.
However, scientific evidence I unfortunately cannot give you. The only randomized trial (this is a type of experiment where people are randomized to two different groups, one with the intervention and one without, to measure whether or not a particular intervention works) that I could find was done back in 1982 and it did not show any difference between the coffee drinkers and the no-coffee drinkers in the resolution of their symptoms.
see "Effects of caffeine-free diet on benign breast disease: a randomized trial" Ernster VL - Surgery - 01-MAR-1982; 91(3): 263-7
I am hardly convinced by a 25 year old study that hasn't been repeated. So I think that the jury is still out. Maybe it does, maybe it doesn't, but I don't think it could harm to try stopping caffeine if fibrocystic breast disease is a problem for you. It may not work, but you'll never know if you don't try!
See you next Tuesday with more breast health tidbits! Dr. Weinreb at AskMyGyn.com
Monday Series: GYN and Alternative Medicine; Herbal Remedies for Menopause
February
04 ,
2008
Do I really need Hormone Replacement Therapy for those nasty symptoms of menopause? Should I try one of those herbal remedies that I could pick up at the health food store?
These are questions that so many women ask me, so here it is, a quick review! The following are the major herbal remedies used, and a very short analysis of each one, do they work, how they work, and are they safe.
Black cohosh: Symptom relief: Most studies indicate some reduction in symptoms Mechanism: Estrogenic effect? Safety: watch out in women with history of breast cancer!
Dong Quai: Symptom relief: Studies do not show any improvement Mechanism: Who knows? Safety: May interact with warfarin (coumadin)
Evening Primrose Oil: Symptom relief: Studies do not show improvement Mechanism: Who knows? Safety: probably safe, maybe a little nausea and other mild symptoms
Ginseng: Symptom relief: Studies support some mild general relief, especially with mood and depression symptoms Mechanism: Who knows? Safety: generally safe
Red Clover Leaf: Symptom relief: Some studies show reduction in hot flashes, night sweats etc.. most don't Mechanism: Estrogenic effect? Safety: probably safe, but careful in women with history of breast cancer!
Soy (isoflavones): Symptom relief: conflicting data, some studies say yes, some say no Mechanism: estrogenic effect of the isoflavones Safety: generally safe, but possible effect on the thickness of endometrial lining of the uterus, increased risk of uterine cancer - unlikely but possible.
Sunday series: Gynecologic Controversies! Should I get a vaginal enhancement procedure?
February
03 ,
2008
You may have noticed ads for things like "vaginal rejuvination" or "revirgination" or other sorts of vaginal surgeries supposedly designed to help enhance vaginal appearance, sexual satisfaction, or both. Are these things for real? Do they work? Are they safe?
Well the problem is, that we simply cannot accurately answer this question. Ordinarily, a surgical procedure is deemed safe after there is a standard known description of the procedure that is taught to surgeons, surgeons can then perform the procedure and the data can be analyzed and collected to determine what the risks and benefits are. Then patients can make informed choices as to the possible benefit and safety of the procedure.
Bottom line is: We don't know exactly what all of these docs are doing! What do these terms mean? We have no standards and no way to compare success rates, failure rates and risk long term effects etc.. So you on your own if you decide to get one of these procedures done.
According to the American College of Obstetricians and Gynecologists, as stated in a committee opinion in September 2007:
" So-called "vaginal rejuvenation," "designer vaginoplasty," "revirgination," and "G-spot amplification" are ...not medically indicated, and the safety and effectiveness of these procedures have not been documented. ... Women should be informed about the lack of data supporting the efficacy of these procedures and their potential complications, including infection, altered sensation, dyspareunia, adhesions, and scarring..... Often the exact procedure performed is not clear because standard medical nomenclature is not used. ...... No adequate studies have been published assessing the long-term satisfaction, safety, and complication rates for these procedures......It is deceptive to give the impression that vaginal rejuvenation, designer vaginoplasty, revirgination, G-spot amplification, or any such procedures are accepted and routine surgical practices. Absence of data supporting the safety and efficacy of these procedures makes their recommendation untenable...."
Take Care and comment if you'd like. Looking forward to hearing from you. Dr. Weinreb at AskMyGyn.com
Saturday series: Politics of Gynecology! Where do the candidates stand? Contraceptive Information
February
02 ,
2008
The Saturday blogs will be devoted to the politics of the Gynecology world. You didn't think I could avoid this subject during an election year did you? We will try to take an issue that is related specifically to gynecology and see where the candidates stand. We will concentrate on the top candidates that are still standing at the time of the posting, which right now seems like Clinton and Obama on the DEM side and McCain and Romney on the REP side.
In order to be eligible for this blog, the topic needs to fulfill the fol owing criteria: 1) It has to be primarily a GYN subject, not general health care which is adequately covered by a bazillion other sites 2) it has to be current and we must be able to identify some political connection 3) I will not. Let's repeat ... I will NOT be promoting different views. I honestly do not have an agenda. I just want to explore this because I think it will be fun to look at the candidates through a GYN prism.
Some posts may lean more liberal, some may lean more conservative, but we can try to keep the peace and analyze it together. if you have comments, PLEASE tell me. I will be the first to admit a mistake if i am wrong, I PROMISE!
So here goes with the first entry. Hillary Clinton declares on her website that "She has championed the Prevention First Act, which expands access to family planning services for low-income women, requires health insurance companies to cover contraception, and provides a dedicated funding stream for age-appropriate, medically accurate, comprehensive sex education." Although there are aspects of this bill that may be controversial that I will rather not comment upon, I like the "truth in contraception" part of the bill which requires that "any information concerning the use of a contraceptive provided through specified federally funded education programs be medically accurate and include health benefits and failure rates" (acc. to govtrack.org) For a summary of this proposed legislation, click here.
Barack Obama is a cosponsor, so we can assume that there is not much difference between the two Democratic candidates on this one. Mitt Romney has no comment, as he hasn't been in the senate so we cannot know his opinion on this matter.
John Mccain has not signed on as a sponsor, and it seems that he is against it. maybe he has a problem with the other parts of the bill, or maybe the whole thing, i really don't know. I'll have to leave that to the political speculators among us. I am not a political expert, but one would think that at least some form of this bill should be acceptable to both sides of the abortion debate. Why would someone want to be against providing MEDICALLY accurate information?
I don't see how anyone can find this to be a problem. As a physician, shouldn't this always be required? Isn't this the best way to make sure people make informed choices.
Even if our government won't mandate it, on AskMyGyn.com, our goal is to provide ONLY medically accurate information. Of course, no one is perfect, but we'll do our best. What you do with that information is up to you, we are only here to provide, to the best of our ability, accurate information.
Friday Series: 15 minutes or less to better health! Calcium and Vitamin D
February
01 ,
2008
I've been thinking about how there are so many easy things that every woman can do to improve her health and increase her chances at having a happier, healthier and longer life. Unfortunately, so many people neglect them and one day may pay the price for that neglect. So I decided to use this platform in this blog to try to mention at least one thing each week that every woman can do to improve her health. We will add one thing each Friday, so over every weekend you will take one more step to improving your health!
Now each things we will mention will have to fit the following criteria.
1)It will not take longer than 15 minutes each day, usually much shorter
2)It will be scientifically proven to improve your health
3)It will be very easy to do
4)It will not be expensive
Today's recommendation is regarding calcium and vitamin D. Calcium is the specific nutrient most important for attaining peak bone mass and for preventing and treating osteoporosis.
Vitamin D is required for optimal calcium absorption and thus is also important for bone health.
The scientific data support the importance of specific dietary calcium intakes at various stages of life. The Institute of Medicine recommends calcium intakes of 800 mg/day for children ages 3 to 8 and 1,300 mg/day for children and adolescents ages 9 to 17. For adults, calcium intake should be maintained at 1,000 to 1,500 mg/day.
However, only about 25 percent of boys and 10 percent of girls ages 9 to 17 are estimated to meet these recommendations. This may be due to restriction of dairy products, a generally low level of fruit and vegetable consumption, and a high intake of low calcium beverages such as sodas.
In the adult population, only about 50 to 60 percent of people meet this recommendation.
Now with Vitamin D, the recommended intake is 800 IU/day for adults.
Most infants and young children have adequate vitamin D intake because of supplementation and fortification of milk. However, as we get older, Vitamin D intake is less likely to be adequate, and this may adversely affect calcium absorption.
Considering the impact of serious bone diseases like osteoporosis, this is something very simple that you can do to improve your health. Either take a supplement that includes 1200mg/day of calcium and 800 IU of vitamin D, or adjust your diet to make sure you get enough calcium. For more information, see our section on AskMyGyn.com on bone health.
