Thursday Series:Lessons i've Learned from my patients today; You can count on your family and friends!
March
20 ,
2008
My favorite daily series is Thursday's, because I get to tell you about great things that I learn from my patients every day. Today I am took care of a woman in labor having her first child. She is 40 years old, and she's seen her share of suffering this pregnancy. She had an abusive boyfriend, who then died during the pregnancy, leaving her completely alone. She never seemed to have any support system, always coming alone to her prenatal visits. She was depressed, and kept to herself. To top it off, she suffered from some pregnancy related illnesses that caused her significant physical discomfort.
When she came to the hospital to have her baby, she was once again alone. I wondered how she would be able to cope with raising this child, and how sad she must be. How sad it was to not have friends and family there when your child is born. But I shouldn't have worried. As she was telling me about her labor pains, and how she was sad and didn't want to see anyone, an entourage of aunts, nieces, and friends made their way into the room. Although she hadn't asked anyone to come, they wouldn't miss the big moment.
The smile on her face was enough to light up the room. the lessons mearned were obvious, and I am so happy to have been a part of the birth of her little baby girl.
Wednesday Series: Little known big topics in GYN; If you are still having periods, you still need birth control!
March
19 ,
2008
The rule of thumb is, if you are still having periods, you still need to think of contraception. I cannot count how many times I had patients tell me that they didn't need to worry anymre about getting pregnant because, "aren't I too old for that?"
Even if you have been getting lucky and haven't gotten pregnant in five years, unless you are using protection, the possibilty remains that an unexpected pregnancy may occur.
There are many forms of birth control that are appropriate for women in their 40's and 50's who do not desire pregnancy. It is usually OK to use pills if you are healthy and do not have high blood pressure and you don't smoke. However, most women that have finished having children choose to use more long lasting methods.
Some popular choices are getting your tubes tied, using essure, or choosing an IUD. Speak with your doctor about what may be right for you, but don't ignore contraception and wake up one day to a real surprise!
Tuesday Series: Breast health tidbits; How do I know what to check for?
March
18 ,
2008
The most common question I get from my patients about their monthly self breast exam is, "How do I know what is abnormal?" "There's so many lumps and bumps, how do I know which ones I should be worried about?"
Well, nobody expects you to go to medical school to be able to do your own breast exam. Sure, there are some signs that are particularly worrisome. These include signs such as: irregular (not smooth and round) masses, masses that are fixed and stuck to the surrounding tissue, masses that cause skin dimpling or discoloration, masses that are continuously growing, and more. However, the bottom line is as follows.
If you check your breasts every month, you will know what they feel like. You will know what is normal for you. As long as things are the same from m on th to month, you're probably doing fine. However, if you feel something new or different, something that you haven't felt before, that is when you should be concerned.
Of course, if you are ever concerned about a breast lump, you can always call your physician, but your own familiarity with your own breasts is what makes doing the monthly breast exam such an important part of the surveillance for early breast cancer.
Monday Series:GYN and alternative medicine;Lycopene and fibroids
March
17 ,
2008
Today's blog is about the now popular alternative treatment for fibroids, lycopene. Lycopene is a substance found in the tomato, which has been the topic of much research in recent years for its possible use in the prevention of cancer. Lycopene is a chemical called a carotanid, and is related to vitamin A.
Recently, there has been a proliferation of websites selling products to treat fibroids "naturally" by using supplements that contain Lycopene. They claim that "clinical studies" indicate that lycopene is effective in treating fibroids.
Let us be clear, there is no evidence at all that lycopene can treat, cure, or prevent uterine fibroids. The only scientific study ever done relating lycopene to the treatment of fibroids is a study of the Japanese Quail, which develops fibroids similar to human fibroids. A tomato powder containing lycopene seemed to reduce the incidence of fibroids in the quail.
To jump from the conclusions of a small study of Japanese Quail to selling products for "fibroid treatment" for human beings is simply misrepresenting the truth. This is typical of the alternative medicine industry to make such unproven claims. People have a right to know the truth before they spend money to buy products like these.
If you really want to eat lycopene, maybe try a few fresh tomatos in your salad! Certainly this would be a lot cheaper and healthier way to get lycopene into your diet.
Sunday series:GYN Controversies; Hysterectomy vs. embolization
March
16 ,
2008
One of the big debates raging in the world of gynecology is over the best way to treat fibroids that are causing bothersome or dangerous symptoms. Traditionally, surgical removal of the fibroids, or a hysterectomy, have been the mainstay of treatment. However, recently a new type of treatment called embolization has been gaining popularity as a way to avoid surgery.
This procedure involves threading a thin catheter into the groin, through the patient's blood vessels into the uterine artery, and then releasing a substance that "embolizes" or blocks off the artery that supplies the fibroid with blood. By blocking its' blood supply, the fibroid will shrink away and stop causing problems.
The debate is whether this procedure is "better" or "worse" than surgery. The two methods must be compared in terms of relief of symptoms, how long does the relief last, risks of the procedures, pain and recovery, cost and so on.
A recent study compared the two methods, but came to some interesting conclusions. The study is called "Embolization or Hysterectomy—Results from the Randomized Clinical Embolisation versus Hysterectomy (EMMY) Trial and it was published in the March issue of the journal Radiology.
We will continue this discussion next week, as we analyze this study and others like it. Hopefully, if you follow our blog's Sunday Series, GYN controversies, we will make sure you understand the sides of this important debate. If you have any thoughts, please feel free to comment. Debates are much more fun when we hear all sorts of opinions.
Saturday Series:GYN news; AskMyGyn.com's Press release
March
15 ,
2008
Since Saturday is devoted to GYN news, We will post today our AskMyGyn.com's major press release from this weekend. It is really interesting news, and has been picked up by many news sites including World Net Daily and albawaba (a major Arab news Site). The following is the text of the press release:
INCREASING NUMBERS OF ISLAMIC WOMEN USE INTERNET FOR GYNECOLOGIC INFORMATION
Forty Percent of Hits on Gynecologic Health Website Comes from Islamic Countries
Baltimore, MD, March 13, 2008. When a group of American gynecologists started a new website called AskMyGyn.com, they expected to provide an easy to use, comprehensive source of gynecologic information for women with questions about their health care.
When women search the web for health information, they want reliable and up-to-date answers. They want quick answers, and they want to know about their own unique situation. So AskMyGyn.com was designed for today’s internet health consumer. Information is available for free on hundreds of topics, everything written and reviewed by board certified gynecologists. But if you have a unique or personal question, you can submit it and get quick and complete answers directly from a physician.
After only two months online, AskMyGyn.com has quickly become a popular site, fielding numerous questions every day. But some intriguing and possibly disturbing trends became noticeable. Sure, AskMyGyn.com was fielding questions from women around the world, but the doctors noticed that many of these information seekers were logging on from very surprising places. As the traffic statistics indicated, approximately 40% of the visitors in the first month online were from countries like Saudi Arabia, Malaysia, Kuwait, and Iran.
“Is this a good thing or not?” asks Dr. Saul Weinreb, senior medical consultant of AskMyGyn.com. “Of course I’m happy that we can provide people with reliable information, but I’m concerned that these women may not have access to real healthcare providers.”
The internet can be a great place to learn about health issues, but when people use it to replace a visit to their health care provider they are taking a tremendous risk. Women need to feel comfortable discussing issues that may sometimes be embarrassing and uncomfortable. Sometimes one embarrassing detail, withheld from the healthcare provider because of shame and discomfort, can be the difference between life and death.
The women using AskMyGyn.com obviously have access to the internet. It is worrisome to think about the women without access to the internet who also may need information.
According to Steven Friedman of AskMyGyn.com, “We realize the importance of what we are doing, so the doctors at AskMyGyn.com decided to take another step toward bringing quality health care information to people around the world. For every question asked on our website, 25 cents will be donated to Doctors Without Borders, a group recognized for its’ important work providing urgent medical care around the world.”
Friday Series: 15 minutes to better health; drinking soda
March
14 ,
2008
In our Friday series we have been trying to find simple quick and cheap things that you can do to improve your health. Today's topic will be something you can avoid rather than something that you can do.
I would suggest that you can avoid drinking soft drinks or soda-pop whatever it is called where you are from. I am referring to both diet and regular drinks. Here are the reasons.
Regular soda has so many calories that it should be obvious why they should be avoided. a 16 ounce bottle of coke has about 250 empty and useless calories. Why waste so many unnecessary calories?
Now comes the surprising part, don't think that diet soda would be a better alternative. A recent study published in "Circulation: Journal of the American Heart Assn."
According to this study, drinking as little as one can of soda a day — regular or diet — is associated with a 48% increased risk of metabolic syndrome, a key predecessor of heart disease and diabetes, according to results released Monday.
This is interesting and alarming. We have known for a long time that regular sodas contributed to the risk of metabolic syndrome, but now we have a study that implicates diet sodas as well. We may not be sure why, but it would seem wise to cut out sodas altogether. There's plenty other stuff to drink.
Thursday Series: Things I've learned from my patients today; you have to trust people at their word
March
13 ,
2008
One of the most challenging things about being a physician is taking care of people in pain. The most difficult thing is trying to differentiate between the people who truly have pain and people who are simply addicted to pain medications.
One patient of mine taught me a lesson that I always keep in mind, and she helped me learn the right way to understand who is for real and who is not.
The bottom line is, when someone tells me I have pain, I believe them, period. You might think I am naive, but this is so much more of a safer approach. Once I develop a relationship, if a person starts to take advantage of my attitude, and they start having suspicious behavior, that is when I make them agree to a specific plan. If they do not abide by our agreements, that is when I start to suspect addiction to medication rather than true pain.
This particular woman is someone who I had been seeing for pelvic pain for several months. My nursing staff was convinced that she was simply a drug seeker, and she complained that she was being treated suspiciously every time she called.
After months of trying everything, we had to do a laparoscopy to determine the cause of her pain. At we found that her pelvis was full of endometriosis and inflammation. It hurt simply to look at what she had, I could hardly imagine what it was like to live with this every day.
I am happy that I took her seriously, and she is now getting effective treatment for her disease. With time and the right medications, she will get some relief from her pain. This is an important lesson she taught me that helps me treat people better every day.
Wednesday Series: Little known big topics in GYN; you don't really need to have a period every month!
March
12 ,
2008
It has become a basic rule of life for many women that it is "natural" to have a period every month. For this reason, when a new birth control method promises to eliminate the monthly period, many women ask, "Can this be healthy?" "Isn't there something wrong with not having a monthly period?"
Well, scientific evidence is clear that women do not "need" to have a period every month. In fact, there may be significant health benefits to not having a period so often. For one thing, anemia (low iron due to blood loss) is less common when periods are suppressed. Then there is the relief of PMS, menstrual cramps and menstrual migraines.
Over the past few years, several birth control pills have become popular that suppress the"natural" monthly cycle. If your periods bother you, you should be able to find a way to make sure you don't have to suffer every 28 days or so. Speak with your doctor to find a method that is right for you.
Tuesday Series: Breast Health Tidbits; alcohol and breast cancer
March
11 ,
2008
The Tuesday series has been devoted to breast health, today's tidbit is another little known fact about breast health. It has been well established in the medical literature for many years, that large amounts of alcohol consumption does increase the risk of developing breast cancer.
In a review reported in the Journal Lancet in 2006, they calculated that the risk of developing breast cancer was 1.1 times as high as a non drinker if you had one drink a day, and was as high as 1.4 times as high if you drank four or more drinks a day. The risk is increased for both premenopausal and postmenopausal women, and it is unknown whether the period of life in which the drinking occurred makes a difference.
Although the increased risk is not as high as some other risk factors for breast cancer, if one considers how common this disease is, we can wonder how many women would have been spared this disease if they only drank a little less.
Monday Series:GYN and alternative medicine; Genital warts and green tea extract
March
10 ,
2008
A fascinating new medicine has been approved by the FDA for treatment of genital warts. The most interesting part - it is an extract of Green Tea!
The medicine is called Veregen, and it was developed in Germany by a company called MediGene, and is marketed in the US by Bradley Pharmaceuticals under the name Veregen.
The chemical extracted from the green tea is called kunecatechins. The kunecatechins are a defined mixture of catechins derived from a water extract of green tea leaves, and catechins are potent antioxidants that have anti-inflammatory activities. However, says Jennifer L. Donovan Ph. D, research assistant professor, Clinical Neuroscience Division, Medical University of South Carolina "It is unknown how the kunecatechins work," said Jennifer L. Donovan, Ph.D. "These (antioxidant) properties may not be responsible for their effects," she explained.
In women, 60.4% of patients treated with Veregen showed a complete response to the drug.
The ointment is applied three times a day, and one does not need to wash it off prior to the next application. This makes it more convenient than the current most popular drug used for warts in the US, imiquimod (sold as Aldara - Graceway Pharmaceuticals). Imiquimod needs to be washed off every morning to prevent skin irritation, which can be severe.
Ask your doctor if this interesting new medicine may be right for you.
Sunday Series: Gynecologic Controversies, Hormone Replacement Therapy and osteoporosis
March
09 ,
2008
For those of you who have been following our Sunday series, I promised you that we were going to give some more reasons why many physicians are still prescribing HRT (Hormone Replacement Therapy), despite the much publicized increased risk of breast cancer and heart disease.
This will be the last installment in this series If you haven't been following along with us, it's worth your while to go back in the archives to review all of the arguments that we've presented so far.
Here are some more benefits of HRT. It is still a great medication for the prevention of osteoporosis. It has been proven that HRT decreases fracture risk in postmenopausal women by up to 50%.
It has also been shown to reduce the risks of colon cancer. HRT helps with a woman's libido and treats vaginal dryness, which are common adverse symptoms of the postmenopausal period. If you couple these benefits with the obvious benefits of relieving menopausal symptoms, it is no wonder that many doctors and patients still find that HRT is a good choice for them.
Of course, every woman needs to speak with her doctor about what treatment is right for her. Stay tuned for next weeks GYN controversial topic, coming next Sunday.
Saturday Series: GYN news;New nonhormonal therapy for menopausal hot flashes?
March
08 ,
2008
For a long time, the mainstay of therapy for symptomatic hot flashes for postmenospausal women has been hormone replacement. However, people have been desperately searching for suitable alternatives ever since links have been found between hormonal therapy and breast cancer and heart disease.
A new therapy being studied seems to provide a possible new approach for women who need treatment for severe hot flashes, but are concerned about the risks of hormones.
The new medicine is called desvenlafaxine succinate, a new experimental nonhormonal therapy.The medicine is a selective serotonin norepinephrine reuptake inhibitor (SNRI), and was shown to be effective in a recent clinical trial presented at the annual meeting of the North American Menopause Society.
This is hopeful news, so maybe soon we will see this drug come to market. It will be a welcome weapon in the hands of women against the often severe symptoms of menopause.
Friday Series: 15 minutes to better health; Hand Washing
March
07 ,
2008
Fridays have been devoted to simple, quick, and inexpensive things that we can all do to improve our health in less tha 15 minutes a day. Check the archives to see all of the things we have discussed during the past weeks so you can get up to date and make your life a little healthier.
Today's suggested healthy change in your life will be hand washing. Lately, this has received a lot of press when the media was focusing on the transmission and prevention of the serious disease causing bacteria called MRSA (methicillin resistant staph aureus). But now that this "hot topic" has faded from the limelight, people have stopped talking about it, so I'm just here to remind you how important this is.
Why is hand washing important? Because it is the single most effective way to reduce the transmission of disease causing bacteria and viruses.
Most doctors recommend hand washing at the following times:
after contact with animals
after working with unwashed produce or farm products
after using the bathroom (for urination or a bowel movement)
before eating or drinking
before preparing food or drink
any time your hands are soiled
This may sound obvious to some of you, but it important enough to repeat here anyway. The following are hand washing instructions that will help reduce the transmission of disease:
Wet hands with running water; place soap in palms; rub together to make a lather; scrub hands vigorously for 20 seconds; rinse soap off hands.
If possible, turn off the faucet by using a disposable paper towel.
Dry hands with a disposable paper towel. Do not dry hands on clothing.
Assist young children with washing their hands.
Stay tuned each Friday for more quick and easy ways to improve your health.
Thursday Series: Things I've learned from my patients today; You gotta be ready!
March
06 ,
2008
Surgery is a serious matter, and the decision to have surgery should not be taken lightly. So when I offered surgery for fibroids to a patient of mine around three years ago, I understood her hesitations. She didn't want to have surgery unless it was truly necessary. "When the discomfort is bad enough, that's when I'll get the operation," she said.
I've seen her each year since then, and she still was not quite ready, until this past week. Finally, the pain and heavy bleeding had gotten to the point where she needed to have something done about it. We discussed various options, and we are going to go ahead with surgery.
It was nice to see her satisfaction and comfort with her decision, and I felt good knowing that I hadn't pushed her into making decsions that she may not be happy with. I learned from her how important it is to be patient and thoughtful when making important decsions like these.
Wednesday Series: Little known big topics in GYN; endometrial ablation
March
05 ,
2008
Today's little known topic should be the latest buzz in GYN health care. Many women in their 40's and 50's suffer from heavy and bothersome periods. Until recently, there were two options for treating this problem.
The first option was to use hormones, but this method has its' side effects, and the second option was to do a hysterectomy, a major surgery not without major risks and a long and difficult recovery.
Well, over the last ten years or so, new methods have been developed that don't have either the side effects of the hormones, nor do they have the risks of the major operation.
These methods are called endometrial ablation. There are numerous types of endometrial ablation which use different technologies. These include balloon ablation, cryoablation, hydroablation and microwave ablation.
We will not get into the details of the advantages of one method over the other here. However, all of the methods have some things in common.
They are simple, low risk, outpatient procedures
Most women have either no periods, or very light periods after the procedure is done
They have minimal recovery time
very few side effects
They are appropriate for almost any woman who has finished having children
If this sounds ideal, well, maybe it is. The women that I have treated in my practice with these procedures are some of my happiest and most satisfied patients. If you are suffering from heavy periods, and you do not plan on having children in the future, you should speak with your gynecologist about endometrial ablation.
Tuesday Series: Breast health tidbits; breastfeeding and breast cancer risk
March
04 ,
2008
Today's breast health tidbit is about breastfeeding and breast cancer risk. It is pretty well established in the medical literature, that women who beastfeed their children have a lower risk of breast cancer.
According to a huge analysis of data done published in the jouirnal Lancet in July 2002, for every 12 months of breastfeeding, a woman,s risk of breast cancer was reduced by 4.3%. The 12 months are measured cumulatively. This means that breastfeeding six months for one child and six months for the next is equivalent to 12 months for one child.
There are numerous other benefits to breastfeeding, but this one is not well known or well publicized. I wonder what would happen to the breast cancer rates in the US if more women would breastfeed? How many lives would be saved? If there are any statisticians out there who could help us out, it would be quite an interesting thing to calculate.
Monday Series: GYN and alternative medicine, cranberries for UTIs
March
03 ,
2008
One of the most frequently prescribed natural remedies for urinary tract infections is cranberry juice and other cranberry products. Well, now all of those people that have sworn by cranberry juice can point to real scientific evidence. A review of numerous trials by a group of Scottish researchers has proven that cranberry products—such as juice, tablets, or capsules—significantly reduced the incidence of urinary tract infections.
Cranberry products were most effective in women with recurrent urinary infections, but seemed to work better in younger people. In elderly people, the evidence was inconclusive.
Like many home remedies though, we don't know exactly how much you’re supposed to drink to prevent infections. We also don't know whether cranberry juice, cranberries, or other cranberry extracts are the best way to go.
Sunday Series: GYN controversies; Hormone replacement therapy and breast cancer risk.
March
02 ,
2008
For those of you who have been following the Sunday series, I promised that I would tell you a little bit about the risks of breast cancer and hormone replacement therapy.
Anyone who knows anything about postmenopausal hormone replacement therapy is aware that according to the famous WHI (Women's Health Initiative) study, which we've mentioned every Sunday since we started this thread, that taking hormone replacement after menopause increases the risk of breast cancer.
Well, what was the true increased risk of breast cancer according to the study?
For every 10,000 women per year who were taking combination HRT, there were eight more cases of invasive breast cancer in the hormone group than there were in the group that was taking placebo.
That's it, only eight more cases per 10,000!
What's more, in the women who are on estrogen only HRT (which is only recommended for women who have had a hysterectomy) there was actually a 23% reduction in breast cancer rates!
So for those women who really need the therapy because of severe menopausal symptoms, maybe you are starting to get a little better idea why many gynecologists are still prescribing this medicine. If you haven't been following this thread on the blog, I suggest that you read the previous blog posts from the past three Sundays to catch up. It's worth the read.
Stay tuned next week for some more reasons why many doctors are still prescribing HRT.
Saturday Series: Gynecology News, Obstetric hospitalists?
March
01 ,
2008
A new trend in obstetric care has been getting some press lately, that is the hiring by some hospitals of "obstetric hospitalists." Largely a result of increasing pressure on obstetricians in the US, some hospitals have decided to hire obstetricians who work hourly shifts in the hospital, rather than the traditional private practice obstetrician who is always on call to deliver his/her patients.
The hospital usually pays a salary and covers malpractice insurance, which is a major benefit to obstetricians, especially with insurance rates skyrocketing across the country. The doctor also doesn't have the hassle of handling the administrative and business aspects of running his/her own practice.
So what does this mean to you the patient? Does it mean that you will be delivered by a doctor who's job it is to manage labor and delivery, but never see you throughout the pregnancy? Well, not really, mostly because this trend hasn't caught on very well throughout the country. It is possible that it will become more prevalent, but so far it is not too common. Of course you always should speak with your obstetrician to find out what his or her practice is and find out who you should expect to see when it comes time to have your baby.
We'll have to see how this trend develops over time. Have a nice weekend, looking forward to hearing what you'all think.
