Tuesday, July 29, 2014
Monday, July 28, 2014
|Cervical Fibroid Trying to Deliver Itself|
Thursday, July 24, 2014
Hepatitis B and C can cause liver disease or liver cancers although they are viruses that couple potentially be cleared spontaneously from your body. The United States Preventative Task Force estimates between 700,000 and 2.2 million people in the U.S. have chronic Hepatitis B, The Centers for Disease Control and Prevention (CDC) estimates that the number of new cases ofacute HCV infection in the United States is about 17,000 cases per year. Indeed, estimates are that between 15% and 25% of people with chronic Hepatitis B (HBV) eventually die of cirrhosis or liver cancer. People with chronic HBV can also transmit the infection to others, the task force noted, and screening could identify people who might benefit from treatment or other interventions. Testing for hepatitis is a blood test that can be ordered on any of our patients (or of family members by special arrangement). At your next appointment find out if you would be a candidate for testing, even if you think you may have once been vaccinatated. Most of the infections begin with no symptoms but can be detected by blood testing.
Wednesday, July 23, 2014
|Rash Consistent With Lyme's Disease|
Monday, July 21, 2014
at all cancer, not just gynecologic. Some cancers were lower than the non-using general population including uterine, ovarian, lung and pancreatic cancers, and breast cancers accounted for most of the excess risk of cancer cases. Over 5 years of IUD use in this study significantly increased risk. Since these women specifically had disordered menstrual bleeding, it's possibly they have other risk factors that were not obvious from this study.
Thursday, July 17, 2014
Once a woman gets fully dilated in labor she has completed her first stage. Once she has her baby she has completed her second stage. The amount of time it takes to complete the second stage is dependent on many factors: the size of the pelvis and the size of the baby, the force of the contractions and the force of the pushing, the direction the baby is going (even a bit off of coming straight down the pelvis slows one down), and whether she has an epidural that is affecting any of the power of pushing. Whether the obstetrician shortens the second stage with a vacuum or forceps or c-section obviously affects that time sequence. And the delivery of the head can be accomplished more easily than the delivery of the shoulders which are a larger diameter than the head. American College of Obstetricians and Gynecologists guidelines to define prolonged second stage for nulliparous women as greater than 3 hours with epidural or greater than 2 hours without epidural. For multiparous women, they defined prolonged second stage as greater than 2 hours with epidural or greater than 1 hour without epidural. . As your birth provider watches you there are clues beyond the stop watch. Specifically the amount of progress, with very little progress from the early pushes there is less hope of achieving a healthy vaginal birth.
S. Katherine Laughon, MD, Investigator, Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland, and colleagues published the results of their labor review study in the June issue of Obstetrics & Gynecology, showing that beyond 2 hours there are increased risks for both the mother and the child. They noted that labors are longer in these past few years than they were in the past.
The investigators reviewed electronic medical record data from 2002 to 2008, using a retrospective cohort from 19 hospitals at 12 US clinical centers. The researchers included 43,810 first time moms and 59,605 women who had had a child before who were at least 36 or more weeks of gestation, with head down (vertex) presentation and 10 cm of cervical dilation in the analysis, meaning they specifically studied the second stage.. Longer labors are common, about 10-15% in women who have epidurals, and about 3-5% of women who do not, and yet most women, about 80-90% will still accomplish the vaginal delivery even if they are moving slowly compared to normal standards.
The risks for mom of having that long second stage are infection and more significant tears to the pelvic floor, with baby also infection rates, and rates of having low oxygen increase, although they found no severe complications of that hypoxia, it is critical to note there was no increased rates of perinatal death. Experienced obstetricians can diagnose this lack of progress prior to two hours, and be able to predict whether normal or slowed progress is occurring, and whether it is healthy for you to keep pushing or have your obstetrician intervene.
Monday, July 14, 2014
Sunday, July 13, 2014
We have never been completely sure on a physiological level as to what about smoking raises the cancer risk, however we have many clues. Smoking and eCigarettes contain nanoparticles, that are so tiny they have ability to affect our cells, our stem cells, and the DNA within cells producing a wide variety of ways they can are or can transform into carcinogens. And for those who only use eCigarettes part time to decrease overall nicotine, it's questionable how that wide variety of different chemicals and particles will interact with each other to produce risk. Generally physicians know that less is more and certainly in pregnancy the safety of tobacco, alcohol, coffee, energy drinks, and marijuana are all not established!
Friday, July 11, 2014
Thursday, July 10, 2014
Monday, July 7, 2014
Saturday, July 5, 2014
Polycystic Ovarian Syndrome (PCOS)
The doctors Stein and Leventhatal in 1935 discovered why some women had big cysts on their ovaries, extra hair growth and troubles getting pregnant. And though we recognize their work as the beginning, their name long left the condition of Polycystic Ovaries. After it was called Stein and Leventhal's disease this has been called a disease, a condition and now a syndrome, PCOS or Polycystic Ovarian Syndrome. The definition has been changed so that almost 1/10 women can meet the definition and in fact many women with perfectly regular menstrual periods are surprised to learn upon visiting their gynos that they are now diagnosed with an important condition that can have fertility and life long health consequences. If you’ve got to shave your chin regularly, you may just have that sort of genetics, and on the other hand your ovaries may be producing too much testosterone, or one of the other boy hormones that emanate from the ovary or the adrenal gland. The most common symptom of PCOS is hyperandrogenism (too much boy hormone), chronic anovulation (skipped periods due to not popping an ovarian egg), many are overweight (7 out of 10) and finally either diabetic or pre-diabetic (again 7 out of 10), insulin resistance (you have it but it won’t work like it’s supposed to with your metabolism) and compensatory hperinsulinemia (the pancreas cranks out extra) are also features. And many have ovaries seen on ultrasound with a “string of pearls” look…little cysts all lined up around the edge as seen when looking with the ultrasound.
The insulin excess in a woman's body is probably in large part responsible of the extra hair. The insulin stimulates the cells of the ovary to produce more male hormones. These extra male hormones right in the ovary mess up ovulation. Insulin can also suppress the liver substance SHBG (sex hormone binding globulin) which is supposed to bind male hormones and keep them inactive and there for in check. So the more deranged your metabolism is, the heavier you get, the worse your PCOS gets.
So how to fix: well to some extent there is no fix, it’s in your genes, but it can be controlled. Control anything and everything diet: lower bad LDL cholesterol, lower the blood fat triglyceride, exercise and increase good HDL cholesterol, and changing the biology of your blood fats so you change your cholesterol particle sizes and numbers of particles. Overall weight is related to how serious your PCOS is, slim by even 5%, control the sugar and use diabetic drugs like metformin if you need to. But watch for side effects of the medications used to control insulin and blood sugar. metformin can have its negative side, it can lower vitamin B12 levels (side effects of low B12 levels might include numbness, other odd neurologic symptoms such as memory loss and behavior changes). Oral contraceptives can suppress the boy hormones of the ovary, so that’s a good bet that it will be recommended as a possible solution by your gyno.
The fix for PCOS is not simple, and the more we learn, the more we know that we have to follow our PCOS patients closely, check their sugars, scan their gall bladders, check their hormone levels, discuss contraception carefully, help them control their weight, and help them when they want to get pregnant, there's a lot to gab about here!
Friday, July 4, 2014
Uterine Fibroid Study
If you are a female between the ages of 18 and 50 years old and are experiencing abnormal bleeding due to uterine fibroids, you may be able to take part in the VENUS research study, testing an investigational medicine. Qualified participants will receive study-related medical evaluations and care at no cost. If interested, please call 217-356-3736.
Join one of our studies, become a patient at Women's Health Practice, come for an event, or visit any one of my websites!
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