Tuesday, January 27, 2015

Menstrual Migraines are not a Myth

Menstrual migraines are often listed under migraine myths, but they do occur.  Menstrual migraines do exist and are not a myth. Migraine sufferers have headaches, but often they will have warning symptoms as well. Some of the warning symptoms are vague and some are more typically recognized as migraines. These may be nausea, light adversity, odd sense of smell or even vomiting. These non-headache neurological symptoms that occur when the pain starts are known as auras. Recent studies have shown that it is actually more common to have migraines without warning than with warning auras. But other women might have migraine symptoms that precede the actual headache pain by a day or even several days. And these symptoms may be those that are commonly recognized to be associated with migraines: like spots before your eyes, vision changes or, fatigue. But it is also possible to get more obscure symptoms such as a condition known as facial congestion or swelling that can even be mistaken for a sinus infection. So make sure you think about when you are having those sinus “infection” symptoms. Migraine medication not an antibiotic is more likely to be the cure! Any of my Gals having these symptoms? Call!

Monday, January 26, 2015

Breast Problems? Check your Sugar!

The WHO just issued it's guidelines about sugar consumption.Katie Couric wants you to eat less sugar too. And now in a recommendation regarding painful breasts, there is a suggestion to eat less sugar. in general less sugar in the diet can reduce many sympotoms.  There is a breast condition often mistaken for a case of fibrocystic breast condition, but it's not. It's the Diabetic Firm Breast Disease: DFBD. Women with uncontrolled blood sugars are more predisposed, but not all women with uncontrolled diabetes gets this condition. For those living with diabetes, they know there are many options for sugar control, and for more information look at American Diabetes Association. And watch for sugar calories where you are least likely to count them, like your drinks, for a count of calories in beverages look at this industry report. Another hidden source of sugar imblance: medications and supplements such as glucosamine. Glucosamine can cause blood sugar and blood insulin disorder, and even has been shown to kill pancreatic cells! Breast ultrasounds and Breast mammograms do have a characteristic appearance although often examiners are not experienced in this diagnosis either. Let Gyno Gal know if you suspect you have this condition.

Don't Touch Me There: Breasts Untouchable? That's Hormonal

A patient was complaining of not wanting her breasts to be touched. For some women it has nothing to do with pain, lots of people don't like body parts touched. For some women it does have to do with breast pain, and that pain may be cyclic and there are those that have this pain all the time. Breast pain or as your gyno would say, mastalgia,  is a common complaint when on birth control pills or hormone replacement therapy. It may be reported from use of vaginal estrogens as well. It is not related to the size of your breast, even women with gynecomastia (big breasts) don't necessarily suffer from breast pain when on birth control pills. It could be related to how your bras fit. And some women have persistent fat around the edge of their breasts that doesn't seem to resolve with dieting, but might resolve with treatment such as fat cell elimination with cold such as with Coolsculpting. The hormonal link between our hormones, and birth control pills was one of our top 10 questions on breast pain. In general, breast pain is common. If you had breast pains prior to starting your pills, the birth control pills might be a successful way of managing your pain as some pills are formulated to decrease the amount of hormonal swings. If you have pain that is cyclic it is manged differently than pain that is non-cyclic. Patients may even have breast pain that has a non-breast origin, like if you have too much pain in the underlying muscles from a new workout regimen. Other causes of breast pain that aren't directly related to the breast can be a fractured rib, shingles or cartilage inflammation of the ribs. Women with hormonal breast pain are usually experiencing cyclic complaints, and it may be worse just as a period is approaching, and watching nutrition as your menstrual cycle approaches is important. Without cyclic breast pain, you may complain that the breasts are burning,. If you have that symptom you should get a gyno visit to see if you have an infection or blocked milk duct that shouldn't be ignored.. New starts on BC have to adjust to the hormone levels. In the beginning your ovaries are still producing hormones and you are adding in hormones, after a time, the overall level of hormones decrease and you are less likely to get pain. Give it 3-4 months to adjust, then it may be time for a pill switch. And that is something your gyno is particularly knowledgeable about.

Sunday, January 25, 2015

What we mean by Love Muscle May Differ

So You think Your Not Fat? Are you only Relying on Your Scale

FAT? Not FAT? Which is it? Are you only relying on your scale? Get the Facts before you brag, brag, brag about all that muscle...or before you whine, whine, whine about the lack of muscle. Simple body fat analysis can give you that % of lean body mass vs body fat. And then we can talk. And what's important on a diet: maintaining that lean body mass while you loose fat, and loose abdominal fat. So when this gyno gal gets you on a diet we get you on the Lunar Prodigy for a bit of analysis. Then you can be compared to your age group, your ethnicity, and your goals. A few facts are in order to help the exercise and nutrition plan along!

Friday, January 23, 2015

Diabestes in Pregnancy: One Test,Two Tests or Multiple Tests? Or Just Check The Baby?

Everyone in pregnancy will be tested for diabetes through your pregnancy as normalizing blood sugar prevents multiple pregnancy complications. Every time you come in for a check up they dip your urine to see if you are spilling sugar, it is a diabetes test. At other times there are blood tests of sugar, blood tests of your sugar levels that you have had for over three months, and sugar tests that are stress tests for your pancreas by giving you sugar to drink.The World Health Organization began looking at diabetes in pregnancy in a new way. They checked the babies after birth for the amount of sugar they were exposed to. They checked the babies for large birthweight (macrosomia) and for cord blood levels of C-peptide (think of this as a marker for insulin levels). They found that these problems in the babies were associated with single abnormal results on a 2 hour 75 g glucola test. So no more two step testing in pregnancy. In the past we would do a 1 hour test, randomly, and bring people back who didn't pass, for three hour test after fasting. Now we will have to have our patients fast, and come in between 24 and 28 weeks and be tested in a 2 hour test for diabetes in pregnancy. More women will get the diagnosis of diabetes, we are fairly sure of this. And what is important is that effects on mom and baby just from abnormal sugar are virtually eliminated by a tight blood sugar control. And control doesn't necessarily mean medicines, it may mean a change in diet and more exercise if that is possible.

Thursday, January 22, 2015

Appointment Today? Will You Be Protected Tonight?

Every contraceptive method has it's on effectiveness date.  Each gyno will have a plan for you as to when to start your birth control pills when first getting started on pills. "Sunday" start means that you run out of your 28 day pill pack on Saturdays, and that may be efficient for many women, but not so efficient for others. Especially if you just got your prescription and missed your Sunday start, yet you are wanting to be protected against pregnancy as soon as possible. So gynos have long been recommending "quick starts" meaning, start your pills as soon as you can, regardless of where you are in your cycle. Once you have taken 7 days of pills, you are protected against pregnancy. (By the way, the ring being a bit stronger, you only need three days of NuvaRing use to be protected against pregnancy). We have worried about causing break through bleeding when you first start pills in the middle of a pack. But all studies reviewed recently in a publication in the May 2013 issue of Contraception showed that there was no difference between break though bleeding or pregnancy rates as long as there was not a follicle that was over 10 mm. So follow your gyno's instructions as to when to start your birth control pills, but she may advise quick start for you.And if that is not quick enough, perhaps another method is best for you. Some methods will protect you from pregnancy the day you begin them. At Women's Health Practice we have contraceptive research trials enrolling, as well as many other contraceptive alternatives.

Wednesday, January 21, 2015

Bleeding After a Hysterectomy?

After a hysterectomy there is no uterus, and women stop having menstrual periods. Irritation of the lining of the vagina can produce some slightly pink discharge, but actual blood passage is not the norm. However, it's not uncommon to develop a small nub of tissue where the stitches repaired the top of the vagina. This is called granulation tissue, it is not cancerous, it can bleed, especially with exercise and sex,; and what is more important is is easily treated. So be sure to come in to your gyno and be evaluated for this if you have had bleeding after a hysterectomy.
Vaginal vault granulation tissue

Tuesday, January 20, 2015

What Carb Should You Eat?

A carb is not a carb, is not a carb: meaning that different carbs can raise our blood sugar a lot, and some carbs don't really cause that blood sugar to soar. To research that investigators ran the OmniCarb Randomized Clinical Trial and published their results in the JAMA of December 2014. In this trial they point out that scientifically the carb effect of our individual foods is measured by the glycemic index, their example is that a banana and an apple have identical carbs, but blood sugar will generally rise a lot more after consuming a banana than an apple. But in a generally healthy, fiber and fruit and veggie filled diet, investigators wondered if this is so important we need to keep these small differences in mind when planning our meals? If it did maybe you'd do best with the DASH diet which is low in salt but a bit higher in carbs or perhaps you need to keep that salt low, but go heavier on the protein as in the OmniHeart diet? And perhaps this depends on your current weight, your current age, your current exercise regimen and just how healthy your body is to maximize nutrition extract from your food? And indeed, in the research setting, comparing these two excellent diets (not the day to day diets we all have) they couldn't really separate out the minute effects of your food choices on your glycemic index in a large trial of obese people. The dietary sugar can affect your morning blood sugar level and your morning insulin levels, but your overall fat levels, blood pressure, and in general what we call insulin sensitivity did not change with these very different diets in a 6 week trial. That is not to say longer trials wouldn't have bigger impacts, or that your own gyno couldn't help you sort this sort of thing out but it is to say, the verdict on the 'best' diet is still in the hung jury stage!

Friday, January 16, 2015

The Best Reason To Lose Some Weight Now: Permanant Solution Coming!

Physicians and health care providers have finally learned that obesity is a disease to be attacked through a multi-front Napoleonic approach. Life style changes, nutrition strategies, and medical strategies have all been tried, true and remain a critical component. The newest front on the battle field is an electronic implantable device. It is for the morbidly obese patient, and the FDA has cleared it for individuals who have already embarked on some weight loss using the prior armentarium. The device isn't for everyone, it has side effects, and may or may not help sustained weight loss. As for what to buy today at your grocery store run? According to the US News and World Report, DASH diet out does all the others.At Women's Health Practice, we see that all diets work, but that your food desires, lifestyle, current health, and genetics will determine whether you will have success, so as with all things: customize your plan. As for what medication will help you get ready to qualify for the implant, if you will ever qualify? And then for the stubborn pockets of fat that won't go away, would you consider Cool Sculpting? These are just some of the things to gab with your gyno about, see you soon!

Monday, January 12, 2015

When is Comes To Sex are you More Male or More Female (Hormone) Related?

Sexual function is related to hormone levels. The question is how? Male hormone testosterone and the female hormone estrogen affects sexual function. When we study body image, positive sexual energy, and overall stamina for sex, these hormones take on a whole different set of implications for our body. And in women with medications, diets, or genetic reasons to metabolize the hormones differently, there are going to be diverse effects on you sex life as all of those can impact hormones. In most studies we are more in the mood mid cycle when male hormone levels rise, but sadly not even every study has firmly confirmed that link. As with other female sexual studies the mystique is still a mystery to gynecologic
researchers. As you age your relative testosterone, estrogen balance may change. Thus we like to say you are female hormone dominant or male hormone dominant. And this can be established by a medical visit and testing. Some sexual function in women appears to be positively related to testosterone levels. Some studies show some sexual function is related to estrogen levels, and some sexual function is not apparently related to our hormone levels at all. In a study of desire, orgasm, arousal, and sexual pain. It appears that testosterone levels positively affected desire, masturbation, and orgasm. In most categories of sexual function FSH (which raises as estrogen lowers) was higher if sexual function was poorer in the study by Randolph and colleagues.The question is: what were your hormones when you functioned the best, what are they if function has fallen off, and finally will boosting your hormones improve your sex life if it needs a bit of a nudge? Worthy topics for you and your personal gyno to sort out!

Wednesday, January 7, 2015

New Year New Baby Pictures!

Do You Resolve to Continue Mammograms or To Change Your Routine?

Women’s Health Practice Recommendations on Mammography: Come in to Discuss Remember They Do Save Lives!

Mammography is safe, appropriate as a screening tool for many women, and has saved many lives according to most studies, in genrally the Breast Cancer Detection Demonstration Project showed that cancers that cannot be felt can be detected even those less than 1 cm. At least 89% of cancers will be accurately found, and of those about half would not be felt by the woman or her health care provider. There are those studies which question whether it really saves lives. When and how often, and now even what type of mammogram to get  is an important decision for each women. Individualized evaluation and risk assessment for your risk of breast cancer should occur on an annual basis, and an important reason for women to continue yearly visits. Factors that we should consider will include: your personal history, lifestyle, do you smoke or consume alcohol, your family history of breast disease or breast cancer, your personal genetics if you have been tested, hormone, cancer prevention treatments and medication history, whether you have had children or breast fed your children, nipple discharge, breast pain, cysts or masses, or prior breast surgery.

Newest  guidelines calling for fewer mammograms, and mammograms beginning later in life, and perhaps being done every other year are being recommended by the U.S. Preventive Services Task Force Breast Cancer Screening group. These guidelines are in conflict with some of the recommendations I have given you, our patients, over the past few years. As a Board Certified Obstetrician and Gynecologist the organization I belong to called the American Congress of Obstetrics and Gynecology (ACOG). They are studying the new guidelines, but they have not yet changed their current guidelines.

Insurance coverage for medical exams are based both on medical necessity and on recommendations of organizations such as these. Insurance coverage you may have had in the past may be affected by these changes, but most insurance plans will cover screening mammograms well, virtually all plans cover diagnostic mammograms (meaning done to check a problem) well.

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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.

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