Friday, April 17, 2015

Platetet Rich Plasma and Regrowth of Hair

Hair restoration by the use of platelet rich plasma (PRP) is the newest and most dramatic treatment for regrowing one's own hair. In the New York Times on April 16th the technology of treating the scalp with the PRP for women is highlighted as an extremely effective treatment for women It is a treatment that actually involves the use of your own blood plasma. The plasma with the platelets is prepared by extraction from the red blood cell component and then concentrated to release growth factors. the Arteriocyte Magellan PRP machine is the leading PRP company on the market as ti provides the highest concentration of growth factors. Treatments with products that do not concentrate enough growth factors are less likely to produce successful results. For women with hair loss it is important to evaluate causes of treatable hair loss. Hair loss on the crown has been shown to respond the best to the PRP treatment. PRP can be combined with other therapies for hair loss. PRP has been successful for the treatment of other medical conditions, although not covered by most insurance companies, it would typically qualify for coverage under medical savings plans.

Wednesday, April 15, 2015

When a Mammogram Result Is Wrong

No test is perfect, but especially tests we use in many woman and repeat often we want to know that it's pretty accurate or the total cost of chasing wrong results can be enormously high. Mammograms are one test that seems to be endlessly debated as to how it is done and the accuracy of what we are finding. A new report discussed on the AMA site states that we spend over 4 billion dollars to chase false positive tests. In the case of mammograms a false positive test means the mammogram states a suspicion of cancer, but there is actually no cancer. So it is more accurately termed, "positive of an abnormality, that may be cancer or may not be." As opposed to the situation in which there was an incorrect interpretation of that spot.  Each and every medical test, including mammograms, has many facets to it. The technology to perform the test, the decision to have the test, the results themselves, the interpretation, and when to have repeat testing. All this must be taken within the context of the woman having the test and the gyno helping to navigate this complex set of decisions. And then there is the fact that some tests don't really change therapy, so if not is it really worth having the test. And medical thinking as to the results may have changed, and thus the interpretation of the test can change! In the case of the new report, CBS news is saying maybe the cost benefit ratio doesn't go towards screening mammograms, but away from them, and yet NBC is saying new treatments make breast cancer even more treatable so we should think about continuing to diagnose each and every breast cancer.  And be sure you differentiate screening mammograms from diagnostic mammograms. In one case you have no symptoms but the gyno is checking for lesions that cannot be felt. In the case of diagnostic mammograms you are being evaluated for a symptom or sign you do have. Diagnostic mammograms are critically important as the step after a screening mammogram to help interpret what the screening test or physical examination found, and their interpretation is closely linked with the symptoms you and your gynecologist convey at the time of the test. Test results, as you see, have many intricacies and even more implications in their interpretation.

Tuesday, April 14, 2015

Another Placental Secret Unlocked

The reasons for miscarriage are many and complex. Early pregnancy miscarriage (defined as before 20 weeks of pregnancy or a fetus weighing less than 500 grams) causes fall into two very broad categories: fetal factors and factors in the mom. Most miscarriages are very early in pregnancy, in the chemical pregnancy stage at which time it cannot be determined. Just over two thirds of all miscarriages are before they are clinically detectable. Overall blood studies of the HCG determines that about 50% of fertilized eggs do not make it to a live birth. The HCG test can determine a lot about the heath of the baby, but it is not a good test to predict miscarriage. yet researchers at the Imperial College London, United Kingdom has determined that low blood levels of the peptide kisspeptin during their first trimester of pregnancy are significantly more likely to miscarry, in their new study shows.Kisspeptin is made by the placenta. The study was presented at  ICE/ENDO 2014, where he presented the research, Dr. Abbara said their study is the first to show that a plasma kisspep. Commenting on that study was colleague from my former teaching post, when asked by Medscape Medical News about the work, Ann Nardulli, PhD, a researcher at the University of Illinois Urbana-Champaign, said: "It looks like we may have another marker to tell us whether there's a healthy pregnancy." If this test's findings are confirmed, this then is a placental secret we would all want to share in.



Sunday, April 12, 2015

Ready To Cuddle Up But Your Legs are Twitching


Sometimes you just want to read in bed, or cuddle, or perhaps get an early night of sleep, but your legs are twitching and you just can't. It may be due to a medical condition called

restless leg syndrome (nocturnal myoclonus). Restless leg syndrome is characterized by uncomfortable sensations in the lower legs that persist unless the legs are moved. The symptoms can include numbness or actual cramping. These sensations usually occur shortly after going to bed but may also occur during the daytime. The urge to move the legs can last for an hour or longer, and prolongs the time it takes to fall asleep. Severe cases may cause interruptions in sleep throughout the night. Restless leg syndrome most often occurs in middle-aged and older adults, but there is no specific association with menopause. The cause of the disorder is unknown, but it is a contributing factor in menopausal sleep disturbance for many women. The problem seems to be exacerbated by many factors including low iron and in times of stress. The low iron can be measured by ferritin level which is also a measurement of your iron stores. Iron therapy can be given in pills or by iv treatments.  Treatment with muscle relaxants may be helpful. Now there is a newly approved medical device that is approved for non-medication treatment, that is essentially a vibration device.

 

Friday, April 10, 2015

Listeria Recall and Pregnancy

We are getting phone calls regarding the hummus recall and the risk of listeria in pregnancy. The CDC also has found this in ice cream. It is best if you can check the product number you consumed and make a note of the date you consumed the food. Pregnancy itself is a time when a woman's immune system may not be as good. The risk of Listeria monocytogenes listeria is 13 times greater in pregnancy than when a woman is not pregnant. In general the basic recommendation in pregnancy to avoid listeria include avoiding luncheon and deli meats and hot dogs unless heated, make sure all fish have been cooked, avoid pate and uncooked meat spreads, and are told to avoid unpasteurized dairy products that are more likely to have listeria bacteria. Since acquiring the bacteria does not require treatment unless symptomatic we are just urging pregnant patients to be vigilant about their symptoms, and to not be tested or treated unless you are having a fever, fatigue, or body aches. We also want to know about any GI symptoms such as diarrhea. More advanced disease could be signaled by headaches, neck soreness, balance issues, or other generalized symptoms. We are asking people to watch their symptoms for at least 2 months and report them to us.

Thursday, April 9, 2015

How Accurate is A Single Pap Test

Pap tests are a screening test for cervical cancer, as are HPV (Human Papillomavirus) tests, so the accuracy of a single pap is not really as helpful as having both a pap and an HPV test. Whenever you are getting screened, those at risk for abnormal tests are probably going to get the most accurate testing. If you want to know how accurate your test is, there are a lot of considerations, and basically you and your gyno will have to answer this  together. It depends if you are talking a single pap test, ever, or just one pap in a series of pat tests. Basically the pap test reduces the rate of cervical cancer by about 75%, by alerting testing in the precancerous, non-invasive stage. A pap can be fairly insensitive at picking up what is wrong on any single test, inaccuracy can be as high as missing 10 to 15% of cases. HPV is a DNA virus that infects skin and mucosal tissues and causes cell changes that lead to what is known as cell proliferation (overgrowth) and conversion to neoplastic changes (premalignant and malignant). HPV is the source of virtually all of cervical cancer. If we add tests for the most cancer causing HPV we can almost double the rate of pick up of the abnormal pap that are missed by the single screen. More precise tests are coming, you may want to know, do you have HPV16, 18, 45, or perhaps do you have p16NK4a34. Now it will be awhile until we can tell you the latter.

Monday, April 6, 2015

How To Decide When To Have A Baby, According to Measured Ovarian Age

Some women are able to be fertile until they are quite old, others are running out of usable eggs even though they are quite young. There are tests of the age of your ovaries, but then usually it's only fertility patients who get these tests; and while very interesting it doesn't typically change medical care to know whether you are still fertile unless you are seeking pregnancy. Those wondering how close to menopause you are, or even more interestingly, when to time having a baby. You might make a different decision if you know your ovaries are running out of eggs, rather than if you had plenty of eggs and could easily postpone while you work on that job change, that new marriage, or that bucket list. And that was one of the questions a recent Practice Committee of the American Society for Reproductive Medicine opinion tried to answer for you: how to use tests of ovarian aging. Generally speaking, the most eggs we will ever have is during the 4th or 5th month of fetal life! Then we begin to lose egg through illness, medications, ovulation and ovarian surgery. And we're not sure how to preserve the numbers we have, birth control pills and pregnancies don't change our fertile egg numbers or lifespan a bit.  Your age of menopause is the day you run out of eggs, but often women will prematurely enter menopause only to find themselves cycling again in the future, which is what is known as POI or premature ovarian insufficiency.. So the obvious question is, will this happen to you, or to phrase it a different way,: Women want to know are they loosing eggs. And if the eggs are still able to be fertilized. Since an egg going from it's latent state to fully ready for fertilization takes 3 months, this question isn't as straight forward as it seems. Older women, younger women, many of us have the same question, what is the age of the ovary so one could plan pregnancy. Women seeking fertility and women seeking not to be fertile, and women wanting to establish if these hot flashes are menopause or something else all want to know: just how many eggs do they have left. Their Gynos want to know as well, and how we can determine this is that has been as critical as knowing that running out of eggs may have really occurred. We tend to have clues, the age of average menopause, the age your mom went through menopause, and other factors. Ultrasounds have been used to look at how many growing eggs are in the ovary at the start of the menstrual cycle to determine if you have many eggs or fewer than you should, and this is literally a count of follicles that are between 2 and 10 mm in size. The measurements of your estrogen levels have been used to just name a few tests, and just the plain old obvious: are you still having regular periods. Now new blood tests may be what you need to determine if you have any ovarian reserve, or to put it bluntly, do you have any eggs left. So you may need a series of measurements. One set is really not enough, and beginning these tests in your 30s may help them be more useful.. One random blood test is just not enough to say where you are in the menopausal process. Just like you can’t say if a kid has grown just because they seem tall in their class, you have to know what the height was at the beginning and the end of that school year. Two tests that we now use are FSH, and AMH (some doctors also use inhibin B, it wasn't endorsed by the recent committee opinion). If you know your basal (at the point you are starting to look)  FSH and anti-mullerian hormone (AMH) levels and  then your later levels, you may have a clue. Otherwise there seems to be a pretty big variation in what levels are associated with some fertility. and if you have to do IVF the physicians need to harvest many more eggs than you need for a spontaneous conception. Theoretically we can get pregnant with only one egg being ovulated, but for IVF the reproductive team may prefer to have 10 or 20 eggs to pick from.  Once done with birthing children, if having a hysterectomy some gynos have suggested that measuring the age of your ovary may help to plan whether to keep your ovaries or not. An old ovary with not many fertile eggs has less a role in your total health than an ovary that is quite fertile still.There are other endocrine organs aging as well, and perhaps you need those tests at the same time.

Sunday, April 5, 2015

Breast Cancer Risk Factors



Major Risk Factors
Aging, although most are diagnosed around menopause
Personal history of breast cancer
Close family history of cancer
Genetic mutations known to cause breast cancer 

Minor Risk Factors
Early age of first menstrual period (before age 12)
Late age of menopause after age 55
Hormone therapy with progesterone for greater than 5 years
Having no children or having first child after the age of 30
Previous benign breast biopsy (within 3 months)
Lack of exercise, meaning under 4 hours a week 
Alcohol consumption, over 2 drinks per day
Obesity after menopause, especially over 44 pounds of weight gain
Hormone imbalance like PCOS
Endometrial cancer and colon cancer
Ovarian cancer
High blood pressure
Low Vitamin D levels
Diet Low in fruit and vegetables

Friday, April 3, 2015

Essure Coils Under More Sc

The FDA is bringing the Essure sterilization procedure under more scrutiny. Women have reported a variety of complications from Essure devices, including dislodged devices, organ perforation, and pelvic pain. Various groups have been tracking the symptoms women have reported from the device for awhile. Previously there was another device, the Adiana, that was also a transcervical sterilization method that was removed from the market. It's failure rate was greater than the Essure device. Women should remember the DMPA and IUDs when properly used have success rates of contraception that are not markedly different from sterilization and they are reversible, making these excellent contraception choices. If you currently have an Essure it may be worth discussing any symptoms you are having so that the placement of your coils can be ascertained and any potential side effects reported to the FDA.

Thursday, March 26, 2015

Runny Noses in Pregnancy, Possibly Not Just an Upper Respiratory Infection

When you are pregnant every part of your body is dramatically effected by the physical changes that accommodate the developing baby. The uterus grows from 70 grams to 1000 grams, most women gain  at least a couple of stone, and your skin starts taking on pigments that may fade but never leave! We notice a our tastes changing, and our smell changing, and generally we ignore what seems minor. But what may seem minor, but often isn't in pregnancy, is the runny nose and altered hearing women report. The changes in the ear, nose and throat are primarily due to changes in the circulatory system, such as the extra fluid in our circulation and the extra fluid our heart pumps. We also have some presumed increased susceptibility to viral infections, as well as some pressure changes from the bulk pressure of the growing uterus. All of these can oddly lead to increased runny nose! This can range from the very minor changes such as an occasional sneeze or drips, or become ringing in the ears or tinnitus, facial palsies, and even cases of deafness. Since it is the pregnancy that caused it, it should be self limiting to pregnancy as well. As the levels of estrogen and progesterone rise without enough corresponding change in cortisol levels or immune enhancement there may also be heightened sensitivity to allergens may influence the engorgement of the nasal mucosa. More fragile nasal passage linings can in term cause epistaxis (bloody nose) and rhinitis. Most treatment regimens of these complaints do not differ from the treatment of these conditions in the non-pregnant state other than being aware of the effects of any selected medication on the fetus, as most advice relies on case reports or reports of case series. What did you notice during your pregnancy? Were there any treatments that helped you especially? Let me know!

Don't Just Sit There, Don't Just Stand There, Don't Just Lie There

Too much sitting, standing or lying in one place can have medical consequences. For instance, the habit of reading hone the toilet? That's too much sitting, and can contribute to too much straining and pelvic floor weakness. You are to get up and walk around a bit, and when you get the urge to finish, return at your leisure!Too much standing, especially locking your knees, that can contribute to fainting. So if moving around will not solve the problems of the pelvic floor, other solutions are possible. We begin with a pelvic floor evaluation and then some suggestions. 

Sunday, March 22, 2015

Preventing A Second Miscarriage

Low dose aspirin is the new way to prevent a second and third miscarriage is to begin aspirin before becoming pregnant has now been shown to be effective in a new study.They studied women of ages 18 to 40, who had had one or miscarriages, and those who miscarried at any point. Beginning low dose aspirin therapy before conception iincreased conception rates by 28% in women with a history of only one pregnancy loss of <20 a="" can="" cause="" check="" gestation="" important="" in="" is="" issues="" it="" medical="" preceding="" span="" still="" that="" the="" to="" weeks="" year.=""> second miscarriage such as checking the lining of that baby bed (the uterus) is ready including hormonal checks and infection checks February 2014 Fertility and Sterility Other tests including an endometrial biopsy and hormone measurements to check on the progesterone levels, and further more evaluating gynecologic problems like fibroids, or  medication use, lack of vitamins or other nutritional deficiencies, chromosomal problems, or perhaps problems with the male sperm count. And if problems are identified then treating them. Some women are ready physically but are not ready emotionally, which is of course critical as well.
But the trouble is that most women do not have anything that can be treated. So normalizing your nutrition, your rest, and beginning aspirin is the modern way to go when attempting pregnancy after a miscarriage.

Monday, March 16, 2015

Sleepless in...America

We just can't get to sleep, and the newest scientific study proves it. This is not good news as those with poor sleep have much poorer health and a shorter life span as well. To try to over come this we take sleeping pills! At any given time millions of adults in the United States — or 8.6 million — report taking prescription sleeping aids, according to a new report released by the Centers for Disease Control and Prevention (CDC). The rates are creeping towards 10% of those 80 and above taking sleep medicine, and it's mostly the women who are taking them. As a gyno I do not want the patients taking medication unless they need to, but what is more disturbing is that over 50% of adults report poor sleep, so we need to think about the things we can do to improve sleep. There is another culprit which is robbing us of sleep and that would be shift work. Those with shift that rotate or those that take night shifts have a lot worse sleep. Maybe its just living a in city that is the problem. Night time light exposure, even if you think it doesn't bother you, changes your body's melatonin production and gives us a distorted sleep cycle 9by the way it disrupts our eating patterns as well!).

Sunday, March 15, 2015

Mammogram Interpretation Extends To The Density of the Tissues

Mammographic breast density is also now graded along with the other characteristics of your breast reported on a mammogram.Women with dense breast tissue have 3-5 times greater risk of breast cancer than women with normal breasts, and hormone therapy can increase breast density in 30-50% of women who take it. Generally a physician can look at the mammogram and the amount of ‘black’ verses ‘white’ components of the x-ray. Very white means very dense. Since breast tissue is actually 3 dimensional the denseness of the breast also is based on the internal structures that the radiologist is seeing. The thought has been that too dense of a breast would then obscure the view of a cancer. In general the pictures are graded by the ‘percentage’ of density, and greater than or equal to 75% dense correlates with dense breasts and less ability to predict the presence of a very small cancer. For decades the individual reading a mammogram reported their interpretation of density, but now the CAD or Computer Aided Detection programs can very accurately reportthe percent of density. Women who are heavier tend to have more dense breasts, like other features of our breast the density is somewhat genetic. Density is also related to hormone use and thus it is the position of the North American Menopause Society that taking estrogen and progesterone hormone therapy will hare the diagnostic interpretation of mammograms.Your density on your mammograms will change with many factors besides hormone use. Having a baby decreases density, and having too much alcohol increases density. Aging and decreasing hormones will change your density the most dramatically and decrease its density. And the more your density decreases the less your risk for breast cancer over time.So next time you are discussing your mammogram report with your gyno, ask if your breasts are less or more dense than the last picture!

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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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