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Menopause: Making Peace With Change

Thursday, May 25, 2017

Preventing Time Running Out on Your Biologic Clock With Menopausal Therapy.

Menopausal hormone therapy begun as menopause was starting was associated with lower mortality in countless studies in the last century. Mostly that was thought to be due to less cardiovascular disease. It was only the studies done on women who began hormone therapy many years after menopause that did not have this effect. Now we have evidence that fundamentally, on a microscopic level, hormone therapy may truly have anti-aging effects.
We age one cell at at time. Cells can age through actual physical trauma, but they generally age through three main pathways: a)a breakdown in the reproducing stage, b)cancer gene inducing mistakes, or c)damage to the DNA of the cell. The control of this cell by cell aging determines our biologic age, and the pace that this occurs is collectively known as our epigenetic clock. If the clock speeds, as it will through menopause, we age more. If the epigenetic clock slows as we age, youth is restored, and metaphorically speaking time is added to our clock. Menopausal hormone therapy has been shown to have some direct cellular effects that can reverse epigenetic clock changes! What role toxins, nutrition, exercise, circulation, and a host of other factors have in this process is still working out.

Wednesday, May 24, 2017

Don't Be the Biggest 'Re-Gainer" of Lost Weight

How to prevent rapid re-gain of weight is one of the biggest challenges to weight loss. Not only that but when you read the fine print of side effects of a new medication, what if one of the side effects is weight gain? Would you take the medicine any way? Is fear of weight gain a factor keeping you from trying to quit smoking? Physicians have long told their patients that weight gain maybe a side effect of the offending medicines, but few offer a solution to prevention. Watching what you eat and exercising has been the dictum, and still a healthy strategy that will help protect you. But eating even somewhat fewer calories when you take a medication which may make you actually gain weight is not going to be effective for keeping your same weight or body fat composition.  The new diet medications such as Belviq, Contrave, Qsymia, and Saxenda are  indicated as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adults. they are approved for long term weight control. Diet physicians are also learning that in the right patient, with no contraindications giving medication can help prevent weight gain when you begin on medications that can cause weight gain. This could even be a hypertensive medication.  Knowing which is the right medication has to be determined by your physician. There are pharmocogenomic tests that may be able to determine how you process medication that can help you know if a particular medication is going to be safe or steer your physician to another agent. Exactly how the metabolism of medications affect weight we don't yet completely understand. But much can be done to help manage that dreaded side effect, especially if you have recently worked hard to lose some weight. So don't let fear of weight gain stop a rational strategy for appropriate medical management. At Women's Health Practice we can prevent you from being the biggest re-gainer of lost weight!

Tuesday, May 23, 2017

Try This Before Resorting to IVF

Open fallopian tubes are critically important to getting pregnant without IVF. We think of the hysterosalpingogram test as just a way to determine if they are open, or closed. In the distant past we used to use air testing, then x-ray testing, and now we use ultrasonography testing. Ultrasound testing is usually with saline, and now we have a device to use air bubbles. The ultrasound test is safer from the respect of no radiation exposure, but the exposure levels are low. Now a new study that looked at x-ray technique with oil found that an extra 10% of women got pregnant with oil based fluid as the medium over not using oil. The Australia group that looked at this has decided that this is a new alternative for women not ready for IVF instead of giving up. 

Tuesday, May 16, 2017

Are You Going Through Some Changes?

Did you know the original medical version of shake it out? This medical treatment might surprise you:

Prior to the development of the stethoscope Hippocrates around 400 BC recommended the process of succession, which was essentially shaking a patient, to listen to the sounds from their chests. Medical test interpretation after stressing a body through chemical or physical means such as the commonly employed stress test, is just an evolution of that technique.

find out more medical pearls in Menopause: Make Peace with Change

Saturday, May 13, 2017

PRP Use For Infertility; Getting the Uterus Ready!

Getting pregnant has several critical steps. Even couples who are helped to ovulate, have a good sperm count, and time their conception perfectly may not conceive if the lining of the uterus is not healthy enough for implantation. Preparing the uterine lining has mostly been done with estrogen treatments. It's also important to be sure you don't have other problems with the uterus, including scaring, or infection, or polyps, but again, in the absence of these some women do not conceive. Hundreds of genes that are differently expressed at the time of implantation, as well as the immune system, play an active role during embryo-endometrium interaction Other than estrogen medicines like silenafil, aspirin and heparin have been tried with varying success. The lining is so complex that it takes the coordinated efforts of many hormones and the synchronization of literally hundreds of genes to establish a uterus with the proper place for  implantation so that coordination between embryo and endometrium can proceed and a pregnancy implant A new way to prepare the uterus with PRP therapy has been studied with some promising success. 
Platelet Rich Plasma (PRP) therapy is one of the most versatile treatments in medicine and for aesthetic uses. It’s first studied medical therapeutic use was for wound healing, and it is ideally suited to heal the endometrium as well. The PRP therapy contains growth factors, adhesive proteins, clotting factors as well other important healing compounds, and compounds that help our tissues stay healthy. PRP components help us fight both inflammation and infection that may be the cause of poor implantation.  PRP also stimulates new nerve formation and new blood vessel formation. The growth factors act as chemical messengers signaling the appearance of new cells. When these factors work on a tissue, stem cell production is triggered. After stem cells are produced other cells, in this case the endometrial, or uterine lining cells. The scientific definition of concentrated platelet rich plasma must meet the level of 1 million platelets per 5 cc of plasma. It is important to have this concentration in order to be able to get effective healing and treatment response. Inadequate concentration during the preparation is responsible for some reports of less than satisfying results from therapy. So it is important to be treated by PRP therapy prepared by the best technology. The platelets have a number of proteins in addition to the growth factors which are released from the platelets when they are activated. The release of the important compounds in sufficient numbers can affect the result as well. There is a direct proportion of numbers of cells produced in the treatment area directly in relationship to the concentration of the PRP. 5 x PRP concentration increases cell production of over 200% in certain parts of the body, and in active tissue like the endometrium this may be more. It may be that the PRP could enhance the effects of the other medicines like estradiol. It is used by instilling it into the uterus with a catheter.  The risks are relatively few from PRP treatment, and is regarded as something to try prior to going to a surrogate. For those interested in PRP therapy contact Women's Health Practice, 217-356-3736. 

Wednesday, May 10, 2017

Should You Have Eaten Broccoli, Cauiflower and Cabbage Last Night?

GynoGab blogger Dr. Trupin enjoying an early morning walk at Balboa Park
When you plan dinner do you think, calories, comfort, food groups, fiber, what leftovers are there in the fridge? All seem sensible, and none of which should be ignored when planning your meals. But when you planned dinner last night did you really think hard about why you should or should not eat certain vegetables. Well, this may be the newest frontier in personalized medicine. We process many medications through a complex network of enzyme pathways. Based on our genetics we either metabolize a particular medication well, poorly, or perhaps modestly poorly. However, it turns out that your diet can factor into this equation. Did you know about the gene CYP1A2? It is a factor in the metabolism of many medications as varied as naproxen, acetaminophen, and estradiol. Did you realize that some women  who normally process this enzyme reaction can switch and the function of CYP1A2 can switch and in the face of eating cruciferous vegetables become a rapid metabolizer of these medications. The cruciferous vegetables including broccoli, cauliflower, and cabbage  can be very good four you, as they are high in vitamin C, fiber, phytochemicals and other important nutrients. Thus it is good, as a general rule to eat these cruiciferous vegetables. But how about you, personally, and your health? Do you understand the genetics of your metabolism? One dinner is unlikely to change your medication, but we are always looking for reasons medications, for instance the prescription of estrogen for hot flashes, seems to be working, and then may be reported by a patient to be less effective in controlling her symptoms. The diet certainly can help explain some short term symptoms. This is what prioritized medicine is about. Perhaps it's time to get tested!

Friday, May 5, 2017

Fixing Incontince Without Surgery

30% of women in reproductive age or older have urinary incontinence, and by age 72 over 70% of women have this. There are specific types of urinary incontinence, including urge, stress, or mixed incontinence. Very few women will have other conditions such as neurological causes or conditions called overflow incontinence. There are many reversible causes of incontinence that you could evaluate with your gyno: 

  1. Healing the vaginal wall and fixing Vaginal Atrophy
  2. Improving your mobility
  3. Improving constipation and straining
  4. Curing low grade bladder infections
  5. Strengthening pelvic floor muscle training 
  6.  Mona Lisa Touch Therapy
  7. Fluid management
  8. Medications if training is not successful
  9. Pessary use
  10. Physical therapy
  11. Botox
  12. Bulking agents
  13. Posterior Tibial Nerve Stimulation

Thursday, May 4, 2017

The Healthy Way To Style Your Body

Longevity and living well is determined by having the healthiest tissues possible. Being leaner, even if not lean specifically is healthy. We have focused a lot on body height per weight, and as a general measure. The newest concept is to look at your fat percentage. Some experts set these percentages by age, others set it as a single number. Research shows  that greater than 42% body fat is obese for women and greater than 34% for men is obese. These numbers are not set arbitrarily, but above these ranges women begin to get hormonal disruption, dysfunctional fat, and ectopic fat. Secondarily there is loss of muscle medically which is termed scarcopenia. We see this more commonly in vegetarians, especially vegans and carb addicted individuals. The healthiest way to lose weight is to do it slowly, in a controlled way. Weight loss varies over the course of a diet, and not just due to calorie count and exercise. What happens is that as you begin on a diet, if we follow your body composition closely, muscle loss is more intense in the beginning first (5‐26 days of a diet) . To actually lose fat, that process is much more difficult. Fat loss takes longer to start (>300 days for fat loss predominance with standard diets!). Using slim shots, changing the way you eat, CoolSculpting, are all ways to speed this up!

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Vaginal Contraceptive Ring

If you are a female between the ages of 18 and 35 you may be eligible for a contraceptive ring investigational contraceptive medication study. Qualified participants will receive study-related medical evaluations and care at no cost. If interested, please call 217-356-3736.

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