Sunday, July 24, 2016

Brain Boost: It's Possible: Here's How



We have much reserve, much power to improve our learning, and ability to function at a very high level until the time of death. Yet it’s always a goal to do better! The best antiaging brain boost strategies involve lifestyle modifications. The critical common denominator is better cardiovascular health. The better you are able to exercise, relax, get proper sleep, and nutrition, the better your brain power will be from youth to old age. Lots of strategies may enhance these basic instructions.  French lessons, to exercise, to positive thinking have been opined as the solution to brain boost, and we have long discussed that beginning hormone therapy was just one more intervention that has not proven that your physician can impact on your ability to think better as you age. Multiple studies including the Seattle Midlife Women’s Health Study showed that 60% of women in the menopausal transition report decreased memory function over the past few years, including forgetfulness. The Decision at Menopause study was also relied upon for some of their findings, so make no mistake you probably have lost some brain function as you age. So you do need to take  . Since hormone therapy can influence the health of the brain, and can influence the quality of one’s sleep, we always thought that adding in estrogen therapy would improve thought. And when to ad in the estrogen therapy, early or late menopause, has been debated. So the ELITE study attempted to ask hormone therapy has different effects on thought function depending on whether you are in the early or late postmenopausal years, and cognitive part of the study — ELITE-Cog — was published online in Neurology on July 15. Their conclusions were unfortunately that "results show there is no cognitive benefit or harm of estradiol over a 5-year period in either early or late menopausal women," lead author, Victor W. Henderson, MD, Stanford University, California, commented to Medscape Medical News. They based their studies on the use of  estrogen in 567 healthy women age 41 to 84 given oral 17β-estradiol, 1 mg/d, or placebo. They were looking at verbal memory, and they studied only women with good memory at the start of the study. There has remained strong evidence that hormone therapy, initiated what is termed ‘early’ meaning as you transition through or in the first few years of menopause, has significant beneficial cardiovascular effects, while it is clear that late hormone therapy can contribute or worsen heart disease. This study didn’t look at the question as to whether estrogen affects dementia/Alzheimer's. And ultimately better cardiovascular health will bring better healing and nurturing blood to the brain, and that is what is going to preserve brain health .
Neurology. Published online July 15, 2016. Abstract

Wednesday, July 20, 2016

The Least Understood Aspect of Endometriosis: Adenomyosis

In a medical review today, published on line ahead of print, the treatments of for the least known aspect of endometriosis, the condition adenomyosis, is reviewed. Adenomyosis, a name of Greek origin, is a condition whereby the glands of the uterus become trapped deep within the wall of the uterus and produce symptoms. The symptoms of adenomyosis can be variable, but most likely will at least cause heavy painful periods. The diagnosis of adenomyosis used to just be made at hysterectomy, but we have gradually recognized that ultrasound and MRI examinations can determine whether a woman has adenomyosis as the cause of her heavy periods. The condition of adenomyosis could be asymptomatic, and if a woman has no symptoms she does not need treatment. But in a large percentage of cases adenomosis causes the uterus to be enlarged. The uterine enlargement can be from the endometrial glands filling the walls, but also due to blood within those glands. Many treatments have been tried, including those hormonal treatments which suppress the menstrual cycle, including continuous use of oral contraceptive pills, high-dose progestins, selective estrogen receptor modulators, selective progesterone receptor modulators, the levonorgestrel-releasing intrauterine device (Mirena or Liletta), aromatase inhibitors, danazol, and gonadotrophin receptor hormone agonists can temporarily induce regression of adenomyosis and improve the symptoms. Newer treatments are emerging, if you wish to participate in a research study of Adenomyosis, please call Women's Health Pr
actice. 217-356-3736.

Monday, July 18, 2016

Endometriosis: Patient Questions Answered

Mom's Day Monday: The First Year of the Zika Epidemic



  • Zika, The first year of the epidemic as we understand it so far is summarized in these points. The information physicians are receiving is changing regularly, and it’s important to speak to your own physician about any personal concerns you have.
  •   As of June 2016 over 200 pregnant women in the US have tested positive for the Zika Virus.
  •   Zika is not yet being spread in the continental United States, other than by individuals who have traveled to areas with the Zika virus.
  •  In Brazil, where the epidemic began about a year ago, there have been over 1600 infections.
  • There is no vaccination for the Zika Virus.
  • The Zika virus is mostly spread by the Aedes aegypti mosquito. We do not have a lot of these mosquitos in the US, but the few pockets we have are in the very southern parts of our country. These mosquito populations have not been shown to have the disease. There are a few other mosquitos which can spread the virus if they should become infected, which they are not yet in the US.
  •   Zika virus can infect an unborn fetus and cause the head to be small in a condition known as microcephaly.  Other brain conditions are possible due to the virus infection, including calcium deposits in the brain.
  • When a mother gets an infection she may have a fever, a rash, generally feel poorly, or an eye infection. Often the mom does not have recognizable disease. If a mom is, in fact, very sick from Zika infection, then she is more likely to pass the infection on to her unborn child.
  • The Zika virus is from a category of flaviviruses, the other flaviviruses do not seem to cause similar fetal conditions. Other flaviviruses include dengue and chikungunya.
  • The similarity of these viruses may enhance infection of each other if you have had a prior infection.
  •   The Zika Virus can infect a fetus, but the placenta has some resistance to viruses (thus we do not see many viral infections of the fetus in pregnancy).
  • It is also possible that some women have infections of the uterine cavity itself, present prior to conception, and this is why the infection occurs to women exposed prior to, but not during, pregnancy.
  •   A very early infection might cause a miscarriage.
  • There are cases of Zika infection that have been reported as late as at 27 weeks of pregnancy, although  it  typically occurs only an infection very early in the pregnancy.
  • The virus can gain access into the uterus via sperm (like with HIV), via ruptured membranes, or from medical procedures (such as an amniocentesis).
  • The theory, therefore, is that the Zika Virus crosses the placenta into the fetus (only) very early in pregnancy before all the viral defenses of the placenta are functioning.
  • It is not clear whether Zika preferentially would infect fetal tissue verses mom’s tissue, but we do know that the Zika virus affects nerve cells.
  •   We classify a set of infections that can cause diseases in the newborns as TORCH infections: including toxoplasmosis, syphilis, cytomegalic virus infection, herpes, rebella, chicken pox, and parvovirus infection. Zika disease is different from all of these other infections, but can be much worse in pregnancy.

Sunday, July 17, 2016

Scholarly Sunday: Why Now, the Causes of Vaginal Yeast Infection





Candida albicans yeast organism is what we call a human commensal organism. Yeast organisms can thrive without oxygen, they reproduce by budding. and they can live without causing medical problems in the vagina, the rectum, and the mouth. Because these are the locations they live oral sex can transmit the organism. Just harboring the organism doesn't produce symptoms but is in the state of symbiosis known as being a commensal. When the numbers of organisms begins to multiply the body sets up a response that clinically becomes an infection. Vaginal Yeast infections are extremely common, often annoying, and the question is what are the causes of infection. Put medically, what moves the growth of yeast colonies from being commensal to an actual infection. The imbalance between the good bacteria, the lactobacilli, and the yeast organisms are ultimately the cause of the infection, and there are causes of the bacteria becoming overwhelmed by yeast organisms. Therefore yeast treatment such as the creams, pills and suppositories will only go so far as a therapy, as they don't treat the underlying cause. Here are some of the reasons:

  • Heat, warmer climates, summer
  • Being Obese
  • Hormonal Contraception
  • Hormonal Therapy in Menopause
  • Pregnancy
  • Diabetes
  • Antibiotics (generally those known as broad spectrum)
  • Menstrual periods (this is more likely a hormonal effect in that the yeast infection rates are higher both before and after the cycle) 
  • HIV disease
  • Stress and stress on your body such as poor sleep, hygiene, poor nutrition 

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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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