Ask The Doctor (from The Ledger-Transcrpit) Q. How safe are hormones in
menopause?
A. Recent studies have questioned the over all safety of HRT
in relation to heart attack, blood clots,
stroke, breast cancer, and most recently Alzheimer’s Disease. These results seem to
be significant statistically and are of concern. However, overall the increased
risks are minimal and therefore, there are still indications for the use of hormones in
menopause. Each individual is different so it is important to discuss your
situation with your physician prior to making a decision on whether or not to
use them.
Charles J. Seigel, M.D.
Q. What is the latest info from
the WHI?
A. The Women’s Health Initiative
study, which changed the use of HRT because of
potential risks,
completed it’s portion related to women taking estrogen alone.
It found that the
breast risk was not statistically significant, and that there may be
an increased risk
of Alzheimer’s, but that is still unproven. In short the
recommendation
for HRT remains the same-use only for severe symptoms at the
lowest dose and
shortest duration possible and for osteoporosis where other
treatments cannot
be used.
Charles J. Seigel, M.D.
Q. What about alternatives to
hormones for menopausal symptoms?
A. There are numerous other entities, both medicinal and
herbal that can be used.
In most cases
these do afford some relief, but not to the extent of hormone
replacement.
There are pro’s and con’s in the use of any alternative therapies
and your
gynecologist is a resource in determining if any of these are right
for you.
Charles J. Seigel, M.D.
Q. Doesn’t postmenopausal
hormone replacement prevent Alzheimer’s disease?
A. Recent findings of the
Women’s Health Initiative showed insignificant probable
increases in
dementia. This will probably not change any guidelines. It is just
more information
on the lack of efficacy of hormones for prevention of chronic
diseases of aging.
It is reported that
these studies were in older women and are not addressing
the use of hormone
replacement therapy in healthy 50 year olds on it for hot
flashes.
Charles J. Seigel, M.D.
Q. Why & when do I need a
mammogram? A. Every three minutes a woman in
the United States
learns she has breast
cancer. Regular
mammograms remain the key to early detection. Small
breast cancers
can be detected up to two years before they can be felt with
a mammogram.
Low risk women
should have a baseline mammogram around the age of 40. Factors
such as a family
history or previous breast disease may indicate the need for an
earlier mammogram.
After 40, a mammogram should be done annually.
In addition to
getting regular mammograms, women should also continue monthly
self breast
examinations and see their health care provider regarding any concerns.
Heather L. Arel, ARNP
Q. I’ve heard there are certain foods you
shouldn’t eat in pregnancy.
A. Pregnant women should avoid foods that
can cause food poisoning or contain
harmful
pollutants. Food borne illness caused by certain bacteria can result in
premature
delivery, miscarriage, fetal death and/or severe illness of a newborn due to an
infection. Some foods to avoid are: Swordfish, shark,
king mackerel, tilefish & certain game fish ▪ Raw
fish, especially shellfish ▪ Because of it’s mercury content, limit
consumption to
one can of “white” tuna or two cans of “light” tuna per week
▪ Undercooked
meats, poultry, seafood and hotdogs ▪Deli/luncheon meats and
hotdogs should
be reheated until steaming hot ▪ All foods made with raw or lightly
cooked eggs ▪
Certain soft cheeses ▪ Unpasteurized (raw) milk or juices ▪ raw
sprouts.
As always, it
is important to wash your hands and surfaces often when preparing
food, take
care not to cross-contaminate, refrigerate perishable foods promptly and
cook food to
the proper temperatures.
Heather L. Arel, A.R.N.P.
Q. I’m a smoker. What are my
risks if I’m trying to get pregnant?
A. Smoking is harmful before,
during and after pregnancy. Smoking can make
it more difficult
to become pregnant or cause ectopic (tubal) pregnancy. While
pregnant, there
are risks to an unborn child. Some potential effects are miscarriage,
preterm delivery,
low birth weight or even still birth. In fact, there is a three times
greater risk of
sudden infant death syndrome (SIDS) for babies born to a smoker. The
child is also
more likely to suffer respiratory infections, bronchitis, pneumonia, and
ear infections.
A clinician can
help you make an individualized plan to quit smoking. Your baby
is depending on it
for his or her health.
Heather L. Arel, A.R.N.P.
Q. What is folic acid & why
do I need it before I’m pregnant?
A. Folic acid is a B vitamin. If
women have enough folic acid before pregnancy
it can prevent
birth defects of a baby’s brain or spine. It is recommended that
all women who
could become pregnant take 400 micrograms of folic acid daily.
This could
prevent up to 70% of some types of serious birth defects. To do
this, women need
folic acid at least a month before they become pregnant
through the first
four weeks the baby is growing. Because by the time a
woman finds out
she’s pregnant, her baby’s brain and spine are already formed.
The easiest way
for a woman to get the folic acid they need is through a standard
multivitamin.
Heather L. Arel, A.R.N.P.
Q. How do I keep my bones healthy?
A. Taking care of your bones can help prevent
osteoporosis, a disease
that makes bones
weak, brittle and easy to break. There are simple
steps you can
take to stay strong and active for life.
1. Make
sure you are getting adequate calcium and vitamin D every day. The
recommended daily intake of calcium, for most
people, is 1200 mg and for
vitamin D is 400
I.U. If you are getting too little calcium, through your diet,
talk to your
health care provider about taking supplements.
2. Exercie regularly. The best types are those that have you on your
feet.
3. It is also important to avoid lifestyle habits that harm bone,
such as
smoking and alcohol abuse.
Heather L. Arel, A.R.N.P.
Q. What are menstrual flow
problems in adolescents?
A. The initial two years of
menstruation can be variable. On average, flow
lasts 5 days,
21-40 day interval between flows, and blood loss is about
7 teaspoons. When
blood loss falls outside these parameters, consider:
infections
(STD’s), endocrine problems such as PCOS (increased acne
and hair growth),
anatomic obstructions to vagina, eating disorders,
and pregnancy
complications.
David R. Levene, M.D.
Q. Why is ultrasound performed
during pregnancy?
A. Ultrasound is used to evaluate the growing fetus inside
the mother’s uterus. In a way, it serves
as a type of physical exam of the baby.
It can provide valuable information to you and your health care provider
about your baby’s health and well being. Ultrasound uses sound waves and is safe in
pregnancy. Ultrasound is used to
determine:
Age of the
baby
If the baby
is growing at the correct rate
Location of
the placenta
Fetal
position, movement, breathing and heart rate
Amount of
Amniotic fluid in the uterus
Number of
babies
Detection
of some types of birth defects
Karen Glenny, RTR, RDMS, RDCS
Q. What can I do for
nausea and vomiting of pregnancy?
A. 1. Eat whatever
sounds best to you. Don’t be worried
about a balanced diet at this time.
2. Eat small frequent meals.
3. Avoid getting dehydrated. Drink small amounts of fluids during the day.
4. Avoid stress and fatigue. Try to rest and get plenty of sleep at night.
5. Take your prenatal vitamin with food. If it’s still a problem, try a multivitiamin
or
a
chewable.
Be sure to call your doctor if you are unable to keep fluids
or solids down for a 24 hour period, or if you are losing weight.
Remember-You will feel better soon
David Levene, M.D.
Q. I’m 45 and have
irregular/heavy bleeding but I don’t want to have a hysterectomy,
what are my
alternatives?
A. Hysterectomy can
usually be avoided, as a treatment for irregular or heavy bleeding.
You should be
evaluated for potential anatomic causes such as fibroids, polyps,
overgrowth of
the uterine lining or cancer. Hormone
levels may be assessed. If all
studies are
normal it is considered “dysfunctional uterine bleeding.”
Treatment
include correction the underlying cause (simple procedures to remove
polyps or
fibroids or correction of hormones).
Hormonal treatment with birth control
pills or
progesterone may be considered. An off
lable use of a progesterone IUD
may decrease
bleeding. Another procedure called an
endometrial ablation may also
be performed.
Fletcher R. Wilson, M.D.
Q. I want to get my
tubes tied what should I consider?
A. Tubal ligation
(trying and/or cutting the fallopian tubes of a woman) is a procedure
done in the operating room using a type of
surgery called laparoscopy, which is
operating
through tiny incisions in the abdomen.
The failure rates are generally
considered to be
about 1% lifetime risk. It takes a few
days to a week to fully
recover. One thing to remember about these are they
are considered permanent
procedures and
the regret rates for women who have the procedure when they are less than 25
are as high as 65%. The alternatives are
vasectomy (cutting and tying the vas differens in a man) or the IUD
(intrauterine device), which is the only easily reversible alternative.
Fletcher R. Wilson, M.D.
Q. Why should I get a
pap smear when there is no cancer in my family?
A. Since the advent
of pap smears in the 1940’s cervical cancer has gone form one of the largest
killer of women to one of the least. It
is not a cancer that travels in families.
The cancer is believed to be caused by “high risk” strains of virus
called HPV. The virus is in about 50% of
the population. It is passed most
frequently by intercourse but any sexual contact can transmit it. At this point we have cure for the virus but
we can detect precancer cells on the cervix and thus remove them before they
progress to cervical cancer.
Fletcher R. Wilson, M.D.
Q. Am I the only
woman who leaks urine? Is it treatable?
A. Studies generally
show 25 to 50% of women experience incontinence at some point in their
life. The two major causes in women are
STRESS Incontinence (leaking with laughing, sneezing, running ect.) and URGE
incontinence (where you feel an urgency prior to leaking). Treatment for stress incontinence begins with
exercise like Kegel’s or physical therapy (755 cure rate) and if that fails
possible surgery. Treatment for urge incontinence
usually entails behavior changes, timed voiding, and if that fails sometimes
medications are needed. Don’t suffer,
talk with your healthcare provider.
Fletcher R. Wilson, M.D.
Q. My husband and I
have been trying to conceive for 3 months, should we be
concerned?
A. Infertility is a
condition affecting over five million couples annually. It is defined as the
inability to achieve
pregnancy for a year or more. There are
many factors which may
contribute and a full evaluation should be undertaken
after a year. Approximately 35%
of
infertility can be attributed to underlying female factors, 35% to male
factors, 15% to
both and the remainder is unexplained. In an older women, the work-up may be done
sooner as fertility is known to decline after the age of 35. Improved diagnostic and
therapeutic
approaches have allowed many couples to ultimately achieve pregnancy.
David Levene, M.D.
Q. What are my
options for pain control in labor? I’ve
heard that epidural anesthesia in labor is dangerous.
A. Labor results in
severe pain for many women. There are
many options available to treat such pain.
Some women choose non-pharmacologic approaches, such as walking,showering or laboring in a tub. Other
options include short-acting narcotics and regional anesthesia such as an
epidural or intrathecal. Regional
anesthesia offers the most effective form of pain relief and is generally
considered safe. Most of the
complications associated with epidural anesthesia are preventable or treatable.
David Levene, M.D.
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