Saturday, April 30, 2011

Back Pain

Back injuries and back pain are responsible for more missed workdays than any other non-chronic medical condition. About 80 percent of people experience low back pain at some time in their lives. Pain may occur when someone lifts something too heavy or lifts at the wrong angle causing a sprain, strain, or spasm in the muscles or ligaments of the back. The most common cause of significant back pain is due to muscular strains. A strain is the result of a heavy load or sudden force essentially ripping the muscle tissue or blood vessels. This may also cause bleeding into the injured area. It may take several hours before sufficient bleeding or irritation sets in, delaying the onset of significant pain. If the spine becomes overly strained or compressed, a disc may rupture or bulge outward causing often severe, searing and radiating pain. A strain is an injury to a muscle or tendon and a sprain is an injury to a ligament. As people age, muscle and tendon elasticity decreases and muscle tone diminishes, increasing the risk of back injuries or pain. The vertebral discs will also deteriorate with time, losing fluid and flexibility, decreasing their ability to cushion and protect the vertebrae.

Causes of back pain:
Muscle Spasm: when a muscle goes into spasm, all the fibers within the core of a muscle contract simultaneously. This most commonly occurs when you suddenly move or overextend a tensed-up muscle that hasn't been properly prepared for the movement. Unlike an ordinary muscle cramp that also involves a sudden contraction, a spasm does not easily release and then you can't move.
Muscle Strain: is damage in the form of tearing of the muscle fibers and the tendons attached to the muscle. The tearing of the muscle can also damage small blood vessels causing local bleeding.
Ligamentous Sprain: occurs when the ligaments of the back are stretched beyond their means. The ligaments can, in some cases, can completely tear. It is common to have both ligament sprains and muscle strains occurring together, especially the case of trauma such as motor vehicle accidents.
Degenerative Disc Disease (Osteoarthritis): is a natural part of aging and over time everyone will  exhibit degenerative changes in their discs. Without this cushion, the bones begin to rub against each other, resulting in inflammation, swelling and stiffness, that in turn cause back pain.
Osteoporosis:  is where the bone mineral density (BMD) is reduced and the bone is deteriorating, leading to a stooped posture, putting more stress on the back muscles causing  pain. This also results in making one more susceptible to vertebral compression fractures, or broken bones.
Bulging Disc: occurs when one of the vertebral discs develops a weak spot and spreads out beyond its normal perimeter, compressing the spinal nerves.
Herniated Disc: is a tear in the outer, fibrous ring of a vertebral disc allows the soft central portion to bulge out, compressing the spinal nerves, causing severe and radiating pain. They are often the result of repetitive motion or due to a sudden heavy load on the back.
Sciatica: is pain that is caused by the compression and/or irritation of one the spinal nerves that give rise to the sciatic nerve. This is often caused by a herniated disc.
Spinal Stenosis: is a narrowing of one or more areas in your spine, most often in your neck or lower back. This narrowing can put pressure on the spinal cord or spinal nerves causing pain. It occurs more commonly in people over 50 years old. Spinal stenosis has many causes including thickened ligaments along the spinal canal, bony spurs, and enlarged joint cartilage from arthritic changes. This condition often results in back pain that is worse with extended periods of weight bearing or walking.
Facet Syndrome: is a low back pain attributed to osteoarthritis of the spinal facets (the small joints joining the vertebrae in the spine).
Bone Cancer: may be a primary or a metastatic cancer causing pain in the bone itself or from compression on the nerves.
Fibromyalgia: is a common cause of chronic back pain. It is a condition characterized by widespread pain, fatigue, sleep disturbances and evenly distributed areas of tenderness. A history of at least three months of widespread pain and tenderness in eleven or more of the eighteen designated tender point sites is required in diagnosing this disorder.

Preventing back pain:
Back strengthening exercises.
Weight management.
Stretch before you workout.
Don't over do it.
Wear proper footwear.
Warm up properly before activities.
Stretch before rising.

Initial therapy:
Ice and heat: as soon as possible apply a cold pack or a cold compress to the tender spot multiple times a day for 20-30 minutes. After 2 to 3 days of cold treatment, then apply heat (such as a heating lamp or heating pad) to relax muscles and increase blood flow.
Bed rest: for a few days at most. A Finnish study found that persons who continued their activities following the onset of low back pain appeared to have better back flexibility and decreased pain. Other studies suggest that bed rest alone may make back pain worse and may lead to a higher risk of depression.
Exercise: may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles. Maintaining and building muscle strength is particularly important for people with scoliosis and osteoporosis.  A routine of back strengthening and stretching exercises, swimming or movement will improve coordination and posture. Yoga is another way to gently stretch muscles and ease pain.

Over-the-counter analgesics: including non steroidal anti-inflammatory drugs (naproxen, and ibuprofen...) to reduce stiffness, swelling, and inflammation. Topical analgesics can also reduce inflammation and stimulate blood flow. Many of these compounds contain aspirin.
Antidepressants: particularly tricyclic antidepressants such as amitriptyline (Elavil) have been shown to relieve pain (independent of their effect on depression) and assist with sleep. Antidepressants alter levels of brain chemicals to elevate mood and dull pain signals. Many of the new antidepressants, such as the selective serotonin reuptake inhibitors (SSRIs) are also being used.
Opioids: such as codeine, oxycodone, hydrocodone, and morphine are often prescribed to manage severe acute back pain, but should be used only for a short period of time. Side effects can include drowsiness, decreased reaction time, impaired judgment, and the potential for addiction. Chronic use of opioids may be detrimental adding to depression and even increasing pain.
Muscle relaxants: refers to two major groups, the neuromuscular blockers and spasmolytics. Neuromuscular blockers act by interfering with nerve transmission in the muscles. Spasmolytics are also used to alleviate musculoskeletal pain and spasms by reducing brain stimulation to the muscles.

Natural Therapies for Back Pain:
Acupuncture: Acupuncture has been shown to have comparable success rates when compared to traditional therapies.The National Institutes of Health now recognizes acupuncture as an acceptable alternative to conventional therapies for low back pain.
Therapeutic Yoga: Yoga can help relieve pain and protect against recurrences by increasing your strength and flexibility and decreasing the tightness that may cause many types of back pain. It also can decrease stress, balance the nervous system and promote flexibility, all of which can help improve back pain.
Spinal Manipulation: Practitioners perform spinal manipulation by using their hands or a device to apply force to the spine, moving it beyond its normal range of motion, thereby decreasing muscle tension.
Biofeedback: Using a special electronic machine, one is trained to become aware of and to gain control over muscle tension, then learn to change in his or her response to the pain by using relaxation techniques.

Other options:
Transcutaneous electrical nerve stimulation (TENS): is a battery-powered device that sends mild electric signals along nerve fibers to block pain signals to the brain. Small electrodes placed on the skin at or near the site of pain generate nerve impulses that block incoming pain signals from the peripheral nerves through what is called the gate theory.
Ultrasound: is used to warm the body’s  muscles causing them to relax. Sound waves pass through the skin and into the injured muscles and other soft tissues improving blood flow and decreasing muscle spasm.
Interventional therapy (Epidural Steroid Injections, ESI): can ease chronic pain by using medications to block the nerves causing the pain. Options include injections of local anesthetics, steroids, or narcotics into the nerve roots or below the spinal cord.

Surgical therapy:
Discectomy: is a common procedure to remove pressure on a nerve from a bulging or herniated disc. During the procedure the surgeon removes the disc material that presses on a nerve root or the spinal cord.
Foraminotomy: is an procedure that enlarges the hole (foramen) where a nerve root exits the spinal canal. Bulging discs or joints thickened with age can cause narrowing of the space through which the spinal nerve exits and can press on the nerve, resulting in pain, numbness or weakness.
IntraDiscal Electrothermal Therapy (IDET): uses heat treat pain resulting from a bulging disc. A special needle is inserted into the disc and heated to a high temperature reducing the disc bulge and irritation of the spinal nerve.
Nucleoplasty: uses radiofrequency energy to treat mildly herniated discs. A wand-like instrument is inserted through a needle into the disc to create a channel that heats and shrinks the tissue, sealing the disc wall.
Radiofrequency lesioning: is a procedure using electrical impulses to interrupt the nerve conduction of pain signals for up to a year. The tissues surrounding the needle tip are then heated  60 to 120 seconds, numbing the nerves.
Spinal fusion: is a complex procedure used to strengthen the spine and prevent painful movements. The spinal disc(s) between two or more vertebrae is removed and the adjacent vertebrae are fused with bone grafts and/or metal plates. Spinal fusion will result in some loss of flexibility and requires a long recovery period.
Spinal laminectomy (spinal decompression):  the most common type of surgery done to treat spinal stenosis, involves the removal of parts of the vertebrae and/or thickened tissue that is narrowing the spinal canal and squeezing the spinal cord and nerve roots.

Friday, April 29, 2011

Testing For Heart Health

These tests are a little more in depth for evaluating heart health.

Cholesterol: A normal level is less than 200mg /dl and optimal is around 150 mg/dl. Cholesterol is an essential fatty acid used for cell wall formation, the production of certain hormones and vitamins such as A, D, E and K.   

HDL: High Density Lipoprotein levels, called thegood cholesterol”, should be greater than 50mg/dl. These little proteins will help break up the dangerous plaque in the blood stream responsible for heart disease.

LDL: Low Density Lipoproteins, also called “bad cholesterol” should be less than 100. These proteins will help to form the dangerous responsible particles for plaque formation and heart disease.

Triglycerides:  A normal level is less than 200mg/dl and optimally less than 150 mg/dl. Triglycerides in high levels are linked to hardening of the arteries and therefore strokes and heart attacks. High carbohydrate diets can, surprising to many, increase your triglyceride levels.

Glucose: Fasting level should be 100mg/dl or less. High levels are responsible for type 1 or type 2 (most common) diabetes.

Fasting Insulin: The normal range is 5 to 25 IU/ml and optimal levels are around the 5 IU/ml range.

Homocysteine:  You may want to check homocysteine levels if you have heart issues and no other risk factors. This amino acid is a powerful predictor for heart disease when over 10 micro mol/L. The normal range is between 4 and 10 micro mol/L and the optimum level is below 7 micro mol/L. Vitamins B6, B12 and folic acid as well as regular exercise have been shown to lower homocysteine levels.

C Reactive Protein: A normal CRP level is up to 10mg/L. An optimal level is less than 2mg/dl. CRP is simply a protein which is elevated in response to an inflammatory process. This may include heart disease, high blood pressure and diabetes as well as infections and the like.

Brain natriuretic peptide (B-type natriuretic peptide, BNP): A peptide (protein) produced by the heart and blood vessels which helps the body to eliminate sodium and fluids and relax blood vessels. A damaged heart secrets a high level of BNP to help ease the strain in the heart.   

Wednesday, April 27, 2011

Brain Food and Supplements

Your brain needs simple sugars (glucose) to function properly, and it likes them in a constant, steady supply. The brain does not like extreme swings in glucose levels, caused by eating things such as simple carbohydrates (processed and sugary foods, "white foods"). These foods cause a surge of glucose into the bloodstream, triggering a release of insulin, which then leads to a drop in sugar levels (hypoglycemia). This will then cause the release of adrenal hormones (cortisol), sending blood sugar levels back up again. These fluctuations will decrease the level of functioning in the brain. High protein, low carbohydrate foods improve brain function and include seafood, lean meats, eggs, soy, and dairy. Conversely, high carbohydrate, low protein foods, which diminish brain function, include: desserts and pastries and starches such as breads or pastas.

Proteins are important because they provide the amino acids to make neurotransmitters (which carry the signals in the brain). The amino acids tryptophan and tyrosine are the building blocks for the neurotransmitters norepinephrine, serotonin and dopamine. Tryptophan is an essential amino acid and must be obtained from the diet; where as, tyrosine is not an essential amino acid because the body can make what it needs. Omega-3 fatty acids are also essential for brain function and development; they help make the cell membranes that allows the neurons to work properly. Omega-3′s are essential and are not made by the human body; you have to get them through food sources and supplements.

In general, the "healthy foods" are best for the brain. This includes foods rich in omega-3s, vitamins, minerals, and antioxidents. This type of diet is considered an "anti-inflammatory" diet. Inflammation is seen as a primary catalyst behind many illnesses such as Alzheimer’s, cardiovascular disease, diabetes, dementia and other diseases affecting memory and brain function (as well as general health). Antioxidants, in general, improve the body’s defense mechanisms and tend to slow down the aging process.

And lastly, exercise your brain to keep it active and growing. This spurs the development of new nerve connections which help to improve memory and function. By developing new mental skills, especially complex ones challenging your brain (with puzzles and games...), you will keep your brain active and greatly improve its functioning. Consider things such as crosswords, Sudoku, and other games which challenge you on a daily basis.

Supplements for the brain:
 Omega-3s: are highly concentrated in the brain and are important for memory and brain performance.
 Pregnenolone: thought to improve mental function, especially memory and attention.
 Folic acid: helps the brain is by decreasing the amount of homocysteine (inflammatory) produced in  
 the body.
 Vitamin B12: helps maintain healthy nerve cells and red blood cells.
 Vitamin D: low levels appear to be associated with dementia and decreased cognitive function.
 Vitamin E: helps keep the brain oxygen levels elevated.
 CoQ10: is a potent antioxidant and helps produce the energy for brain cells.
 Gotu Kola (Centella asiatica): improves blood flow to the brain.
 Phosphatidyl serine: increase and enhance the communication between brain cells.
 5-HTP (5-Hydroxytryptophan):  is converted directly into the neurotransmitter serotonin in the brain.
 Tyrosine: is converted into the neurotransmitters dopamine and norepinephrine.

Good Brain Foods:
 Acai berries
 Brown rice
 Brussels sprouts
 Dark chocolate
 Flaxseed oil
 Green Tea
 Lean beef
 Peanut butter
 Pumpkin seeds
 Red cabbage
 Red grapes
 Romaine lettuce
 Rice bran
 Wheat germ

Bad brain foods: (and additives)
 Artificial food coloring (red dye 40...)
 Artificial sweeteners
 High glycemic foods ("white foods")
 Colas (especially non-diet)
 High fructose corn syrup
 Partially hydrogenated foods
 Junk foods

Monday, April 25, 2011

Stress Management

The term stress was first coined in the 1930s, referring to the ability of an individual to respond appropriately to emotional or physical threats. Basically, stress is considered any outside force that has an effect on our body or mind. Stress is considered normal and even useful, helping you to work hard or react quickly; however, chronic stress may have a significant effect on your body (and mind) possibly leading to longer term issues. The important thing is to recognize the long term effects and seek help if the stress level becomes unmanageable. These days it seems like our society breeds stress at every level (and no one is immune), especially in these economic times.

Effects of stress ...(from the Mayo Clinic)
... On your body... On your thoughts and feelings... On your behavior
  • Headache
  • Back pain
  • Chest pain
  • Heart disease
  • Heart palpitations
  • High blood pressure
  • Decreased immunity
  • Stomach upset
  • Sleep problems
  • Anxiety
  • Restlessness
  • Worrying
  • Irritability
  • Depression
  • Sadness
  • Anger
  • Feeling insecure
  • Lack of focus
  • Burnout
  • Forgetfulness
  • Overeating
  • Under eating
  • Angry outbursts
  • Drug or alcohol abuse
  • Increased smoking
  • Social withdrawal
  • Crying spells
  • Relationship conflicts

Ways to improve stress:
Learn to say "no."
Learn better ways to manage your time; make a schedule and prioritize.
Find better ways to cope (don't rely on drugs or alcohol,they just prolong the issues).
Look at how you have been dealing with stress and be honest with yourself.
Think about how things might work better.
Take care of yourself; get plenty of rest, eat well, and please don't increase smoking.
When you find yourself starting to worry, try to rationalize.
Take a night to "sleep on" the situation causing stress.
Let go of things you cannot change.
Talk about your needs and concerns. This approach improves stress and can improve negative feelings.
Take a deep breath and count to ten in a stressful situation.
Keep a diary listing the negatives and what it will take to make them into positives.
Ask for help. People who have a strong network of family and friends will usually manage stress better.
Learn ways to relax, consider breathing exercises, massage or yoga.
Exercise, participate in a sport or engage in fun activities.
Consider medication if the symptoms continue to worsen.

Prescription medications for stress:
Anti-anxiety medications: includes the benzodiazepines Xanax, Valium, Ativan, Librium and Klonopin. Buspar is another anti-anxiety medication that has a different way of working and does not have the sedation or addiction concerns.
Antidepressants: primarily includes the SSRIs (Prozac, Zoloft, Paxil, Lexapro and Celexa) and the SNRIs (Pristiq, Effexor, Cymbalta).
Beta blockers: limit the "fight or flight" response to stress, helping to control physical symptoms of stress. Most commonly used are Inderal and Tenormin.

Natural therapies for stress:
Adaptogens: herbal products and vitamin supplements believed to increase resistance to stress, trauma, anxiety and fatigue
5-Hydroxytryptophan (5-HTP): an amino acid needed to produce serotonin, a natural antidepressant.
Melatonin: a natural hormone which improves sleep and well being.
Kava Kava: a supplement known for relaxing and anesthetic properties.
St-Johns-Wort: commonly used as an herbal treatment for depression.
Inositol: is considered a mood stabilizer.
Magnesium: may help due to the belief that a magnesium deficiency can lessen depression, anxiety and elevated stress.

Saturday, April 23, 2011

Pregnenolone Supplementation and Memory

Pregnenolone is an adrenal hormone produced from cholesterol and is a precursor for the following steroid hormones: androstenedione, dehydroepiandrosterone (DHEA), estrogen, progesterone, and testosterone. Because pregnenolone is the precursor (first in the making of) of these hormones, it has been suggested that boosting the body’s pregnenolone levels through supplementation will offer the same health benefits as taking the hormone supplements individually. There are a number of studies purporting that pregnenolone may offer some of the same benefits as DHEA and hormone replacement therapy (HRT).

Pregnenolone is thought to improve issues such as mental function, especially memory and attention, mood disorders, PMS, arthritis,and stress. It has been reported to help slow the symptoms of mental and physical decline that are a natural part of aging. Pregnenolone has also been used for the treatment of arthritis since the 1940's, when it was first discovered to be effective against joint swelling and inflammation.

Pregnenolone may help:
 Memory (most common use)
 Clarity of thinking,
 Mood disorders
 Sexual function
 Weight loss
 Hot flashes (Menopause)
 Premenstrual symptoms (PMS)

Since both DHEA and pregnenolone have similar effects, you should lower your dose of DHEA if you start pregnenolone and vice versa. Before you add one or the other, make sure you try them separately to see what kind of effect they may have. The amount of conversion of pregnenolone to other steroid hormones is not fully known and taking too much pregnenolone could theoretically upset your hormonal balance leading to unwanted side effects such as breast enlargement (estrogen effect or hair loss (testosterone effect) in men or facial hair in women (testosterone effect).

The dosage generally used for pregnenolone is 50 mg/day, while arthritis sufferers typically use up to 500 mg daily. Side effects include headaches, over-stimulation, insomnia, anxiety and irritability, especially with higher doses. There is a more dangerous side effect, especially at higher doses, heart palpitations. The American Cancer Society also reports that pregnenolone use may increase the risk of liver problems, breast and prostate cancer; although I am not aware of a study proving this, use with caution. A single daily dose in the morning is probably best, since pregnenolone is fat-soluble (absorbed with fat in the diet) and follows the (circadian) highs and lows of cortisol (highest in the morning).  

Friday, April 22, 2011

What Are Intergrative, Complementary and Alternative Medicine?

Integrative Medicine is the combination of alternative and complementary medicine, which have some scientific proof of efficacy and an emphasis on prevention, with conventional medicine. Alternative Medicine is any healing practice that does not fall within the realm of conventional medicine and is frequently grouped with Complementary Medicine; which generally refers to the same interventions when used in conjunction with mainstream techniques. The term Complementary and Alternative Medicine (CAM) is commonly used (instead of Integrative Medicine) and includes: herbalism, chiropractic medicine, traditional Chinese medicine, meditation, yoga, biofeedback, hypnosis, acupuncture, vitamin supplementation and nutritional-based therapies. Defining CAM can be difficult because the field is very broad.

Types of CAM:
1. Alternative Medical Systems
 Naturopathic medicine
 Tibetan medicine
 Traditional Chinese medicine

2. Mind-Body Interventions
 Art therapy
 Biofeedback Dance therapy
 Guided imagery
 Humor therapy
 Music therapy

3. Biologically-Based Therapies
 Diet modifications
 Dietary supplements
 Herbal products
4. Manipulative and Body-Based Methods
 Alexander Technique
 Massage therapy
5. Energy Therapies
 Qi gong

 Therapeutic Touch

Be aware that some forms of alternative medicine can be dangerous when used in conjunction with conventional medicine. Examples include immuno-augmentation therapy, shark cartilage, bioresonance therapy, oxygen and ozone therapies and insulin potentiation therapy. Some herbal remedies can cause dangerous interactions with chemotherapy drugs, radiation therapy, anesthetics or promote significant bleeding problems during surgery. Please list all herbal and dietary supplements along with convention medications when visiting your physician or preparing for a surgical procedure.

Thursday, April 21, 2011

Muscular Dystrophy and Testosterone Therapy

Muscular dystrophy (MD) refers to a group of inherited muscle diseases that progressively weaken muscles over time. Muscular dystrophies are characterized by skeletal muscle weakness, defects in muscle proteins, and the death of muscle cells. The onset may occur in childhood or has an adult. There is no known cure for muscular dystrophy. These conditions are inherited, and the different muscular dystrophies follow various inheritance patterns. The main cause of Duchenne and Becker types of muscular dystrophy is the inability to properly create the protein dystrophin.

Types of MD:
 Myotonia congenita
 Myotonic dystrophy

Symptoms of MD include:
 Progressive muscle weakness
 Delayed development of muscle motor skills
 Difficulty using one or more muscle groups
 Problems walking or delayed walking
 Decreased mobility
 Loss in muscle size
 Muscle contractures
 Loss of strength
 Lung failure
 Eyelid drooping (ptosis)
 Frequent falls 

The diagnosis of muscular dystrophy is based on the results of a muscle biopsy and increased levels of creatine phosphokinase (CpK3). In many cases, a DNA blood test may give the diagnosis. A physical examination and the patients medical history will also help determine the type of muscular dystrophy.

While there is no specific treatment for any of the forms of muscular dystrophy, testosterone therapy has been used with success in some men for a number of the symptoms of MD. I have seen improvements in some symptoms such as strength and tremors, in my own office, with testosterone supplementation in a limited number of individuals. Physical therapy, occupational therapy, speech therapy and aids such as wheel chairs or walkers may also be helpful. Medications such as quinine, phenytoin, or mexiletine may also be used for myotonia (delayed muscle relaxation after a contraction) occurring in myotonic muscular dystrophy.

Low Thyroid and The Baby Blues

Postpartum Blues and Postpartum Depression are relatively common. The Baby Blues are a mild and transitory moodiness suffered by up to 75% of new mothers in the days after delivery. Most new mothers experience a feeling of “let down” after childbirth, especially when they are alone at home with the child. Symptoms may include sadness and crying for no apparent reason, irritability, frustration, moodiness and a of feeling dependence on others. These symptoms are generally transient and usually disappear within a few weeks.                

Postpartum depression, less common and more severe occurs in 10% of new mothers. Symptoms can begin during pregnancy, right after delivery or appear anytime during the first year. A woman may have postpartum depression if her depressive symptoms do not go away within a few weeks after giving birth. A new theory has emerged recently; which is that postpartum depression may be linked to low thyroid levels. Even women that have never had thyroid problems prior to pregnancy may experience them postpartum.

Postpartum depression symptoms:
 Feeling sad or depressed
 Crying for no apparent reason
 Lack of energy
 Loss of appetite or overeating
 Severe fatigue or total exhaustion
 Changes in sleep pattern
 Lack of motivation
 Difficulty concentrating or focusing
 Sleeping too little or too much
 Feeling hopeless, helpless or worthless
 Feelings of guilt
 Feelings of not being a good mother
 Lack of interest in the baby
 Lack of concern or being overprotective towards the baby
 Thoughts of hurting herself or baby
 Headaches, chest pains, heart palpitations, numbness or hyperventilation
 Feeling restless, irritable or “on edge”

A new study from Greece has shown that even when thyroid hormone levels are within the normal range during early pregnancy, the levels may change after childbirth and may be associated with significant mood disturbances. Lower antenatal levels of thyroid hormones were associated with maternity blues in the days following delivery. The results are consistent with two prior studies in the U.S. The new belief is that thyroid hormone levels should be measured throughout pregnancy, especially in the third trimester. And women found to have lower levels of thyroid hormones should be monitored more closely and possibly treated with thyroid hormone. Hypothyroidism, in general, has been associated with depression and mood disorders.

The bottom line is that thyroid levels should be checked in mothers who exhibit post partum symptoms, and possibly in all women during the third trimester or post partum.They may want to consider thyroid therapy if their levels are "borderline" and they have depressive symptoms.

Wednesday, April 20, 2011


Endometriosis is a condition in which endometrial type cells are found outside the uterine cavity. These cells grow around the uterus, on the ovaries and occasionally outside the pelvis. Endometriosis is influenced by the female hormone estrogen; and may cause significant symptoms including pelvic pain, pain with menses or intercourse and problems with fertility. Endometriosis is typically seen during the reproductive years and has been estimated to occur in roughly 7% of women. The most common age of diagnosis is in the early to mid twenties.

Endometriosis lesions react to hormonal stimulation (estrogen) and may "bleed" at the time of menses. The blood accumulates locally, causes swelling, and triggers inflammatory responses with the activation of what are called cytokines. This process may cause an "inflammatory" type pain. Pain can also occur from adhesions (scar tissue). Fallopian tubes, ovaries, the uterus, the bowels, and the bladder can be bound together in ways that are painful on a daily basis, not just during menstrual periods. Also, endometriotic lesions may also develop their own nerve supply, thereby creating a direct and two-way interaction between lesions and the central nervous system, potentially producing a variety of individual differences in pain. The main complications of endometriosis are pain and impaired fertility. Approximately one-third to one-half of women who have endometriosis have difficulty getting pregnant. Endometriosis may obstruct the tube and keep the egg and sperm from uniting. 

Most common symptoms of endometriosis:
Pelvic pain: is the most common symptom of endometriosis. It is typically a recurring or cyclic pain; however, it may be of a chronic nature and the quality can be mild to severe. The character of the pain may be a cramping or burning type that occurs in the pelvis, the lower back and occasionally in the rectum or down the legs. The amount of pain a woman feels correlates poorly with the extent or stage of endometriosis.
Dysmenorrhea: painful, crampy periods which may get worse over time.
Dyspareunia: pain with sexual activity, especially in the "missionary position".
Dysuria: pain with urination, urgency or frequency.

Other symptoms may include:
 Chronic fatigue
 Heavy or long menstrual periods
 Gastrointestinal issues (diarrhea or bloating)
 Pain in legs and thighs
 Back pain
 Pain in rectum
 Premenstrual spotting

Theories of Endometriosis:
Retrograde menstruation: suggests that a woman's menstrual flow is retrograde (or backwards) and some of the endometrial debris exits the uterus through the fallopian tubes and attaches itself to the peritoneal surface (the lining of the abdominal cavity). The endometrial tissue then implants on the peritoneal linings and establish itself as endometriosis.
Müllerianosis: another theory states that cells with the potential to become endometrial tissue are laid down during embryonic (fetal) development. This theory is supported by fetal autopsies.
Coelomic Metaplasia: this theory is based on the fact that the peritoneal (abdominal) tissue is the common ancestor of endometrial cells and the belief is that the tissue changes from one type of cell to the other. This theory is supported by laboratory observation of this transformation.
Genetics: it is well known that daughters or sisters of patients with endometriosis are at a higher risk of developing endometriosis. There is an about 10-fold increased incidence in women with an affected first-degree relative.
Transplantation: It is known that endometriosis can spread directly. Thus endometriosis has been found in abdominal incisional scars after surgery for endometriosis. It can also grow invasively into different tissue layers. On rare occasions endometriosis may be transplanted by blood into organs such as the lungs and brain.
Immune system: Research is focusing on the possibility that the immune system may not be able to cope with the onslaught of retrograde menstrual fluid. In this context there is interest in studying the relationship of endometriosis to autoimmune disease and allergic reactions.

Diagnosis: (there are no blood tests to detect endometrosis)
Pelvic exam. During a pelvic exam, your doctor manually feels areas in your pelvis for abnormalities or painful areas. Often it's not possible to feel small areas of endometriosis.
Ultrasound.  Uses sound waves to provide a video image of your reproductive organs. Ultrasound imaging won't definitively tell whether you have endometriosis, but it is a useful tool for identifying cysts associated with endometriosis (endometriomas).
Laparoscopy. The only way to know for certain that you have endometriosis is by looking inside your abdomen for signs of endometrial implants. This is accomplished during a minor surgical procedure placing a scope in the abdomen.

Contraceptive agents: birth control pills help control the hormones responsible for the buildup of endometrial tissue each month. Most women have lighter and shorter menstrual flow when they're using a hormonal contraceptive. Continuous cycle pills can reduce or possibly eliminate the pain of mild to moderate endometriosis.
Gonadotropin-releasing hormone (Gn-RH) agonists (Leupron and Synarel): These drugs block the production of ovarian-stimulating hormones, therefore estrogen. This action prevents menstruation and dramatically lowers estrogen levels, causing endometrial implants to shrink sometimes for months or years afterward. These drugs create an artificial menopause that can sometimes lead to troublesome side effects, such as hot flashes and vaginal dryness.
Danazol: Another drug, rarely used. that blocks the production of ovarian-stimulating hormones, preventing menstruation and the symptoms of endometriosis, is danazol. In addition, it suppresses the growth of the endometrium. It can cause unwanted side effects, such as acne and facial hair.
Medroxyprogesterone (Depo-Provera): This injectable drug is effective in halting menstruation and the growth of endometrial implants, thereby relieving the signs and symptoms of endometriosis. Its side effects can include weight gain, decreased bone production and depressed mood.
Aromatase inhibitors (Famara): Although not specifically approved for the treatment of endometriosis, studies suggest that aromatase inhibitors may significantly reduce endometriosis-related pain. Aromatase inhibitors work by blocking the conversion of hormones such as androstenedione and testosterone into estrogen and by blocking the production of estrogen from endometrial implants themselves. This deprives endometriosis of the estrogen it needs to grow. To reduce the risk of side effects, such as bone loss and follicular cysts, aromatase inhibitors must be taken in combination with a Gn-RH agonist or an oral estrogen-progestin contraceptive.
Laparoscopy: this procedure is done both to diagnose endometriosis and to treat it. Operative laparoscopy may be done to remove implants and scar tissue.

    Monday, April 18, 2011

    Thyroid Cancer and X-Rays

    The thyroid is a small, butterfly-shaped gland located in the front of the neck and is part of the endocrine system which produces and regulates hormones. The thyroid makes the hormones thyroxine (T4) and triiodothyronine (T3) which control the body's heart rate, blood pressure, temperature, metabolism. The thyroid also contains cells which make the hormone calcitonin which helps regulate calcium. While thyroid cancer isn't common in the U.S.(about 40,000 people are diagnosed each year), the rate of diagnosis has risen steadily in recent years. This is probably due to improved detection of smaller tumors with high tech imaging. Unlike many other types of cancer, thyroid cancer occurs in a younger group, usually between the ages of 25 and 50. Most people with thyroid cancer will undergo surgery (thyroidectomy) to remove all or most of the thyroid.

    There has been a lot of discussion recently about the risk of thyroid cancer with either dental x-rays or mammograms. The risk with mammograms is considered extremely low and the use of a thyroid guard (a simple guard around the neck) may obscure part of the image. For this reason, experts (radiologists) do not recommend routine use of thyroid guards during mammos. The guard may also necessitate repeating the test, thus doubling the dose of radiation. Dental x-rays are much different in that the thyroid will receive a higher (albeit still relatively low) dose of radiation, repeated more often and are done at a much earlier age. For this reason, a thyroid guard seems to make sense.

    Types of thyroid cancer :
    Papillary thyroid cancer: this type of thyroid cancer is the most common, making up about 80 percent of all thyroid cancers and is most commonly diagnosed in the 30s and 40s.
    Medullary thyroid cancer: uncommon, sporadic, originates from the C cells and is associated with inherited genetic syndromes that include tumors in other glands. The average age is around 50.
    Follicular thyroid cancer: includes Hurthle cell cancers and typically occurs in slightly older people (50+).
    Anaplastic thyroid cancer: is very rare, aggressive and very difficult to treat and occurs in people age 60+.
    Thyroid lymphoma: is very rare, begins in the immune system cells of the thyroid and occurs most often in adults age 70+.

     A lump that can be felt on your neck.
     Changes to your voice, increasing hoarseness.
     Difficulty swallowing.
     Pain in your neck or throat
     Swollen nodes in your neck.

    Risk factors;
    Exposure to high levels of radiation: such as radiation treatment to the head and neck for other diseases or nuclear accidents.
    Family history of goiter: a goiter is a noncancerous enlargement of the thyroid.
    Certain inherited genetic syndromes:  include familial medullary thyroid cancer, multiple endocrine neoplasia and familial adenomatous polyposis.

    Consider using a thyroid guard for dental x-ray imaging, especially in children. The use of one in mammograms may obscure the image and require another dose of radiation. If you have a higher risk factor, then using a guard for mammos makes sense. 

    Sunday, April 17, 2011

    Cooking Oils 101

    Cooking oil is purified fat of plant origin, which is usually liquid at room temperature. The oil you use should have a high smoke point, the temperature to which it can be heated without smoking. This is important because heating oil above its smoke point, causes the oil to smoke which produces fumes and harmful free radicals. The general rule is: the more refined the oil, the higher its smoke point. The best oils for frying are probably peanut, sunflower, safflower and soy. The healthiest oils are the ones with higher levels of unsaturated fats and lower levels of saturated fats. Try to limit the saturated fats and omit anything hydrogenated.

    Here is a list of the commonly used oils and how they are used:

    Avocado Oil: Pressed from avocados, it is more than 50% monounsaturated and Vitamin E, making it heart-healthy. Refined avocado oil has the highest smoke point of any plant oil, making it suitable for quick searing of food in very hot oil. It is commonly used in salad dressings and to saute fish or chicken.
    Canola Oil: Canola oil is one of the healthiest and most versatile cooking oils available. Canola oil is high in healthy unsaturated fats, free of cholesterol and trans fat, and the lowest in saturated fat of any common edible oil. It has known heart health benefits, has a beneficial omega-3 fatty acid profile and is perfect for light cooking, sauces, stir-frying, baking, salads, marinades and desserts.
    Coconut Oil: Pressed from the fruit of the coconut tree, coconut oil is used for light fair and lightly flavored dishes. Coconut oil is high in saturated fats and should be used sparingly. This oil has been used for many years to make popcorn and it gives movie theaters its distinctive smell.
    Corn Oil: Most corn oil is golden yellow in color; unrefined oil will have a darker color and richer corn taste. Corn oil has a high smoke point and a fair health profile; it is the most popular frying oil used for cooking french fries at major fast food outlets. This oil is primarily used in salad dressings and dips with stronger flavors such as garlic.
    Grapeseed Oil: Grapeseed oil has a relatively high smoke point, so it can be safely used for preparing foods at high temperatures. You can use grapeseed oil for stir frying or sauteing, on salads or in dips, sauces and salsas.
    Olive Oil: Olive oil contains predominately monounsaturated fat. Extra virgin olive oil comes from virgin oil production only, contains no more than 0.8% acidity, and is judged to have a superior taste. It is used on salads, soups and stews and at the table for dipping.
    Peanut Oil: Peanut oil is relatively high is unsaturated fats. Peanut oil is superior for frying, light sauteing and stir-fries due to its very high smoke point. It is a common oil during the Thanksgiving holiday as many people use it in turkey fryers. Peanut oil is commonly used in Asian foods.
    Safflower oil: A clear, almost flavorless all-purpose oil low in saturated fat and high in polyunsaturated fat.  Two different kinds of safflower oil are produced: 1) high in the monounsaturated fatty acid, oleic acid. It is used for heat stable cooking like deep frying and 2) high in the polyunsaturated fatty acid (PUFA), Cacid. It is good when used as salad dressings, soft margarine and as a nutritional (linoleic) supplement. PUFAs are fragile and can quickly turn rancid. So it is best when used and kept cold. Safflower oil is a favorite for salads because it doesn't solidify when chilled and has a bland flavor. Safflower oil is also used in hair care products and moisturizers.
    Sesame Oil: Light sesame oil has a high smoke point, a high antioxidant content and is generally used for deep-frying; dark sesame oil (from roasted sesame seeds) has a slightly lower smoke point and is commonly used for the stir-frying meats and vegetables, Asian sauces and dips.
    Sunflower Oil: This oil is typically used for frying and is considered healthier than most fatty oils based on its low trans fat and saturated fat content. It is light in taste, and sunflower oil provides more Vitamin E than all other vegetable oils. Sunflower oil also works as a protective and moisturizing solution for the skin.
    Soy Bean Oil: Soybean oil is low in saturated fat, contains no trans fat, and is high in poly and monounsaturated fats. It's also the principal source of omega-3 fatty acids in the U.S. diet, and the primary commercial source of vitamin E as well. Soy Bean Oil is superior for frying due to its high smoke point.

    Here are the specifics on some common oils:

    Type of oil
    SaturatedMonounsaturatedPolyunsaturatedSmoke pointUses
    Almond8%66%26%221 °C (430 °F)Baking, sauces, flavoring
    Avocado12%74%14%271 °C (520 °F)Frying, sauteing, dipping oil, salad oil
    Butter66%30%4%150 °C (302 °F)Cooking, baking, condiment, sauces, flavoring
    Ghee, clarified butter65%32%3%190–250 °C (374–482 °F)Deep frying, cooking, sauteing, condiment, flavoring
    Canola oil6%62%32%242 °C (468 °F)Frying, baking, salad dressings
    Coconut oil92%6%2%177 °C (351 °F)Commercial baked goods, popcorn, candy and sweets, whipped toppings, nondairy coffee creamers, shortening
    Rice bran oil20%47%33%254 °C (489 °F)Cooking, frying, deep frying, salads, dressings. Very clean flavoured & palatable.
    Corn oil13%25%62%236 °C (457 °F)Frying, baking, salad dressings, margarine, shortening
    Cottonseed oil24%26%50%216 °C (421 °F)Margarine, shortening, salad dressings, commercially fried products
    Grape seed oil12%17%71%204 °C (399 °F)Cooking, salad dressings, margarine
    Hemp oil9%12%79%165 °C (329 °F)Cooking, salad dressings, ...
    Lard41%47%2%138–201 °C (280–394 °F)Baking, frying
    Margarine, hard80%14%6%150 °C (302 °FCooking, baking, condiment
    Mustard oil13%60%21%254 °C (489 °F)Cooking, frying, deep frying, salads, dressings. Very clean flavoured & palatable.
    Margarine, soft20%47%33%150–160 °C (302–320 °F)Cooking, baking, condiment
    Diacylglycerol (DAG) oil3%38%59%215 °C (419 °F)Frying, baking, salad oil
    Olive oil (extra virgin)14%73%11%190 °C (374 °F)Cooking, salad oils, margarine
    Olive oil (virgin)14%73%11%215 °C (419 °F)Cooking, salad oils, margarine
    Olive oil (refined)14%73%11%225 °C (437 °F)Sauteing, stir frying, cooking, salad oils, margarine
    Olive oil (extra light)14%73%11%242 °C (468 °F)Sauteing, stir frying, frying, cooking, salad oils, margarine
    Palm oil52%38%10%230 °C (446 °F)Cooking, flavoring, vegetable oil, shortening
    Peanut oil18%49%33%231 °C (448 °F)Frying, cooking, salad oils, margarine
    Safflower oil10%13%77%265 °C (509 °F)Cooking, salad dressings, margarine
    Sesame oil (semi-refined)14%43%43%232 °C (450 °F)Cooking, deep frying
    Soybean oil15%24%61%241 °C (466 °F)Cooking, salad dressings, vegetable oil, margarine, shortening
    Sunflower oil (linoleic)11%20%69%246 °C (475 °F)Cooking, salad dressings, margarine, shortening

    Saturday, April 16, 2011

    Heard of The ORAC Antioxidant Score?

    The Oxygen Radical Absorbance Capacity (ORAC) test is a method of measuring antioxidant capacities in a wide variety of foods, with spices, berries and legumes being some of the highest rated. It was developed by scientists at the National Institutes of Health to insure that consumers had the information needed to protect themselves from free radical damage. The correlation between the high antioxidant capacity of fruits and vegetables and the positive impact on our diets is believed to play a role in the "free-radical theory" of health and anti-aging. The assay measures the oxidative degradation (oxidation) of the test food after being mixed with free radical generators (called azo-initiator compounds). The first of its kind, the ORAC scale measures both the time and degree of free-radical inhibition. All antioxidant capacity measures are estimated by "Ferric Reducing Power" and are expressed as micromole Trolox equivalent (TE) per 100 grams (µTE/100 g). Limitations of this assay include the fact that only antioxidant activity against particular free radicals is measured and the nature of the damage due to free radicals in not well understood.

    There is no hard proof that the free-radical theory truly causes us to age faster or increases our risk to disease; however years of observation leads one to believe anti-oxidants have a very positive health impact. Foods higher on the ORAC scale will probably be more effective in neutralizing free radicals, thus  slowing the oxidative processes and free radical damage that can contribute to age-related degeneration and disease. Make sure you interpret the results correctly as it can be confusing. You must remember that the scale is reported in 100 grams, not per serving. A common example is essential oils, one of the richest sources of antioxidants; a few drops of clove oil would be nowhere near 100 grams, so there is no way you would get 1,000,000 plus µTE in a "normal serving." A serving of berries might be around 150 grams, giving you an ORAC score of around 4,000 µTE. As a side note, be aware that boiling vegetables, can reduce the ORAC value by up to 90%, while steaming retains much more of the antioxidants (you can watch them, the antioxidants, go down the drain as colored water).

    I have not seen the ORAC values labeled on any foods we have purchased, even from the "healthy stores." I was not even aware of this assay until this week, even though it has been around for at least a few years. A comprehensive list of ORAC graded foods may be found at the following USDA website: Below is a sampling of some of the higher ORAC values.

    The ORAC Scale on antioxidant capacity

    Cloves, ground314,446 µTE
    Sumac, bran, raw312,400
    cinnamon, ground267,536
    Sorghum, bran, hi-tannin240,000
    Oregano, dried200,129
    Tturmeric, ground159,277
    Acai berry, freeze-dried102,700
    Sorghum, bran, black100,800
    Sumac, grain, raw86,800
    Cocoa, dry powder, unsweetened80,933
    Cumin seed76,800
    Maqui berry, concentrated powder75,000
    Parsley, dried74,349
    Sorghum, bran, red71,000
    Spices, basil, dried67,553
    Baking chocolate, unsweetened, squares49,926
    Curry powder48,504
    Sorghum, grain, hi-tannin45,400
    Chocolate, dutched powder40,200
    Maqui berry, juice40,000
    Sage, fresh32,004
    Mustard seed, yellow29,257
    Ginger, ground28,811
    Pepper, black27,618
    Thyme, fresh27,426
    Marjoram, fresh27,297
    Goji berries25,300
    Rice bran, crude24,287
    Chili powder23,636
    Sorghum, grain, black21,900
    Candies, chocolate, dark20,823
    Flax hull lignans19,600
    Candies, semisweet chocolate18,053
    Nuts, pecans17,940
    Chokeberry, raw16,062
    Tarragon, fresh15,542
    Ginger root, raw14,840
    Elderberries, raw14,697
    Sorghum, grain, red14,000
    Peppermint, fresh13,978
    Oregano, fresh13,970
    Nuts, walnuts, english13,541
    Nuts, hazelnuts or filberts9,645
    Cranberries, raw9,584

    Friday, April 15, 2011

    Is The Yeast Connection For Real?

    There has been a great deal of controversy for many years over the role of yeast (Candida) and ones health. Many books have been written on the subject and many alternative health care providers have treated an "overgrowth" of yeast in the body with stated success. Scientific evidence is fairly limited on whether yeast is really a culprit for many of the proposed health care issues including chronic fatigue. I do know that many people feel better when they complete anti-yeast therapies in conjunction with significant lifestyle changes. The change in diet for Candida problems consists of removing all fermented foods from the diet; the worst offenders are alcoholic beverages, vinegar, barley malt, chocolate, pickles, and cheese. Many other foods such as baked goods and milk also contain yeast. I suspect the lifestyle changes have a great deal to do with the way people improve. One thing that appears to be missing from the data is how many of these people are tested for a true yeast allergy, instead of simplybeiin treated for a Candida hypersensitivity.

    Candida albicans (monilia) is a fungus normally present on the skin, in the mouth, intestinal tract, and vagina (in post-pubertal women). Under certain conditions, it can multiply and cause a symptomatic infection. These infections are usually minor, but more serious ones can occur; especially in patients whose immune system has been weakened by things such as immunosuppressant drugs or AIDS. Some practitioners claim that even when the clinical signs of an infection are absent, yeast-related problems can cause multiple symptoms (such as those listed below). And in recent years, many health care providers have suggested that chronic fatigue syndrome and Candida infections are interrelated. The the term commonly used is "candidiasis hypersensitivity" which is generally used to indicate a hypersensitivity to yeast, not an symptomatic infection nor an allergy.

    William G. Crook, M.D., author of The Yeast Connection, claimed that the problem arises because antibiotics kill the "friendly germs" while they're also killing the infectious bacteria; and when friendly germs are knocked out, the yeast multiplies. Also, diets rich in carbohydrates and yeast, birth control pills, cortisone (an imunosupressant), and certain other drugs may allow yeast to grow. His medical hypothesis is that yeast produces toxins that weaken the immune system; and a diet deficient in certain nutrients, high in sugar or exposure to environmental molds or chemicals will cause a host of medical issues. To correct these problems, he prescribed allergenic extracts, anti fungal medications, vitamin and mineral supplements, and diets that avoid refined carbohydrates, milk, processed foods, and certain fruits.

    The Yeast Connection survey is a 70-item candida questionnaire which can be found at A score sheet is used to determine if your health problems are yeast related. The rule of thumb is that if your point score is over 180, candida almost certainly plays a role in causing your health problems, a score over 120 means candida probably plays a role, and 60 to 120 means it may play a role," and scores under 60 mean it most like ly does not play a role.

    Reported symptoms of yeast overgrowth: (
     Allergies and allergy symptoms, chemical sensitivities.
     Anxiety, Hyperactivity, Attention Deficit Disorder.
     Avoiding food helps to alleviate symptoms.
     Chronic inflammation and irritation of the eye and conjunctiva.
     Diarrhea, chronic gas, and abdominal cramps alleviated by bowel movements.
     Irritable Bowel Syndrome.  
     Extreme lethargy.
     Eye fatigue.
     Facial rash.
     Frequent urination.
     Frequent yeast infections in women.
     High sugar or mold foods drastically increase symptoms.
     Inflammation of the hair follicles (candidiasis folliculitis) of various parts of the body (feet, legs, arms).
     Lactose intolerance.
     Muscle weakness and bone pain.
     Obsessive Compulsive Disorder.
     Panic attacks.
     Psoriasis/seborrheic dermatitis/dandruff, dry, itchy skin.
     Rectal itching.
     Sinus problems.
     Swollen lips/face.
     Symptoms worse after waking.
     White tongue and a white coating.

    Foods to avoid for yeast allergies: 
     Alcoholic beverages.
     Fruits (except for grapefruit, lemon, lime, tangerines, strawberries, cranberries, kiwi,   
     mangoes, bananas & fresh pineapple).
     Fruit juices.
     Refined Sugars.
     Left over foods 
     Nuts (peanuts).
     Soda Pop
     Milk products.
     Foods enriched with yeast (crackers, pasta, etc.).
     Breads that contain yeast.

    Natural therapies for "yeast overgrowth":
    Vitamin E: enhances the anti-body effect of the immune system and has antihistaminic properties. It also helps to improve leg cramps at night which interfere with sleep.
    Vitamin C: enhances immune function by increasing natural killer (B and T) cells allowing the necessary antibody production in the body
    Vitamin D: regulates immune functions of monocytes and neutrophils.
    Magnesium: Enhances immune function by increasing natural killer cells. Magnesium is also critical for the relief of muscle pain.
    Inositol: enhances immune function by increasing natural killer cells.
    Malic Acid: works with magnesium to improve energy levels by improving cellular functions.
    Zinc: supports the immune system and plays a role in cell division.
    Selenium: supports immune function and the body uses selenium to create antioxidants.

    Medical therapies for yeast infections:
     Diflucan (Fluconazole)
     Lamisil (Terbinafine HCl)
     Sporanox (Itraconazole)

    The use of probiotics may be effective in treating candida overgrowth. As the candida is scaled back to it's normal levels, the "good" bacteria, found in probiotics, will need to be replenished. Probiotics can be found in dietary supplements and in foods. A common probiotic, Lactobacillus acidophilus (the "good" bacteria), can be found in natural food stores, or increasingly in your local grocery store.

    The bottom line is that there is no definitive evidence that systemic yeast causes the multitude of symptoms listed above. That being said, there is no definitive studies that prove yeast does not cause health issues. A course of Nystatin is usually without side effects, but I believe the lifestyle changes will have the biggest effect on the multitude of symptoms allegedly associated with yeast. Yeast allergies are for real and one should suspect this if there are bowel changes or allergy type symptoms associated with yeast in the diet.

    Thursday, April 14, 2011

    Abnormal Pap Smears

    The Papanicolaou test (Pap smear) is a screening test used to detect a premalignant or malignant (cancerous) processes on the cervix. A pap smear is really just a scraping or brushing of the cervix. The test aims to detect potentially pre-cancerous changes (cervical intraepithelial neoplasia (CIN) or cervical dysplasia), which are usually caused by the human papillomavirus (HPV). The test was invented by and named after the Greek doctor Georgios Papanikolaou. According to ACOG (American College of Obstetrics and Gynecologist) guidelines, women aged 21 to 30 years should be screened every 1-2 years and women 30 years and older who have had three consecutive negative Paps may be screened once every 3 years, if they do not have evidence of an HPV infection. Since HPV is sexually transmitted and is closely linked to abnormal Pap smears, high risk women (ie, multiple partners) should be screen annually. If a woman's last three Pap results were normal, according to ACOG, she can stop at age 65. Lastly, smoking or having an impaired immune system will often increase your chances of an abnormal Pap smear progressing.

    Abnormal results include:

    Atypical squamous cells of undetermined significance (ASC-US): this means minor changes in the cervical cells have been detected. These changes are also usually a sign that an HPV infection is present. ASC–US is the most common abnormal Pap test result and is generally followed with Paps every 6 months for up to two years.
    Low-grade squamous intraepithelial lesion (LGSIL or LSIL): indicates a higher risk with mild precancer changes, and an HPV infection is also most likely present. Fortunately, LGSIL also usually goes away without further treatment. You may also follow with Paps every 6 months or consider colposcopy (looking with a magnifying glass and special stains) and biopsies. One caveat is that a smoker, especially over 40, should take extra precaution as they have a much higher risk of progression to a more advanced disease process.
    High-grade squamous intraepithelial lesion (HGSIL or HSIL): HGSIL indicates more serious and advanced changes. This diagnosis generally requires colposcopy (looking with a magnifying glass and special stains) and biopsies. The treatment depends on the colposcopy results and may include a LEEP (loop electrosurgical excision procedure) procedure or cone biopsy.  
    Carcinoma in situ (CIS) is the more severe form of HGSIL. It is the result most likely to progress to invasive cancer (over a period of months to years). This level of disease requires more investigation usually with colposcopy (looking with a magnifying glass and special stains) and biopsies. A LEEP (loop electrosurgical excision procedure) procedure or cone biopsy may be done, to remove to diseased tissue for diagnosis and treatment.
    Atypical squamous cells - cannot exclude HGSIL (ASC-H):  means changes in the cervical cells have been found. These changes are not clearly HGSIL but could be. Colposcopy with biopsies is generally needed to verify the diagnosis.  
    Squamous cell carcinoma: is a cervical cancer of varying degrees and requires much more aggressive therapy, often a hysterectomy if not considering future children.
    Atypical Glandular Cells not otherwise specified (AGC or AGC-NOS): are changes that suggest a precancer of the upper part of the female reproductive tract (cervix or uterus). This diagnosis usually requires tissue sampling from the uterine cavity, the cervical canal and the cervix.

    Therapies used to treat dysplasia (CIN):
    Loop electrosurgical excision procedure (LEEP)—A thin wire loop that carries an electric current is used to excise abnormal areas of the cervix. A LEEP usually is performed in the doctor’s office with local anesthesia. The areas that are removed are then sent to a pathology lab.
    Cone biopsy: a cone-shaped wedge of the cervix is removed and the tissue is sent to pathology for analysis. This procedure may be done in an operating room with general anesthesia or in a surgical center with other types of anesthesia. You should be able to go home the same day.
    Cryotherapy (freezing): with this technique, a practitioner freezes the abnormal tissue, which later sheds. The biggest complaint is a heavy watery discharge for 1-2 weeks.
    Laser treatment: with laser treatment, a beam of light (Laser) destroys or burns the abnormal tissue.

    This chart is from ACOG and outlines the guidelines for abnormal Pap smears.

    Tuesday, April 12, 2011

    Recurrent Urinary Tract Infections

    A urinary tract infection (UTI) is a bacterial infection that affects the bladder (most commonly) or the kidneys. Symptoms generally include a frequent feeling or need to urinate (frequency), pain during urination (dysuria) or a cloudy urine. The most common cause is due to the bacteria Escherichia coli (E coli). An infection of the upper urinary tract (kidneys) is known as pyelonephritis and may present with flank (lower back) pain, a fever or possibly an infection in the blood (sepsis) and is usually more serious. Urinary tract infections are generally treated with a short course of antibiotics, lots of water and limiting things such as sodas and alcohol. Women are at greater risk of developing a urinary tract infection, most likely due to the fact that they have a shorter urethra which is also closer to the anus. Urinary tract infections are generally limited to the bladder, painful and annoying.

    If a woman has two UTIs within a short time frame (2-3 weeks), she will have a 75% chance of more recurrences. The most common theory of recurrent bladder infections is that the bacteria will attach to the cells lining the bladder in some individuals. A recent NIH (National Institute of Health) study found that some bacteria formed a protective film on the inner lining of the bladder allowing it to colonize (grow). Another line of research has indicated that some women may be more prone to recurrent UTIs because the cells lining the vagina, bladder and urethra may allow bacteria to attach more easily. The bottom line is that some individuals are simply more prone to urinary tract infections due to the way their bodies respond to the bacterial invasion.

    Risk factors for recurrent UTIs:
    Being female: women have a shorter urethra, which cuts down on the distance bacteria must travel to reach the bladder. Also, the urethra is much closer to the anus and young women (or girls) must be taught to wipe from front to back.
    Sexually activity: women, primarily who are sexually active, tend to have more urinary tract infections because the physical trauma of intercourse will allow bacteria to travel up the urethra. In highly sexually active women, sex is the cause of approximately 75% of bladder infections. The term "honeymoon cystitis" has been frequently used to describe this phenomenon.
    Menopause: after menopause, urinary tract infections may occur more commonly because estrogen, which is protective to the bladder, decreases.
    Urinary tract abnormalities:  having a urinary tract abnormality may cause urine to back up in the urethra increasing the risk due to a lack of drainage.
    Having blockages in the urinary tract.: kidney stones or an enlarged prostate can trap urine in the bladder and increase the risk due to a lack of drainage.
    Diaphragms: women who use diaphragms for birth control also may be at higher risk, as may women who use spermicidal agents.
    A suppressed immune system: diseases such as diabetes, sickle-cell, HIV or those requiring steroids will increase the risk of urinary tract infections.
    Genetics: sometimes individuals simply have a predisposition for bladder infections, which may run in families.
    Using a catheter to urinate: such as individuals who are hospitalized, paralyzed or have neurological problems and can't urinate on their own will have a significantly increased risk of urinary tract infections.

    Drink lots of water: drinking water helps dilute your urine and increases urination, allowing bacteria to be flushed from your system.
    Drink cranberry juice: as it will limit the ability of bacterial to "stick" to the bladder wall.
    Wipe from front to back: helps prevent bacteria in the anal region from spreading to the vagina and urethra.
    Urinate after intercourse: this action helps flush the bacteria from the urethra.
    Consider an antibiotic after intercourse: taking a single dose of an antibiotic before or after sexual activity may be required in some cases.
    Avoid irritating feminine products: deodorant sprays and powders can irritate the urethra, possibly making it more prone to infections.
    Consider a vaginal estrogen in menopausal women: to improve tissue health.
    Avoid bubble baths: which does not necessarily cause infections but can irritate the urinary tract.

    Medical therapies:
    Sulfamethoxazole-trimethoprim (Bactrim, Septra)
    Nitrofurantoin (Macrodantin, Macrobid)
    Ciprofloxacin (Cipro)
    Levofloxacin (Levaquin

    A prolonged course (up to six months) of low-dose antibiotics (usually nitrofurantoin, 50mg/day) is generally safe and effective in treating recurrent UTIs. As stated above, post-menopausal women may benefit from intravaginal application of a topical estrogen cream.