Obesity in America Has Reached a New Level

Some unbelievable statics from obesitycampaign.org include:

• Today two-thirds of U.S. adults.
• Nearly one in three children struggle because they are overweight or have obesity.
• Obesity is the reason that the current generation of youth is predicted to live a shorter life than their parents.
• Twenty years ago, no state had an obesity rate above 15 percent. Today, more than two out of three states, 38 total, have obesity rates over 25 percent.

Why Are So Many Americans Obese?

When we look at the cause of obesity it comes down to two simple points – the American diet and lack of activity.  The American diet includes way too much food and defiantly the wrong type of foods.  The American food industry continues to direct us to think that we are eating such rich healthy foods, but in essence these foods contain a significant amount of processed carbohydrates and bad fats.  Many people do not understand what makes them obese!  One of the main factors involves an overabundance of processed carbohydrates.  From a physiological standpoint, the processed carbs are easily digested in the intestinal system.  The byproduct is a surge of sugar into our blood stream. Our muscle and liver use and store this sugar, but most of the time extra sugar is just surplus with no purpose.  A hormone called insulin will surge in relationship to the amount of sugar.  The extra sugar gets converted into triglycerides and stored in our midsection and thighs as fat.  As times goes by if insulin cannot control the sugar then the individual may develop high blood sugar or diabetes.

Ditch the Processed Carbs

So, we need to get rid of the processed carbs and eat more complex carbs.  The complex carb takes much longer for our digestive system to break down so we do not get the surge of glucose and insulin. So many times people do not understand the idea of processed carb versus complex carbs.  I tell my patients to ask themselves this question:  “Can I pick it or grow it?”  It’s as simple as that!  You can pick fruits and vegetables.  You cannot pick or grow bread, pasta, white rice, bagels, chips, etc.

Americans need to become more conscientious of the foods that we place in our mouths by also considering the sources of these foods.    The American diet needs to return to the foods that our great grandmother would prepare for us for dinner.  They would use whole foods.  Maybe we need to go back a little further in history when things were much more simple – the hunter and gathers.

So remember to think of the portions on the plate but also remember to ask yourself: “Can I pick it or grow it?” It’s as simple as that!

1. Endometrium – lining of the uterus, that allows a suitable environment for a pregnancy to implant and grow
2. Myometrium – muscle layer, that enables the uterus to contract during labor.

Unfortunately, these tissues can deviate from their intended functions and cause various problems.

One of the most common problems are fibroid tumors, or the medical term, lieomyomas. Although called tumors, fibroids are very, very, very rarely cancerous. Muscle cells usually lie flat and move together to shorten and allow contractions. When these muscles grow in circles they harden and form super-ball like structures that, as they enlarge, become fibroid tumors.

Fibroids can be easily diagnosed either through a pelvic exam or with an ultrasound. They are very common, as many as 2 out of 3 women may develop them during their reproductive years. The hormone estrogen may stimulate, or feed, their growth while the hormone progesterone may inhibit their growth.

Fibroids do not always cause problems, in fact, many women are totally unaware that they have them. However, when problematic, fibroids can cause symptoms such as heavy, prolonged bleeding; pain; or difficulty with urinating or bowel movements. They may also grow large enough to be seen through the abdomen, similar to how a pregnancy does.

If none of the above problems, or symptoms, develope, treatment is not necessarily needed. The fibroids can be safely monitired until menopause; when without estrogen stimulation, fibroids simply quit growing and may eventually shrink. However, if they are symptomatic, then treatment is indicated. Treatment can be either medical or surgical. Treatment regimens are specifically designed to meet the patients unique symptoms, needs and expectations.

Our gynecologists have access to all the most up-to-date diagnostic and treatment modalities available. If you think you have fibroids, or if you do and think they may need to be treated, please, call us. We will do everything we can to help you.

Postpartum depression is different than postpartum blues or the “baby blues”. Postpartum blues usually occurs shortly after delivery and usually resolves within 2 weeks. In women the symptoms may last months. Some of the symptoms of postpartum depression include: the feeling of depression, frequent crying, feeling sad most or all of the time, the inability to concentrate, the inability to enjoy things that used to be enjoyed, no interest in sex, the inability to sleep even when the baby sleeps, feeling like a failure, constant fatigue, changes in appetite ( not eating or eating excess sugars or carbohydrates), lack of laughter, being short tempered, difficulty bonding with the baby and feeling hopeless. Women that have four or more of these symptoms likely have postpartum depression.

Postpartum psychosis is an extreme type of postpartum depression which is very rare and occurs in one in one thousand women. Women with this condition may see and hear things that are not there. They may have thoughts of hurting themselves or their baby. This condition is an emergency and needs emergency attention.

Women are at increased risk of postpartum depression if they have depression or have had postpartum depression with a previous pregnancy. Women are also at risk if they have a lack of support at home, if they have a sick or colicky baby or if they have significant stress in their life. Traumatic events that occur during the pregnancy may also increase the risk of postpartum depression.

Treatment for postpartum depression includes anti-depressant medication and seeing a psychologist and or psychologist. There are medications that are safe for nursing mothers.

Many hospitals and physicians have screening tools for this condition. The limitation for the hospital screening is that women may not be experiencing symptoms when the screening is done (one to three days after delivery), and some of these symptoms within days after delivery are related to normal postpartum adjustment. It is so important to address these symptoms with your doctor at your postpartum visit in the office or at any time that the symptoms may arise. Many women feel embarrassed or ashamed of their feeling and are embarrassed to talk to their doctor.

Remember that the cause of postpartum depression is changing hormonal levels after a pregnancy. It is caused by something that is not in our control.

Support Groups for Postpartum Depression

• Tree of Hope Foundation
• Postpartum Support International
• TEXT4BABY
• Postpartum Stress Center
• Postpartum Education For Parents
• Mother to Mother Postpartum and Pregnancy Support
• Perinatal Pro

These are actually more common than you might think, especially among young healthy women, and are rarely due to any underlying abnormality within the bladder or urinary tract system. Most bladder infections are caused by bacteria that naturally live in the bowels, and because the urethra (the tube you urinate through), the vagina and the rectum are so close together in women they are in general at higher risk than men for bladder infections.

Risk Factors for Recurrent Bladder Infections

Risk factors for recurrent bladder infections in premenopausal women include sexual intercourse (especially with a new partner within the last year), diaphragm and/or spermicide use for contraception, first UTI at or before age 15, having a mother with a history of recurrent bladder infections and a history of frequent bladder infections in the past. Recent antibiotic use for another type of infection can also put you at risk for a bladder infection by disrupting the normal bacteria that keep the vaginal area healthy.

Anatomical changes such as a dropped uterus (uterine prolapse) or dropped bladder (cystocele) also predispose a woman to recurrent bladder infections. These changes in pelvic anatomy disrupt the ability of the bladder to empty fully, therefore leaving urine in the bladder for longer periods of time which can allow bacteria to invade and cause an infection.

In rare cases, recurrent infections in the bladder can be the result of an underlying defect within the urinary system in your body. Because of this, it is important to see your doctor when you think you have an infection. This allows us to keep track of how often infections occur, what bacteria we are treating and if we are using the appropriate antibiotic treatment for you. In some cases it may be necessary to follow up with an urologist for a full evaluation of the urinary system; your doctor can determine if this is necessary.

Preventing Bladder Infections

To prevent recurrent bladder infections it is important to go to the bathroom right after intercourse, increase fluid intake to flush the bladder, and cranberry juice can be helpful by keeping bacteria from clinging to the wall of the bladder. Probiotics may also be helpful to increase the number of healthy bacteria in the vaginal area that would decrease the ability of bacteria that can cause UTIs to grow. In some cases antibiotics are used to prevent future infections by treating after intercourse, treating on a daily basis or allowing patients to treat whenever they feel symptoms starting.

If you are having any of these issues, please follow up with your gynecologist so the appropriate treatment options can be reviewed and if necessary, specialist referrals can be obtained in a timely fashion.

These symptoms are most often the result of excessive production of prostaglandins in the uterus which lead to increased uterine contractions during menses. This also affects the intestines, therefore leading to many of the other symptoms associated with the cramping. Very rarely are the symptoms related to other female gynecologic issues such as endometriosis, which gives symptoms of worsening pelvic pain over time with and without menses, or pelvic infections.

To determine if your daughter needs to be evaluated by a physician, you need to evaluate whether it is impacting her life. If she is missing school, sports events or other social activities due to the pain, it is time to see a physician. The physician will evaluate her medical history, especially how her cycles have progressed since she began menstruating. Honesty about sexual history is also very important, in order to rule in/out the possibility of pelvic infections.

Many young women are intimidated by going to the gynecologist, but most of the evaluation for painful periods in the adolescent woman involves discussion. An exam is very important, but does not always require a pelvic exam. The physician determines this after discussing the patient’s symptoms. A pelvic ultrasound may need to be performed for further evaluation, but many times this is not necessary either.

First line treatment for painful periods is Non-steroidal anti-inflammatory medications (NSAIDS) such as Motrin or Aleve. These tremendously reduce the prostaglandin levels that develop within the uterus, therefore decreasing the painful cramps. Ideally, the NSAIDS are started 1-2 days prior to the onset of menses and are continued for 3-4 days into the menses. If your daughter fails NSAID therapy after 2-3 months, the next step would be trying hormonal contraception such as birth control pills (OCPs). OCPs work by both suppressing ovulation which in turn decreases prostaglandin production in the uterus as well as by decreasing blood flow during menses.

Painful periods can really interrupt a young woman’s life and the treatment can be simple, with very little risk. If your daughter is experiencing these issues, please discuss this with your pediatrician or make an appointment for her to see a gynecologist. She will be happy you did.

Preparing for the Endometrial Ablation Procedure

At Associated OBGYN we use multiple endometrial ablation technologies.  Hands down the best procedures appear to be Novasure and Thermachoice.  The basic idea is to destroy the endometrial lining that women shed each month down to the base layer.  This will then prevent the lining from being able to regenerate each month.  Not all women are able to undergo endometrial ablation.  Contraindications include women that desire to become pregnant, bleeding between cycles, enlarged uterus > 12 weeks size and large fibroid tumors of the uterus.  The first step is to perform an in office ultrasound to check the endometrial cavity.  After making sure the uterus is appropriate, a simple sample of the endometrial lining is taken while in the office.  The endometrial biopsy is a great way to make sure the patient will be able to tolerate the in office endometrial ablation.  The reason we perform the endometrial biopsy is to make sure there is no precancerous growth in the lining of the endometrium.  As long as the menstrual cycles are regular the chance of precancerous cell is very rare.  Most women at this point are placed on a low dose oral contraceptive pill to thin out the lining to reduce the time and pain of the procedure.

The Endometrial Ablation Procedure

On the day of the procedure women come in to the office like they would as for an office exam.  One hour prior to the procedure the patient will receive medication to reduce pain and anxiety.  Once the medication has taken effect, the patient is seen in the examination room where numbing medication is place within the cervix to reduce the pain.  15 minute later the doctor with gently dilate the cervix and place a small camera to evaluate the endometrium cavity.  Once the cavity is found to be normal a Novasue device is placed within the cavity.  A test is performed to make sure the integrate of the cavity has not been disrupted.  An energy source is activated for approximately 60 seconds.  Most women describe the pain similar to uterine contraction in labor.  After the 60 seconds most doctors will look back inside the uterus to make sure the entire cavity has been ablated.

Recovery from the Endometrial Ablation Procedure

After a short period of time the patient is sent home with a driver to rest and take Motrin to reduce the cramping for 24 hours.  Most women will experience a slight watery discharge or minimal bleeding for 4 weeks.  At associated OBGYN, we’ve performed over a hundred procedures without any significant problems. Most insurance companies cover the procedure.   Over 50 % of the women will not have any further periods.  The remaining 50% of the patients will have mild menstrual cycles that are significantly lighter and shorter with reduced PMS symptoms.

In summary I would have to say that there is no other gynecological procedure that is so simple, yet has such a positive effect on a woman’s life. If you have any further questions about endometrial ablation, please do not hesitate to ask one of our gynecologists.

Mastitis may occur when bacteria from the skin get into the breast duct through a cracked or sore and inflamed nipple. Risk factors for mastitis include: a cracked or sore nipple, having a history of mastitis previously, breast engorgement (resulting from skipped feedings or changes in feeding schedules), or incomplete emptying of the breasts.

Treatment for mastitis includes warm compresses to the area before nursing, gentle massage, ibuprofen (Motrin), continuation of nursing or pumping and antibiotic use. Mastitis is not a reason to discontinue nursing. If the breast is not emptied the infection may worsen.

If you have a concern that you have this condition you should see your health care provider for an exam and probable treatment with antibiotics. The diagnosis of this condition can be made by your history and physical exam with the aid of your obstetrician.

We’d like to thank all the moms who participated in our recent Facebook contest.  We had a lot of cute entries and it was so fun to see some of of the babies.  Our team has delivered at lot of babies over the years, so it was like a walk down memory lane.  To us, each and every baby is special.

The winner of our contest was Marianne Brooks from Waterford, Michigan.  Her picture of son Aiden was the clear winner.  We have to admit that Aiden in a pumpkin patch is pretty darn cute.  Aiden, who was delivered by Dr. Corsi, received 58 votes and 35 likes.

Babies submitted by doctor delivering:

• Dr. Robins = 1
• Dr. Jewell = 4
• Dr. Corsi = 5
• Dr. Kondratenko = 2
• Dr. Helmick = 1

Click on any of the images below to see some of our entries.  Aiden, our winner, is the first cutie.

Prolia is recommended for women who have osteoporosis with multiple risk factors for fracture, already have experienced an osteoporotic fracture, are intolerant to current medications, or have experienced a significant decline in bone mineral density (BMD) despite treatment.

Prolia’s method of action is different than the Bisphosphonate medications, however, attains a similar result.  Through an immunologic pathway, it binds to RANK Ligand and inhibits the osteoclast cell formation, function and survival.  The osteoclast cell is responsible for bone resorption: it eats away at bone thus decreasing bone mineral density.

Benefits of Prolia

• Initial 3 year studies on women with osteoporosis showed that treatment with Prolia resulted in a 68% reduction in vertebral fractures, a 40% reduction in hip fractures, and a 20% reduction in nonvertebral fractures (ie: wrist).
• A recent 5 year study soon to be published revealed a 35% reduction in nonvertebral fractures for women with a T-score < -2.5 (the level used to diagnose osteoporosis via a Dexa-bone densitometry machine).
• Treatment with Prolia also revealed a 6.4% increase in BMD at the hip, 5.2% increase in BMD at the femoral neck (the thinnest part of the hip bone), and 8.8% increase in BMD at the vertebral spine.
• Patients switching from treatment with Fosamax to Prolia enjoyed an increase in BMD when compared to patients who continued taking Fosamax.

Additional Data Points for Prolia

• Bone biopsies revealed normal bone architecture and quality in both cortical and trabecular bone.  These results are as good, if not better, than the results seen with trreatment using the Bisphosphonate medications.
• Atypical femur fractures seen rarely with the Bisphosphonates have NOT been reported with Prolia.
• There have been 2 reported cases of osteonecrosis of the jaw in patients treated with Prolia, a rare complication seen with Bisphosphonate treatment.
• Gastrointestinal side effects commonly seen with the Bisphosphonates are not seen with Prolia.
• The most common side effect of Prolia (which is 2-3%) therapy is an increase in infection risk.
• A slight increase in skin rash, skin infection, ear infection, and urinary tract infections  have been reported over placebo treatment.

Prolia is given in our office a subcutaneous injection 2 times per year and is covered by many insurance programs.  If you have osteoporosis, you may want to discuss this treatment option with your family doctor or gynecologist.

Almost every one of us has known a close family member or friend that has been affected by breast or ovarian cancer. We have seen the devastation that it has taken on patients and their loved ones. In the past many families would have generations of women affected with either breast or ovarian cancer. With many years of research, the medical field has been able to find a major piece of the hidden puzzle.

BRCA 1 and 2 Gene Mutation

All cancer results from an accumulation of mutations in genes that normally control cell division. Most of these mutations are acquired during a person’s lifetime. In some individuals, an initial mutation in a critical gene is inherited. Approximately 7% of breast cancer and approximately 14% of invasive ovarian cancer results from such genetic mutations passed down from either the father or the mother. The majority (approximately 84%) of hereditary breast and ovarian cancer results from inherited mutations in two genes called BRCA1 (52%) and BRCA2 (32%). Although sometimes referred to as the “breast cancer genes,” BRCA1 and BRCA2 are also associated with the majority of hereditary cancers of the ovary.

Who is at Risk for Breast and Ovarian Cancer?

As a gynecologist and obstetrician, I ask my patients detailed questions focusing on both the mother’s and the ‘s father side of the family. Many times people have a misconception that these gene mutations can only come from the mother’s side of the family. This is far from being true. An individual has an equal risk from obtaining the gene mutation from the mother or the father. As a health care provider, I look for red flags that tell us someone is at risk. Individuals with a personal history of, or a close blood relative (1st, 2nd, or 3rd degree in the maternal or paternal lineage) with, any one of the red flags is at increased risk of HBOC.

Risk factors and red flags include a family history of:

• Ovarian cancer
• Breast cancer < age of 50
• Two primary breast cancer in one family
• Triple negative breast cancer
• Pancreatic cancer with another HBOC cancer
• Ashkenazi Jewish ancestry with another HBOC cancer
• Family history of a previous identified family member

Why We Test for BRCA

It has been estimated that in a general OBGYN practice, at least one in every ten women are at risk. One of my most memorable experiences that I had was when I met with was a patient who had a paternal aunt with breast cancer at 55 and a paternal cousin with breast cancer at 40. The most effective way to evaluate the patient would be to test the affected family members for the gene mutation. If the family members are unable to be tested, then the unaffected patient should undergo testing. For the above mention patient, she underwent testing and was found to be positive for the BRACA2 mutation.

With this gene mutation, a patient has a 50% chance of developing breast cancer by age 50 and up to 87% chance of developing breast cancer the age of 70 (compare to 8% of general population). With regards to ovarian cancer, A BRAC affected patent has a 44 % of developing ovarian cancer.

Many people are hesitant to be tested because they believe the misconception that there is nothing that can be done about cancer. This is far from the truth. Medical and surgical management is used very effectively in identifying and reducing cancer. The National Comprehensive Cancer Network (NCCN) recommends the initiation of clinical breast examinations, mammography, and MRI at age 25 for BRCA1/2 mutation carriers. For ovarian cancer screening, NCCN recommends pelvic examination, pelvic ultrasound and CA 125 blood test every 6 months. Early detection helps to reduce cancer deaths. It has been shown that oral contraceptives reduce the risk of ovarian carcinoma in both BRCA carriers and non-carriers. Studies have shown, women with mutations in BRCA1 or BRCA2 that demonstrated that the use of oral-contraceptives for 6 or more years was associated with a 60% reduction in the hereditary risk of ovarian cancer. Selective estrogen receptor modulators (SERMs), like tamoxifen, can decrease the risk of breast cancer in high risk patients. One study reported that tamoxifen reduced breast cancer incidence by 62% among healthy women with BRCA2 mutations.

For surgical management, Prophylactic oophorectomy reduces the risk of ovarian cancer by up to 96% in women with BRCA mutation. Prophylactic oophorectomy has also been shown to reduce the risk of breast cancer by up to 68% in women with BRCA1 and BRCA2 mutation. Prophylactic mastectomy has been shown to reduce the risk of breast cancer in high risk women by more than 90% and studies have demonstrated that prophylactic mastectomy specifically reduces the risk of breast cancer in women with mutations in BRCA1 or BRCA2 by 89.5% to 100%. Such decisions must be highly discussed between the patient and physician in an individualized manor.

Knowledge is Power!

Women with significant family history can make informed decisions to reduce the risk of developing cancer. Not only are they at risk, but the family members that they are raising are at risk. In the above mentioned patient that was diagnosed with BRACA mutation she decided to undergo surgical intervention by removal of both fallopian tubes and ovaries because she decided she wouldn’t be bearing any additional babies. The final pathology report showed early cancer that was contained! If this had continued to grow without the surgery the prognosis would have been bleak.

Without this test, she would have been another statistical death. Now she can live a full life and enjoy interacting with her grandchildren as they grow up! Priceless!!!