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What are probiotics, and what are they good for?

12/4/2018

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What are probiotics?  Probiotics are bacteria.  Yep, they’re the same type of organism responsible for pneumonia or strep throat or gonorrhea.  Fortunately, not all bacteria are bad, and, in fact, many of them are part of a healthy body.  There are actually more bacteria in your intestine than there are cells in your body.  While typically the “good” bacteria outnumber the “bad” bacteria, problems begin to occur when there are shifts in the types of bacteria usually found in the healthy body.  This type of imbalance can lead to bowel issues, weight gain, some skin conditions and may be a contributing factor to bacterial vaginosis.

​What are the most common types of probiotics?
  Bifidobacterium may be helpful in treating IBS (irritable bowel syndrome), and this bacteria can be found in certain dairy products.  Another common probiotic that can be helpful for bowel symptoms is lactobacillus.  It can be found in a number of fermented foods.  Lastly, saccharomyces boulardii, a yeast, and bacillus coagulans, another bacteria, can also be helpful for digestive issues.

Why take probiotics?
  A diverse gastrointestinal flora (lots of different kinds of bacteria in your digestive tract) may help reduce irritable bowel symptoms, manage weight, improve diarrhea after antibiotics, increase immune function, bolster mental and heart health, and decrease the severity of allergy symptoms.  That being said, research hasn’t been able to consistently show these benefits in all studies, and there is still a lot of research to be done.

Is there anyone who shouldn’t take probiotics?
  Anyone who has a suppressed immune system or serious health conditions should probably avoid taking these supplements, and pregnant women should also use caution.  Remember, effective probiotics are live bacteria, and some bacteria can call illnesses.  More common side effects are GI distress, although serious allergic reactions or infections can sometimes occur.  Since probiotics are a nutritional supplement rather than a medication, the FDA guarantees neither the safety or efficacy of a probiotic supplement.

What is the best way to get probiotics?
  The simplest way to incorporate probiotics is often to supplement, but since these supplements aren’t FDA regulated, the quality can vary a lot from one supplement to the next.  For instance, probiotics have to be both living and highly concentrated to be effective, so any process that either kills the bacteria or doesn’t adequately protect the bacteria from stomach acid isn’t going to allow proper supplementation.  For a more natural way to add probiotics, look toward fermented foods such as yogurt, kimchi, sauerkraut, kefir milk, and some cheeses. 

Another option to improve gastrointestinal health is to feed the bacteria already present in the intestines.   Bacteria in the bowel thrives on fiber, so increasing daily intake of fruits and vegetables can be helpful in improving overall GI health by nurturing the good bacteria already present in the bowels.  In fact, for the roughly half of people who have “resistant” gastrointestinal flora, this may be more effective than a probiotic supplement that will end up making for some expensive poop.  Even for those whose GI tract welcomes the new probiotics, these bacteria are more likely to grow (and their hosts reap benefits) when fed a high fiber diet.

So, there you have it.  Probiotics seem to have a lot of promise for helping with a variety of health conditions, but for now, the best way to incorporate them into the diet and who is most likely to benefit from them is still up for debate.  In the meantime, it appears that an old-fashioned high fiber diet will still be a winner whether you plan to supplement or not 😊

Dr. Nick
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Want to Be Smarter, Thinner and Live Longer?  Sleep May Be the Answer

9/11/2018

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For Pam and me, despite our busy lives, we can typically find time to exercise, and we generally eat pretty well.  Sleep, on the other hand, can often be a bit more elusive (thank you middle of the night babies!), but there are certainly a number of positive health benefits from sleep that we just can’t get any other way. 

​Ever go to bed wondering about a problem and then woke up with the answer?  Sleep actually helps consolidate memory and new skills, and it can help clear out the “junk” processes that occur during the day.   In fact, a correlation has been suggested between lack of sleep and development of dementia, whereas adequate rest can not only help with improving cognition, it can also help spur creativity.  Whether studying for a test, writing new music or practicing your golf swing, you’ll likely perform better after a good night’s sleep.

Speaking of your golf swing, sleep can also help improve athletic performance.  Studies suggest that participants in sports see both speed and stamina are improved following an increase in sleep duration.  These athletes also saw improved ability to focus and learn plays due to less daytime fatigue.

Got your diet and exercise in line but still aren’t seeing the results you want?  Lack of sleep may be a culprit.  One studied showed that dieters who had adequate sleep lost more fat than those who were sleep deprived, who tended to lose more muscle mass.  Sleep deprivation also tends to trigger hunger, which can in turn increase caloric intake.  The bottom line is sleep more, lose more fat and consume fewer calories.

Think those issues are bad enough?  Unfortunately, there’s more.  Lack of sleep is a known trigger for inflammation, which is a risk factor for cardiovascular disease such as heart attack and stroke, not to mention diabetes, arthritis, and inflammatory bowel disease among others.  Even more concerning, it can lead to premature aging :0

So, what can you do to help improve your sleep?  Chances are, if you’ve been dragging through the day, you’re looking for caffeine.  Caffeine is fine, just remember to avoid it, alcohol and nicotine for at least 4 hours prior to bedtime.  Screen time should also be limited before bed.  Blue light can disrupt your natural sleep/wake cycle and negatively affect your quality of sleep.  Other culprits for sleep disturbance can include a room that’s too noisy, too hot (cooler rooms tend to promote sleep), or too bright.  Lastly, try for consistency (both with bedtime and duration) when your rest.  Adapting to a routine can help establish better sleep quality.

Whether becoming a new parent, working at a stressful job, or simply being born an insomniac, sometimes getting adequate sleep can definitely be a challenge.  Still, by making time for rest, you can begin to see significant improvements in your health.  Good luck with your good night’s sleep, and we hope you have sweet dreams!

Dr. Nick
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Will I Get Addicted to My Antidepressants?

4/24/2018

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So, I get asked this question all the time.  If I start an anti-depressant pill, will I have to take it forever?  Is it addicting? Anti-depressants have helped millions of people with the debilitating symptoms of depression.  However, long term use of anti-depressants has been increasing significantly.  Overall 35 million people in the U.S. are on antidepressants.  15.5 million of Americans have been taking these medications for depression for at least five years.  This number has tripled since 2000. 

Some people have no problem stopping the medications without any issues.  However, a large percentage of patients (about 75%) have significant withdrawal symptoms.  These symptoms consist of dizziness, confusion and fatigue.  Anti-depressants were never considered an addictive medication like opiates.  Because they are so effective at treating the symptoms of depression, withdrawal symptoms and the inability to discontinue were not well studied.  Most studies really explored use for a couple of months, not years.  However, today there are millions of patients that have been on these medications for years and we have very little data about the effects of taking these medications for so long. 

So, who cares and why is this an issue?
  If it makes you feel better, you should just stay on it right?  Anti-depressants are not harmless and have lots of side effects.  They can cause increased appetite, weight gain, erectile dysfunction, loss of sexual desire, insomnia, dry mouth, fatigue, drowsiness, constipation just to name a few.  There is also concern that instead of developing good coping skills for common life issues like death in the family, financial hardship, relationship issues, we are resorting to popping pills.  While there are lots of patients that have legitimate psychiatric issues that require them to be on medication to prevent them from harming themselves, milder forms of depression, such as life circumstances like a death in the family, can often be solved with counseling and developing better coping mechanisms. 

So, what can be done to help patients transition off anti-depressants better?
  First, we need more studies that explore long term effects of different classes of anti-depressants.  This will allow us to counsel patients more carefully about withdrawal symptoms prior to starting the medication.   Second, as providers we need to be more careful about prescribing antidepressants and encouraging our patients with milder symptoms to seek other options first.  Third, for patient that have had bad experiences with withdrawal symptoms, there are certain antidepressants with a longer half-life that have fewer symptoms.  It may be prudent to switch them to one of those medications or start them on one of those it they need to reinitiate antidepressants.  Fourth, encouraging micro tapering over 9 months to a year rather than quicker tapering may help prevent the severity of withdrawal symptoms for some. 

Hopefully, you won't find yourself in a position to need these medications, but if you do, be sure to discuss all possible options with you doctor.  Also, and even more importantly, be sure to speak with your doctor before stopping your current medications or changing your own dose.  Everyone goes through challenging circumstances in his or her life, but only you know if your current situation is beyond your abilities to get through.  In those cases, seeking help isn't a sign of weakness; it's a sign that you're strong enough to do whatever it takes to get through your challenges.

​Dr. Pam
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Are You Addicted to Sugar?

4/10/2018

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I’ve often heard people joke about “being addicted” to sugar, but as it turns out, sugar addiction may not be a laughing matter.  Believe it or not, the same reward pathways in the brain the reinforce drug and nicotine use also reinforce sugar use.  Dopamine (essentially a chemical in the brain the makes you feel good) causes us to feel both withdrawal from and cravings for sugar.  The bottom line is withdrawal+craving=addiction.

As Americans, we consume roughly the equivalent of 65 lbs of sugar per year.  That’s a lot, right?  To put it in perspective, even the suggested amount of no more than 9 teaspoons of added sugar per day for men and only 6 per day for women add up to 29 lbs and 19 lbs, respectively.  Instead we consume nearly 20 teaspoons per day, more than double the recommended daily amount!

So, what’s the problem with some sugar?  Obviously, most people are aware of the negative effects on heart health, blood pressure, cholesterol, and rotten teeth, not to mention risk of diabetes and obesity, but that’s really only the tip of the iceberg.  Cancer cells thrive on sugar, and there’s probably also a link between asthma and sugar intake.  Also, excess sugar intake can inhibit the ability to get a good night’s sleep and even predispose to depression and dementia.  Lastly, if the above reasons aren’t good enough to limit sugar intake, excess sugar consumption makes you look older faster, aging you nearly 5 years faster per 20 oz soda per day.  You might as well be smoking for all of the harm it does to your face.

Good thing I really don’t add sugar to my food, right?  Unfortunately, roughly ¾ of packaged food contains added sugar, and the companies don’t have to let you know until 2020.  Not only that, but many packaged foods marketed as “healthy” are actually some of the biggest culprits.  Gluten-free foods typically have more sugar, salt, fat and saturated fat as well as less protein and fiber than their gluten-containing counterparts.  Not to mention, these products are typically much more expensive.  Other “healthy” products that often contain high amounts of added sugar include smoothies, trail mix, flavored yogurts, oatmeal and salad dressing.  Even juices labeled 100% juice often have very high sugar concentrations.
Trading in soda for energy drinks?  On average, energy drinks contain about 30 grams of sugar.  Sports drinks can have as many as 40 grams, and flavored coffee drinks can clock in at nearly 50 grams.  Just one of these per day can push you well past the recommended 24-36 grams per day.

Ready to make a change?  Often the first, and simplest, step is limiting sugary drinks.  Focus on increasing water, unsweetened tea, unsweetened coffee, and did I mention water intake?  Not only will this reduce your intake of added sugar, but being well-hydrated also increases satiety (fullness) thereby decreasing cravings.  Next, be sure to check out nutrition labels.  In addition to sugar levels, scan ingredients for other sweeteners like honey, anything named syrup, and anything ending in -ose (dextrose, glucose, maltose, fructose, etc.)  Finally, use whole fresh ingredients whenever possible so that you get to be in charge of the flavoring/seasoning process.

Good luck kicking that nasty sugar habit!

Dr. Nick
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What is phentermine?

2/6/2018

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In the US, 68% of adults and 33% of children are either obese or overweight.   Obesity increases an individual’s risk of developing cardiovascular disease, cancer, diabetes, just to name a few.   I see patients every day that struggle with their weight.   They have tried different diets and increasing their activity level and are still unable to reach their ideal weight.  So, they ask me- can you just give me some of those diet pills called phentermine, so I can lose that weight?
​

First, lets start with what phentermine is.  Phentermine is an appetite suppressant and a stimulant that can help increase metabolism.  Of course, that is just music to most people’s ears who have struggled with weight loss: it will make me eat less and burn more calories!  Unfortunately, nothing is that simple right?  What we have found is that phentermine if used in conjunction with lifestyle changes such as diet and exercise can help obese and overweight individuals loose weight.  However, short term use without changing your diet and starting an exercise regimen, usually only results in short term weight loss.  Most of these people will gain all the weight back and maybe even a little more once they stop taking phentermine.  Most providers that work with their patients on weight management will only prescribe phentermine for 3 months at a time.  So, while phentermine can have some great results if properly used, it can also have dangerous results if abused or used improperly.
  1. One of the biggest concerns with phentermine is the risk of developing pulmonary hypertension.  Pulmonary hypertension is a rare disease, but it can be fatal.  People that take other diet medications with phentermine like fenfluramine (sold under the brand name Phen-Fen) can develop pulmonary hypertension.
  2. Phentermine has a lot of side effects.  It can cause restlessness, headaches, dizziness, itching, diarrhea, change in libido, and sleep problems.  Serious side effects can be substantial such as shortness of breath, chest pain, confusion or increasing your blood pressure to dangerously high levels.  If you experience any of these severe symptoms, you must discontinue the medication immediately and see your provider.  Drinking alcohol can intensify the side effects of phentermine.  These should not be taken together.
  3. Phentermine can be very habit forming.  There are many people that become reliant on phentermine for weight loss. Remember phentermine is a stimulant and in the same class of medications as cocaine and amphetamines.  While cocaine and methamphetamines are much more potent releasers of norepinephrine and dopamine and therefore more addictive than phentermine, the potential for addiction is there.  
  4. Long term phentermine use and sudden discontinuation can lead to withdrawal.  The most common symptoms are exhaustion and depression.   This is one of the main reasons we only use phentermine for short periods of time to aid in weight loss.  If a person has taken it for long periods of time, their dose should be decreased gradually to avoid the symptoms of withdrawal. 
For patients that are overweight and obese, the risk of developing cardiovascular disease, diabetes, cancer and even infertility is substantial.  If you are motivated to lose weight, we want to help you in your journey.  However, we want you to be able to do it safely.  Making lifestyle changes that will decrease your risk of heart disease and diabetes and allow you to be more active is the key to achieving your weight loss and fitness goals!  If you have questions about phentermine, be sure to discuss this option with your provider, or schedule an appointment with Dr. Pam to see if this is a safe choice for you.

Dr. Pam


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Want to Live Forever?  Lift Weights and Run!

1/16/2018

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Some of the most common New Year’s resolutions typically involve changes to a person’s health, but these resolutions often go quickly by the wayside as school resumes and kids’ activities return (what am I, a taxi service?) and/or work deadlines begin to loom again.  Soon, “I’ll get that workout in tomorrow” can easily change into “let’s see what happens next year.”  So if you’re looking for something to get or keep you motivated, here are a few recent study results that show some real benefit to working out.

Strength has a direct influence on how long you live.  In short, a recent study looked at the relationship among strength, muscle mass and mortality.  While muscle mass didn’t have much of an effect on life expectancy, those people who fell into the low muscle strength group were twice as likely to have died during the roughly 10 year follow-up.  So, even though I don’t look like the Rock (yet!), as long as I have good functional strength, I’m likely to live longer.  A second study of 80,000 subjects in Great Britain showed that those who reported doing strength training were 23% less likely to die during the study period and 31% less likely to die of cancer.

In addition to strength training twice a week, we’re technically supposed to get at least 150 minutes of moderate aerobic exercise or 75 minutes of vigorous exercise.  In fact, running may be the single most effective exercise to increase longevity.  On average, runners live about 3 years longer than non-runners, even if it’s done slowly or intermittently, and regardless of whether they drink, smoke or are overweight.  Even 5 minutes a day can make a difference, although the recommendations are certainly for a bit more sustained activity.  Risk of premature death, from causes like heart attacks, decrease by about 40%.  The return from running is pretty good as well.  For the average runner who runs 2 hours per week (about 6 months total over 40 years), he or she typically lives about 3.2 years longer than a non-runner.  That means, for every hour run, life expectancy increase about 7 hours.  So, does that mean if I run 4 hours a day, I can live forever?!  Not exactly...the maximum return for time invested peaks at about 4 hours per week.  That being said, 4 hours x 7 is 28 hours, or a little more than a day per week of running.

So, if I hate to run, am I gonna die?  Even walking, cycling and other aerobic activities can help reduce the risk of premature death by around 12%, so there’s still some benefit to be had with the other choices, too.  Not to mention, the best outcomes typically occur with a combination of strength and aerobic training.  Whether you’re looking to enjoy a long, healthy retirement with a significant other or meet your great grand-children (or even to just keep up with your 18 month old), the time to begin that investment in yourself and your health starts today :)

Dr. Nick
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Raw Water: A Dangerous New Health Craze?

1/9/2018

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What is raw water?  It is supposedly unfiltered, untreated, unsterilized spring water that can cost more than $60.99 for a 2.5-gallon jug.  So, what is the concern here?  Why would someone pay so much to get their drinking water from the Middle Ages before proper sewer and sanitation systems had been created?  The rationale is that the existing water supply has many chemicals and pollutants and that there are naturally occurring minerals that are filtered out when the water is treated.  
 
How does water treatment occur?  Step one is coagulation and flocculation.  This is a fancy way of saying that dirt has a negative charge so adding a chemical with a positive charge will grab the dirt floating in the water (opposites attract).  This new bigger particle is heavy and settles to the bottom of the water (sedimentation).  Filtration happens next.   Small holes allow water to pass while trapping bigger particles (remaining dirt, bacteria, etc).  Lastly, a small amount of chlorine is added to kill any remaining viruses and bacteria.
 
What are the health risks of consuming “unfiltered, unsterilized, untreated spring water?” Unfiltered and untreated water even from the cleanest streams can contain animal feces which can lead to the spread of Giardia, Hepatitis, E. Coli and cholera.  Not to mention, runoff from our streets generally drains through a creek system.  Because of the advances in sanitation and safety of our water supply, most of us don’t know anyone that has died of hepatitis and cholera (although a recent outbreak in the homeless population in California led to 20 deaths in 2017).  Ever hear of dysentery, that illness which can kill people by extreme dehydration from nonstop defecation (pooping)?  It’s another example of water-borne illness.  Even for those who recover, it’s hard to imagine them calling bloody diarrhea a fun way to spend 2-4 weeks of recovery time.  One last example is naegleria fowleri.  This little amoeba isn’t ingested, but if some water contaminated with this species accidentally goes up your nose, it can cause primary amebic meningoencephalitis (PAM).  With fever, nausea, seizures, hallucinations and coma, nearly all cases of this illness have been fatal.
 
Who is consuming this raw water?  It’s currently limited to a largely wealthy clientele and seems popular in more expensive neighborhoods.  At 60 bucks for 2.5 gallons, this is only something that only the likes of Silicon Valley executives can afford in significant quantities.  If you are spending $4000.00 to rent a one-bedroom apartment- what is 60 bucks for a gallon of water?  Otherwise, people are left to collect their own.
 
From the standpoint of a health professional, recommendations would certainly be to avoid drinking untreated water due to concern for water-borne infection, and this applies doubly during pregnancy.  We know that the immune system is weaker during pregnancy, and any of the bacteria, viruses or amoebas listed above could easily cause a pretty devastating illness.  Not to mention, if you’re spending nearly $30 per gallon of drinking water, how much money are you going to have left over for diapers?  😊

​Dr. Pam
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Is My Gluten-Free Diet Causing Me to Gain Weight and Develop Diabetes?

3/28/2017

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1. First of all: what exactly is gluten?

Gluten is a protein found in grains such as wheat, rye, oats and barley and is responsible for the elastic texture of dough.  Gluten helps foods maintain their shape and acts as a glue (hence, where the word 'gluten' comes from), holding foods together.

2. Who should stay away from gluten?

A lot of people eat a gluten-free diet.  However, only people with Celiac disease (about 3 million Americans or 1% of the population are afflicted with celiac disease) really *need* to eat a gluten-free diet.  Celiac disease, also known as celiac sprue, is an autoimmune disorder that results in damage to the small intestine when foods with gluten are eaten. When someone with celiac disease consumes something with gluten, their bodies' immune system overreacts to the protein and starts to destroy the lining of the small intestine.  When the small intestine is damaged it cannot properly absorb nutrients from food and this can lead to malnutrition, severe diarrhea, abdominal pain, anemia, loss of bone density and a myriad of other symptoms.  

3. Why have gluten free diets become so popular for people without Celiac disease?

The gluten-free has become so popular, that about 30% of Americans are trying to eliminate or decrease their gluten consumption.  Even products that never contained gluten in the first place like potato chips and popcorn are being marketed for their lack of gluten.  There are even gluten free dating sites!!  I can’t wait until someone tries to market gluten-free water!  Many people claim that going gluten-free has helped their GI distress and even if it is just a fad, it’s making you healthier, right?

Let's set the record straight: There is no evidence that going gluten-free has any health benefits.     Actually, the reverse is true.  Going gluten-free when you do not have Celiac disease actually increases the chance that you will gain weight and possibly develop diabetes.  A recent study by Harvard University that included over 200,000 patients has found that decreasing your gluten intake can increase the risk of developing diabetes by as much as 13%.  Many gluten-free foods are high in calories, fat and sugar while being low in actual nutrients. When people eat too much of these highly processed low nutrient food, they gain weight and this increase their chances of developing diabetes.  

4. Why are so many people sticking to a dietary regimen that offers no tangible health benefits and actually makes them actively unhealthier?

Unfortunately the gluten-free food fad is shrouded in a healthy halo, and millions of people perceive it as the healthy thing to do for their digestive tract.  If you are concerned that you may have celiac disease, go to your provider and you can get a simple blood test that will provide you with an answer.  If you do not have celiac disease, then you are more likely to benefit by focusing on a diet that is rich in nutrients and staying away from highly processed foods.

Dr. Pam
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Steam: not just for taking the wrinkles out of shirts or is it?  A quick word on how douching affects health and why your favorite movie stars may be wrong

3/7/2017

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Douching, or washing out the inside of the vagina, is a common practice in the U.S. with as many as one in four women between the ages of 15 and 44 engaging in this practice.  Different methods range from solutions of water, vinegar and other chemicals sprayed into the vagina in order to “clean” it.  Some women even use steam!  Still, whether suggested by family, friends or even movie stars, there are no proven health benefits to douching; however, there are a number of potential health risks.

First of all, douching can affect the normal bacteria and pH in the vagina.  Generally, the bacteria is an acidic environment, but douching may encourage a less acidic bacterial population predisposing to bacterial vaginosis (BV) and yeast.  In fact, women who douche may be up to 5 times more likely to develop BV than women who don’t douche.  This can result in vaginal discharge with odor and increased irritation.

Another popular misconception is that douching can prevent sexually transmitted infections (STIs).  Unfortunately, this couldn’t be more wrong.  The fluid pushes bacteria from the vagina into the uterus and fallopian tubes, and in fact, is associated with an INCREASED risk of STIs, including HIV, and also development of pelvic inflammatory disease.

Even pregnancy can be affected by douching, even though pregnancy can’t be prevented by it.  Women who douche are at increased risk for development of ectopic pregnancy, a pregnancy outside the uterus that often occurs in the fallopian tube.  This type of pregnancy can’t be carried long enough to deliver a healthy baby and may be life-threatening for women who have ectopic pregnancies.  One last negative effect of douching on pregnancy is the increase in risk of preterm (early) pregnancy delivery.

So, is there ever a good indication for douching?  Not that we’re aware of.  Fortunately, the vagina is a rather self-sufficient organ.  Mucous is produced internally to clean away blood and semen, and the normal bacteria can help provide an acidic environment that helps prevent not only STIs but also colonization by bacterial vaginosis and yeast.

If you do develop vaginal discharge with odor, green/yellow/pus-like appearance, fever, vaginal lesions, pelvic pain or pain with urination, be sure to seek evaluation with a doctor.  You may have an infection that requires treatment.  Without medication the infection may be spread to a partner or even affect your ability to have children.  The good news is that these infections generally resolve with antibiotics, so let your medical provider know if you have any of these symptoms.

Dr Nick
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Maintaining your Breast Health:  An Owner's Guide

10/11/2016

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As we take time to commemorate breast cancer awareness month and remember those who have battled breast cancer valiantly and lost, we also would like to celebrate those who have won their personal struggle against breast cancer.  For all of those who brave women who have overcome breast cancer, we salute you.  For those who have been fortunate to avoid a personal experience with breast cancer, we would like to offer a few suggestions on how to continue good breast health.

How many women are affected by breast cancer? Even in absence of a genetic predisposition to breast cancer, a woman faces a 1 in 8 chance (about 12%) of getting breast cancer in her lifetime.  That means, if you and seven of your girlfriends go to dinner, odds are that one of you will likely be affected by breast cancer in her lifetime.  For women who are BRCA 1 carriers, this may increase to 55-65% chance of breast cancer by age 70, and it increases to 45% by age 70 with BRCA 2 mutation.

What are risk factors for breast cancer?  Age (older than age 50), genetic mutations, early menses (starting your cycle prior to age 12), later or no pregnancy (first pregnancy after age 30), late menopause (after age 55), lack of physical activity, being overweight or obese after menopause, dense breast tissue, use of combination hormone therapy (estrogen and progesterone) after menopause, use of HIGH (not low) dose combination birth control pills (estrogen and progesterone), personal history or family history of breast cancer, personal history of atypical hyperplasia or lobular carcinoma in situ of the breast, previous radiation therapy, history of DES use and drinking alcohol.

What are warning signs of breast cancer?  New breast lumps (although not all breast lumps are cancer); thickening or swelling of the breast; irritation, redness, flaking or dimpling of breast skin; pulling in of the nipple (retraction); painful nipples; discharge, including blood, other than breast milk; change in size or shape of the breast; and new breast pain.

Who should be screened and when?  Screening guidelines vary depending on the organization’s guidelines are used.  The American College of Obstetricians and Gynecologists (ACOG) suggests annual clinical breast exams and mammograms annually beginning at age 40 for women of average risk.  Although this varies slightly in comparison to the US Preventive Task Force and American Cancer Society guidelines, given the frequency of affected women as well as the more rapid progression of breast cancer in comparison to cervical cancer, we generally use the ACOG guidelines. Lastly, self breast exams are recommended monthly in all women.  This is generally best done in the shower while the tissue is softest.

What about BRCA testing?  It may be considered in those with a close relative (i.e. mother, sister, grandmother) diagnosed with breast cancer earlier than age 50, cancer in both breasts in the same woman, breast and ovarian cancers in the same woman or same family, multiple breast cancers in the same family, two or more BRCA-associated cancers in the same family member, male breast cancer and Ashkenazi Jewish ethnicity.

Is there anything I can do to decrease my risk?  Maintaining a healthy weight, exercising regularly, either avoidance of or limiting alcohol consumption, avoidance of carcinogens (chemicals that can cause cancer), limiting radiation exposure (except with medically indicated testing), breastfeeding children, limiting use of combined hormone replacement (use of estrogen and progesterone, used to avoid endometrial cancer in menopausal women with a uterus), and using lower-dose birth control pills when possible.

If you have any concerns about breast health, please be sure to contact your provider for more information.  Once again, we would like to take a moment to honor those brave women (and the families of those women) who have faced, or are facing, breast cancer.   While we certainly want to acknowledge you this month, know that you are in our thoughts all year.

Nick
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Location

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Teton Women's Health Center

2001 S Woodruff Ave #10
Idaho Falls, ID 83404









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Contact Us

Tel: 208-523-2060
​Fax: 208-523-9874

Office Hours

Mon - Thurs: 8:00 am - 12:00 pm & 1:00 pm - 5:00 pm
Fri - 8:00 am - 12:00 pm

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**While we are excited to answer your questions, please be aware that the links below are not intended to provide urgent or emergent medical advice.  Thank you!