GynoFiles

Protecting ourselves from illness is a complex process: unfortunately, not just a shot: but nutrition, improvement of our immune system, exercise, hand washing, limiting exposure when possible all are an integral part of avoiding disease. We cannot prevent Ebola by vaccination, but then again there are many diseases we can prevent. Vaccinations are invaluable however, and I have always urged patients to take full advantage of them, and that means rechecking with your health care provider regularly . Vaccination has eradicated small pox, and hopefully polio will be the next to go. We have talked about eradicating cervical cancer, and sexual health has to be added to the list of behaviors that contribute to the eradication of cervical cancer! Flu shots are only about 62 % effective in the 2013 flu season in sophisticated viral studies, although improvements, mentioned below, are coming for 2014. Most women can take most vaccines, but there are some contraindications to gett...

Uterine fibroids are non cancerous muscle knots that develop with in the muscle of the uterus. They can be cause of heavy bleeding, and there are few effective therapies that are not surgical.  Eventually they can be within the cavity of the uterus, the wall, or protruding out of the uterus, and be from pinpoint size to quite large (basketball size)Fibroid risk is almost ubiquitous, but in fact it is more common for some groups of patients to have uterine fibroids. It has bee thought for a long time that there is a genetic component, and that black women have a greatr risk of uterus fibroids. According to a study of gynecologic population trends from the Mayo Clini c and reported in the November 2011 American Journal of Obstetric and Gynecology, by age 50 about 70% of Caucasian women and 80% of African American women have fibroids. But by the age of 35 over a third of Caucasian women and over half of black women will already have them, and be symptomatic. These numbers are so la...

Danish researchers working with researchers at the University of Barcelona have been studying girls born smaller than average size. They have been studying their body size, their fat cells, their fat hormones like leptin and adiponectin and watching how they develop from birth, to age 2, 4, 6 and 8. Because prior research shows that reduced fetal growth can actually trigger both early puberty, and early onset of adrenal gland maturity, but small ovaries, they have been trying to then determine what happens to their physiology after that.  In a study published in the July 2011 issue of Fertility and Sterility they published the interesting result of a group of about 30 girls. On the surface being born tiny didn't affect their body type much. The girls grew height, they gained muscle and they developed healthy bones at the same rates. But when they looked more closely they saw physiological changes. The fat hormone leptin began to run higher in girls born small, the fat hormone a...

Sexy is Beautiful, and Beauty, well to some cultures other subtleties are desired. The entomology of the word beauty in many cultures gives us insight as to what the culture values and finds beautiful.I'm enjoying the musings on this topic in the discussion by Claude Hagege in his "bewitching beauty and language's secret formulas," as reading between the lines and beyond the obvious has always fascinated me. In Hebrew the word hen means grace as well as beauty, and in Korean, arecumdab talks about actual intellectual beauty, like landscape, and mosissda is beauty of elegance and distinction. And lest we forget that synonymous "young and beautiful" which was an adage long before it was a Soap. Perhaps some of the etiology of  the youth culture brought to us by the Summer of Love and never really left. Looking for that perfect poem for your loved one, what gender do you need? Having trouble, grab a Persian poems, they  are ambiguous in their gender. Or do ...

Testosterone testing is very useful for gynos, and you may want to gab with yours to see if you need this hormone checked. But getting the right test, and an accurate test is very important. The Testosterone Tests were Toppled in 2011. Laboratories changed the way they reported tests, and they had to change how they interpreted the results. Results of Testosterone Tests called into question by the endocrine society  and then the tests have been improved. All patients need to understand that all testing has flaws, but with hormones it's often difficult to get a test that your gyno can use. Times of day, part of the menstrual cycle, are just two of the obvious sources of error to testosterone testing. Then there is the fact that physicians have not been able to decide what level is a normal blood level of testosterone. It may not even be so simple as what is normal per decade of life, but may be what is normal for a certain ethnicity.  But there is more to it t...

Xu and Xu and Zhu, and co-workers have done a fascinating study that was buried in the very back of the September issue of Contraception (good thing GynoGab Gal does the cover to cover of the good ones!). Working in Jiangsu, China they have discovered that the progestin component, the levonorgestrel, may actually both suppress the growth and cause death of uterine fibroid cells! WoW! These researchers have been studying the fine points of fibroid growth. We know that it's probably a chromosome glitch in a single uterine muscle cell that gets that fibroid cell's growth unleashed and causes a tumor to grow. So they did a study of cells in culture from twenty women with fibroids who had hysterectomy. They point out that the growth, based on active DNA (ok, for the accurate scientists, actual mRNA phase of growth) was more active in the progesterone (luteal, second half) of the menstrual cycle, but paradoxically the growth of fibroids is somewhat restricted during phases of pr...

There are many complex ways of figuring out if your leg aching and swelling is an issue. Pain in one leg, not both, is something to watch for. Swelling on one side, not the other is another thing to watch for, so that if one calf is close to an inch bigger than the other calf, measured at the same spot, that's a warning sign. And if you are prego, or on the pill, or on hormone therapy, or on Evista, the osteoporosis therapy, or on Lysteda, the new heavy bleeding medication, all reasons to call the Gyno 911(or your primary care MD)  to check it out!

Is that gyno of yours gabbing away in gyno-isms blah blah blah, who can understand these biologic neologisms? So if you need to fix in on some fibroid terminology, just read on. Fibroid tumors are simple muscle knots that grow from the wall of the uterus itself. The uterus is essentially a three layer structure: the lining, or endometrium (you shed it during your periods), the muscle wall or myometrium, and then the thinnest of coverings called the serosa, sort of a shinny skin layering. Fibroids only grow from the myometrium, and they are either poking under the endometrium into the cavity of the uterus, entrapped within the wall, or sticking out the top. But we use other terms, we call the ones within the wall intramural, and those poking out the top subserosal, and those poking into the cavity submucosal.We need to know in case we are planning an endometrial ablation or other treatment And if the fibroid is within the wall but pokes out the top, we don’t split hairs, we just go a...

Sir William Osler was a Canadian physician who gained fame in the USA at Johns Hopkins Hospital, and then became knighted in 1911 in England. Truly a man of the world, and the words he left us in medicine are often quoted and often thought of when we get the chance to actually sit and talk with patients. For those who even have read only one or two of my posts, one would say, I'm not shy of prescribing and recommending medication. So it's always with a bit of pause when I mull over the words of Osler: "the desire to take medicine is perhaps the greatest feature which distinguishes man from animals." Was this rally a backhanded complement? Does this mean that we cannot be natural? Did this mean we are too quick to take medicine? Does this mean that we must only fix with medicine? Understanding the subtext of this sentence reminds me to start each piece of advice with: remember: lifestyle choices are as important as the medicines to swallow that my recommendations may...

Miller Park Zoo, W. Scifres About one in 4 Americans is registered in what is called the National Cancer Institute’s Surveillance, Epidemiology, and End Results study. As these Americans get cancer they get followed as to how they do. The study doesn’t formally group each patient, they get grouped according to how they were treated by their physicians. For instance, in a study published in the spring of 2010 in Obstetrics and Gynecology from the Columbia University College of Physicians and Surgeons they reported on 1400 women with the vary earliest forms of Cervical cancer, looking at both what they called Stage IA1 and IA2 cancers. Actually IA! Cancers, a cancer that is only 3 mm by 7 mm or less invasion past the surface’s basement membrane account for about 60 to 70% of all cervical cancers, so about 7000 cancers per year. So over the 9 years they gathered data for this study they probably looked at 1400/63,000 or as I estimate about 2% of all of those cancers that occurred....

Miller Park Zoo, by W. Scifres Fibroids mostly are actually not finicky, probably 2/3 rd s of women who have them, can keep them in quite silence. They won’t require any treatment at all in these 2 out of three women. Now having said that, I say most often no the fibroids won’t need treatment, definitely not needing any treatment initially, but that doesn’t mean they don’t need to be watched, poked, measured, and tested in other ways. Are you having pain, pressure, problems conceiving, and not flooding, but just a menstrual period that is on the side of annoying rather than forgettable? If the symptoms of your now properly measured and diagnosed fibroid get more than minor, there are alternatives. Cutting the fibroid off the lining can be done very non-invasively and even modestly bothersome symptoms are worth treating if that’s the case. And often when I do consultations many women haven’t even heard of their alternatives. We’ve reviewed some of the issues you and your gyno are g...

Lots of factors have to do with the preservation of the pelvis and preservation of the pelvic floor during birthing. How big the bay is, whether you are birthing twins, how long the labor, how much pushing, what devices were used, whether you had an epidural. Too many to list, and not all studies are really clear if these factors are all damaging, and if so, how damaging. For instance in the 70s a gyno named Bickers thought epidurals were pelvic floor protective, and in research published much laters Legino in Nebraska did work that said epidurals actually led to more birth injuries. But both those studies were before epidurals were as common in the labor wards as they are now, so I'm not sure how much to believe either. But then there is the situation of one birth injury that could lead to the next round of birth injuries. It's safe to say your risk of a second injury is at least doubled with the next birth. We apparently cannot just rub it out, Labreique studied over 1500 C...

Most women who have had a delivery know the word episiotomy, we never had to learn it for scrabble, pretty much too many letters, but we had to learn it for birthing. It's the cut between the vagina and rectum that makes more room for the baby. And most know that the cut can be made straight towards the rectum, essentially at the "6:00 o'clock" position, and it's a risk for a major rectal tear, but on the other hand can make a lot of room. The other option is to go towards the edge or your leg, and sort of towards the butt, and not straight down in sort of a "8:00 o'clock" slant. It's even a bigger cut, but it does tend to avoid cutting into the rectum. It's more likely to heal a bit worse (in many studies, not all) so we tend to cut down. But then there are those that do the J. They cut down and then do a bit of a right turn to avoid the rectum. Sort of looks like a change of course. But then again, perhaps it's a just in time miss th...

Amniotic fluid is an interesting fluid in oh so many ways. It begins as an excretion of mom's fluid seeping across the circulation into the uterus, then once there is a fetus in the uterus it seeps fluid through it's skin to create the fluid, and lastly, after about 20 weeks when the skin is too thick through the natural maturing process of skin codification the fluid is mostly made of fetal urine. Yet, we always call it amniotic fluid, and many of the properties remain remarkably the same. None the less, it's always been considered one of the better signs of the health of the mom and the health of the baby. And we mostly measure that health by the absolute amount of fluid in the uterus. That fluid can be measured by saying "yep there's a lot" (literally the look of it), or the actual 4 quadrant vertical deepest pocket of fluid. Sonographers do both when doing your ultrasound. But since some of mom's fluid still creeps into the mix, moms who are run dow...

Check your pulse. What is it? What was it last year, and ten years ago? High heart rates can be due to a number of factors, nerves, sure, that's part of "the jitters." But it may not just mean you are overweight, and out of shape, yes, it means that too...but it might mean a serious health concern. The National Institute of Health has decided to study the beating of the heart. And heart rates over 80 (what was yours? check again) may mean poor health according to the ARIC study . And for the first time they looked at the consequences of an abnormal heart rate on your kidneys. Higher than normal heart rates don't help the kidneys either. Women may in fact have lower heart rates than men, but the general cut off for 80 is right now used for both women and men. So if you need to think about why your heart rate may be abnormal, go see your gyno.

There has been a new link proposed between the use of bisphosphonates and esophageal cance r, already one of the smoking linked cancers. So remember, like with other cancers, it's important to have your individual risk profile looked at by your own gyno. The link was the strongest if a woman had filled over 10 prescriptions, essentially the amount you'd fill if you were on the  medication for at least 5 years. Again, remember, most drug approvals are based on 1-3 year data, rarely longer. Although longer studies are published, it's not always possible to know the effects of very long term medication use without careful follow up. So when you see your gyno next, ask about what things you can do to overall reduce your chances of long term harm from long term medication use. Remember with every medicine we talk about the "risk benefit ratio." Make sure the benefit part of your equation is the heavily weighted part!

She's is the Queen. Literally. She was a queen, a queen of Great Britain and a queen of miscarriages. Well actually she was, Queen ascended to her throne in 1702, at the time she ruled England, Scotland and Ireland, and it was she who untied England and Scotland. Queen Ann's legacy was destined to be historical rather than genetic as her obstetrical history was very poor. We have never established what her medical problems was, perhaps a double uterus, uterine fibroids, infections, or something more complex such as antiphospholipid syndrome, but she never produced an heir although she had many pregnancies. Queen Anne of England had so many miscarriages she would have been labeled a habitual aborter in our time. We label those who have three or more miscarriages a habitual aborter. In truth, they are extremely common in fertile as well as those who never have a birth to term. Actually once you have 2 miscarriages your chance of miscarrying again is roughly 30%. 80% of miscarr...