An Alternate Way to Remove Those Ticks!

…..Last weekend, I was reminded that we are deep into another summer that is full of the problems with ticks.  At the end of a great summer day, I watched as my daughter checked her little ones for ticks.  She keeps them away from the bushy areas, but at bath time the checking takes place.

…..I recently learned about a different way to help remove a Ticks 4 Green Cotton Ballstick.  Take a cotton ball and put liquid soap on it.  Cover the discovered tick with the cotton ball and rub the soap on the tick for a few seconds.  Usually the tick will dislodge on its own and be stuck to the cotton ball as you take it away.

…..Hopefully you will not need to try this method but keep it in the back of your mind.  Enjoy the summer!

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…..For my instructions on removing a tick with tweezers: You Found a Tick on Yourself – What Are the Next Steps?

-Dr. P

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Concerned About Mercury Consumption During Pregnancy? The FDA Has Relaxed Its Stance

The Food and Drug Administration of the United States has recently drafted new guidelines, reassuring pregnant women and nursing mothers that they should include more seafood in their diets.  This is because the health benefits far outweigh the risk of the mercury content.  The new suggestions advise eating 8 to 12 ounces of seafood a week, whicTwo fresh sea bream on wooden board with herbs and lemonh means 2 to 3 meals per week.  The FDA also suggests that young children should also be eating fish 2 to 3 times per week in portions that are appropriate for their age.

Some important facts:

  • Fish are loaded with the types of omega-3 fatty acids that are high in DHA, which is important in brain and eye development.
  • The FDA suggests that women and children should consume fish low in mercury.  These include canned light tuna, salmon, tilapia, catfish, cod, shrimp, and pollock.
  • Four fish to avoid because of their high levels of mercury include shark, swordfish, tilefish from the Gulf of Mexico, and king mackerel.
  • Almost all fish contains trace amounts of mercury.  Mercury in high amounts can harm the brain and nervous system.

-Dr. P

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Herpes Information Made Simple

…..A few times a week a new case of genital herpes presents to my office, and the patient always experiences great psychological and physical pain and stress.  The classic presentatioBeautiful Woman with Pencil and Folder Isolated on White.n of HSV (herpes simplex virus) is a painful group of vesicles and ulcers.

…..The infections are classified as primary, non-primary first episode, or recurrent.  The primary infection is the most painful and may be associated with tender lymph nodes as well as a fever and body aches.  If not treated, these primary lesions can last 2 to 6 weeks.  Recurrences vary in their frequency; however, 50% of patients will have one within 6 months.  These recurrences are generally milder with fewer lesions and a much shorter course.

Herpes, Type 1 and Type 2

…..HSV is a DNA virus classified into two subtypes, 1 and 2, based on various proteins making up the virus.  HSV-1 is primarily the cause of herpes of the mouth and in the past was said to be the cause of infections above the waist.  It can also be responsible for genital infections, and these infections are becoming more common, especially among young women.

…..HSV-2 is almost always a genital infection.  The virus is spread through direct contact with mucosa (moist tissue like the vagina and lips/mouth) or damaged, irritated skin.  Incubation of the virus lasts for about a week, and the virus then reproduces in the superficial layers of the skin, causing inflammation and damage.  During the first infection, the virus enters the nerve cells and becomes dormant.  The virus can reactivate and cause ulcerative disease or shed without any symptoms.

…..Let me leave you with a few facts:

  • In the US, 20% of women have had an HSV-2 infection
  • Most infections are spread by those who are unaware of having HSV
  • Recurrent disease is more common in those with type 2, compared to those with type 1

Methods of Herpes Treatment

 …..For now we will finish our discussion of herpes.

…..During a symptomatic outbreak, the treatment consists of supportive measures such as oral and topical pain medications and special genital hygiene.  An antiviral medication can be added to decrease the viral shedding and the duration of the painful ulcers.  These medications should be started at the onset of the symptoms.

…..Acyclovir and valacyclovir are the two most common antivirals used and have a long history of safety in pregnancy.  There are some patients who experience frequent attacks, and a daily treatment of these medications can greatly suppress the episodes and therefore decrease the chance of spreading to a sexual partner.

…..In the future we will have a discussion of herpes and pregnancy, but for now I am going to get a donut.

-Dr. P

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Urgent Care

…..I am happy to announce a new program called urgent gynecological care.  This means that immediate appointments are now available 6 days a week.  In gynecology offices, when a patient calls to make an appointment, many times she cannot see her OB/GYN for a few weeks or even months.  This can have a negative impact on her health if immediate attention is needed.  Call us and we will be happy to set up an appointment.

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Polycystic Ovary Syndrome in Young Women – Signs You May Have It

…..P??????????????????olycystic ovary syndrome (PCOS) is a common endocrine problem in young women, and it often goes undiagnosed in the adolescent population.  The patients are frequently presented with menstrual irregularity and signs of androgen excess, which includes unwanted excess hair growth and acne.  These are the symptoms that usually lead the patients to visit their health care professional.  The weight of the young women can range from normal to elevated, and with obesity, the androgen affects can be more advanced.

…..To make the diagnosis of PCOS, certain criteria need to be met.  The most common guideline requires 2 of the following characteristics:

  • Signs of androgen excess
  • Irregular menses (probably secondary to problems with ovulation)
  • On a sonogram exam of the pelvis, the ovaries are found to have many small cysts (polycystic ovaries)

…..PCOS can have metabolic consequences with major effects on the glucose metabolism, affecting up to 25% of these young women.  There are different ways to screen for this abnormality, from obtaining fasting levels of glucose and insulin to a full glucose tolerance test.  Elevated weight levels, monitored by determining the BMI, increases the risk of developing these metabolic problems.

…..Next time we will review management for the young PCOS patients.

-Dr. P

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A Vitamin That May Reduce the Risk of Uterine Fibroids

…..It seems that every day there is a study revealing the importance of having a normal level of vitamin D.  A new report even points to an association between fibroids and vitamin D.  Uterine fibroids are benign tumors of the uterine smooth muscle, and this affects approximately 30 to 40% of all women.  It is one of the leading causes for a hysterectomy in the United States.  In the laboratory it has been shown that an active metabolite of vitamin D can inhibit the growth of fibroid tissue.

…..AA Vitamin That May Reduce the Risk of Uterine Fibroidspproximately 1000 women ages 35 to 49 years old were enrolled in a study where the vitamin D level was obtained, and the fibroid status was determined by ultrasound screenings of these premenopausal women.  The group with normal vitamin D levels had a 30% lower risk of fibroids as compared to those with vitamin D insufficiency.

…..More research needs to be done to confirm these findings but it seems that sufficient vitamin D may be associated with a reduced risk of uterine fibroids.  As always, speak to your health care provider before beginning any new vitamin supplement program.

-Dr. P

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Hair Loss – Its Cycle, Most Common Causes, and the Effect of Stress on It

Hair Loss 7…..I would like to start a discussion of hair loss in women.  This is a common condition for many women.  By age 50, 50% of women will suffer from this problem.  Another term for significant hair loss is alopecia, and affected women can suffer great anxiety and stress.

…..There are two types of alopecia: scarring and non-scarring.  Scarring alopecia can be found in discoid lupus erythematosus and other conditions.  The scar formation destroys the hair follicle, thus causing the hair loss.  These patients should see a dermatologic specialist as soon as possible.  On the other hand, in non-scarring alopecia, the hair follicles are not permanently destroyed, and so the hair loss may be reversible.

What Cycle Does Your Hair Bear Throughout Your Life?

…..Let us start with the hair growth cycle.  There are three phases of this cycle: anagen (growth phase), catagen (transitional or resting phase), and telogen (testing or shedding phase).

…..In the anagen phase, the hair grows, and 80 to 90% of all hair follicles are included in this phase.  This growth pattern can last for 2-3 years, and the length of time is genetically determined.

…..The catagen phase lasts only for 2-3 weeks.  In this resting phase, only 1 to 3% of the scalp follicles are included.

…..The last phase is the telogen phase.  This is when hair is shed usually at a normal rate of 75-100 hairs per day, and it lasts for about 3-4 months.  So it is important to remember that it is natural for some hair loss every day!

Why is Hair Loss Harrowing You?  What is the Cause?

For most patients, a careful history of their hair loss will give a good indication of the cause.  There are many questions to be considered; the following are some of them:

  •  Is the loss diffuse or is it in a specific area?  If it is in a specific area, it is important to delineate the location.
  • Hair care techniques and the products used can provide important Hair Loss 4information.  Are chemical straighteners being used?
  •  Are cornrows part of a new style of yours or have they been used for some time?  Traction alopecia has been seen with the cornrows hairstyle.
  • During a physical exam, the scalp should be carefully inspected.  Is there any scaling, inflammation, or reddish areas?

…..In the areas of the hair loss, if there are hair follicles then you are dealing most likely with non-scarring alopecia.  If there are no follicles then this could be scarring alopecia, and this patient should be sent to a dermatologist, who will consider a biopsy.  The hair should be evaluated for its length, thickness, and fragility.  Lastly, a pull test could be performed, which will help determine if active shedding is taking place.

Women: Your Most Common Cause of Hair Loss

…..The most common cause of hair loss in women is androgenetic alopecia (AGA), which is also known as female pattern hair loss.  This is a genetic disease that can be inherited on many genes, but it does not affect everyone who carries the genes.  By menopause, 40% of all women will be affected in some way.  It is identified as a gradual onset of diffuse hair loss.

…..The problem’s basis is the male hormone found in all women.  It attaches to sites on the hair follicles and affects the follicles that are genetically susceptible.  These follicles have a shortening of the growth phase, and the hair from these follicles are short and thinner than normal ones.

…..Again, hair loss in women is generally diffuse, and there is usually a preservation of the frontal hairline.  This is distinct from male pattern hair loss, with frontal peak and top loss.  AGA’s onset is usually gradual with no specific bare areas.  There does not appear to be an increase in shedding because the hair growth does not become less but is only affected.

…..At the medical exam, the scalp should be examined for redness, signs of infection, and scarring.  A family history should be taken to look for a similar condition in other family members.  Usually, there is not an endocrine cause for this problem, but if general hirsutism accompanies the finding, then a full hormonal investigation should be started.

…..The only FDA-approved treatment is the topically applied vasodilator called Minoxidil (Rogaine).  It comes in an over-the-counter preparation of 2% and 5% foam or liquid, which are all effective.  There seems to be better results with the 5%, but there may be an increased chance of local irritation.  How it specifically works is uncertain but there seems to be an increased growth phase, and the hairs grow longer and stronger.  Remember, the treatment is 2x per day and forever.  When you stop, the hair you gained will be lost.  Lastly, you may not see any results for 3-4 months, so patience is needed.

Is the Stress in Your Mind Causing Stress on Your Hair?

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…..Remember how our mothers always told us that stress could cause so many 

problems and make us feel terrible?  As always, our mothers were right.  For women, a severe illness, psychological stress, or having a baby are inciting stressful events that can cause physical affects.  One of these affects is hair loss.

.…..Usually 90% of our hair is in the growth phase, with 10% in the resting phase.  Keep in mind that some hairs are always shedding in the resting phase, and it is usually a small and regular amount.

…..Telogen Effluvium (TE) is a condition of diffuse hair loss that is caused by an identifiable stressful life situation; three of those situations were stated above.  In TE, 70% of hairs are in the growth phase and 30% in the resting phase.  This results in about 3 times as many resting phase hairs being shed daily.  The hair loss is gradual and diffuse and may be similar in appearance to the loss associated with the female patterned hair loss called androgenic alopecia (AGA).

…..With TE, a woman usually is aware of shedding, but with AGA, the loss is gradual, and shedding is not usually a complaint that is presented.  Also with TE, the loss may not become apparent for several months after the stressful event.

…..To treat TE, you must first identify and resolve the stress the body has been subjected to.  With pregnancy or an acute illness, the hair loss is usually self-limiting with complete recovery within 6 months after having the baby or recovering from the illness.  When TE is caused from psychological stress, since the treatment and recovery can take some time, the hair recovery can also involve a prolonged period.

Four Reasons Why Your Hair Could Be Losing

…..Now we will close our discussion of hair loss in women with a few more causes.

…..Traction Alopecia is hair loss from excessive pulling at the hair roots over a prolonged period of time.  The loss occurs where the hair is pulled in one direction, for example, by a ponytail or a cornrow pattern of braids.  The treatment is usually just discontinuing the particular hairstyles, and in time, the problem resolves.

…..Tinea Capitis is caused by a fungal infection of the hair shaft.  It is most common in children.  However, it can be found in immunocompromised adults such as AIDS patients and patients receiving chemotherapy.  The presentation is usually a round patch of hair loss associated with pruritis and scaling.  The diagnosis is made with cultures and the examination of scrapings along the border of the lesion.  The usual treatment is oral antifungals.

…..Trichotillomania is classified as an impulse control disorder.  It involves compulsive and repetitive pulling or plucking of the hair, which leads to noticeable hair loss.  Patients have described feeling tension before pulling out the hair, and the tension is relieved after the hair is pulled out.  This condition is usually managed by a trained mental health professional.

…..Anagen Effluvium involves an acute loss of scalp and body hair when the growth phase of hair is disrupted.  This occurs mostly with patients on chemotherapy.  Because 80 to 90% of hair is in the growth phase, this hair loss is dramatic and diffuse.  The loss usually begins 1-3 weeks after the chemotherapy is started, and the hair returns typically 3-6 months after the treatment is finished.  The initial hair that returns may differ from the patient’s usual hair, but these changes are mostly temporary.  Permanent hair loss from this condition is usually rare.

…..I hope this information on hair loss in women has been enlightening and helpful.

-Dr. P

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