Osteoporosis
Did you know that we reach our peak bone mass by age 18-25? As we age, we can begin to lose bone mass and particularly as we enter menopause. Osteopenia is low bone mass and is a precursor to osteoporosis. Most fractures occur with low bone mass, or osteopenia, and if you've had a bone fracture, you are at risk for osteoporosis. Women with osteoporosis have a greater risk of fracture that can be detrimental. Fracturing the hip can alter lifestyle, and may lead to the need for a long term care facility and possibly death.
We can maintain good bones and prevent osteoporosis by supplementation and lifestyle choices.
Recommended Calcium supplementation is 1200 mg daily in divided doses. This is because our bodies only absorb about 500-600 mg with one dose. Vitamin D also helps our bodies absorb Calcium and is obtained through diet and sunshine. Since most of us work inside and are concerned about prolonged sun exposure and the risk of skin cancer, many of us are deficient in Vitamin D. Therefore, recommended dose of Vitamin D is 800-1000 IU daily.
Exercise is important as well, and not just for a healthy weight, heart, and mind. Exercise keeps our bones strong and helps improve our balance, preventing falls. We encourage all our patients to get 30 minutes of exercise daily, to include muscle resistance training. Lifestyle choices such as stopping smoking, minimizing alcohol intake and avoiding caffeinated beverages make healthy bones too. There are many things we can't change in life, but we can start here!
Bone Density scans can be performed to determine bone health. Hill Country OBGYN physicians usually recommend women having a baseline scan at age 50 and any woman over the age of 65 should have a scan. Women who are under age 65 with risk fa ctors for developing osteoporosis should have a scan as well. Risk factors include history of a bone fracture, family history, caucasian, thin, smoker, high alcohol/caffeine intake and a variety of medical conditions. If you’re interested, you can have your bone scan done here in our office.
Keep a spring in your step, don’t let your bones shatter your life!
Diabetes
Did you know that 23.6 million Americans are living with Diabetes? Only about 17 million have been diagnosed, however. And more than this, around 57 million Americans are pre-diabetic. This is an epidemic affecting our country’s health and health care in a powerful way. So, let’s learn more about this disease so we can head in a positive direction!
Diabetes Mellitus is a condition involving the pancreas. Our pancreas produces a hormone called insulin, which is used to help our bodies process glucose from our blood stream. Glucose is produced by our bodies and derived also from our diet. It is the energy source for the body. Glucose can be used quickly for energy as well as stored for future use. The job of insulin is to transport glucose from the blood stream to be stored in our muscle, fat or liver.
There are three types of diabetics: type I, type II, and gestational diabetes (GDM).
Type I diabetics are more commonly juvenile onset diabetes and is about 5-10% of all diabetics in America. It is usually discovered when a child suddenly develops a condition called diabetic ketoacidosis. This occurs when blood glucose levels are very high and can result in a serious life threatening diabetic coma. In type I diabetics, insulin is not being made by the pancreas. Therefore, it must be substituted through insulin injections and blood glucose being continually monitored. Many type I diabetics live a healthy, long, normal life.
Type II diabetics are the overwhelming majority in this country. The pancreas does produce insulin, however, the body has become insulin resistant. Because the body’s tissues have become insulin resistant, blood glucose levels remain high and therefore, the pancreas begins to work overtime producing more insulin. Type II diabetes is first treated with lifestyle (diet/exercise) modifications, medication and if needed insulin injections.
Signs and symptoms of type I and type II diabetes are fairly similar. Both may present with increased thirst, frequent urination, extreme fatigue and irritability. Type II may additionally present with frequent infections, cuts that heal slowly, blurred vision and tingling in the hands and feet.
Normal fasting blood glucose levels should be below 130mg/dL. In recent years, blood glucose between 110mg/dL-129mg/dL is considered pre-diabetic. Something to consider is Metabolic Syndrome, a term given to a variety of factors that increase a person’s risk for developing diabetes. Metabolic syndrome includes elevated cholesterol, elevated blood pressure, increased abdominal thickness and elevated blood glucose. With the combination of these factors, serious medical complications can ensue. Complications can affect every part of the body. Damage to the eye may lead to glaucoma and even blindness, decreased feeling and circulation to the extremities can result in amputation, kidney damage can result in dialysis, and skin infections such as recurrent yeast or folliculitis. Increased blood pressure and high cholesterol can add to the severity of diabetes.
Gestational Diabetes can develop during pregnancy. Screening is done around 28 weeks of pregnancy unless there are increased risk factors. Your healthcare provider can determine this. Gestational diabetics are monitored throughout pregnancy. Risks of uncontrolled gestational diabetics can result in a large baby making delivery difficult for mom and baby, blood glucose concerns for baby postpartum, and increased risk of developing type II diabetes.
Management of diabetes includes lifestyle changes. Yep, that’s right…diet and exercise. In fact it is possible to reverse diabetes and prevent it as well. A diet high in grains and fiber and low in fat, salt and sugar help lower cholesterol and decrease the risk for high blood pressure. Exercise actually wakes up the body’s tissues making it more receptive to insulin. If lifestyle changes are not attainable, medications and insulin can be used.
If you think you are at risk for diabetes, please talk with your healthcare provider.
Skin Cancer
More than 56,000 people a year are diagnosed with Melanoma skin cancer. Take time to learn your ABCDEs about pigmented areas on the skin. If you have a family history of melanoma, you should be evaluated by a Dermatologist. We recommend daily sunscreen use and proper clothing to protect your skin. Please enjoy 20% off of our Sunscreens or C-Serums during the month of May!
ABCDE
Asymmetry: Not uniform in shape
Borders: Irregular, jagged
Color: Tan, brown, black, pink, red, variation, “fried egg” pattern
Diameter: >5mm up to 15mm
Enlargement: Increasing in size
The Menstraul Cycle with Dr. Landwermeyer
It is pretty much universal, most women hate their period. We call it by many endearing nicknames: “Aunt Flo”, “The monthly curse,” you get the idea. We all know it is a necessary evil for reproductive health. Let’s take a closer look at the menstrual cycle and learn about it.
Ovulation occurs when a mature egg is released into the fallopian tube in hopes of conception and subsequent pregnancy. Calculating the day of ovulation is kind of tricky. This is because it is a constant 14 days from ovulation to the first day of menstrual flow. However, the number of days between the first day of the period and ovulation is variable. To determine ovulation, count backwards 14 days from the first day of bleeding and this is the day of ovulation that occurred in the previous cycle. You should be able to then predict when the next ovulation is likely to occur.
The lining of the uterus thickens throughout the month in hopes of sustaining a pregnancy. However, if the egg is not fertilized by the sperm, hormonal signals cause the lining of the uterus to shed which is the menstrual bleed. The menstrual cycle on average begins at age 13 and ends on average at age 52. The range of normal can be from 21 to 35 days from Cycle Day 1 to the next Cycle Day 1. Average length of bleeding ranges from 3 days to 10 days.
Hemorrhage concerns occur if a woman soaks through a pad/tampon an hour for 2 consecutive hours, or becomes light-headed, dizzy, or feels like she may pass out. Contact your provider if these symptoms occur.
Your Pap and HPV
The questions I get over and over in my office is, “Should I get tested for HPV?” and “I’ve tested positive for HPV, what does this mean?”
We screen for abnormal cells on pap smears. We want to see if any cells are abnormal, precancerous or cancerous. To obtain a pap smear, we use a swab on the outside of the cervix and a small brush on the inside of the cervix to obtain cells. The pap is screened for two things: (1) Are the cells normal or abnormal? And (2) Is HPV involved?
The sample is then sent off to be tested for any abnormalities. There is a scale of abnormal for paps, a guide to tell us how abnormal the cells appear. There is negative (or normal), atypical (cells that don’t look normal but don’t appear blatantly abnormal either), low grade dysplasia (mildly abnormal cells), high grade dysplasia (moderate to highly abnormal cells), and CIS (carcinoma in situ, pre-cancer or cancerous cells that are located in just that one area).
The Human Papillomavirus is sexually transmitted through skin to skin contact. At this time in research we know there are over 40 different types of the virus in the genital area. We also know there is a direct link with HPV and certain cancers, including but not limited to, cervical, vaginal, vulvar, anal, and throat cancer due to oral sex.
Testing for HPV is done separately. Since HPV is a known factor in causing genital cancers, it helps us screen you better and watch you a little more closely if it is present. As mentioned previously, HPV is transferred by skin to skin contact. Approximately 8/10 people who have ever been sexually active have the virus. Because HPV is a virus, it lays underneath the surface of the skin/mucosa. And because our skin/mucosa is constantly shedding and renewing, it may or may not test positive at the time of your pap smear. There is debate in research at this time whether the HPV can be fought off by our body’s immune system, or if it can become dormant. This debate is ongoing because sometimes patients will test positive for HPV once and then not test positive at another time.
There are two categories of HPV, high risk and low risk. Due to the number of HPV types, results are placed accordingly to their potential risk. We do know that HPV types 16 &18 cause 70% of cervical cancers and are considered high risk. We also know that HPV types 6 & 11 cause genital warts, but not cancer, placing them in the low risk category. (As a side note, the Gardasil vaccine is protective for these four particular types of HPV.)
If your pap smear or HPV results come back abnormal, we will want to repeat your pap within a certain time frame. There are national guidelines that we follow in testing.
We recommend that women over 30 have their pap smear annually and also test for high risk HPV high risk annually. Women under 30, we do not routinely test for high risk HPV. This is because HPV is a slow growing virus and has more potential to cause problems after age 30. However, if a pap result comes back abnormal, we will automatically test for the high risk HPV.
Our office also adheres to the ACOG (American College of Obstetricians and Gynecologists) guidelines in the recommendation not to begin paps until the age of 21. This is because testing for younger women usually leads to unnecessary procedures because their immune system will typically fight off the HPV and its effects. If a young women is sexually active, her doctor may advise her to begin her pap smears.
http://www.cdc.gov/std/HPV/STDFact-HPV.htm
