Index -- WPGYN Newsletter -- Volume 9, Issue , January 2012
Many women suffer from urinary urgency, incontinence, or bladder prolapse. If possible, many women would like to have solutions that don’t involve surgery or medications. Now El Camino Hospital is offering a seven-week program for women of all ages to help correct and strengthen the muscles of the pelvic floor. Classes are taught by Meenal Mujumdar, a physical therapist with special expertise in pelvic floor therapy. The one-hour workout is followed by a brief educational discussion of nutritional, behavioral, and lifestyle changes that can have a positive impact on pelvic health. In the privacy of the class setting, women discover a supportive environment where they can share their most embarrassing moments and take pride in their successes. Class meets twice weekly for seven weeks and costs $150. There are also free introductory classes, including one on January 4 and one on January 6 at the Park Pavilion. Registration is required. For more information on this program, go to http://www.elcaminohospital.org/Womens_Hospital/Pelvic_Health_Program or call 650-940-7285.
I just learned about an interesting community resource for women of all ages. Deborah’s Palm is a non-profit organization that serves as a resource for women in the community by providing support and information in an encouraging and warm environment. As society becomes more challenging and stressful, women of all ages can find help, support, understanding and friendship through carefully selected groups, classes and activities.
The founder, Katie Ritchey, has done research on stress, isolation, and the importance of social support systems. Katie, a native Palo Altan, saw that there was no women’s center in her community for women to gather and encourage one another during daily challenges and seasons of change throughout a woman’s life. She took on the task of renovating an 1896 Victorian, in order to create a welcoming space, for women’s relationships to form and grow, and life to be celebrated.
To learn about the options for counseling, classes, resources, connections, and volunteering, go to http://www.deborahspalm.org/ or drop by at Deborah's Palm at 555 Lytton Ave., Palo Alto from 9 am to 6 pm Monday through Friday or call 650/473-0664 or email: email@example.com.
What about vitamin supplements?
Another recent study in the Archives of Internal Medicine showed that women aged 55-69 who took multivitamins had a 2.4% increase in death rates. Other supplements that increased mortality in that study included Vit B6, folic acid, Fe, magnesium, zinc and copper. Copper was the worst of all with an 18% increased mortality rate. On the other hand, calcium reduced the risk of death by 3.8%.
It is important to remember that the Archives study was looking at postmenopausal women. In women planning a pregnancy, or newly pregnant, prenatal vitamins with extra folate and iron will reduce the risk of birth defects and anemia in pregnancy.
A fun and interactive website to help decide if certain supplements are right for you is http://www.informationisbeautiful.net/play/snake-oil-supplements/ . A sample of how it looks is on the right. You can select a condition of interest and it will show what supplements have been studied for that condition and how strong the evidence is to show if it can benefit the condition. For example, the 2 supplements that appear beneficial for cancer are calcium/Vitamin D and fish oil/omega 3 fatty acids. For cardiac disease, there is evidence supporting garlic, fish oil/omega 3 FA, green tea, dark chocolate, CoQ10, niacin, olive leaf extract, and omega 6.
When doing your own research on things like supplements, be careful about the source of information. Many websites are primarily commercial since vitamins and supplements represent a multi-million dollar market. Always consider the source of any websites. A site ending in .gov will have the highest quality evidence-based health information, such as the fda site. Always consider the credentials of the author and whether there are financial ties or bias. Watch out for sensationalized content and patient testimonials. A good place to start a search is the National Medical Library Web site at http://www.mlanet.org/resources/userguide.html. The National Library of Medicine and National Institutes of Health also provide an outstanding 16-minute lesson on how you can evaluate online health information. Find it at http://www.nlm.nih.gov/medlineplus/webeval/html.
One thing that all studies agree on is that a healthy life style can improve your well-being and decrease your mortality. Eating a healthy diet with adequate vegetables, fruits, and grains will provide you with the vitamins, minerals, and antioxidants that your body needs. Making a point of eating healthy and nutritious foods will also reduce your cravings for foods that are high in animal fats, processed carbohydrates and sugars. A bit of dark chocolate is a nice treat. Regular exercise of at least 30 minutes 5 days a week has also been shown to reduce mortality from both cancer and heart disease.
There have been some changes in recommendations regarding the Shingles vaccine (named Zostavax). In the past, it was only recommended for people aged 60 and above. The FDA has now approved its use for anyone 50 and above. Should you be vaccinated? The information below may help you decide.
What is Shingles and post-herpetic neuralgia?
Anyone who had chicken pox as a child (which is just about everyone 50 y/o and above) could potentially get shingles since it is a reactivation of the chicken pox virus named Herpes Zoster. It is especially likely to happen as one ages or if one is immune suppressed. Shingles is a painful rash that may appear like blisters on one side of the body, often in a line or small grouping. Some people who get Shingles will develop pain along the nerve tracks where the blisters appeared that may last long after the blisters have gone away and may be severe and disabling. This is called post-herpetic neuralgia or PHN.
How common is Shingles and post-herpetic neuralgia?
About 1 million people will develop Shingles every year. The overall incidence is somewhere between 1 in 5 people and 1 in 3 people. If you live to 85 years old, there is a 50% chance you will get it. The incidence of PHN also varies by age. It is only about 20% overall, but in people over 60, it is 40% and in people over 70, it is 50%. It is most likely to occur under periods of immune suppression that may be caused by stress, chemotherapy, or other illnesses.
What is the Shingles vaccine?
The Shingles vaccine reduces your risk of developing Shingles and the persistent pain that sometimes follows. It contains the same virus that causes chicken pox but the virus has been altered so it is not strong enough to cause chicken pox or shingles. Because is is a living virus, it cannot be used if you are immune suppressed so it is important to take it when you are healthy rather than waiting until you think you need it. It also cannot be used if you are allergic to neomycin. The main side effect is redness and tenderness at the injection site.
How effective is the Shingles vaccine?
Zostavax prevents 51% of shingles outbreaks and 67% of post-herpetic
effectiveness depends on the age since the older you are, the less
likely you will be able to develop an immune response.
The reduction in incidence is as follows:
Where can you get the vaccine and how much does it cost?
Women Physicians now has the vaccine in stock, although at times it is in short supply. It costs approximately $220. It is covered by Medicare part D, but not by Medicare part B. Check with your insurance as different insurers handle it differently.
What else can you do for Shingles?
If you think you have Shingles, come in for an appointment right away. If we start anti-viral medicine within 3 days of the outbreak, the outbreak will resolve sooner and you are less likely to get post-herpetic neuralgia.
Every year since the shocking report of the WHI in 2004 we have new information to help clarify how to safely and effectively help women manage the menopause transition and beyond. In 2004, the combined estrogen and progesterone arm of the study was stopped prematurely due to an increased risk of breast cancer and heart disease. Many women discarded their hormone treatments, preferring to suffer hot flashes than take serious risks with their health. Many women entering menopause also suffered significant symptoms, even though the WHI study focused on asymptomatic women and didn’t really apply to them. In 2011, 2 major studies presented some data that helps us to identify women for whom the benefits of hormone therapy may outweigh the risks. The data is reassuring for the younger, recently menopausal women who tend to have the worst hot flashes.
One of the surprising things about the original WHI study is that it showed an increased risk of heart disease with hormones whereas previous studies had suggested that hormones protected against heart disease. Since then, review of the WHI study and the Nurse’s Health Study suggested the timing of when hormones were started had a major influence on whether or not they increased the risk of heart disease. The patients who did poorly in the WHI had often been in menopause for 10 years when hormones were suddenly started. Now we have a third study, the California Teacher’s Study (CTS) with more than 71,000 participants followed for 5 to 7 years that showed a decreased risk of heart disease for hormone users compared to non-users with a risk ratio of 0.54 when the hormones were started in recently menopausal women for control of bothersome symptoms.
Another interesting report that came out in 2011 was a follow-up to the WHI Estrogen-Only study. The original study had followed women who had hysterectomies on estrogen-only therapy for 7 years. Though women taking the estrogen had shown a lower risk of breast cancer and heart disease than those who were not taking them, the study was stopped because the women on estrogen had an increased risk of stroke. Many women in the original trial were looked at again after 4 years of being off the hormones. This follow-up study showed the reduced risk of breast cancer continued and there was no increase in heart disease, stroke, deep venous thrombosis, hip fracture, colorectal cancer or mortality in the group that had used estrogen. Once again, the younger women who used the hormones did the best.
These 2 studies confirm the information provided by previous studies and other ongoing studies. Current evidence suggests that women going through the menopause transition with significant hot flashes and night sweats can use hormones as treatment with no increased risk of heart disease and, in the case of estrogen-alone, no increased risk of breast cancer.
Bottom line: In young symptomatic women who need hormone treatment the most, there is a wide margin of safety.
Two recent studies also confirmed the benefits of having hysterectomies performed by minimally invasive surgery, including the daVinci Robot, instead of a large abdominal incision. Benefits included less bleeding, lower infection rates, less antibiotics, fewer hospital days, and less pain. The overall rate of intraoperative complications decreased significantly from 7.2% to 4% and the rate of minor postoperative complications decreased significantly from 18% to 5.7%. The cost of the equipment and the surgery itself is more expensive but that is offset by the shorter hospital stays and the decrease in complications so overall the costs are the same.
Hysterectomy is one of the most-frequently performed procedures in the United States, with 600,000 operations performed each year. According to the study, 90 percent of the patients undergoing hysterectomies are doing so for benign reasons—leiomyomas, pelvic pain, pelvic organ prolapse and abnormal uterine bleeding, among the most common reasons. Unfortunately, only 1 in 3 hysterectomies are performed by minimally invasive surgery techniques.
Dr. Sutherland is glad that she learned the technique when she did and now is among a small group of gynecologists at El Camino who are proficient with the da Vinci Robot. She is happy to consult with patients who need a hysterectomy and are looking for an alternative to the abdominal approach.
Information on this website is for educational and reference purposes only and should not be interpreted as specific medical advice.
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