Sunday, December 25, 2011

New Technology Finds Breast Cancers that are Missed on Mammogram

Mammograms Often Miss Finding Breast Cancer

Mammography
 
It is widely believed that routine mammography will detect breast cancer if it is there to be found. Unfortunately, this is far from the truth. It is well known to medical professionals and radiologists that mammograms can miss up to 20% of cancers that are in the breast waiting to be found. In fact, women with a palpable cancerous lump can sometimes have a normal mammogram! Why does this happen?
There are many reasons for missing a cancer on mammogram. It might be too small to see. It might be obscured by implants or scar tissue. It might not show any of the changes that are looked for (abnormal calcium deposits are suspicious for cancer but are not always present).
But the single most common reason for a mammogram to miss a breast cancer is that many women have dense breast tissue and the density of the tissue hides the typical findings radiologists use to detect cancer when they read a mammogram.
Awareness of the problem of breast tissue density is growing
The web site, http://www.areyoudense.org/ is dedicated to increasing public awareness of this issue. The awareness of this problem has reached the Federal Government. On October 5, 2011, HR 3102 legislation was introduced that would require all mammograms to report on the patient’s breast density and to inform the patient with dense breast tissue that they might benefit from additional screening tests.

In California, unfortunately, Governor Brown recently vetoed SB 791 which said the same thing, but the California legislation is expected to be reintroduced and likely will become the law in 2012.
What additional tests can help detect breast cancer in a woman with dense breast tissue?
Many people turn to MRI for these situations, but MRI can cost up to $2,000 every time and is often not covered by insurance, leading to a big battle between the worried patient and their health plan.
Luckily, there is another alternative, called SonoCiné AWBU. The AWBU stands for “Automated Whole Breast Ultrasound.”  To quote the company, “SonoCiné is an automated breast ultrasound system that has been cleared by the FDA as an adjunctive examination to mammography. It is a complementary examination and not a replacement for mammography. Peer reviewed, published, clinical trials demonstrated that SonoCiné, when used as an adjunct to mammography, found more and smaller cancers than were found by mammography alone.”
The inventor of SonoCiné AWBU is Dr. Kevin Kelly, a breast radiologist for over 30 years. He used to be on staff here at Huntington Memorial Hospital and Hill Breast Center. He left in order to commit full-time to bringing SonoCiné AWBU to market, and his dream is starting to come true. There are over 20 locations in the U.S. currently offering SonoCiné AWBU and it is being performed in other countries as well. They have over 30 patents on this technology so far, and it only costs about $300! Painless, quick, safe and with the ability to find breast cancers that mammograms will miss. Amazing!
You can schedule a SonoCiné AWBU with Dr. Kelly himself. He is located in Venice Beach, less than an hour drive from Pasadena. Call 310-566-6688. For more information, go to http://www.sonocine.com/

Tuesday, November 1, 2011

Early Detection of Ovarian Cancer

Ovarian cancer is the second most common cause of female reproductive cancer. In 2010 22,000 women were diagnosed with ovarian cancer and almost 14,000 died from their disease. In most cases by the time the diagnosis has been made, the disease is in an advanced stage, with maybe a 30% chance of surviving 5 years, even with the best treatment available.
Our profession has been struggling for years to find a way to detect ovarian cancer in the early stage where there is greater than a 90% 5-year survival.
The CA-125 blood test has been available for many years, but has long been known to be very inaccurate, especially in pre-menopausal women. Many other conditions can lead to elevated levels of CA-125 which then might lead to unnecessary surgery. On the other hand, ovarian cancer can still be present even with a normal level of CA-125.
Routine vaginal ultrasound has been studied in low-risk and high-risk groups. So far, the data do not show an acceptable rate of early detection due to the high number of false positive diagnoses. Many women have positive findings on vaginal ultrasound, but there is not a reliable way to determine if this findings are harmless and will resolve on their own or if thet are suspicious for cancer and thus warrant exploratory surgery.
A new test called the OVA1® may prove to be helpful. OVA1® is the first blood test cleared to help a physician evaluate the likelihood that an ovarian adnexal mass is malignant or benign prior to a planned surgery.
The OVA1® can help determine ahead of time the chance that an ovarian adnexal mass is malignant, help the ob/gyn doctor identify patients who might need referral to gynecologic oncologists and might lead to improved patient outcomes.

New “Ultra Low Dose” Birth Control Pill

Despite the fact that the Pill underwent its 50th birthday not long ago, the pharmaceutical industry continues to develop new versions that promise to be safer, lower dose and have less side effects while remaining highly effective.
The perfect Pill would work 100% of the time with no risks and no side effects of any kind. Wouldn’t that be great! We may not be there yet, but we have moved one step closer with the release of Lo Loestrin Fe.
This is the first and only Birth Control Pill on the market to have 50% less estrogen than commonly prescribed low dose Pills. Low dose pills have been available for years, and typically they have 20 micrograms of estrogen (20 mcg.), but the new Lo Loestrin Fe has only 10 mcg.
This lower dosage leads to less side effects than ever before, but with the same 98% effectiveness shared by all other birth control pills. For more information, click here to go to their web site.

New test for EARLY detection of Down Syndrome

Many expecting parents worry about the chance that their unborn baby has Down Syndrome. This genetic disease nearly always develops after conception and therefore is NOT inherited from the parents. Amniocentesis has long been available as a diagnostic test but poses a risk of losing the pregnancy. Alternatively, the nuchal translucency test (the NT test) is a safe test done at 12 weeks of pregnancy can help determine if the chance for Down Syndrome is high or low with about 90% accuracy.
However, there is now an amazing blood test that can be done on the mother’s blood and can determine with 99% accuracy if the baby she is carrying does or does not have Down Syndrome. The test is called the MaterniT21 test, available only from Sequenom Labs.
The MaterniT21 test was validated in high-risk couples that had either advanced maternal age, an abnormal fetal ultrasound or abnormal screening test, or a family history of Down Syndrome. We still do not know if the accuracy will be as high for low-risk couples, but there is every reason to believe that it will.
Down Syndrome, also called Trisomy 21, means that the person has 3 copies of chromosome 21 instead of the normal 2 copies that the rest of us have. The MaterniT21 test uses breakthrough technology to identify microscopic particles of DNA from the baby that are present in the mother’s bloodstream.  The amount of DNA from the fetal chromosome 21 is compared to DNA from other fetal chromosomes in the blood sample. If the amount of chromosome 21 DNA is normal, then the baby does not have Trisomy 21. Thus a simple blood test, done as early as 10 weeks of pregnancy, can in the great majority of cases provide needed reassurance to concerned expectant parents.

Universal Genetic Screening

Have you ever heard of Alpha 1 antitrypsin deficiency? How about GJB2-related hearing loss? You have probably heard of cystic fibrosis. These 3 diseases are all recessive genetic diseases. In fact there are thousands of these types of diseases but most are quite rare.
People are born with a recessive genetic disease because they inherited a recessive genetic mutation from both parents. Each parent would have been a silent carrier, also called having a recessive trait. This recessive trait does not cause disease and many people have recessive traits that they do not even know they have. DNA testing can identify carriers of recessive traits.
If a couple both carry the same recessive trait, their baby has a 25% chance of being born with a recessive genetic disease. Alpha 1 antitrypsin deficiency is a genetic illness that causes liver and lung disease in children and is the single most common disease requiring a liver transplant, affecting 1 in 2,500 people. GJB2-related hearing loss causes 20% of all cases of childhood deafness, affecting about 1 in 2,500 people. Cystic Fibrosis causes severe lifelong lung and intestinal problems and affects 1 in 3,000 people.
Until recently, it was extremely expensive to test people for recessive traits. But there is now a very affordable test called the Universal Genetic Test, offered by Counsyl Labs. This test can detect over 100 different recessive DNA traits, including the above 3 and many others such as Tay-Sach’s Disease, Spinal Muscular Atrophy (SMA) and more.
We now offer this test to both expecting parents. Testing early in pregnancy can help to identify if the baby is at risk for a genetic disease that we would never have known about otherwise.

Sunday, May 22, 2011

Have You Completed Your Family?

Once a couple has decided that their family is complete, the option of having some type of permanent birth control or sterilization is worth considering. Unintended pregnancy is a possibility for women even close to age 50! For years, the choices were basically vasectomy for the male or a tubal ligation for the female. Now there is another option - Essure®!
The ESSURE® Procedure - non-surgical sterilization for women
The Essure® procedure is performed in the doctor’s office. It is quick, almost painless, and does not involve surgery. There is almost no down-time and people often resume their normal activities the very next day. Five year data shows a success rate of 99.8% making it the most effective form of permanent birth control available. There are no long-term side effects and no changes in hormones or the menstrual cycle.
Compare this to the alternatives. Vasectomy is a 30 minute surgery requiring an injection of local anesthesia in the scrotum. There is discomfort in the area for days afterwards. Many men are concerned enough about the risks of vasectomy that they will not consider this option, even if their family is complete. Tubal ligation for women is usually performed via laparoscopy. This is an out-patient surgical procedure requiring general anesthesia and up to a one-week recovery time.
What exactly is the Essure® Procedure?
In the doctor’s office the patient is set up for a pap smear type exam. Some local anesthesia is used internally and some oral pain medication has already been given ahead of time. A thin scope is gently placed through the vagina into the uterine cavity, and the images are displayed on a monitor. In minutes, an Essure micro-insert is placed through each tubal opening. That’s it!
These soft, flexible micro-inserts expand and block the tubal opening. This blockage results in permanent sterilization and is not reversible.

Three months afterwards, an X-Ray dye study is performed to confirm that the tubes are blocked and that the micro-inserts are in the proper position. Until then, a form of birth control is still necessary.
This procedure is covered by most major health insurers. For more information about having an Essure® procedure, contact our office at (626) 304-2626.

Sunday, March 27, 2011

The most common inherited cause of mental retardation

What is the most common genetic condition that can lead to mental retardation, or the more modern phrase, “intellectual impairment?” If you thought the answer was Down Syndrome, you would be wrong. The answer is Fragile X Syndrome, a condition that many of us have likely never heard of.

What is Fragile X Syndrome?
The intellectual impairment of FXS can range from learning disabilities to more severe cognitive or intellectual disabilities. There are also speech and behavioral abnormalities.
Males with Fragile X
Approximately 1/4,000 males have Fragile X Syndrome and many of them have never been diagnosed. Males with Fragile X Syndrome almost always exhibit mental retardation. FXS is the most common known cause of autism or "autistic-like" behaviors. Symptoms can also include characteristic physical and behavioral features and delays in speech and language development.
Behavioral characteristics in males include attention deficit disorders, speech disturbances, hand biting, hand flapping, autistic behaviors, poor eye contact, and unusual responses to various touch, auditory or visual stimuli.
Females with Fragile X
The characteristics seen in males can also be seen in females, though females often have milder intellectual disability and a milder presentation of the behavioral or physical features. About a third of the females have a significant intellectual disability. Others may have more moderate or mild learning difficulties. Similarly, the physical and behavioral characteristics are often expressed to a lesser degree. Many girls thought to have Attention Deficit Hyperactivity Disorder (ADHD) actually have FXS.
One well recognized consequence for women who carry the mutation is an increased risk for premature ovarian failure (POF), defined as the cessation of menses before the age of 40. Among women who carry the mutation, approximately 21% have POF compared to only 1% in the general population.
Fragile X Syndrome is an X-linked genetic disease
Why are males far more severely affected than females? This is because the mutation exists on the X-chromosome. (FXS is due to a mutation in the X-linked FMR1 gene). X-linked conditions are more severe in males than females, because males have only a single X-chromosome (males are 46 XY) and females (who are 46 XX) have two. In females, if one X has the mutation, the other X chromosome does not and this can minimize or prevent many of the features of an X-linked condition.
Other common X-linked genetic diseases are hemophilia and color blindness, also much more common in males. Of these conditions, females who carry the mutation are unaffected.
How does someone get Fragile X Syndrome?
This is a genetic disease, and a person is born with it. The Fragile X mutation follows the traditional rules of X-linked inheritance: Half of the children of carrier mothers will receive the mutation. If the father is the carrier of the mutation, none of the sons and all of the daughters will receive the mutation.
Approximately 1/200 females and 1/1,000 males carry the FXS mutation. Also about 4% of males and 8% of females of Northern European descent will carry the mutation.
Is there any treatment?
At this time, there is no cure for FXS. However, special education, speech and language therapy, occupational therapy and behavioral therapies are helpful in addressing many of the behavioral, and cognitive issues in fragile X syndrome. In addition, medical intervention including medications can be helpful for aggression, anxiety, hyperactivity and poor attention span. Because the impact of fragile X is so varied, it is important to do a careful evaluation of the individuals' abilities and difficulties to tailor a treatment plan to address specific needs.
Is prenatal diagnosis available?
Only in the past few years has there been a simple blood test which is an affordable and accurate diagnostic test for a woman to find out if she is carrying the FXS mutation.
In one study, families with a son affected by Fragile X were asked if they knew during the pregnancy that their baby was going to grow up with this condition, would they have chosen to continue the pregnancy.
99% of the families said no. Why is that?
Boys with Fragile X have a common set of behaviors that make them extraordinarily difficult to take care of. Other than sleeping, these kids never stop moving. 16 hours a day, these boys are in motion: running, jumping, tumbling, grabbing, throwing and breaking things. They can’t help it. Year after year this continues, getting far worse during adolescence. Families cannot keep babysitters. Schools expel these kids. These parents are desperate just to have an occasional day off. 95% of the marriages end in divorce. You do not see numbers like this in families whose child has Down Syndrome.
What if someone has the mutation and still wants to have children?
Today’s world offers a near-perfect, but not inexpensive solution for this scenario, called PGD. This stands for pre-implantation genetic diagnosis. The couple goes to an IVF clinic. The fertilized embryos are genetically tested prior to implantation. Only embryos that do not carry the mutation are transferred, so any child born from this process will not carry the mutation.
Some of the above material was obtained from The National Fragile X Foundation. http://www.fragilex.org/html/summary.htm

Other Links
Medicine.net article.

Sunday, March 6, 2011

Early Detection of Ovarian Cancer

In 2010, over 21,000 women were diagnosed with Ovarian Cancer, and almost 14,000 women died from it. Three out of four women who are newly diagnosed with ovarian cancer will already be in Stage 3 or Stage 4, and only 25% of these women will be expected to live 5 more years. Furthermore, there are almost no specific symptoms for ovarian cancer. This is why ovarian cancer is so scary to so many women.
Diagnosis of Ovarian Cancer
Currently, the only way to diagnose ovarian cancer is to undergo abdominal surgery. There is no biopsy for ovarian cancer. Imaging studies lead to suspicion for cancer, but they cannot make the diagnosis. Due to the risks of surgery, avoiding unnecessary surgery is very important when attempting to diagnose early ovarian cancer. Knowing who to operate on and who to watch closely is a challenge for the ob/gyn physician.
Is there a way to screen for ovarian cancer?
Women know that a pap smear is an excellent way to screen for cervical cancer. Why is that? Because abnormal cells on a pap smear can be identified, leading to simple yet effective treatment that will prevent cervical cancer from developing. This is the ideal screening test.
A mammogram is a very good screening test, but not as good as a pap smear. Why? Because a mammogram will still diagnose cancer rather than finding a treatable precancerous condition. But, breast cancer can be diagnosed in a very early state, Stage 1, leading to less invasive treatments and very good long-term survival. Also, many women check themselves for breast lumps, leading to another method for diagnosing early stage breast cancer.
Unfortunately, there is still no pap smear or mammogram equivalent for the early diagnosis of ovarian cancer. The key for women is early suspicion. This is how we can diagnose ovarian cancer at an earlier stage.
Could these vague symptoms actually be due to Ovarian Cancer?
Is ovarian cancer a silent disease, one that shows up without any warning? Perhaps not. In one study of woman diagnosed with ovarian cancer, 70% of women had symptoms for up to 3 months prior to being diagnosed. Further studies have identified symptoms that might be due to early ovarian cancer. These are: increased abdominal size, bloating, feeling full easily, increased urge to urinate and pelvic discomfort or pain. If these symptoms occur 12 or more times in one month, the chances are still very low that these symptoms are due to cancer, but seeing the doctor is advisable.
What about using routine vaginal ultrasound?
Many studies have been done to using routine vaginal ultrasound as a way to diagnose early ovarian cancer. The results have been disappointing. In some studies, hundreds of women were identified as possible ovarian cancer and underwent surgery. Only 1% actually had cancer. In one study of 10,000 women, 300 underwent surgery. One woman had ovarian cancer, and one died from complications of surgery.
What about the CA 125 test?
CA-125 has been around for over 15 years. Gildna Radner (1946-1989), a famous comic and wife of Gene Wilder was diagnosed with ovarian cancer in 1985. It took almost a year before doctors made the diagnosis. Despite aggressive treatments, she died in 1989. Her name is often linked to the CA 125 test. If only they had done this test, they might have diagnosed her cancer sooner!
The reality is much more frustrating. We know a lot about CA 125. It is called a tumor marker, a chemical in the blood associated with the presence of cancer in the body. CA 125 is elevated in 80% of women with ovarian cancer (which means it is negative in 1 out of 5 women who have ovarian cancer). Unfortunately, CA 125 is elevated in many other conditions including endometriosis, fibroids and colon diseases like inflammatory bowel disease. Further, it is often elevated in women prior to menopause for no reason at all. Therefore, CA 125 is NOT considered a useful screening test for ovarian cancer.
A new test – the OVA1
Researchers have been looking for years for a better blood test that the CA 125. Recently, the FDA-cleared OVA1 test has become available. This test measures five different chemicals in the blood, one of which is the CA 125. It has not been approved as a universal screening test, however. The OVA1 can only be done if the patient has an ultrasound showing an enlarged ovary or an ovarian cyst. The test can help the doctor determine whether the chances are low or high that the cyst is actually a cancer.
Conclusion
There is still no FDA approved screening test for ovarian cancer. Routine ultrasound and routine CA 125 testing for low-risk women has not resulted in improved diagnosis. Women need to be aware of the combination of common symptoms that can sometimes be caused by early ovarian cancer. Your gynecologist has an array of blood and imaging tests available that often will be able to reassure you that your situation is benign and that surgery may not be necessary.
*portions excerpted from the March 2011 Committee Opinion of the American College of Ob/Gyn, Number 477.

Wednesday, February 23, 2011

How do I know if I am going through menopause?

This is a question that millions of women ask themselves and also ask their gynecologist. How do I know if I am going through menopause?
Definitions
Menopause – means that menstrual periods have stopped because the ovaries can no longer produce eggs or hormones.
Going through menopause – refers to the 12 month interval since the last menstrual period. This is because after 1 year without a period, a woman is no longer “going through” menopause. Instead, she is now on the other side so to speak, she is now post-menopausal.
Pre-menopause (peri-menopause) – refers to erratic and unpredictable periods and hormonal symptoms, starting from a few months to a few years before the onset of menopause.
Menstrual Function
To understand menopause requires some basic knowledge of female biology. The ovaries start producing eggs about age 12 or so, this is when many young girls experience their first menstrual period. Egg production usually continues once every 28 days until about age 50 (with many exceptions, such as pregnancy, breast-feeding, hormonal imbalances, etc.).
Estrogen and Eggs
Estrogen is the most important female hormone. It is responsible for female sexual characteristics and it is the loss of that estrogen leads to most of the symptoms of menopause such as hot flashes, night sweats, loss of sex drive, hair loss, mood swings, and more.
Mother Nature has inextricably linked the production of estrogen to the production of eggs. This is the key to understanding menopause which is the inability of the ovary to produce eggs or estrogen. When there are no eggs and no estrogen, there are no periods.
But, the ovaries often approach menopause in an erratic manner. Sometimes egg production and estrogen production stop at the same time. This leads to the abrupt cessation of menses, but this is not how most women enter menopause. Most of the time egg production stops and estrogen production fluctuates, or both egg production and estrogen production fluctuate.
Hormonal “Roller Coaster”
When egg production and/or estrogen production fluctuate, this can lead to a “roller-coaster” of hormonal symptoms: irregular bleeding, periods every 14 days, mood swings from one extreme to another, hot flashes that come and go, loss of sex drive, flushing, sweating, sleep disruption… the list is long! But, these symptoms are NOT menopause. Not yet. These symptoms are characteristic of the peri-menopause. These symptoms are what bring most women to the doctor! Treating this condition requires significant hormonal expertise, and many doctors do a poor job of it. Peri-menopause is NOT menopause, and cannot be treated the same way menopause is treated.
Blood tests – “Doctor, please check my hormone levels”
I get this request almost every day, and I always find it a bit challenging. We can draw blood tests, and these blood tests will tell us what the hormone levels are at that exact moment. But the tests will not tell what the hormone levels were yesterday, or what they will be tomorrow. Testing hormone levels is like testing blood sugar levels. They can be high, or low, or stable, or fluctuating. Knowing one set of numbers might not be so helpful.
One important test is the FSH level. FSH stands for Follicle Stimulating Hormone. This is a hormone produced by the pituitary gland, a grape-sized gland in the brain. FSH tells the ovaries to make a follicle, which is what the egg grows in. The follicle makes the estrogen and also makes and releases the egg.
The FSH is usually a low number, less than 10. Many labs state that an FSH over 40 is consistent with menopause, but this has to be explained further.
Rolling Hills
FSH is like the gas pedal on your car. Approaching menopause is like driving on a hilly road, up and down, with the up hills getting longer and steeper as you get closer and closer to true menopause. You need more gas to go up those hills. This means the body has to increase the release of FSH to get an egg produced. The body is capable of producing very large amounts of FSH, and for a very long time. This explains the “roller coaster” of fluctuating hormones.
On the way to menopause the FSH will go above 40, but the body may still be able to produce the egg. Therefore, the eggs and periods have not stopped yet. As the hill gets steeper, you press the gas pedal all the way to the mat. Maybe the car will get over this hill, this time, and thus another egg will be released. Thus, you can have an FSH above 40 and still make eggs.
One day, with the “pedal to the metal”, you will not make it over that hill. The FSH will be high, no egg will be released, and no period will occur. This could be it, the onset of menopause. But maybe not. Maybe, with enough time, keeping that pedal down, the car will inch its way up the hill. It might take a few months, but amazingly, it does it (your body does it, I mean)! One more egg has been produced, so this is still not menopause yet!
No More Periods
There comes a time when your body will produce huge amounts of FSH, but there will be no more eggs. This is true menopause -- a permanent and irreversible condition, where the ovaries can no longer produce any estrogen or any eggs. Menopause occurs on average about age 51; however, some women even at age 57 will still have menstrual periods.
How do we know that the body is permanently done producing eggs?
I have seen patients stop having periods for 10 months and then start up again. They were not done with menopause. Statistics show that if a woman goes 12 months without a period, she is extremely unlikely to ever have another period. This is how we know someone has gone through menopause. Some women have ALL of the symptoms of menopause for months; no periods, hot flashes, all of it, and yet sometimes their periods return and these symptoms disappear, for a while. This is still not menopause
The answer
Thus, the answer is: 12 months. This is a medical definition based on statistics! 12 months without a period equals menopause. You are going through menopause once you enter this 12 months without-a-period phase. Your symptoms and your blood tests might show menopause, but your periods could come back. If they do, it’s not menopause. If they don’t come back it is menopause. Once you have gone 12 months without a period, you are no longer “going through menopause.” You are now done. You are post-menopausal. The roller coaster is over. No more hormone fluctuations. But, now you have to deal with the next 30 years of your life, without hormones (or maybe not).
Future articles will include how to treat peri-menopause, how to treat menopause, use of alternatives to hormones, and also various pros and cons of different hormonal therapies.

Sunday, January 16, 2011

A New Type of CPR

Do you know how to do CPR? It’s easy, right? Just compress someone’s chest and then give them mouth-to-mouth resuscitation. That’s all there is to it. But, if somebody does collapse where there are witnesses, studies show that there is only a 1 in 3 chance that they will receive CPR. There are many reasons for this, but one is that a lot of people, fearful of communicable diseases, will not perform mouth-to-mouth resuscitation, and therefore will not perform CPR, even if they know how to do it.
So, after much deliberation, the American Heart Association has begun to promote a new type of CPR, called “Hands-OnlyTM CPR” (http://handsonlycpr.org/).
Hands-OnlyTM CPR is CPR without mouth-to-mouth breaths. It is recommended for use by people who see an adult suddenly collapse in the “out-of-hospital” setting (like at home, at work, in a park). It consists of two steps: First, call 911 or send someone to do that. Second, begin providing chest compressions by pushing hard and fast in the center of the chest with minimal interruptions. That’s it. No mouth-to-mouth, just chest compressions. Doing this can save a life, and it is extremely easy to learn.
Any attempt at CPR is better than no attempt. Hands-OnlyTM CPR has been shown to be as effective as conventional CPR when given in the first few minutes of an out-of-hospital sudden cardiac arrest. Conventional CPR may be better than Hands-OnlyTM CPR for certain victims, such as infants and children, victims of drowning and adults whom you did not see collapse.
CPR AnytimeTM
The AHA has produced a 22-minute CPR training program where you can learn how to perform high quality chest compressions, all in the comfort of your own home! (http://www.cpranytime.org/). You can also find information about instructor-led CPR courses by going to www.americanheart.org/cpr or calling 1-877-AHA-4CPR.
Conclusion
There is a new type of CPR which is easy to learn, can save lives, and does not involve mouth-to-mouth breathing. This should allow bystanders to overcome some of their reluctance to perform CPR on a stranger if they witness someone collapse. We urge you to learn how to perform Hands-OnlyTM CPR as soon as possible. You never know when it might be your turn to save someone’s life.

Monday, January 10, 2011

The HCG Diet

As a physician, I know how desperate people can become when they want to lose weight. Over the years, there have been so many popular and wondrous (and unfortunately, also worthless) diet programs, it is impossible to remember all of them. One that I have heard about lately involves my field of Ob/Gyn, so I thought it wise to research this latest “miracle” weight loss program. It is called the hCG diet.
The hCG diet is all over the Internet. It is amazing. You can lose 1-2 pounds per day, and thus lose 20 pounds in 3 weeks! And it is so simple! All you need is a single daily injection of the hormone hCG and then just stay on a low calorie diet. You do not even need to exercise. Isn’t that incredible? Amazingly, there is also oral hCG that you can drink!
Let’s look closer.
What is hCG?
hCG stands for human chorionic gonadotropin. This is the hormone produced by a woman when she becomes pregnant. It is made by the placenta, and can be isolated from the urine of pregnant women. There are many functions of hCG in the woman’s body during pregnancy. The most critical function is that this hormone tells the ovary to keep producing the hormone progesterone, because progesterone is required for the body to hold on to the early pregnancy.
Without progesterone, the pregnancy will not survive and a miscarriage will result. hCG keeps the progesterone level very high in early pregnancy. Together, these two hormones bring on the many symptoms of early pregnancy such as decreased appetite, sensitivity to odors, nausea, vomiting and fatigue.
hCG diet proponents will tell you that hCG also allows your body to mobilize and metabolize stored fat, something that nature requires during pregnancy. More on this later.
Other uses for hCG
The hormone hCG is very similar to the female hormone known as LH. Ovulation is preceded by a surge in LH. This is how urine ovulation kits work, they detect high levels of LH in the urine, indicating the LH surge which is followed by ovulation. During fertility treatments hCG acts as a substitute for LH. By giving it at the correct time of the cycle, ovulation will occur about 24 hours after the hCG injection. The dosage for this is about 10,000 units, given as an injection. Protein hormones such as hCG (and insulin for example), must be given by injection. If these hormones are swallowed, the body will digest them the same way we digest steak.
The hCG diet
In the 1950’s, a British physician named Dr. A. T. W. Simeons claimed that hCG injections of 125 units daily plus a diet of 500 calories per day achieved significant weight loss. He also claimed that hCG suppressed hunger and enabled the body to burn fat beyond the normal daily needs resulting in a guaranteed weight loss of 15 pounds in 26 days using 23 daily injections.
A 150 pound low-activity person burns about 2200 calories per day. To lose one pound a person has to burn or reduce calorie intake by about 3500 calories. On a 500 calorie per day diet, the maximum biologically plausible weight loss would be 10 pounds in 3 weeks.
But, a 500 calorie per day diet is a starvation diet. It is almost impossible for anyone to adhere to this voluntarily. It is so low in calories and protein, the body will digest it’s own organs to obtain protein necessary for the body to function and this low calorie intake will quickly lead to exhaustion. Furthermore, the body can go into a dangerous state called ketosis from burning too much fat. When a person is starving, they will burn their own body fat for energy, hCG or no hCG!
History of the Simeon’s diet
Numerous studies showed that the addition of hCG to the diet was worthless. The only reason people lost weight was because they starved themselves. There was never any scientific proof that the hCG added any benefit, other than a financial benefit for the practices selling this diet to gullible and desperate patients. Critics say that as early as 1962, the Journal of the American Medical Association warned against the Simeons Diet.
In 1976, clinical research trials published by the Journal of the American Medical Association and the American Journal of Clinical Nutrition showed that hCG was ineffective as a weight-loss aid. There were “no statistically significant difference in the two groups” and that “hCG does not appear to enhance the effectiveness of a rigidly imposed regimen for weight reduction.”
In 1976, the Federal Trade Commission (FTC) ordered the Simeon Management Corporation, Simeon Weight Clinics Foundation and hCG Weight Clinics Foundation to stop claiming that their hCG-based programs were safe, effective, and/or approved by the FDA for weight-control. Although the order did not stop the clinics from using hCG, it required that patients who contract for the treatment be informed in writing that:
“HCG has not been demonstrated to be effective adjunctive therapy in the treatment of obesity. There is no substantial evidence that it increases weight loss beyond that resulting from caloric restriction, that it causes a more attractive or "normal" distribution of fat, or that it decreases the hunger and discomfort associated with calorie-restricted diets.”
So the hCG diet basically disappeared after that until 2007, when it came roaring back into public consciousness, propelled by a sensational infomercial guru/criminal named Kevin Trudeau, who published the book “The Weight Loss Cure They Don't Want You to Know About.”
Kevin Trudeau
Trudeau's activities have been the subject of both criminal and civil action. He was convicted of larceny and credit card fraud in the early 1990s, and in 1998 he paid a $500,000 fine for making false or misleading claims in his infomercials. In 2004, he consented to a lifetime ban on promoting products other than his books via infomercials.
His book describes a three-phase plan originally made by Dr. Simeons in the 1950s. The first phase involves switching to all organic foods with repeated colonics (enemas) and “liver cleansing”. This is followed by a second-phase period of daily hCG injections under the direction of a health care provider. In phase three, use of hCG stops, but food must continue to be 100 percent organic. Other recommended activities include walking an hour a day or more and doing breathing exercises.
Additionally, the Trudeau version had a list of over 50 different supplements, food avoidances and prescribed behaviors that had to be strictly followed. These including taking bizarre supplements such as raw apple cider vinegar, heavy metal cleanse, laxatives and digestive enzymes. The dieter had to use an “Electromagnetic Chaos Eliminator,” listen to “destressing CDs” and no microwaved food was allowed.
On November 16, 2007, Trudeau was found in contempt of his 2004 court order for making “patently false” claims in his weight loss book. U.S. District Court Judge Robert W. Gettleman ruled that Trudeau “clearly misrepresents in his advertisements the difficulty of the diet described in his book, and by doing so, he has misled thousands of consumers.” In October 2008, Trudeau was fined more than $5 million and banned from infomercials for three years for continuing to make fraudulent claims pertaining to the book.
But wait, there’s more!
No, this did not put an end to the hCG diet craze. It has now evolved to the point where you do not need the injections. Numerous web sites promote the use of oral hCG instead of the injections. You can drink it or just place a few drops under the tongue and get the exact same benefit as the injectable hCG. Isn’t that amazing? No prescription needed, no medical clinic needed. You can do all of this online and through the mail.
But, is this possible? As stated earlier in this article, adding hCG to water and drinking it will result in the hCG being swallowed and then digested. So how can this be promoted and believed by so many people? The answer is one word…homeopathy.
hCG in water is so wrong for so many reasons
“Modern homeopaths actually preach that liquid chemical solutions (minus the chemicals) are as powerful as the chemicals themselves, because of water's powerful ability to 'remember' what it was supposed to do.  Confused yet?  In some parallel dimension, it actually makes sense.  On the bright side, homeopathic preparations usually have the same side effects as water does.  Go figure.”
(ref: http://healthwyze.org/index.php/component/content/article/449-the-hcg-diet-scam-exposed.html)
It turns out that hCG is a prescription drug and cannot be sold to consumers directly. So oral hCG is actually homeopathic hCG. It is a solution that used to have hCG in it, but through a series of increasing dilutions (which homeopathic believers claim actually make their product stronger), a type of water is created that has no measurable quantity of hCG in it any longer, thus no requirement for a prescription. The water remembers the hCG and when introduced into the body, will provide the same benefits as hCG injections. Of course it will.
Someone, please pick me up off the floor, please someone help me! This is absolute nonsense! How can any reasonable, logical person believe this garbage? The battle for the hCG weight loss patient has gotten so bad that the hCG clinics who promote the useless injection method are now attacking the hCG clinics who promote the even more worthless oral hCG preparations! (http://www.diet-hcg.com/).
Enough said about the hCG diet!

Saturday, January 8, 2011

Emergency Contraception

also referred to as the “morning after pill”
[Portions of his article are from the May, 2010 ACOG Practice Bulletin (American College of Ob/Gyn, Practice Bulletin number 112, May 2010)]
A single act of unprotected intercourse -- if it occurs around the time of ovulation -- is associated with about a 1 in 6 chance of the woman becoming pregnant. If pregnancy is not desired, then one option is the use of the morning-after pill, also referred to as emergency or post-coital contraception.
The two most common reasons to consider post-coital contraception involve condom failure (it broke, or was used incorrectly, during intercourse) or not using contraception at all (unprotected intercourse).
There are 2 FDA approved products that can be used for emergency post-coital contraception. One is the original Plan B, which is being phased out and replaced by the company with a newer version called Plan B One-Step.
Plan B One-Step is a single pill containing a high dosage of a progesterone-like hormone (called a progestin). Plan B One-Step can be taken up to 72 hours after the act of unprotected sex and is about 85% effective in preventing a pregnancy that would otherwise have occurred. One study showed effectiveness even when taken up to 120 hours after unprotected sex. It is thought to work by changing the uterine lining so that the fertilized egg will fail to implant or by delaying ovulation but experts disagree on the mechanism of action.
There are possible side effects, usually mild, that include: cramping, bloating, breast tenderness, spotting, headache and nausea. There is also the possibility of a continuing pregnancy, and the rare chance of an ectopic pregnancy. If you do not get your period about 2 weeks after taking Plan B One-Step, you should perform a home pregnancy test. If you remain pregnant, it is important to know that Plan B One-Step is not known to be a cause of birth defects.

If you are 17 or older, Plan B One-Step can be purchased without a prescription, but usually you have to request it at the pharmacy counter. Persons under age 17 are required to have a doctor’s prescription. The original Plan B is the same product except there are 2 pills. They are taken 12 hours apart and together contain the exact same dose of progestin as the single pill of Plan B One-Step.
The “morning after” Pill should not be used as a routine form of birth control due to the higher failure rate compared to other forms of birth control such as the birth control Pill, condoms and IUD’s. This approach also provides no protection from STD’s or HIV. For the rest of the cycle, you should use condoms to prevent the chance of becoming pregnant later in the same cycle.

Friday, January 7, 2011

Is Vitamin D the Next Big Thing?

It is common knowledge that Vitamin D is important for strong bones. We have heard this since we were kids. Drink your milk, it’s fortified with Vitamin D! But the past few years has witnessed an outpouring of new information and new claims for Vitamin D such as: “it will boost your immune system” and “it can help prevent cancer” and the universal “most Americans are Vitamin D deficient."
Vitamin D is Big Business.
In 2008, consumers bought $235 million worth of vitamin D supplements, up from $40 million in 2001. Some experts, though, are starting to sound alarms about the boom in testing, which has been increasing by 80 to 90 percent per year, with several million people expected to be checked in 2010.
Here are some useful facts about Vitamin D. Once you know the facts, you may not be surprised to learn that (oh my!) there has been a lot of hype about this essential but unfortunately, not miraculous vitamin.
What exactly is Vitamin D?
There are 2 forms of Vitamin D in the body. Vitamin D2 (called ergocalciferol) and Vitamin D3 (called cholecalciferol). Both of these forms still have to be converted by the liver into the biologically active form, called calcitriol. Direct sun exposure to our skin enables humans to produce Vitamin D3 (not D2).
How do we measure Vitamin D in the blood?
In the blood we test for a form of Vitamin D called calcidiol (also called 25-hydroxy Vitamin D). Calcidiol is converted into calcitriol, the active form of Vitamin D (also called 1,25-hydroxy Vitamin D). Levels are reported as nanograms per milliliter (ng/ml). The normal range varies depending on the lab. Low Vitamin D might be less than (<) 18 ng/ml in one lab or < 30 ng/ml in another lab.
What does Vitamin D actually do in the body?
Vitamin D is necessary for the body to be able to absorb calcium in the intestines. It is also needed to help regulate the blood levels of calcium and phosphorous in the body. A deficiency of Vitamin D causes rickets; a disease characterized by extremely soft bones and bent legs. In the U.S. this is a rare disease, but it's not so rare in poorer countries.
What is the daily dose of Vitamin D supposed to be?
The recommended daily dose of Vitamin D is 400-600 units (higher for the elderly and lower under age 1). High doses can lead to toxicity, characterized by nausea, vomiting and hypercalcemia (elevated calcium in the blood that can cause seizures and kidney stones). Doses of 1,000 units per day given to an infant can lead to toxicity in 1 month. Units are also called IU for International Units.
Sun-exposure Vitamin D production
If you're fair skinned, experts say going outside for 10 minutes in the midday sun -- in shorts and a tank top with no sunscreen -- will give you enough radiation to produce about 10,000 IU of the vitamin. But in winter there is not enough UV-B radiation for most people to produce Vitamin D, even with good sun exposure.
Naturally occurring Vitamin D
A great source of both Vitamins A and D is cod liver oil (1 Tbsp. contains 1,400 units!). Fish such as salmon, catfish, sardines and tuna are rich sources, providing about 300 units of Vitamin D per 3 oz. portion. Interestingly, a quart of milk provides only 400 units of D. Human breast milk is naturally quite low in Vitamin D. Also, almost no vegetables, fruits or nuts contain Vitamin D (small amounts are in mushrooms).
Can Vitamin D prevent cancer?
Many studies have looked at this. Vitamin companies heavily promote this and advise people to take high doses, 1,000 to 2,000 units a day, to try and prevent cancer. The boring truth…there is no proven cancer protection benefit from high Vitamin D, and there IS a proven risk.
What are the other supposed benefits of Vitamin D?
Some studies showed a lower risk of dying from cancer, any kind of cancer. Some showed a boost to the normal immune system, and a lower risk of getting the flu. Others show reduced risk of diabetes and heart disease and high blood pressure. None of these studies are considered proof.
What is proven about Vitamin D?
When Vitamin D supplements were given to elderly nursing home residents, along with a calcium supplement, there were fewer bone fractures in the treated group. Vitamin D and calcium can help prevent osteoporosis, likely due to fixing a deficiency, rather than any benefit from megadoses.
Psoriasis Treatment
A team of scientists at Boston University School of Medicine, determined that topical Vitamin D could be used for the treatment of psoriasis. Initial experiments with vitamin D hormone have shown that topical applications of the hormone are remarkably effective. In 1994 the U.S. Food and Drug Administration approved a vitamin D-based topical treatment for psoriasis, called calcipotriol (Dovobet).
The hype
The promising benefits of high vitamin D amounts were demonstrated in studies that simply looked at vitamin D levels in various populations and then correlated them with disease. But, people need to realize that high levels of vitamin D in the bloodstream may just be due to good genes or some other factor beyond sun exposure or dietary intake. This is not proof of any beneficial effect.
Experts advise us not to “...jump on the bandwagon and take megadoses before we have results from research trials.” After all, a host of supplement studies—on vitamin C, vitamin E, selenium, beta carotene—found that those who were given supplements fared no better, and sometimes worse, than those who took placebos.
Summary
Yes, we all need adequate Vitamin D intake, but the evidence for additional health benefits from taking high doses is just not there. Food can provide enough Vitamin D but supplements work just as well and vegans have to take supplements. Milk is actually a poor source of Vitamin D because very few people will drink one quart of milk per day to get their 400 units! Be wary of the "emergency" need to supplement with 50,000 units of D just because your blood level is below 30 ng/ml. Many experts believe that levels above 18 ng/ml should be considered normal.