Advanced OB-GYN News

OVULATION INDUCTION

By Joseph Hazan, M.D.,FACOG

Lack of ovulation is the most common

cause of female infertility.

By inducing ovulation, a mature follicle

can be developed and released.

Half of all female infertility cases are

related to lack of ovulation or

irregular ovulation.

Development of a primary follicle which is mature

and ready to be released can be verified by a

progesterone level above 3 ng/ml, preferrably

over 10 ng/ml.

Subsequent lack of period might indicate

the occurence of pregnancy.

Some of the problems that need to be addressed

prior to ovulation induction

are issues of overweight or underweight,

thyroid dysfunction or high level

of prolactin (produced by the pituitary).

There is increased risk of multiple pregnancy

with some agents utilized

for ovulation induction.

Please obtain a consultation to evaluate

your options by calling our offices

@314-291-2140 or 636-928-1800.

Pelvic Ultrasound

By Joseph Hazan,M.D.,FACOG

Pelvic ultrasound based on sound waves

helps visualize pelvic structures.

During pregnancy screening and details

of fetal anatomy can be imaged.

Specialized ultrasounds in pregnancy

will be addressed tomorrow under the

OB ultrasound.

The most common reasons for obtaining

a pelvic pregnancy are to help

diagnose the causes of pelvic pain,

painful periods, heavy and irregular

periods, cysts, infertility, delayed menses,

postmenopausal bleeding

and suspicion of abnormal pelvic findings.

The benefits of ultrasound are the ease of

performing, relatively wide

availability, the safety and the fact that it is

not an invasive procedure.

A full bladder facilitates visualization

of pelvic structures.

For infertility the ovaries and follicles in

ovaries can be visualized.

The structural anomalies can be detected

in some cases.

For ovarian cysts, ectopic, fibroids or

endometrial thickness ultrasound

is beneficial.

For diagnosing developmental problems

ultrasound can be helpful.

Sudden onset Pelvic Pain

By Joseph Hazan,M.D.,FACOG

Sudden onset pelvic pain is usually severe and can be associated with

nausea, vomiting, fever or backache. It is an emergency and urgent

management is required.

The most common causes are gynecologic in origin such as ectopic

pregnancy, ovarian cyst, ruptured ovarian cyst, torsion of tube and ovary,

fibroid degeneration or pelvic inflammatory disease.

Other causes are bladder infection (cystitis), kidney infection also known

as pyelonephritis, kidney stones, irritable bowel, ischemic bowel, other

bowel diseases such as inflammatory bowel disease, diverticulosis,

diverticulitis, appendicitis and constipation.

Pelvic ultrasound is helpful in diagnosing pelvic causes.

Treatment is based on the diagnosis.

Sudden onset pelvic pain requires urgent management.

Age of Women

By Joseph Hazan,M.D.,FACOG

Age of Women

It is estimated that the number of women over 65 will more

than double in the next four decades. The number

of women over 85 years will triple and the number of women

over 85 and over 90 will increase even more.

This is partly due to the baby boom generation,partly because

of better socioeconomic and medical conditions, also greater

survival among women.

Demographic trends indicate that the number of Americans aged

65 and older will increase from the current 40 million to 88.5 million

by 2050.

The number of those 85 and older will increase from the current 5.8

million to 19 million. Most of the increase will be among women.

While there were 6.2 million women than men who are elderly in 2000,

due to higher survival rates among women these numbers increase

more steeply at higher age groups. For instance, 54% of population

aged 65-69 are female, 69% of those aged 85-89 are female and 80%

of those aged 95-99 are female.

This is why the healthcare and lifestyle needs of women come to the fore

as they attain greater longevity.

FIBROMYALGIA

By Joseph Hazan, M.D.,FACOG

FIBROMYALGIA is pain in many areas of the body

for over three months

due to increased pain sensitivity of the brain.

There are related symptoms which accompany

pain such as tenderness in many areas.

The common accompanying complaints

are sleeplessness,

depression, slow or impaired cognition,

forgetfulness, anxiety, stiffness,

social and occupational impairment.

FMS (Fibromyalgia syndrome) is 7 times

more common in women than

man and 90% of cases occur in women.

It is estimated that 3.5 % of women

might have this syndrome.

Between the ages of 70 and 79 it is

estimated that 7.5% of women have it.

Related illnesses are CFS

(Chronic fatigue syndrome,

IBS (irritable bowel syndrome),

migraine headaches, tension headaches,

mood and sleep disorders.

It is thought that other pain or increased

sensitivity related problems such as painful

bladder (IC-interstitial cystitis), vulvadynia

(painful vulva), mastalgia (painful breasts),

chronic pain, PMS (pre- menstrual syndrome),

RLS (restless leg syndrome), TMJ

(temporomandibular joint)

related bruxism (grinding of teeth at sleep)

could be present

in some of these patients.

OAB (overactive bladder) could

be seen in some.

The causes are thought to be stress,

OA (osteoarthritis), RA (rheumatoid

arthritis), hypothyroidism,

SLE (systemic lupus erythematosus),

EM (endometriosis) and Lyme disease.

There is a FM (fibromyalgia) website

wwww.fibromyalgiahcp.com.

Treatments are available and you

should have a visit and exam for this.

Pelvic Pain Questions

By Joseph Hazan,M.D.,FACOG

As previously discussed in our blog

under Pelvic Pain

some causes of pelvic pain are

non-gynecologic and

could be related to muscles,

bladder, bones, joints,

nerves, lymph nodes, bladder

or bowel.

To help elucidate the source of

pelvic pain this brief

questionnaire is helpful:

1) Do you have a problem with

diarrhea or constipation?

Does the pain become more

intense with bowel movements?

2) Do you have a problem with,

frequent urination, urgency,

painful voiding and do you have

to get up at night to use the

bathroom?

3) Does the pain become worse when

you stand, walk or exercise?

4) Did you have abdominal

surgery or injury?

5) Do you have regular cycles and

do you have pain related to you

periods?

Based on your answers to these five

questions the source of your

pelvic pain can be determined

and be treated.

Please contact our offices

@ 314-291-2140 and 636-928-1800

to schedule an appointment for

additional assistance.

ANTIOXIDANT AGENTS AND ANTIAGING

By Joseph Hazan,M.D.,FACOG

Antioxidant agents and antiaging

capabilities are being studied and some

intriguing facts are emerging.

Vitamin C or ascorbic acid is a direct

antioxidant.

It is abundant in citrus

fruits and berries.

It also aids in collagen production.

Vitamin E as alpha tocopherol and

tocotrienols found in olive oil,

asparagus, almonds, nuts, green

leafy vegetables, spinach and wheat

germ.

Vitamin A and carotenoids are found

in spinach, kale, mangoes, papayas,

carrots, yams, sweet potato leaves

and sweet gourd leaves.

Co Q 10 and Lipoic acid are found

in fruits and vegetables.

Co Q 10 or Ubiquinone helps in

electron transport, in aerobic

cell metabolism and in generating

energy from ATP.

Lipoic acid helps in aerobic metabolism

and is able to regenerate

vitamin C, vitamin E and GSH.

Plant Polyphenols are found in

fruit skins, berries, grapes, olive oil,

pomegranates, walnuts and peanuts.

Green tea Polyphenols are found in

green tea.

Resveratrol is found in grapes, blueberry,

mulberry, bilberry and peanuts.

Because it has anticancer and cancer

preventing effects it is very important.

Ferulic acid, chlorogenic acid, quinic acid,

caffeic acid are found in grains,

fruits, vegetables and coffee cherry.

Phloretin is found in apple skins.

Quercetin is found in apples, green

leafy vegetables, prickly pear cacti,

berries, cherries, red grapes,

red onions, tea, capers, tomato, orange,

broccoli, raspberries and cranberries.

Soy flavonoids and Genistein have

anti-inflammatory and antioxidant

benefits.

Silymarin is found in milk thistle.

Curcuminoids are found in curcumin

roots.

It is also anticancer.

Isothiocyanates (Sulforaphane)

are found in broccoli sprouts.

Nordihydroguiaretic acid is

found in the creosote bush and the chaparral

bush.

Carnosic acid, ursolic acid and rosmarinic

acid are found in rosemary, basil,

sage, lavender, peppermint, elder flower,

oregano, thyme, prunes, apples,

cranberries, hawthorn and bilberries.

They are antiinflammatory and anti

cancer.

Other antioxidants are Acai berry,

CoffeBerry, ginseng, tea tree oil, Gingko

Biloba, soy, licorice and pomegranate,

bromelain and chamomile.

ANTIOXIDANTS

By Joseph Hazan,M.D., FACOG

Antioxidants counter the oxidative harm

caused by reactive oxygen

species which are damaging to the cells in

your body.

Oxidative stress

is caused by normal oxidative metabolism

by giving rise to free radicals

which create the changes characteristic

of aging.

Some of this is natural and some of it is

due to extrinsic factors such

as smoking, exposure to sun rays and

ultraviolet radiation, cold, heat,

smog, dust, faulty diet, exercise,

sleep habits, stress and disease.

The most visible effect of aging is

skin aging, sagging and wrinkles.

This is aggravated by solar UV radiation

by exposure to sun and

is called photoaging.

Daily exposure to sun especially to UVB rays

is damaging to skin.

UVA also causes damage deeper and is 20 fold

higher especially during the summer.

The damage due to oxidative stress in

your body causes the cells to

lose normal functioning of mitochondria,

DNA, ribosomes, electrone

transport, telomere repair.

This can lead to inflammatory response,

cell membrane damage and can

cause impaired immune response

and cancer.

ANTIOXIDANTS help minimize this

damage by interaction or elimination

of free radicals or reactive oxygen

species or their by-products.

The following are the best known

antioxidants:

Ascorbic acid also known as Vitamin C

Tocopherols and Tocotrienols known

as Vitamin E

Lipoic Acid

SOD -superoxide dismutases,

catalase and quinone reductase

GSH -glutathione enzymes peroxidases,

reductase and S-transferases

NAC: N- acetyl cysteine

(by increasing GSH levels in tissues)

Quercetin

Phloretin

Silymarin

Curcuminoids

Isothiocyanates (Sulforaphane)

Nordihydroguiaretic Acid

Green tea polyphenols

Plant Polyphenols

Ubiquinone (Co Q10) also known as

Co-enzyme Q 10

Carotenoids(Lycopene, Lutein/Zeaxanthine,

Vitamin A)

Resveratrol

The sources and specific effects of

these will be addressed tomorrow.

SAFE NUTRITION IN PREGNANCY

By Joseph Hazan,M.D., FACOG

Safe nutrition in pregnancy includes

yesterday’s precautions

and goes further by adding

more safeguards.

There are infections that are

especially dangerous during pregnancy

such as LM (listeriosis monocytogenes).

Possible sources of contamination

are unpasteurized milk products,

soft cheeses, deli meats, salads,sandwich

meats require special attention.

Heat sandwich meats to steaming for safety.

Another infection dangerous during

pregnancy is TG (toxoplasmosis gondii)

which can be contracted through

cat litter if the cat strays outdoors,

hunts and eats raw meats,

but another important source of

contagion is

unpasteurized milk products,

unwashed fruits, vegetables and

uncooked or undercooked meats

especially wild game and venison.

Also raw fish can contain parasites,

flatworm, tapeworms, roundworms,

bacteria and viruses.

This includes raw fish sushi.

The risk of E. coli and Salmonella

infections from alfalfa, radish or clover

or other sprouts is also potentially high.

These should be avoided.

Salmonella also infect egg shells and eggs.

Cooked eggs with firm yolks

and whites are safer.

Additional safeguards are listed here:

1) Recommended storage times for

foods should be followed.

2) Use by dates should be followed.

3) Raw meats should be avoided next

to other food items to avoid

contamination.

4) Raw milk and raw milk based

products should be avoided.

5) Smoked seafood such as kippered,

nova-style, lox, jerky

types of seafood should be avoided.

Canned versions are

considered stable and safer.

6) Refrigerated meat and other

animal products should not be

consumed unless they are cooked

to at least 165 degrees Fahrenheit.

7) Fresh produce should be vigorously

be washed and peeled.

8 ) Cat litter box should be cleaned daily

prefferably by someone else.

If you clean it you would need to wash

your hands well with warm water and

soap after doing this.

The litter bow should be disinfected

with near boiling

water for five minutes

before filling it again.

9) Remember that meats that

are brine cured, smoked or dried can have

contaminants and are dangerous.

10) Remember that sandboxes are

potentially infectious and they should

be kept covered.

If you handle sand from a sandbox it could be

contaminated.

Therefore you need to wash your

hands with soap and

warm water if you handled the

sand in a sandbox or if you do gardening.

11) Fluid from hotdogs can be

contaminated and should be avoided as

uncooked hotdogs are not safe,

SAFE NUTRITION

By Joseph Hazan,M.D., FACOG

SAFE NUTRITION

Safe nutrition relates to avoidance of food-borne contaminants,

pathogens and toxins that cause food -borne infections and food

poisoning. There are 76 million cases of food-borne illnesses in

the US annually and 5000 fatalities from this cause.

The following precautions are beneficial in preventing these illnesses.

1) Hand washing completely with water and soap before handling any

food item or any dishes used in preparing or serving of food.

Food should be well washed and rinsed.

2) Food to be eaten without cooking should not be in contact with

uncooked meat,fish seafood, poultry or other potentially contaminated

food items.

Raw or undercooked meats, seafood, poultry should not be eaten.

3) Unpasteurized milks, foods prepared with unpasteurized milks,

unpasteurized fruit or vegetable juices should not be consumed.

4) Cooking should be done thoroughly by reaching appropriate

temperatures. These temperatures are found at www.fsis.usda.gov/

Factsheets/Keep_Safe_Food_Safety_Basics/index.asp.

5) All leftover food, including gravies, sauces and soups should be

reheated to 165 degrees Fahrenheit.

6) Refrigerators should be at or below 40 degrees and freezers should

be below zero Fahrenheit. Most bacteria tend to grow between 40 and 140

Fahrenheit. Food should be kept below 40 or above 140 Fahrenheit.

Food should not be kept at room temperature for more than two hours.

If the room temperature is over 90 Fahrenheit food can become spoiled

in only one hour.

Safe maintenance and preparation of food items are especially important

during pregnancy. Tomorrow we will look further into precautions in this

area.

Advanced OB-GYN News

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OVULATION INDUCTION

Pelvic Ultrasound

Sudden onset Pelvic Pain

Age of Women

FIBROMYALGIA

Pelvic Pain Questions

ANTIOXIDANT AGENTS AND ANTIAGING

ANTIOXIDANTS

SAFE NUTRITION IN PREGNANCY

SAFE NUTRITION

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