By Joseph Hazan, M.D.,FACOG
It is known that Nicotine causes
blood vessels to constrict.
In addition, there are more
than 4000 toxic substances
in cigarettes that are harmful
to the entire human body.
Here are 4001 more reasons
to quit smoking now!
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By Joseph Hazan,M.D.,FACOG
This is a common and serious problem. It is estimated that 40% of women with high blood pressure are unaware of this or do not get treated. It can cause the life span of women to be shortened by upto 20 years. Women who develop high blood pressure at menopause might think that this is a regular part of aging. This is not true. There are factors that influence blood pressure. The most important are: 1) Obesity 2) Smoking 3) Family history 4) Pregnancy 5) NSAID’s (nonsteroidal antiinflammatory drugs) 6) Stress 7) DD (diastolic dysfunction). Repeated blood pressure readings and treating the cause of high blood pressure is very important for your health. By Joseph Hazan,M.D., FACOG Some of the treatments will restore periods to normal, while others will stop the periods. 1) If the abnormal bleeding is caused by lack of ovulation either starting ovulation or regulating the cycles can control the bleeding. This is usually done with birth control pills or cyclic progesterone. 2) In cases of PCOS (Polycystic Ovary Syndrome) diet,exercise,weight control, birth control pills if fertility is not immediately wanted, or clomiphene if fertility is wanted soon. In cases of insulin resistance medications and proper diet are beneficial. 3) Heavy periods can be temporarily arrested by using a Progesterone IUD. 4) Fibroids can be removed. This procedure is called myomectomy. 5) Endometriosis treatment options are DMPA (Depomedroxyprogesterone acetate) GnRH agonists, surgery, danazole, Progesterone IUD. The appropriate choice varies based on the individual situation. 6) Polyps are removed with hysteroscopy. 7) Bleeding due to clotting factor defects are treated with various modalities. In cases of von Willebrand disease the use of NSAID’s (nonsteroidal antiinflammatory drugs) such as Ibuprofen, Advil, Motrin, Naproxen and some others should be avoided. By Joseph Hazan,M.D., FACOG
About one third of women may experience heavy menses. If you have to use pads or tampons every hour, using two pads, a tampon with a pad, this is considered heavy. Also passing clots, soiling of the linen at night or a period lasting longer than a week is excessive. Sometimes there is dizziness, fatigue or cramps. In cases of easy bruising, bleeding of gums or family history of bleeding problems a bleeding disorder can be present. Blood tests, physical exam, ultrasound are usually done. In some cases a hysteroscopy is needed. This is the inspection of the uterus with a fiberoptic instrument. Endometrial polyps, fibroids, endometritis or adenomyosis could be detected. Iron supplements are important. Once the cause of the heavy periods is determined, the treatment can be individualized. Monitoring of the results is helpful. By Joseph Hazan,M.D.,FACOG
If the contractions get progressively stronger, more regular and longer, labor has started. To make sure it is not false labor, take a warm shower. If the contractions slow down, it was false labor. If they continue as intensely or stronger this is the time to go to the hospital. If there is pink or bloody show this is important. If the water breaks it will have the odor of bleach. If the baby is not active as before this is dangerous. During labor the cervix dilates and the baby descends. If there is a problem with the progress of labor, this can be detected. Following the delivery of the baby, the placenta will be delivered. After delivery, breastfeeding is beneficial to the baby and it also helps to contract the uterus. If you feel depressed following delivery, getting help is very important. Postpartum blues or depression are commonly seen. In case of heavy bleeding following delivery or increased pain, redness in breasts or inflammation of nipples, call your obstetrician. Also please contact your obstetrician if you have a fever over 100 degrees, vaginal discharge that smells bad, pelvic pain, burning on urination or painful urination.
RESOURCES By Joseph Hazan,M.D.,FACOG During pregnancy your baby is inside the amniotic sac which is a bag of fluid. The placenta transfers oxygen and nutrients to the baby. The umbilical cord connects the baby to the placenta. The uterus stretches as the baby grows. During your pregnancy vitamin, mineral, protein,vegetable, fruit and water intake is very important. It is also very important to avoid smoking, drugs and alcohol completely. Pills and other medications should be avoided unless prescribed specifically during pregnancy. Changes during the first three months are some breast tenderness, frequent urination and morning sickness. During the first three months if there is any bleeding or spotting, fever over 100 degrees, pain, cramping, burning on urination, dizziness or severe vomiting you should notify your obstetrician. During the first trimester your baby’s development including heart, brain, eyes, ears, mouth, arms, legs and sexual organ development occur. During the second trimester the baby can suck her thumb, kick, move, sleep and stretch upon waking up. During the second trimester you may gain a pound a week. If it is less or more it needs to be closely monitored. If you have abdominal pain, aching, cramps, fluid leakage from the vagina or bleeding or urinary symptoms you should notify your obstetrician. During the last trimester the baby starts getting into position to be born. If you have swelling, headache,blurred vision, spots before your eyes, abdominal pain, back pain, bleeding or fluid from the vagina please notify your obstetrician. IMPORTANT RESOURCES HELP TO STOP SMOKING 1-800-4-CANCER HELP TO STOP DRUGS 1-800-662-HELP HELP TO STOP DRINKING 1-800-ALCOHOL By Joseph Hazan,M.D.,FACOG
Cervical cell changes are detected by the Pap test. These can then be diagnosed and treated early in order to prevent cervical cancer. The cervix is the mouth of the uterus. Abnormal Pap results are often linked to HPV (Human Papilloma Virus). If the cells are normal, the Pap test results are negative. A positive result can show low grade, moderate or high grade changes. High grade are the closest to cervical cancer. Abnormal results require diagnosis through colposcopy (viewing the cervix through a magnifying instrument) and biopsy. The resulting specimens are sent to the lab for diagnosis. Based on the diagnosis the cervix is then treated. The purpose of these is to detect abnormalities early in order to prevent cervical cancer. Depending on the grade of the lesion either cryosurgery (freezing) or conization is utilized for treatment. By Joseph Hazan,M.D., FACOG
Fertility treatments are directed to the specific problem. If a blockage is preventing an egg or sperm from moving through the tube this can be overcome by either tuboplasty (please see www.tuboplasty.com) or IVF. In cases of Polycystic ovaries there are immature eggs but no ovulation. This can be treated medically. Polyps, fibroids or a septum can be present in the uterine cavity and could prevent implantation. These can be surgically removed. Adhesions, endometriosis or endometrioma would also need to be treated. Cervical, uterine or tubal infections also need to be treated. OVULATION PROBLEMS are addressed by medical treatment. Hormonal problems can be related to the thyroid, prolactin or male hormones. Some of the approaches are listed: Clomiphene citrate Human menopausal gonadotropin Follicle stimulating hormone Human chorionic gonadotropin ART ( Assisted Reproduction Technologies) IUI (Intrauterine Insemination) IVF (In Vitro Fertilization) Treatment plan needs to be individualized based on the specific conditions present. By Joseph Hazan,M.D., FACOG
Fertility evaluation consists of checking for ovulation, semen analysis and determination of tubal patency. Additional tests are done if indicated based on the above. Some of these are blood hormone tests, ultrasound, chromosome studies, cultures, laparoscopy, hysteroscopy, postcoital test. OVULATION is detected by an ovulation predictor kit, elevation of basal body temperature and cervical mucus changes to clear and stretchy. HEALTH ISSUES such as smoking, drug, alcohol, overweight or underweight, chemical exposure, certain medications, sexually transmitted infections are significant. SEMEN ANALYSIS checks the sperm count per cubic centimeter of semen, volume of semen, sperm motility and sperm morphology (shape). BLOOD TESTS are done to check levels of FSH, LH, progesterone, thyroid, blood sugar, estrogen, prolactin, testosterone and STI ( sexually transmitted infection). TUBAL PATENCY is tested by doing an HSG (hysterosalpingogram) to visualize the fallopian tubes and the uterus by x-ray. ULTRASOUND uses sound waves to view the uterus, ovaries and follicles which contain eggs. LAPAROSCOPY could be needed to directly view the pelvic organs. HYSTEROSCOPY is used to visualize the inside of the cervix and uterus. Tomorrow we will look into some of the treatments. By Joseph Hazan,M.D., FACOG
A thorough evaluation of all factors contributing to infertility are needed. The following are essential: 1) Age is a significant factor because after 35 the quality and quantity of eggs decline 2) Sperm count and function should be determined by a semen analysis. 3) Ovulation problems are important and should be given prime consideration. 4) Fertilization can be difficult or impossible due to tubal factors or the inability of the sperm to swim up through the cervical mucus. 5) Implantation issues can be related to the endometrial lining or the shape of the uterus. Tomorrow we will look into these factors and the tests related to them. |
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