Advanced OB-GYN News

HPV (Human Papilloma Virus)

By Joseph Hazan,M.D., FACOG

HPV causes cervical cancer,

cervical intraepithelial neoplasia

and genital warts.

There are over 100 different types

of HPV. About 40 of these infect the

genital tract.

Types 16 and 18 cause 65% of cervical

cancers.

It is known that 20 million

individuals in the US are currently

infected and every year 6.2 million

individuals become infected.

Three fourths of these new infections

occur in 15-24 year olds.

More than a third

of women under 25 years have been

infected.

HPV is sexually transmitted. Multiple

sexual partners and early age of first

intercourse increase the risk of infection.

It is known that 80 % of women have been

exposed to HPV by age 50.

Most of the women who are exposed to HPV

do not develop abnormal Pap tests.

About 28% of the HPV positive patients

have an abnormal Pap.

5% develop high-grade lesions.

GENITAL WARTS are very common and every

year there are about a million new cases in the

US. These are caused by HPV types 6 and 11.

Local treatment of warts is effective.

Types 16 and 18 cause about 65%

of cervical cancers.

PREVENTION is through abstinence, regular

Pap smears and vaccination.

The vaccine has been available over the past

three years.

It is recommended until age 26.

OPTIMAL DIET

By Joseph Hazan, M.D., FACOG

The Modified Mediterranean Diet provides

many health benefits. It is based on plant

foods.

EXCLUDED: meats, sweets, flour,fat, corn

syrup and butter.

INCLUDED:Fresh vegetables, olive oil,

legumes, nuts,(walnuts, pecans,

almond and hazelnut),

seeds, fresh fruits,herbs and spices.

Fresh fish, onion,garlic, tomato are

also included.

For frequency, portion size and

menu ideas there

are many resources.

This diet allows the benefits of

increased

antioxidant intake and reduction of

health risks.

HEALTHY LIFESTYLE

By Joseph Hazan,M.D., FACOG

Healthy diet, regular exercise and

avoidence of smoking,alcohol and

drugs and having a positive outlook

form the basis of a healthy lifestyle.

Here we will review some of the

most recent data on diet in the

prevention of heart disease in women

This approach helps reduce the

incidence of coronary heart disease

and stroke.

In a recent study about 75,000 women

were followed for 20 years.

The women who used the Mediterranean

Diet were found to be at lower risk for

heart disease and stroke.

Previous research also indicated the

findings that lipids,CRP ,risk, morbidity

mortality were all lower in those individuals

who used the Meditteranean Diet.

Tomorrow we will look further into this type

of diet.

REFERENCE

Fung TT,Rexrode KM, Mantzoros CS,

Manson,JE,

Willett WC, Hu FB.

Mediterranean diet and incidence

of and mortality from coronary

heart disease and stroke

in women. Circulation 2009;

119:1093-100

HEART DISEASE IN WOMEN

By Joseph Hazan,M.D.,FACOG

There are several contributing

factors and health issues

contributing to the alarmingly

increased rate

of heart disease in women.

Chief among these is the

increased rate of metabolic

syndrome which is directly

related to the obesity

epidemic.

WHAT IS METABOLIC SYNDROME?

This consists of three or more of

the following:

1) Waist circumference of over

88 inches

2) Blood pressure of 130 mm Hg

or higher systolic

or 85 mm Hg diastolic.

3) HDL cholesterol of less than

50 mg/dL

4) Triglycerides over 150 mg/dL

5) Fasting plasma glucose of

over 100 mg/dL

WHY IS METABOLIC SYNDROME SO BAD?

This is due to the incresed risk to the

cardiovascular system.

Patients with essential high blood

pressure have CRP

(C-reactive protein) levels that are high.

CRP, other factors such as

TNF alpha and interleukin-6 are

elevated.

These are significant in the development

of heart disease.

All of the above risk factors respond

to diet and lifestyle

changes.

RELATED HEALTH ISSUES

1) Sleep disorders

2)Stress and anxiety

3) Depression

4)Vitamin D Deficiency

5)Rheumatoid arthritis

6) Tobacco, alcohol dependency.

Tomorrow we will look at a dietary approach

that holds promise.

NUMBER ONE KILLER OF WOMEN Is Heart Disease

By Joseph Hazan,M.D.,FACOG

Cardiovascular disease kills more women than

any other disease.

This is 12 times as often as

breast cancer related mortality.

Women also have been victims of

heart diease more often

than men for over 25 years.

The fact is that one

in three women die unexpectedly

of heart disease.

SYMPTOMS

Generally there is very little chest pain,

but mostly, shortness of breath and

weakness.

Sometimes neck, arm and back

pain are the presenting symptoms.

Abdominal or shoulder discomfort

with nausea, may mimic indigestion.

WHY SO COMMON?

It is now known that women at

the high risk age group of 45-64

are simply unhealthy at

alarming rates.

This is due to the widespread

incidence of obesity, high blood

pressure, elevated cholesterol,

diabetes and prediabetes.

Prediabetes is found in about

one third of women

aged 45-54.

High cholesterol is found in 60% of

the same age group, one third have

high blood pressure, one in five

smoke and two thirds are

overweight.

It thus becomes obvious that

this is a lifestyle-related health

problem, linked to the obesity

epidemic.

It is directly increased with high body

weight, high blood pressure,

high cholesterol and

high blood glucose.

Therefore it is manageable by

proper diet.

Depression is another common

risk factor.

Women with a history of depression,

anger management problems and

stress factors also

contribute to increased risk.

The highest risk factor is a

waist circumference

of over 35 inches.

If you or any female you know

has a waist circumference over 35 inches,

a thorough

evaluation is needed.

Women who lost 5% of their body

weight and

exercised two and a half hours

per week lowered

their risk of diabetes by 58%.

Tomorrow we will continue to

look into this most

serious healthcare risk for women.

VITAMIN D DEFICIENCY

By Joseph Hazan,M.D.,FACOG

Vitamin D is essential in bone repair and

maintenance. Vitamin D is instrumental

in calcium absorption.

In cases of vitamin D deficiency

osteoporosis is seen.

50% of adults are vitamin D deficient.

Further, many adults who have the

following factors are at higher than

average risk of vitamin D deficiency:

1) Inadequate vitamin D intake

2) Dark complexion

3) Poor absorption due to bowel,

liver or kidney problems.

4) The elderly have lower intake at a

time of increased need.

Insufficient absorption and inadequate

intake are also factors for the elderly.

Vitamin D levels can be measured.

The average intake requirement of vitamin D

by supplementation is 1000-5000 IU

for optimal health.

Higher doses are needed in cases of more

pronounced deficiency.

VITAL FACTS ON VITAMIN D

By Joseph Hazan,M.D.,FACOG

The significance of maintaining

adequate levels of vitamin D

is becoming clearer through

emerging research.

There is now mounting evidence that

higher levels of vitamin can help prevent

Colorectal cancer

Pancreatic cancer

Endometrial cancer

Prostate cancer

Skin cancer

Additionally Vitamin D deficiency

has been found to be associated with

the following:

Heart Disease

High Blood pressure

Type 1 Diabetes

Multiple sclerosis

Autoimmune disorders

Vitamin D3 should be taken in

adequate doses of about 2000 IU daily.

Higher doses might be needed in cases

of deficiency.

Tomorrow we will look into further details

on Vitamin D.

PELVIC FLOOR DYSFUNCTION

By Joseph Hazan,M.D., FACOG

In the US more than 50% of women

over 60 are estimated to have urge

urinary incontinence (leaking).

OAB (overactive bladder) which consists

of urinary frequency which can result

in incontinence is estimated to cost $12

billion per year in the US.

It is usually the result of the inability of

the bladder to relax.

Since the bladder

does not expand, the capacity of the

bladder to hold more urine is restricted.

This leads to the urgency and UUI

(urge urinary incontinence).

Diagnosis is accomplished at our

office by evaluation, examination and

specific urodynamic testing.

Treatment will be based on the findings

of the testing.

The following are some of the treatments:

Bladder training

Fluid management

Scheduled voiding

Biofeedback

Drug treatment

Kegel exercises

INTERSTITIAL CYSTITIS

By Joseph Hazan,M.D.,FACOG

INTERSTITIAL CYSTITIS IS ALSO

KNOWN AS PAINFUL BLADDER

SYNDROME

Approximately 25-85% of women

with chronic pelvic pain may have

IC (interstitial cystitis). The symptoms

are urinary frequency, urgency of

urination, urinary incontinence or

pelvic pain.

Painful intercourse may

also occur.

If you have these urinary symptoms

with negative urine culture, the diagnosis

could be IC.

May appear in girls as early as under 8

years of age as bedwetting. The symptoms

improve for a while, than recur after age 13.

Symtoms of IC could be very similar to

those of endometriosis.

IC and endometriosis could both be present.

In fact one study showed that there was an

overlap in 70% of cases.

IC develops due to damage to the bladder inner

epithelial lining following frequent infections,

vascular insufficiency, increased pain response,

substance P elevation and the alterations in

factors such as APF and THP.

Some patients who have IC may also have the

following:

Fatigue

Fibromyalgia

Depression

IBS

Also as mentioned previously endometriosis

may also be present.

Treatment is medical and diet modification.

Alcohol,spices,high acidity foods such as

tomatoes,sodas,citrus fruits should be

avoided.

Smoking cessation and elimination of

caffeine are also important.

REFERENCE
Interstitial Cystitis Association,11o

Washington St.,

Rockville MD 20850

1-800-HELPICA

http://www.ichelp.org

IRRITABLE BOWEL SYNDROME

By Joseph Hazan, M.D., FACOG

This is present in 15-20 % of the population.

This problem is characterized by recurring

pain, frequent, alternating constipation and

diarrhea.

Tests are usually negative, because there is

no structural or biochemical abnormality.

Patients with IBS have an increased response

to experiencing pain initiated and aggravated

by stress.

Stress management, better sleeping habits and

more physical activity are beneficial.

Reassurance and understanding the

nature of pain also are helpful.

Excluding sugar, wheat, potatoes,onions and

milk from the diet could be beneficial.

Probiotics and increased fiber intake are helpful.

Advanced OB-GYN News

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HPV (Human Papilloma Virus)

OPTIMAL DIET

HEALTHY LIFESTYLE

HEART DISEASE IN WOMEN

NUMBER ONE KILLER OF WOMEN Is Heart Disease

VITAMIN D DEFICIENCY

VITAL FACTS ON VITAMIN D

PELVIC FLOOR DYSFUNCTION

INTERSTITIAL CYSTITIS

IRRITABLE BOWEL SYNDROME

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