Published on July 21st, 2016
Hemorrhoids are painful varicose veins in the anal area, which can get inflamed and cause significant pain and discomfort.
Traditional surgical treatment involves excision of the hemorrhoids that can be very painful with a long recovery time. Using radiofrequency and electrocautery, we are able to treat a large number of hemorrhoids, under local anesthesia, as an out-patient procedure.
An office evaluation of the anal area is necessary to qualify for this treatment and rule out other causes of pain and discomfort such as anal fissures, tumors, infection, abscess, polyps or cancer. Once hemorrhoids are identified, in most cases local treatment involving emollients and steroids are sufficient to relieve the pain. However, if the hemorrhoids are recurrent, treatment using these outpatient techniques are employed.
Treatment requires a duration of less than 15 minutes. Local anesthesia is used. With no down time, in most cases, the patient may return to his or her normal activities subsequent to the procedure. Multiple treatments may be necessary to allow for complete resolution of the hemorrhoids.
For patients that qualify for this treatment, this may be a solution much more tolerable than the traditional excisional treatment.
Published on July 7th, 2016
Postpartum urinary incontinence is post-baby urine leakage no one wants to talk about.
My patient and her friend who recently had children were in the gym trying to get back into shape. It was a routine that involved jumping, dance moves, and exercises aimed at building their core. Even though the moves were fun and they were getting a lot of good exercise, they suddenly noticed they were leaking urine with workout moves that required any type of straining. They now wear black and stand near the exit closest to the bathroom and buy panty liners by the bulk.
Why some have this issue and others do not?
During pregnancy and labor, muscles that support the pelvis and the pelvic floor muscles come under significant stress. During pregnancy, the weight of the baby causes stretching and pressure. During labor, tearing and damage to the muscle fibers and nerves can cause changes in the support they provide.
In ordinary circumstances, when we sneeze the pelvic floor muscles squeeze and stop the flow of urine. After the damage, the squeeze is a lot less effective and sometimes beyond their body’s ability to repair itself.
What can be done to fix it?
The good news is much can be done to help you with this problem. Pelvic floor exercises during and post-delivery can strengthen the muscles and help reduce the damage and encourage repair. Kegels are one such exercise. Kegels can be augmented with physical therapy to involve the internal and external abdominal muscles and back muscles that contribute to the functioning of pelvic floor muscles.
Weight loss is also crucial to regaining control. Studies show 10% weight reduction reduces incontinence by 40%. A healthy weight loss program is crucial to a healthy pelvic floor.
Surgical and non-surgical options include injection of bulking agents, repair of the defects, injection of Botox, and placement of nerve stimulators and are reserved for patients that do not respond well to conservative management.
Published on June 29th, 2016
Yes, you read correctly. Recent studies show multivitamin use in healthy people not only decreases healthiness but also increases the risk of death. The exact conclusion from one study is as follows:
“Most supplements do not prevent chronic disease or death, their use is not justiﬁed, and they should be avoided. This message is especially true for the general population with no clear evidence of micronutrient deﬁciencies, who represent most supplement users in the United States and in other countries.”
All the essential vitamins and minerals that we need to stay healthy and avoid chronic disease are in the foods we eat. So, instead of supplementation we need to pay closer attention to our diet. A diet balanced in nutritional value as well as calorie intake is the key to our health and longevity.
A healthy diet should be high in protein, vegetables, fruits, and low in fat and processed or simple carbohydrates such as white rice and bread. Complex carbohydrates can be found in nuts, wheat bread, and brown or black rice and should be consumed in moderation. It is important to allow enough time for digestion and energy production, and to consume such carbohydrates mostly in the morning and at noon.
Many studies also reject the benefit of organic foods over non-organic. Organic labels do not necessarily indicate better or superior quality foods. The key is to avoid highly processed foods and stick to more natural sources of nutrition.
Published on June 23rd, 2016
One of the most common conditions women complain of is heavy vaginal bleeding and pain during their menstruation cycle. Adenomyosis, or uterine endometriosis, is one of the most prevalent conditions causing these symptoms.
Adenomyosis occurs when the lining of the uterus penetrates the muscle of the uterus and causes the uterus to act as a sponge. As a woman gets closer to having her period, the uterus becomes full of blood and congested and when the period starts, the bleeding pours out of the endometrial lining and the uterus, as if a sponge is being squeezed. The congestion causes fullness and pressure in the lower abdomen and once the bleeding starts, the large amount of blood trying to exit the uterus causes cramping and pressure that can be very severe.
How is the diagnosis made?
An ultrasound examination in the office can easily identify the many causes of pain and bleeding. We use transvaginal or transabdominal ultrasound as needed and with the advanced technology in our ultrasound system, we can use 3D options to further evaluate the uterus and the ovaries. We also utilize Doppler to evaluate the blood flow.
In situations when the problem is hormonal or due to an enlarged uterus as a result of adenomyosis, identified treatment is usually hormonal. We use natural progesterone creams or pills, low dose hormonal birth control, or hormonal IUD as the first line of therapy. The hormone progesterone in these treatments helps decrease the congestion of the uterus and is usually extremely effective in resolving pain and heavy bleeding. Minimally invasive surgical options such as uterine artery embolization and endometrial ablation are also very effective in treating the more severe cases which do not respond well to conservative measures.
Published on June 16th, 2016
My belly looks like a road map. What is going on?
As the baby grows, so does the uterus carrying the baby. This growth stretches the skin over the enlarging uterus. Stretch marks are the red and brown streaks which eventually turn white, and sometimes itchy, that appear on or around your belly. They are a representation of the damage the skin has sustained during pregnancy.
The weight gains that women experience during pregnancy, and increased fat that develops in the tissue under the skin, weakens the skin and causes it to crack as it is stretched. Some women also have a genetic predisposition to stretch marks. If your mother has stretch marks, you are most likely at a higher risk to have them as well.
Currently, there are no effective treatments for stretch marks. However, prevention is always possible through a careful diet. We have designed a diet program that is healthy for the baby and the mother and also helps reduce the chances of stretch marks from developing. We also recommend exercise programs to keep moms healthy and keep their skin healthy.
The best treatment is prevention, and it is certainly true for stretch marks.
Published on June 8th, 2016
As the level of estrogen in women decreases in perimenopause and menopause, shrinkage and dryness of the vaginal and urinary organs occur. The tissues thin out and the blood flow to the genitalia decreases. These changes can result in genital tissue dryness, burning, irritation, pain with intercourse and urinary difficulty such as urgency, frequency and incomplete emptying. These symptoms affect approximately 50% of women.
The changes in a woman’s body that eventually result in the symptoms mentioned above start long before the actual symptoms present themselves, which is why physicians should be watchful during yearly exams for any early signs. Also, women going through these hormonal changes should be aware of changes in their body and report any symptoms to their physicians.
There are several treatment options and each needs to be personalized based on the current level of discomfort and need. However, prevention is always the best policy.
Early hormonal replacement can prevent these changes from occurring. In our office, we prefer natural hormone therapy as it offers minimal adverse effects and maximal benefits to the affected area. We synthesize the hormones naturally and therefore have control over the dosage and ensure that the chemical structure is similar to the ones naturally produced in a woman’s body.
Non-hormonal options are also available for few patients that do not qualify for hormone therapy. This type of medication increases lubrication and reduce symptoms associated with menopause during use.
Evaluation of the bladder can help your doctor determine the exact nature of the urinary problem that may have gotten worse after menopause. Many options are then available to address these issues before they turn into major problems.
Kegel exercise, modification of diet and fluid intake and weight loss help strengthen the pelvic muscles and improve the function of the genital and urinary organs, keeping you healthy and improve the quality of life during this next stage of life.
Published on June 3rd, 2016
I hear this so frequently in my office. Cyclic changes in mood and physical discomfort that usually starts after ovulation and ends with a period is called premenstrual syndrome and is often referred to as PMS. Feelings of depression, anxiety, nervous agitation, breast tenderness, and cravings are the typical symptoms of PMS. These symptoms can begin as mild but can become very severe. With age, they can get worse. Many patients complain of feeling excessively bloated. Others feel extremely sensitive, sad, annoyed or easily irritated. Some patients shyly tell me that their feelings are so unstable that they don’t know why they become excessively agitated with their significant other.
The effects of PMS can be disruptive, and cumulatively can take a negative toll on anyone’s mind and body, not to mention those around you or in contact with you on a daily basis including family and friends. I recently treated a 26-year-old patient who for one week prior to her menstruation could not leave the house. Another patient in her 40’s was so bloated she could not put her pants on before her menstrual cycle. Other times, I have received calls from husbands about the change in the mood of their spouse around the time of their periods.
The treatment we offer is in most cases very successful. A combination of special low calorie and low salt diet eliminates much of the bloating. Exercise, especially swimming also tends to mobilize much of the fluid collection in the extremities. Short duration of diuretics can also be used to relieve symptoms that do not respond to diet and exercise. For other symptoms, we try to use natural products to balance the bodies hormonal balance. Every patient is different and the range of unwanted PMS symptoms varies from patient to patient. With an individualized plan of care, we can properly address your symptoms to alleviate your monthly struggle and become as comfortable as possible with your menstrual cycle. In this day and age, there are mobile applications to monitor your menstrual cycle not only to remind you of your time of the month or how many days on average are in your cycle, but also to document and take note of your symptoms, cravings and feelings. If you are able to routinely keep track of certain things that are consistently appearing prior to and during your cycle, we can better address your needs and provide some relief to the symptoms that come and seem to stay too long.
We are happy to report that we have been able to successfully treat our patients and keep many husbands happy!
Published on May 27th, 2016
Interstitial cystitis (IC) is a chronic pelvic pain condition that has its origin in the bladder. Two to seven percent or the population (primarily women) suffer from this potentially debilitating condition. Women with recurrent urinary tract infection symptoms and negative cultures, recurrent vaginal irritation symptoms without positive culture or significant discharge or irritation, and more classically, pain with bladder fullness should be evaluated for IC.
Traditionally, diagnosis and treatment of this condition has been very complicated. However, with greater understanding of the condition, it has become very treatable.
Diagnosis of IC involves a complete history and physical evaluation, eliminating other causes for the symptoms, along with more specific testing. Treatment is usually by a combination of diet modification and medication, as well as natural therapeutic agents and therapy.
Published on May 11th, 2016
Fourth trimester is the three month period after delivery when a mother’s body deals with the residual changes from carrying the pregnancy and child birth. This time period is critical since neglect in correcting these changes can lead to chronic lifelong issues.
During pregnancy, significant changes occur to a woman’s body in order to support the pregnancy, including the following:
- Swelling of the extremities
- 25-30 pounds of weight gain (on average)
- Stretching of the abdomen and the breasts due to the engorgement of the breast glands and growing uterus
- Hormonal changes that affect mood and a sense of wellbeing
- Changes in the body resulting in a disfavorable self-perception and body image
- Tearing forces during labor may compromise control of the bowel and bladder function
- Sex may become uncomfortable, unpleasant or even painful
- Desire for sex and libido may suffer in some women
- A bulge in the abdomen may indicate diastasis recti (an exacerbating hernia or splitting of the abdominal muscles)
- Persistent back and arm pains affecting mobility
- Bulging tissue from the anal area and bleeding with bowel movement may indicate fissures and hemorrhoids
- Other mental, psychological and physical changes that leave the body different than the one prior to pregnancy
By paying attention to these changes, we have solutions that can correct or minimize the after effects of a pregnancy and allow the body to return to its emotional, psychological and physical state.
Published on May 11th, 2016
One of the most common conditions in women is endometriosis. It occurs in 1 out of 10 women. The symptoms are usually persistent pain with menstruation, bloody cysts of the ovary and fertility issues. It is usually considered to be a benign condition. However, for years there has been suspicion to its association with certain ovarian cancers.
Several recent studies have now shown that endometriosis can transform to ovarian cancer in some patients. It is not clear which patients are susceptible to this harmful transformation into ovarian cancer and what the causes are, but multiple factors such as genetic history and a patient’s environment may play a role.
Early detection and the complete surgical excision of the endometriosis along with hormonal suppression will likely result in a better treatment outcome and will help reduce the chance of ovarian cancer. Also, the removal of the Fallopian tubes in women that undergo a hysterectomy or desire permanent sterilization has shown to reduce the risk of ovarian cancer.
A pelvic ultrasound is one method of evaluating the Fallopian tubes and ovaries that can be done in the office. Another is MRI of the pelvis that increases the chance of early identification of a malignancy.