Female Health Today - Winter 2015 by Cincinnati Magazine

FEMALE

TODAY WINTER 2015 EDITION

SEEKING WELLNESS ACUPUNCTURE BRINGS THE BODY INTO BALANCE

THE HPV VACCINE IS IT THE END OF CERVICAL CANCER? 8 HEALTH TIPS

YOU NEED TO KNOW TEEN TALK:

HEALTHY EATING MADE EASY

Scarlett Johansson

HOLLYWOOD’S SUPERHEROINE

THE REGIONAL

LEADER IN MINIMALLY INVASIVE WOMEN’S SURGERY

THE CHRIST HOSPITAL WOMEN’S SURGERY CENTER

David Aicholz, MD

Kristen Magner, MD

Bruce Allen, MD

You’ve got places to go and people to see We just get you there faster It’s not always the most comfortable conversation, but speaking with your healthcare provider about any gynecologic issues you may have is very important. While many women experience some monthly pelvic discomfort, women whose pain or menstrual flow changes, worsens, affects their daily lives or comes with new symptoms may want to see one of our specialists. We see patients for a variety of reasons, including: • Abnormal uterine bleeding • Chronic pelvic pain • Endometriosis • Uterine fibroids • Ovarian cysts • Infertility • Pelvic floor disorders, such as urinary leakage Often, the best treatment is a non-surgical solution, but when surgery is needed, you can turn to The Christ Hospital for help.

Learn about your options. Talk to your doctor or schedule an appointment with one of our 60 specialists by calling

513-585-1000.

TheChristHospital.com/Womens-Surgery-Center

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Table of Contents

ACTION FIGURE : Scarlett Johansson loves playing intelligent and complex female characters.

FEATURES

SCARLETT JOHANSSON Why playing superheroines suits this Hollywood beauty just fine.

Patients and physicians are looking to acupuncture to bring the body back into balance.

8 HEALTH TIPS WOMEN SHOULD KNOW

THE HPV VACCINE

PAIN-FREE INTERCOURSE

MENOPAUSE RELIEF

DONâ&#x20AC;&#x2122;T SUFFER IN SILENCE

HOW WOULD I KNOW I AM BETTER?

HEALTHY EATING MADE EASY

The benefits of probiotics, strategies for preventing carpal tunnel syndrome, and why sleeping better can improve your mental health.

An OB/GYN explains its promising effects on cervical cancer rates.

A new therapy helps with postmenopause discomfort.

Photograph courtesy Helga Esteb / Shutterstock.com

10:55 AM

SEEKING WELLNESS

Could bioidentical hormone replacement therapy be right for you?

An implantable device helps patients take control of their bowels.

This simple question can help you choose the right treatment.

Tips for teens on establishing good nutrition habits.

Winter 2015 | FEMALE HEALTH TODAY 1

Welcome FEMALE

MAINTAINING HEALTH AT ALL AGES

» STAYING INFORMED AND EDUCATED IS ONE OF THE FIRST steps toward a healthy lifestyle. We invite you to enjoy our comprehensive health articles in this issue of Female Health Today, where our goal is to provide information for all stages of a woman’s life. If you’ve already gone through menopause and find yourself suffering from some of the issues women experience after this change, take comfort in the fact that you are not alone and that help is available. Learn about a brand-new laser therapy that treats painful intercourse due to menopause (page 10). For hot flashes, night sweats, weight gain, and other uncomfortable symptoms, some women are finding relief with bioidentical hormone replacement therapy (BHRT). Read the article on page 11, and talk with your doctor about whether this therapy may be helpful for you. Also during post-menopause, women commonly experience trouble with urinary and fecal incontinence. As the article on page 12 states, women don’t have to “suffer in silence.” Learn about a therapeutic device that is helping women regain control of their bowels and resume their active lifestyles. The Teen Talk column is particularly timely for college students as they head back to campus for second semester. After the indulgence of the holiday season, our tips for healthy eating will help them get back on track to good nutrition. “Seeking Wellness” on page 8 explores the ancient art of acupuncture and its implications for modern medicine. Physicians and patients in the Cincinnati area are finding it to be an effective treatment for infertility, migraines, allergies, and more. It may be the very thing for you that will alleviate chronic discomfort and pain. We’re sure there’s much more in this issue you’ll find of interest. If there are any particular topics you’d like us to cover in the future, please let us know. We’d love to hear from you!

TODAY

Female Health Today is the magazine of the Foundation for Female Health Awareness, a nonprofit organization dedicated to improving women’s health by supporting unbiased medical research and educating women about their health. With continued research and comprehensive education, the goals of disease prevention and improved quality of life can be achieved. All health care content provided by the Foundation for Female Health Awareness is peer-reviewed. All revenue raised by the Foundation for Female Health Awareness is used to support unbiased research in gender-specific medicine.

FOUNDERS

Mickey M. Karram, MD, and Mona Karram

Female Health Today magazine is published three times a year by the Foundation for Female Health Awareness, 7759 University Drive, Suite G, West Chester, OH 45069. © 2015. All rights reserved. The information contained herein is not a substitute for professional medical care or advice. If you have medical concerns, seek the guidance of a health care professional.

For more information or to donate contact: Barbara Bunt, 513.463.2512, BuntJB@aol.com

or visit femalehealthawareness.org

PUBLISHED BY:

Stay happy and healthy, Custom Publications Division PRESIDENT & PUBLISHER John Lunn EDITOR Marnie Hayutin 513.310.5858, marnie@hayutincreative.com ART DIRECTOR Danielle Johnson

MICKEY AND MONA KARRAM FOUNDERS OF THE FOUNDATION FOR FEMALE HEALTH AWARENESS

For a free subscription to Female Health Today, call 513.562.2752

PLEASE RECYCLE THIS PUBLICATION

2 FEMALE HEALTH TODAY | Winter 2015

Cover Photograph courtesy andersphoto / Shutterstock.com

Health Watch

8 THINGS

WOMEN SHOULD KNOW By Mark D. Walters, MD, and Samantha J. Walters, MPH

The following health tips have been specifically chosen from the latest medical research as important suggestions for women to maintain health and well-being throughout their lives. When combined with an active lifestyle and proper nutrition, following these tips may help you stay healthy throughout all phases of your life.

Regular yoga and tai chi exercises can help older adults improve balance, mobility, posture and walking speed. If you are an older adult (or any age for that matter!), it may be helpful to add yoga or tai chi to your exercise regimen. The benefits from these exercises may lead to greater flexibility, better posture, improved ability to walk for exercise, fewer falls, and an improved quality of life overall.

Exercising during pregnancy is important not only to keep your body healthy and fit, but also to reduce your recovery time postpartum. There are many benefits of exercise during pregnancy, such as better sleep and increased muscle tone and energy levels. Studies show that exercise during pregnancy may also decrease the risk of pregnancy complications, such as gestational diabetes, and help women avoid unnecessary weight gain. Postpartum benefits may include more energy and fewer symptoms of postpartum depression. Consult your health care provider about the best exercise options for you.

Getting more sleep may lead to better mental health. Studies have shown that getting enough sleep every night (7-9 hours per night for adults) may increase your brainpower. Conversely, not sleeping enough, or not getting quality sleep, may lead to cognitive decline because is it associated with a deterioration of the brain’s gray matter. If you have problems sleeping at night, there are various ways to enhance your sleep, such as going to bed at the same time every night, being physically active during the day, and avoiding technological stimulation (such as checking e-mails and spending time on tablets or smartphones) before bed.

Mark D. Walters, MD, is Professor and Vice Chair of Gynecology in the Center of Urogynecology and Reconstructive Pelvic Surgery in the Obstetrics, Gynecology and Women’s Health Institute at Cleveland Clinic.

Photographs courtesy Shutterstock.com

Talk to your health care provider about what age to begin and how often to get a mammogram. There is no denying the value of regular mammography screenings for all women of a certain age, but the timing and spacing of mammograms are debated among health care professionals. Whether you have risk factors for breast cancer (such as a certain gene mutation or a family history), or you are at low risk, you should talk to your doctor about when you need to begin mammography screening and how often you should have it done. Remember, at any age, if you experience a suspicious breast change or find a lump, you should get it checked out by a health care provider.

Taking probiotics can be a great way to maintain your health and well-being. Probiotics that contain lactobacilli have been shown to help prevent infections in the bladder and vagina, especially for women with bacterial vaginosis and/or recurrent urinary tract infections. In addition, probiotics might help prevent or ease the symptoms of irritable bowel syndrome and some types of constipation.

Some simple tips can help you avoid or improve bothersome urinary frequency and urgency. Drinking less caffeine, including coffee and sodas, is a good first step if you find you are always “looking for a bathroom.” Voiding in the same time interval during awake hours, such as every two or three hours (whether you need to go or not), is also helpful. Doing Kegel exercises can also help you suppress the urge to go, and may help avoid accidents. If these tips don’t help, see your caregiver to discuss other treatments to improve this annoying condition.

Studies show that limiting your salt intake may decrease your risk of cardiovascular disease and death. Salt intake that is above recommended levels can lead to high blood pressure, which is a major risk factor for heart attack, stroke and other cardiovascular diseases. Limiting processed and high-sodium foods may improve your cardiovascular health and reduce your risk of heart attack and stroke in the future.

Some strategies may help prevent carpal tunnel syndrome. Carpal tunnel is more common in women and in those with conditions that cause fluid retention, such as during menopause or pregnancy. It also may afflict people who do certain types of work, such as typing on a computer for long periods of time or using tools that vibrate. In some cases, you may be able to prevent carpal tunnel syndrome by improving your posture, reducing the force of your grip when using tools or during work activities, and taking frequent breaks when doing repetitive movements using your hand or wrist. Early recognition and treatment of this condition helps to avoid nerve damage that can lead to hand weakness and pain.

Samantha J. Walters, MPH, received her Master of Public Health degree from Oregon State University. She currently works in Cleveland as a Health Educator and Postpartum Doula.

Winter 2015 | FEMALE HEALTH TODAY 3

Scarlett Johansson Why playing action heroines suits this Hollywood beauty just fine.

By Fred Allen / The Interview People

4 FEMALE HEALTH TODAY | Winter 2015

Photograph courtesy Andrea Raffin / Shutterstock.com

» SHE’S PLAYED AN ALIEN (UNDER THE SKIN), A DISEMBODIED operating system (Her), and a porn addict’s girlfriend (Don Jon), but that’s nothing compared to the turbocharged amazon Scarlett Johansson got to play in Lucy, an action thriller directed by Luc Besson. In Lucy, Scarlett Johansson plays the title character, whose work as a drug mule goes wrong when she accidentally ingests experimental pharmaceuticals that increase her brain usage from 10 to 100 percent and she turns into a one-woman wrecking crew. “I love making action films,” Johansson says. “I also like doing as much of my own stunt work as I can even if I wind up getting a lot of bruises and scrapes. It adds something when the audience can see that it’s you doing your own fight sequences or jumps and not your stunt double.” It was while preparing for The Avengers and Captain America: The Winter Soldier that Johansson first went through the kind of rigorous training required for the demanding physical performance required of her on Lucy. Her martial arts skills came in “very handy” for the multiple fight sequences that are spread throughout the fast-paced film. Shot in Taipei and Paris, Lucy, which also costars Morgan Freeman, could well become one of the 30-year-old New Yorker’s biggest movies ever and establish Johansson as the leading female action star in the business, a strange twist of fate for someone whose professed real ambition is to be a “character actress.” In the meantime, Johansson is now spending her time away from film sets living in Paris with her French fiancé, journalist Romain Dauriac, and their new baby daughter, Rose.

••• WHAT ATTRACTED YOU TO A PROJECT LIKE LUCY? I’ve admired Luc Besson’s

work for many years and so this was a great chance for me to work with him and also be part of what I thought was a very interesting story. When Lucy ingests the drugs it has the consequence of transforming her brain, where one normally uses only 10 percent of its capacity to fully 100 percent, and how that alters her personality. HOW WOULD YOU DESCRIBE YOUR VERY POWERFUL FEMALE CHARACTER?

She’s basically a raw nerve. Everything is happening so fast for her, and it’s totally overwhelming. There’s a warm spot in my heart for the woman who means business and doesn’t use every opportunity to pose and look sexy in a catsuit. DOES IT EVER STRIKE YOU AS ODD THAT SOME OF YOUR GREATEST SUCCESSES IN FILM OF LATE HAVE SEEN YOU PLAYING FEMALE ACTION STARS,

I’m very fortunate to be a part of those Marvel films because they have a lot of substance, actually. Most superheroine films are simply not really good. They’re just not well made. They fall back on this hair-flipping, pose-y, hands-on-hips thing. We do a little bit of that in The Avengers, of course, because it’s important that it looks good, but

SUCH AS NATASHA ROMANOFF AND LUCY?

I’ve really had a great opportunity. I love the fact that in The Avengers we went against the trend of presenting female characters that are usually bookends or ornaments in the film to sell the sex appeal. I enjoyed the fact that Joss [Whedon, director of The Avengers] turned Black Widow [Natasha Romanoff] into a character that could get punched in the face and could deliver the blow. She was an intelligent, complex, and really strong female character...and I’m happy to be playing her again. [Johansson recently completed filming on The Avengers: Age of Ultron sequel.] It’s been a real pleasure for me to play those multilayers and to really be able to act and not just pose. I’m not just the romantic interest, and thank God for that. It makes [it] more interesting and interesting to watch, too. I give Joss a lot of credit for creating a very multilayered character and not just wanting to sell her physical attractiveness. IT’S BEEN OVER A DECADE NOW SINCE LOST IN TRANSLATION TURNED YOU INTO A STAR. HOW DO YOU APPROACH YOUR WORK DIFFERENTLY TODAY AS OPPOSED TO THEN? I

have a greater appreciation of my work and what I have to put into it now. It just changes the decisions I make. I think I’m able to make braver choices because I feel braver now and have had more life experience. I have a greater trust in my ability, and I’m curious about taking on the unknown. I feel most confident now. At the same time, I never lose the enthusiasm I have for working. It’s been 20 years, but I still have those moments when I walk around a set going: “Wow! We’re making a movie!”

Winter 2015 | FEMALE HEALTH TODAY 5

this film is not exploitative...I’ve avoided it in the past mainly because it transforms all the attention about you and obscures the kind of response you want from people who look at your work. You don’t want to feed that kind of process. DO YOU HAVE BETTER INTUITION NOW WHEN IT COMES TO CHOOSING PROJECTS? Intuition

I t’s been 20 years, but I still have those moments when I walk around a set going: “Wow! We’re making a movie!”

comes into picking a project quite often, knowing if it makes sense to do something commercially or artistically, and no one really knows the proper formula for either one of those. You have to feel it, you know? Otherwise, forget it. If you don’t know why you are there or what you are doing, then why be there? You have to take risks and trust your instincts, initially. That’s vital, I think.

WILL YOU EVER DO ANOTHER ROMANTIC COMEDY? I YOU’VE SPOKEN OUT AT TIMES ABOUT THE WAY YOU AND OTHER WOMEN IN THE INDUSTRY TEND TO BE OBJECTIFIED AS SEXUAL OBJECTS. BUT ISN’T THAT PART OF THE NATURAL PROCESS THAT DRAWS PEOPLE TOWARD MOVIE STARS AND CELEBRITIES? I’ve been a victim of objectification, but no

more than anybody else. I don’t feel I’ve been particularly affected by that any more than others who are in the spotlight. Or anyone, really. All you have to do is go out to a nightclub and you see it happening right away. It’s not always the case that a man is trying to get to a woman’s brain first! But I think it’s something that I’ve been able to use to my advantage, while trying to avoid getting pigeonholed. I’ve been very fortunate to collaborate with cosmetics campaigns and clothing campaigns, to be photographed by the best photographers and make beautiful pictures and all of that stuff. In other ways, it can be very frustrating at times because I’ve always thought of myself as being a character actor and…you can be placed in this specific stereotype that the media puts you in, but the fact is that a lot of the work that I’ve done isn’t necessarily overtly sexual. YOU’VE WORKED A LOT THE PAST FEW YEARS AND DONE A NUMBER OF PROVOCATIVE FILMS INCLUDING UNDER THE SKIN WITH JONATHAN GLAZER, WHICH HAD YOU PLAYING AN ALIEN. I

also just had an interesting experience working with Jonathan. He hasn’t made a ton of movies, but he spent 10 years working on [Under the Skin]. But it’s hard to compare your experience working with different directors. I could never compare working with someone like Terence Malick to someone like Scorsese. I think while the work and quantity are different, it’s impossible to compare the quality. It’s always interesting to kind of jump off of a cliff with new directors and you never know what you are going to get, but that’s not just a first-time thing. It’s like that with any collaboration.

haven’t really read any romantic comedies lately that I’ve really liked. Don’t get me wrong, I like the genre, but they’re difficult. There are so many clichés, and I think it’s hard to find one that hasn’t been done before. I think that’s why I tend to avoid that genre, because I never want to make something that I’ve seen before.

YOU’VE BECOME QUITE A FASHION ICON OF LATE. ARE YOU GETTING MORE COMFORTABLE WALKING THE RED CARPET AND CHOOSING FROM DIFFERENT DESIGNER OUTFITS? I’m

not really someone who follows the latest trends and I don’t pay that much attention to choosing outfits other than finding something that I like and I feel comfortable wearing. When I go to film premieres I like to be able to choose something that refers back to classic dresses of past eras. WHEN YOU ASSESS HOW THINGS ARE GOING AT THIS POINT IN YOUR LIFE, WHAT WOULD YOUR IMMEDIATE IMPRESSIONS BE? I’ve just been really

WERE YOU UNCOMFORTABLE AT ALL WITH THE NUDITY YOU DID IN UNDER THE SKIN? I’m

not fond of nudity. Like everyone, I am aware of my body and, in this film, I put aside prejudices to get into the skin of an alien. I had the collaboration of an artist, as Jonathan Glazer protected me at all times. The nudity in 6 FEMALE HEALTH TODAY | Winter 2015

fortunate to have quite a productive and diverse past couple of years...I also feel that I’ve dealt with a lot of things during my 20s and that now I feel very happy. Photograph courtesy Debby Wong / Shutterstock.com

To Your Health

THE HPV VACCINE » Is this the end of cervical cancer? By Elizabeth Ruchhoft, MD

CERVICAL CANCER WAS ONCE ONE OF

the most common causes of cancer death for American women. But since 1955, the number of deaths from cervical cancer has declined 74 percent in the U.S., mainly due to the effectiveness of the Pap test. Now there’s also a vaccine that can prevent cervical cancer.

WHAT IS HPV? The most important risk for cervical cancer is HPV, the human papilloma virus. A sexually transmitted virus, almost all cervical cancers (more than 99 percent) are related to HPV. About 79 million Americans, most in their late teens and early 20s, are infected with HPV. Each year, about 14 million people become newly infected. Almost half of these infections are in people between 15 and 25 years of age. HPVs are actually a group of more than 100 types of related viruses. Some HPVs can cause genital warts; these are considered low risk because they rarely develop into cancer. Other highrisk HPVs have been linked to cervical cancer. THE VACCINE To combat the spread of HPV, the U.S. Food and Drug Administration (FDA) approved the use of a new vaccine to reduce chances of infection from the two types of HPV that cause 70 percent of all cervical cancers. HPV vaccines are given as a series of three shots over six months to protect against HPV infection and the health problems

that HPV infection can cause. Two vaccines (Cervarix and Gardasil) protect against cervical cancers in women. One vaccine (Gardasil) also protects against genital warts and cancers of the anus, vagina, and vulva.

THE RESULTS The vaccine is showing promise in reducing the cancer-causing HPV infection. According to the Centers for Disease Control and Preventions (CDC), a study looking at the prevalence of human papillomavirus (HPV) infections in girls and women before and after the introduction of the HPV vaccine shows a significant reduction in vaccine-type HPV in U.S. teens. The study, published in the June 2013 issue of The Journal of Infectious Diseases reveals that since the vaccine was introduced in 2006, vaccine-type HPV prevalence decreased 56 percent among female teenagers 14–19 years of age. While not cures for cancer, the HPV vaccine, Pap test and HPV screening are greatly reducing the incidence rates of cervical cancer in the United States. Talk to your doctor about what is the best course of action for you. Dr. Elizabeth Ruchhoft is board certified in obstetrics and gynecology and has more than 15 years experience in adult and adolescent gynecology care. Dr. Ruchhoft sees patients in her Ft. Wright and downtown practices.

» Guidelines for Cervical Cancer Vaccine and Screening WHO SHOULD GET THE HPV VACCINE?

WHO SHOULD GET THE PAP TEST?

• Girls ages 11 to 12 (as early as age 9). The HPV vaccine is recommended for girls in this age range because most have not yet become sexually active.

• All women should get yearly Pap tests starting about three years after becoming sexually active, or no later than age 21.

• Girls ages 13 to 18 who have not yet started the vaccine series or who have started

Photograph courtesy Shutterstock.com

but have not completed the series. • Young women ages 19 to 26 should talk to their doctor or nurse about whether to get the vaccine.

• Beginning at age 30, most women who have had three normal Pap test results in a row may be tested less often

—every two to three years. • Healthy women 70 years of age or older who have had three or more normal Pap tests in a row and no abnormal Pap test results in the last 10 years may choose to stop having cervical cancer testing.

Winter 2015 | FEMALE HEALTH TODAY 7

“I have not had a migraine in 14 years, and she reset my menstrual cycle from 21 to 28 days,” Flamm says. “That was such a blessing. At that point, I was sold [on acupuncture.]” INTEREST AND AWARENESS

Seeking Wellness Patients and physicians are looking to acupuncture to bring the body back into balance. By Marnie Hayutin

» FOURTEEN YEARS AGO THERE SEEMED TO BE NO RELIEF IN SIGHT for Marijo Flamm’s chronic migraine headaches. For six days out of every menstrual cycle, she battled debilitating pain that made going to work and caring for her four children nearly impossible tasks. Medication took the edge off and allowed her to get out of bed, but Flamm was miserable all day. Compounding the problem, her menstrual cycle had shortened to 21 days rather than the typical 28, so the migraines were occurring frequently. “I thought, I can’t live my life like this anymore,” recalls Flamm, a Monfort Heights resident. “There’s got to be something.” Flamm’s East Coast sister-in-law recommended acupuncture, something Flamm admits she didn’t know the first thing about. But days later when she saw acupuncture services listed on the marquee at the Mercy HealthPlex in Western Hills, she took it as a sign from God. Flamm signed up for a five-session package with Carole Paine, MS, L.Ac., now owner of Cincinnati Acupuncture. 8 FEMALE HEALTH TODAY | Winter 2015

Today, acupuncture wouldn’t sound nearly as mysterious as it did in 2000 when it was first recommended to Flamm. The last decade or so has seen slow and steady growth, both in the availability of acupuncture services in Cincinnati and the interest for it in the community. In addition to traditionally trained acupuncturists like Paine, Cincinnati has several physician acupuncturists who incorporate the treatment into their Western medical practices. And most of the major hospital systems are exploring integrative medicine to varying degrees, offering acupuncture and other holistic services as complements to Western medical treatments. “The fact that a major health care system has just hired a physician to provide acupuncture, that’s huge,” notes Eleanor Glass, MD, medical acupuncturist for UC Health Integrative Medicine. “That never would have happened 20 years ago.” The reasons for growth, practitioners say, are twofold: First, it’s driven by patients, who are learning about alternative therapies in this global information age and who are also embracing natural options in their diets and in their homes. “I think the medical systems are responding to what patients want, which is alternative methods that make them feel better and help them respond to their own bodies in conjunction with their typical Western medical treatments,” Dr. Glass notes. It’s also driven by doctors, who discovered over time that there are still some tools missing from the Western medicine toolbox. “You look at all the cutting-edge [Western medical] discoveries, new theories, gene mutations. Those are amazing discoveries,” says Peter Sheng, MD, medical director for TriHealth Integrative Health and Medicine, as well as an oncologist and an internist. “On the other hand, for a lot of the patients with multiple chronic illnesses, we don’t have very good solutions other than giving them prescription drugs.” It’s not uncommon for Dr. Sheng to see patients who are taking 15 to 20 different medications. “How do they interact?” Dr. Sheng asks. “Honestly, nobody can answer.” Photograph courtesy Shutterstock.com

WHAT IS ACUPUNCTURE?

Dating back to the 2nd century B.C., acupuncture uses very thin needles to unblock the body’s vital life force energy, which is known as “chi” (also spelled “qi”), and move it through the 12 meridians of the body. Western medicine doesn’t have a concept that correlates to meridians, but Western doctors say it seems to work with the neurochemical systems of the body. There are many forms and variations of acupuncture, but essentially they all utilize the 365 major energetic points on the body, along with the thousands of minor points. Practitioners stick ultra-fine needles in at the energetic points that correspond to various systems and organs. The needles are thinner than a human hair, so often the patient can’t feel the insertion point at all. But, interestingly, the moving chi may unblock another point that’s farther up the energetic channel, so a needle placed in, say, the leg may be felt in the hand. At this time, we still don’t know exactly why and how it works, but research is beginning to confirm that it does. “There’s a lot of science behind it,” notes Dotty Shaffer, MD, a physician acupuncturist and an internist. “On functional MRIs, the visual cortex of the brain will light up when points are put in the foot that are used to treat eye problems.” “On a weekly basis, I am e-mailed a new article where someone is investigating the efficacy of acupuncture,” Dr. Glass adds. Current research is documenting the major biochemical shifts and the changes in neuroendocrine modulators that take place in the body when acupuncture is performed. Examining acupuncture’s effects on specific illnesses and quantifying dosage protocols are the next big steps in research, she says, and UC hopes to be a part of it. Although patients may seek acupuncture to address a particular symptom or ailment, the goal of the treatment is actually to bring the body as a whole back into balance and to allow it to heal itself, says Liz Woolford, MD, director of physician education, a family physician and a medical acupuncturist at the Alliance Institute for Integrative Medicine. As such, patients have experienced remarkable results for chronic conditions including allergies, inflammation and pain, hormonal imbalances, insomnia, weight management, smoking cessation and infertility. As the only board-certified reproduc-

tive endocrinologist in the country who is also a physician acupuncturist, NeeOo Chin, MD, provides acupuncture for nearly all his fertility patients. “I’ve found that the pregnancy rates are just so much better,” says Dr. Chin, director of the Fertility Wellness Institute of Ohio in West Chester. “It seems to improve uterine blood flow, it improves ovarian blood flow, it improves pituitary blood flow, and it rebalances the reproductive hormones.” Although he hasn’t attempted to quantify his results scientifically, Dr. Chin can say this: “There are people who have had two or three years of infertility, who have not conceived with other people, who have come to see me and they’re tired of doing fertility treatments, and I do nothing but acupuncture, and they conceive within the next two, three, four months without doing any other treatment.”

“

You become more respectful that there are things that modern medicine can’t explain.

WHAT TO EXPECT

”

Patients may find relief after only one session, perhaps for something like neck pain or plantar fasciitis. For migraine headaches or smoking cessation, patients might need a series of treatments to resolve the issue. And after resolution, some find that they want to check in every few months for a maintenance treatment. Although insurance coverage has expanded somewhat in recent years, it’s still not what you’ll find in states like California. Patients can, however, put pre-tax money aside in medical savings accounts to help defray the cost. Price-wise, acupuncture treatment is comparable to a spa treatment, ranging from about $80 to around $120. In fact, some actually liken the acupuncture experience to a rejuvenating treatment at a spa because, in addition to symptom relief, it provides what patients describe as a remarkable sense of well-being.

“Acupuncture is generally very de-stressing,” Paine says. “People might come for a pain issue and get many side benefits.” WHAT ISN’T ACUPUNCTURE?

“It’s not magic,” says Dr. Chin. “It’s not a religion,” Dr. Shaffer adds. It, unfortunately, won’t cure end-stage cancer, and if you need your appendix out you’d better go to the Emergency Room. In other words, no one expects it to replace Western medicine. What it does, says Dr. Sheng, is offer a very individualized treatment as a complement to our one-size-fits-all Western approach. As a Western physician, he was trained to address symptoms and the patients’ “chief complaints.” As both a physician acupuncturist and a practitioner of Chinese Herbal Medicine, he looks at the body as whole to search for how the complaints are interrelated. “With acupuncture you don’t just follow a formula,” Dr. Woolford concurs. “You personalize and see what the person’s body needs each time you treat them.” You don’t have to believe in it for it to work, either. If you did, Dr. Chin would not be practicing acupuncture today. In 2008 he was “dragged in” for the procedure by his wife, Kim, after two unexplained bleeding episodes threatened his life. Despite the fact that three generations of his family had all been practitioners of Traditional Chinese Medicine, the idea was completely at odds with his Western medical training. After experiencing his own remarkable recovery following acupuncture treatment with Dr. Shaffer, he became trained in it as well. “I’m a very good example of East meets West,” he says, taking a moment to marvel at the irony of performing the most cutting-edge fertility treatments and one of the most ancient medical arts, all in the same practice. “I was there,” he says, describing his former Western-only medical mindset. “But I think you become more open-minded, you become more respectful that there are things that modern medicine can’t explain.” To that end, a patient offers this advice: “Don’t try and understand it before you go,” says Leslie Meier, a Northern Kentucky resident and a patient at the Alliance Institute for Integrative Medicine. “I still can’t explain all the methodology. I just know it works.” Winter 2015 | FEMALE HEALTH TODAY 9

To Your Health

PAIN-FREE INTERCOURSE

» A NEW THERAPY HELPS WITH POSTMENOPAUSE DISCOMFORT.

MOST WOMEN KNOW THAT DECLINING levels of estrogen during menopause can cause hot flashes. What most women do not know, however, is that vaginal tissue is also very dependent on estrogen. As the estrogen levels fall, the vagina becomes thinner, dry, and even inflamed, which results in a condition known as vaginal and vulvar atrophy. A very common and bothersome symptom of vaginal and vulvar atrophy is painful intercourse, which in medical terms is called dyspareunia (dis-puh-roo-neeuh). But because women don’t necessarily associate dyspareunia with menopause, most who experience it due to menopause unfortunately do not seek treatment. Historically dyspareunia has been treated with various lubricants and localized estrogen therapy, and recently a medication called Osphena has come to market specifically for this condition. However, medical therapy has proven to be difficult

By Mickey Karram, MD

to administer at times, especially higher up in the vagina, and it requires long-term use in order to obtain a desirable effect. In 2008 a new therapy was developed in Italy that uses a CO2 fractional laser to rejuvenate the vaginal skin, making it more elastic and more moist. The therapy is called the MonaLisa Touch treatment (MonaLisaTouch.com), and to date more than 300 patients have been treated in Italy under a variety of study protocols with excellent results. To understand how this therapy works it’s important first to understand that the vaginal skin is multilayered and requires estrogen to proliferate and be viable. Within a few years after a woman goes through menopause the vagina dries and becomes very thin. The laser is able to release energy through a special pulse, and the laser energy heat penetrates to a depth that stimulates the synthesis of new collagen. This

results in a thickening of the vaginal skin, increased moisture and better lubrication, which restores the vagina to a state similar to before menopause. This minimally invasive, painless procedure is performed in an office setting and requires no anesthesia. It’s currently done in three treatments (which take less than five minutes each), six weeks apart. The data from Italy seems to indicate that the effects of the treatment last for at least one year before patients need a repeat treatment. This therapy is very well suited for breast cancer survivors who cannot receive estrogen therapy because of the risks estrogen poses for cancer recurrence. The Christ Hospital is one of only two medical centers to be chosen to do the initial United States study on the MonaLisa Touch treatment (the other is Stanford). We treated 15 patients with vaginal atrophy and experienced overwhelmingly positive results. All 15 patients noted a significant improvement in their symptoms with no side effects or adverse reactions. The MonaLisa Touch treatment is now available to patients through The Center For Pelvic Floor Disorders at The Christ Hospital. If you are interested in finding out more about it, please call 513.463.2500.

Currently, The Lindner Center is actively recruiting women who have problems with: THE WOMEN’S HEALTH DIVISION OF

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10 FEMALE HEALTH TODAY | Winter 2015

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MENOPAUSE RELIEF

» IS BIOIDENTICAL HORMONE REPLACEMENT THERAPY RIGHT FOR YOU?

MUCH HAS BEEN WRITTEN ABOUT menopause, and by now many women have some degree of anxiety about the symptoms that will likely accompany it. During this time, the ovaries stop producing eggs, menstrual cycles become less frequent and eventually stop, and estrogen and progesterone levels decline. This hormonal decline is responsible for the following uncomfortable symptoms: • hot flashes • weight gain • sleeplessness • foggy thinking • low sex drive

• night sweats • hair loss • fatigue • irritability

While some women obtain significant relief from changes in lifestyle and diet, some look to hormone replacement therapy, which is known to be the most effective at relieving symptoms. With the controversy surrounding the use of traditional hormone replacement therapy, which uses synthetic hormones, many women are looking at

By Christine Kneer-Aronoff, MD

bioidentical hormone replacement therapy (BHRT) as an alternative. How do you know if bioidentical hormone replacement therapy is right for you? While your doctor is ultimately the best resource to help you decide what treatment option is best for you, below are some general facts:

WHAT IS BIODENTICAL HORMONE REPLACEMENT THERAPY? Bioidentical hormone replacement therapy is the use of supplemental doses of hormones that have a chemical structure identical to the hormones that the human body naturally produces. Many of the bioidentical hormones used are made from plant sources, which contain unique compounds that are processed chemically and made into identical replicas of hormones the body produces. WHAT DOES BHRT DO? It treats the symptoms of menopause, perimenopause, and postmenopause.

HOW ARE BHRT TREATMENTS CREATED? If bioidentical hormones are purchased at a compounding pharmacy, a cocktail of hormones is created, uniquely tailored for each individual patient. If they’re purchased at a conventional pharmacy, these hormones are available in a range of set doses. In both instances, the prescriptions are based on symptoms and possibly tests administered by a doctor. WHAT HORMONES ARE USED? Based on your symptoms, a combination of one or more of the following hormones may be prescribed: estradiol, estriol, estron, testosterone, progesterone, and DHEA. HOW IS BHRT ADMINISTERED? Bioidentical hormones are applied via a cream or suppository, taken orally, or are injected. They can be taken continuously or in a cycling manner, similar to your menstrual cycle.

Dr. Aronoff is board certified in obstetrics and gynecology with more than 15 years of experience in hormone replacement therapy, general gynecology and minimally invasive gynecologic surgery. Dr. Aronoff sees patients in her Norwood office.

Winter 2015 | FEMALE HEALTH TODAY 11

Technology Report

DON’T SUFFER IN SILENCE

» An implantable device helps

patients take control of their bowels. By Mickey Karram, MD

JANICE WAS REFERRED TO our practice for bladder problems, but after some questioning it became apparent that her major quality-of-life issue was another matter: a severe case of accidental bowel leakage, or fecal incontinence. Janice had been suffering in silence for approximately five years, and this was the first time she admitted aloud that she had a significant problem with her bowels. By the time we saw Janice, her quality of life had deteriorated to the point where she would avoid going out, and at times, avoid eating. Her typical day included visiting the bathroom at least five to seven times for small bowel movements. When the urgency to move her bowels arose, she knew that if she didn’t get to the toilet quickly she would soil her underwear. Approximately one out of every four adult women in the United States will have problems with her bowels, and a significant number of these women will have fecal incontinence. Suffice it to say there are few benign conditions that are as distressing as involuntary loss of stool. The exact cause of fecal incontinence is unknown and most likely multifactorial. It certainly is more common in women who, like Janice, have had traumatic childbirth that involved significant tearing. However, many women with intact sphincters also have this problem, which suggests that there are definitely other causes. Historically, few treatment options have been available. Nonsurgical treatments have involved modifying a woman’s diet to bulk up her stools and strengthening her pelvic floor muscle to help her resist the loss of fecal contents. When these nonsurgical approaches

didn’t work, we commonly considered a surgical repair of the anal sphincter. Unfortunately these operations are somewhat traumatic and have very poor long-term success rates. When Janice presented to our practice she had learned on her own to adjust her food intake. We strongly suggested a course of pelvic floor physical therapy, and this did improve both her bowel and bladder function. However she remained very symptomatic. After pelvic floor testing revealed that Janice had a defective, or separated, anal sphincter, we discussed Medtronic Bowel Control Therapy delivered through the InterStim system. This is an FDA-approved therapy that targets the communication problem between the brain and the nerves that control bowel function. To date more than 150,000 people worldwide have been implanted with an InterStim device. The therapy works by stimulating the sacral nerves near the tailbone (a process known as sacral neuromodulation), which helps the brain communicate with the nerves that control bowel function, pelvic floor muscles and bladder function. This improves sensation and also helps the muscles function properly. Medtronic Bowel Control Therapy is a reversible treatment that can be discontinued at any time by turning off or removing the device. Patients first undergo a trial stimulation with an external neurostimulator to confirm that the therapy will be successful before committing to a long-term implant. The test stimulation generally lasts several days to two weeks, and the patient is asked to track her bowel symptoms. If she experiences greater than 50 percent improvement in

12 FEMALE HEALTH TODAY | Winter 2015

symptoms then it is reasonable to proceed to the long-term therapy. Both stages of therapy are outpatient procedures. They are minimally invasive, requiring only sedation and local anesthesia, and the downtime is usually no more than a few days. Medtronic Bowel Control Therapy via the InterStim device is currently the most successful therapy available for bowel control problems. Scientific literature has shown it to have a better long-term outcome then previous therapies, such as anal sphincter repair. Janice reported more than 80 percent improvement in her bowel control when she underwent her test stimulation, and it also improved her mild bladder symptoms. She was scheduled for the permanent implant approximately 10 days

after her test procedure. We recently saw Janice for her three-month follow-up and she continues to have more than 80 percent improvement in her bowel and bladder control. Her quality of life is much improved. If you suffer from a problem of bowel control, you should no longer be silent; talk to your health care provider about the severity of your symptoms. Therapies are available for this distressing problem. For more information about the InterStim technology, visit everyday-freedom.com. For more information about fecal incontinence and other pelvic floor issues, feel free to call The Center For Pelvic Floor Disorders at The Christ Hospital at 513.463.2500 or visit thechristhospital.com/ PelvicFloor.

Mickey Karram, MD, is Director of the Division of Urogynecology and The Center For Pelvic Floor Disorders at The Christ Hospital and a Clinical Professor of Obstetrics and Gynecology at the University of Cincinnati School of Medicine.

Illustration courtesy Medtronic, Inc.

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Good Medicine

HOW WOULD I KNOW I AM BETTER? » This simple

question can help you choose the right treatment. By James L. Whiteside, MD

RECENTLY, IN THE SAME WEEK, I SAW

two women in clinic who wanted second opinions on how to treat a vaginal prolapse. Neither woman was complaining of any symptoms, but both were told by their doctors they needed to have surgery to fix the prolapse. Just so everyone is on the same page, a vaginal prolapse is when the walls of the vagina sag below their normal position, in some cases even beyond the vaginal opening. This loss of vaginal support can be associated with problems controlling the bladder or bowels, as well as interfere with vaginal intercourse. It can also involve the sagging of organs such as the bladder, uterus, rectum, or some combination of all of them. Collectively, these problems are known as pelvic floor dysfunction; it is rarely life threatening but it can negatively impact a woman’s quality of life. Pelvic floor dysfunction is a common problem (affecting up to 40 percent of women according to some studies), but some estimates say only about 2 percent of women actually experience any symptoms. This leads me back to my two patients with asymptomatic pelvic floor dysfunction. Over the years I’ve seen dozens of women with similar stories. In teaching other doctors about pelvic floor

dysfunction, I often ask them to consider the expected outcome of their treatment for a given patient. I want them to ask themselves, “How would this patient know she’s better for having been treated?” For my two asymptomatic clinic patients the answer was, “They wouldn’t.” Will this sort of questioning provide a good benchmark in every case? No. Consider high blood pressure: The patient is often unaware of the problem and, in fact, might feel worse when the blood pressure is normalized. To not treat, however, risks serious health dangers and even death (an outcome that is not at all likely for vaginal prolapse). Admitting this sort of limitation, is it still fair when presented with a given treatment option for a patient to ask, “How would I know I am better?” Recently, a California neurosurgeon got in trouble for doing unnecessary surgery as part of scheme to implant devices he profited from in an arrangement between the hospital and the device manufacturers. This is an extreme example, but how would these patients, enduring unnecessary surgery, know they were better? Is it possible that there are other, much less egregious incentive programs that inadvertently drive unnecessary medical care? A major part of health reform in the United States is to link quality measures to physician payment. For the most part these efforts are directed at primary care physicians, who are increasingly aware that their income is linked to the quality of the care they provide. Specialist physicians and surgeons, however, have so far escaped many of the quality measures. Certainly, it’s trickier to measure the quality of surgery if for no other reason than it is as much a factor of the surgeon as it is the specific procedure. Given this difference, specialty physicians and surgeons, in many (if not most) cases, are paid on what they produce. Do more surgery…get paid more. The link here is not nearly as lucrative as for the aforementioned California neurosurgeon, but the relationship is essentially the same. An informal survey of 12 elite hospital systems in the U.S. found all but two still base physician compensation on productivity. Without a link to quality, surgeons would have a hard time resisting the traps contained in the productivity to pay allure…anyone would. And to be fair, to

not have some link between physician payment and clinical productivity risks the moral hazard of indolence. Thus, the best way to compensate clinical work remains ill defined, and every health system struggles to find the best mix of incentives. Until the ideal system is devised, patients can participate in the process by asking, “How would I know I’m better?” Pelvic floor dysfunction, like lots of health problems, is very common, and how much its effects impact a patient’s quality of life is highly subjective. As a patient, you know best what is important to you. Asking this question will help your doctors provide facts that will help you make the best decision about a treatment plan. This is not a perfect strategy, and there are lots of opportunities for things to go awry. Nevertheless, asking “How would I know I’m better?” is a good starting point.

James L. Whiteside, MD, is board certified in Obstetrics & Gynecology and Female Pelvic Medicine and Reconstructive Surgery. Dr. Whiteside served as an associate professor of Obstetrics and Gynecology at the Geisel School of Medicine at Dartmouth where he remains adjunct faculty. He is also voluntary professor of Obstetrics and Gynecology and Surgery at The University of Cincinnati College of Medicine. He has received numerous accolades, and has been published nationally for his work and research in urogynecology, pelvic floor surgery, and bioethics.

16 FEMALE HEALTH TODAY | Winter 2015

Photograph courtesy Shutterstock.com

Healthy Teen Talk Bites

TK Rubrik

bles or whole grains, such as potatoes, corn, pasta, quinoa, or rice. • Fill the remaining quarter of the plate with lean protein. Healthy choices include fish, chicken, tofu, or beans. Fruits and dairy/calcium-rich foods make good choices for snacks throughout the day. Fruit can also substitute some of the vegetables and starchy foods at some meals.

Healthy Eating Made Easy By Tamara Karram

EATING WELL IS OFTEN hard for teens. Hanging out with friends at fast food restaurants, grabbing quick meals between school and extracurricular activities, and snacking throughout the day are all habits that can lead to excessive intake of fat, sugar, and calories. Mom and Dad usually do a good job of keeping some of this under control for their active high schoolers. Eating well at college, however, becomes somewhat more difficult! And it’s no wonder. For the first time in your life, you’re will know about on your own, making your ose to tell. Call own decisions about what you should and shouldn’t ow about eat. You’re surrounded by tell. Call snacks and sweets, you’re almost always in a rush, and assuming that you actually make it to the dining hall for all three meals, you’re faced with endless choices as you go through the line. Eating right as a teen is easier if you learn a bit about nutrition. Your still-growing body needs certain nutrients, vitamins, and minerals to keep itself in good condition. Protein, calcium, iron, folate, and zinc are necessary for

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proper growth. Iron and calcium are particularly important nutrients for you at this time of life. Iron helps your blood carry oxygen to all your muscles, as well as supports brain function and boosts your immune system. The increased need for strong bones signals your body to grab all the calcium it can. Healthy eating also helps you achieve and maintain your healthy body weight. Those “Freshman 15” pounds people talk about are, unfortunately, not a myth. This is the time of your life to establish good eating patterns that will last a lifetime. And let’s be honest, this is also the time to break the bad ones! Here are some helpful tips to get you started:

CHOOSE VARIETY A well-balanced diet includes a wide array of foods. Make sure you’re choosing a variety of fruits and vegetables, whole grains, nuts, and berries. Pick citrus fruits to boost vitamin C intake. STAY HYDRATED Quench your thirst with water, and limit your sugar-laden soft drinks, fruit punch, sweetened drinks, and even fruit juices. They add extra calories. GET MOVING Lack of exercise is a major contributor to obesity. So run, walk, play soccer, swim, dance, or find other activities that keep your body moving.

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Achieve lasting bowel control…

Leave the Constant Worr y Behind Medtronic Bowel Control Therapy delivers: • Control that’s proven to last 5 years • • Symptom relief when other treatments fail

Ask your doctor if Medtronic Bowel Control Therapy is right for you.

Please note, not everyone will experience the same results.

Contact Dr. Karram for an appointment and visit everyday-freedom.com to learn more: Mickey Karram, MD Director of Fellowship Program Female Pelvic Medicine & Reconstructive Surgery The Christ Hospital Phone: (513) 585-4942

Important Safety Information Sacral Neuromodulation for Bowel Control (Medtronic Bowel Control Therapy Delivered by the InterStim® System)

You should have a successful trial assessment before receiving InterStim Therapy. You cannot have diathermy (deep heat treatment from electromagnetic energy) if you have an InterStim device. Safety and effectiveness have not been established for pregnancy and delivery; patients under the age of 18; or for patients with progressive, systemic neurological diseases. 4 FEMALE HEALTH TODAY | Winter 2015

In addition to risks related to surgery, complications can include pain at the implant sites, new pain, infection, lead (thin wire) movement/migration, device problems, interactions with certain other devices or diagnostic equipment such as MRI, undesirable changes in urinary or bowel function, and uncomfortable stimulation (sometimes described as a jolting or shocking feeling). This therapy is not for everyone. Please consult your physician to decide whether InterStim Therapy is right for you. A prescription is required. For further information, please call Medtronic at 1-800-328-0810 and/or consult Medtronic’s website at www.medtronic.com. USA Rx Only. Rev 0311

UC201503567 EN

InterStim Therapy for Bowel Control treats chronic fecal incontinence (an accident or leaking involving stool). It should be used after you have tried other treatments such as medications and dietary modifications and they have not worked, or if you are not a candidate for them.