Health & Wellness April 2011

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A GAM BIT’S HEALTH & WELLNESS > APRIL 2011 >VOLUME 3 > NUM BER 4

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The choice to have a baby is one of life’s most important and exciting decisions.

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By K at StromquiSt doctors about the effect of medications on their fertility and on a fetus. They should undergo tests for the health problems many people face as they age, as these create complications from conception to birth.

“Simple things like ... thyroid problems, hypertension (and) diabetes are not good for the baby,” Vuong says.

After taking these preliminary precautions, most women should be cleared to begin trying to get pregnant.

Women are most fertile near the time they ovulate, telltale signs of which include cramping near the middle of the menstrual cycle (around days 12 to 14), spotting and a clear discharge the consistency of egg whites. Ovulation thermometers, available at drugstores, can reliably clue you in to your most fertile times. Women should stop taking hormonal birth control the month of intended pregnancy, but no earlier: Vuong says the pill’s after-effects are harmless to an embryo and should not affect one’s fertility on a long-term basis.

With a little luck and an enthusiastic sex life, the journey to pregnancy is speedy and thrilling — in most cases.

Infertility, defined by the Centers for Disease Control as an inability to get pregnant after trying for 12 months, complicates the lives of many individuals and couples. Dr. Ron Clisham, a reproductive endocrinologist at Audubon Fertility & Reproductive Medicine, says fertility specialists play multiple roles from physician, to myth-debunker, to life coach while they work with patients to understand why they aren’t getting pregnant.

“In general, about 35 percent of the

time it’s going to be a male problem, 35 percent of the time it will be the fallopian tubes or some other kind of pathology in the abdomen, about 15 percent of the time it will be related to the lack of ovulation … the rest of the time it’s unexplained,” Clisham says. “For the most part, you need to work on fertility problems as a couple.”

The clinic’s physicians run down a fivefactor list of potential issues including ovulation; the condition of the fallopian tubes, pelvis, cervix and uterus; male factors and sexuality in general.

Some of these elements are easily examined: Menstrual cramps, unpleasant as they may be, are a good sign that you ovulate regularly. Other impediments may be less obvious. A history of sexually transmitted diseases, which can obstruct the fallopian tubes, fibroids (bloodless nodes that can grow inside the uterus), and polyps in the uterus all adversely affect fertility prospects.

Insulin resistance, a common issue for overweight women, also hinders a woman’s ability to conceive. At the Fertility Institute, Dickey supports weight loss for any overweight woman who is trying to conceive.

“The one thing we tell most women they can do on their own is lose that extra 30 pounds,” Dickey says. “Take your weight back to where it was when you were 20.”

As Dickey hunts for an underlying diagnosis of what stands in the way of pregnancy, he doesn’t delay treatment.

Many treatment regimens begin with fertility pills: Clomiphene and tamoxifen (a drug often used to treat breast cancer)

HealtH & Wellness > bestofneworleans.com > aPrIl 05 > 2011

I

t’s difficult to write about fertility issues without dredging up cliches about frantic, 30-something women struggling to conceive before their socalled “biological clocks” run out. It’s even more problematic when these caricatures appear to contain a kernel of truth.

“We talk about the biological clock — you do have one,” says Dr. Richard P. Dickey, founder of the Fertility Institute, a clinic with locations in Metairie, Baton Rouge and Mandeville. “If you have any problems (conceiving) at all ... don’t wait.

You need treatment. By age 40, only 10 percent of women are still fertile on their own.” If this blunt assessment strikes fear in your career-centric or procrastinating heart, take note: Several simple things can maximize fertility and ensure the health of your future children.

Dr. Vu Vuong, an obstetrician/gynecologist at Ochsner Medical Center’s West Bank location, advises aspiring mothers to take prenatal vitamins while trying to conceive. The best pills have at least 400 micrograms of folic acid (to prevent birth defects) and supplemental iron (to cope with increased blood volume during pregnancy). Vuong stresses the importance of rapport with your doctor and of preparing yourself “socially (and) psychologically” for pregnancy.

“Not just physically but emotionally you should be ready,” Vuong says. “Social support networks need to be there.”

To improve the odds of conception, the refrain we hear from physicians on most health-related topics still applies: Maintain a healthy body weight, quit smoking and exercise.

Older women should also talk to their

are two common prescriptions. According to Dickey, these medications work by increasing the level of the folliclestimulating hormone (the hormone that makes eggs develop) in the body, and by increasing other hormones to the level they were when the patient was in her late teens.

Dickey suggests patients not wait more than three ovulation cycles before trying new techniques. If fertility pills fail, women can turn to in vitro fertilization. At $16,000 per cycle, this can be an option of last resort before considering donor eggs, donor sperm or adoption.

(Some states mandate that insurance cover at least one cycle of in vitro fertilization, but Louisiana isn’t one of them.) During this procedure, the doctor stimulates the ovaries with gonadotropin (a hormone associated with reproduction) injections that cause the woman to produce more eggs. The eggs are removed from the uterus and placed in a supporting environment; a clinician adds sperm later. Five days later, if fertilization occurs, physicians place two live embryos in the uterus.

“The latest thing we’re able to do is offer pre-implantation genetic diagnosis,” Dickey says. “Since January, we’ve been able to view all 23 chromosomes ... so only normal embryos are put back (in the uterus).” This dramatically reduces the possibility of birth defects in implanted embryos.

Dickey reports that in vitro fertilization does not solve the problem of “egg quality,” the measure of the completeness of an egg’s genetic material and its ability to respond to a follicle-stimulating hormone. Nothing stops this quality from deteriorating with time.

“You actually have the most eggs numberwise when you’re a 16-week-old fetus,” Vuong says. “The good eggs tend to ovulate first. ... It gets increasingly hard for the pituitary to tell the egg that it’s time to ovulate.”

For couples experiencing the emotional and physical challenges of a difficult fertility journey, the national infertility organization Resolve (www.resolve.org) sponsors related support groups and offers numerous resources concerning assisted reproductive technology, adoption, donor cells and child-free lifestyles.

During infertility awareness week (April 24-30), the organization and its members hold nationwide events in an effort to “put the face on infertility.”

“A lot more people are talking about it more openly,” says Rebecca Flick, director of strategic partnerships and projects at Resolve. “It’s not just about them wanting a baby, it’s about the fact that their body has failed.” She reports that infertility affects one in eight couples of reproductive age, or 7.3 million Americans.

According to Dickey, it is possible to test your fertility by checking the level of follicle-stimulating hormone in the blood and examining via ultrasound how many good eggs remain in your ovaries. In this case, a little knowledge isn’t a dangerous thing — it’s a good precaution.

“There’s nothing wrong with being vetted,” Dickey says.

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sions in the vaginal walls when tampons are inserted, making the tissue susceptible to the bacteria that causes toxic shock syndrome (TSS). The risk of TSS is lower with cups and sea sponge tampons, and sea sponges also are free of chemicals and synthetic fibers. But Reho-Pelias warns that they are delicate and can tear if not removed gingerly. She disinfects the sponges at the end of her cycle using water and colloidal silver, which kills bacteria.

The Fresh Moon website says you also can use baking soda, hydrogen peroxide, tea tree oil or sea salt.

Amanda Devereux, who handles Zuka Baby’s blog and social media marketing, is a fan of cloth menstrual pads, and Zuka Baby sells pads by Fuzzi Bunz, a Louisianabased company. New Orleans native Tereson Dupuy, inventor of Fuzzi Bunz, says the pads grew from the success of her company’s cloth diapers. The pads consist of three parts: a polyester polar fleece that wicks away moisture from the skin, a layer (or more than one layer, depending on the style) of absorbent microfiber terry cloth, and a layer of Polyurethane that prevents leaks.

The pad wraps around the underwear and snaps in place, similar to pads with adhesive “wings.” It’s recommended you carry a “wet bag” — or a reusable, waterproof bag that zips to prevent leaks and odors — to store soiled pads until you can wash them.

“The pads are really absorbent, so a lot of times when I’m going out, I don’t have to change it,” Devereux says. “I’ll put on a fresh pad before I go and I’m set.”

Learning to plan ahead is perhaps the most difficult aspect of transitioning to

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reusable menstrual products.

“With the cloth pads, you have to set yourself up,” Reho-Pelias says. “If you don’t have a wet bag, if you don’t know how you’re going to handle it when you’re out, that will be frustrating. You just need to have everything you need, and know how you’re going to care for them ahead of time.”

With the Diva Cup (a reusable silicone cup), which is what I now use, when I want to remove it, I make sure I am in a place where I’ll have water to clean it.

Luckily, the cup can be kept in place for up to 12 hours because it collects menstrual flow as opposed to absorbing it, so there is no risk of drying out vaginal tissue. It’s convenient because I can change at home before work and before I go to sleep.

The Diva Cup took time getting used to: The flexible cup can be tricky to insert at first, a bit of a mess to remove, and the sight of the captured blood can be jarring. But I find using a menstrual cup feels cleaner and more comfortable — and although I spent a steep $40 to

buy the Diva Cup, I save money in the long run by not purchasing tampons each month. Plus, I’m minimizing my waste contribution.

“If a method doesn’t work, there’s more than one,” Reho-Pelias says. “Try a few different things, and try them at different times in your cycle or times a day, to find which one is going to be the most comfortable for you.”

Switching to a menstrual cup has better acquainted me with my body — seeing what menstrual blood really looks like, struggling with insertion — which has been a weird, but ultimately enlightening, experience.

“It’s kind of like a disconnection to our bodies — we think (menstruation) is gross. It’s part of us, there’s nothing wrong with it,” Reho-Pelias says. “It’s a perfectly natural thing. If you actually do use (reusable menstrual devices) and connect yourself to what is going on, you’re connecting yourself more to your body. And that’s always a good thing.”

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first heard of silicone menstrual cups from a friend who used one while backpacking across Europe, where she knew restroom stops would be few and far between. Initially, ditching tampons in favor of something reusable sounded repulsive, but I was intrigued. After some research and experimentation in the world of alternative, reusable menstrual devices — which includes washable cloth pads, sea sponge tampons and silicone cups — I became a convert.

My initial disdain for these products is by no means unique. Erin Reho-Pelias, owner of natural parenting boutique Zuka Baby (which sells a selection of reusable menstrual products) says the public has a general misconception about reusing personal care items.

“I think our culture has a mental block.

We just want to throw it away,” RehoPelias says. “Cloth pads — you have to clean that; it just freaks people out. They don’t realize how easy it is to care for these products and use them.”

Reho-Pelias uses Fresh Moon sea sponges as an alternative to tampons.

Unlike disposable cotton tampons, the sea sponges have an amorphous shape — similar in appearance to a small loofah. To use, wet the sponge and squeeze out the excess water, then insert into the vagina until it feels like it is in place. You remove the sponge every three to four hours, rinse and re-insert.

“I find that it’s much more comfortable,” Reho-Pelias says. “Cotton tampons are so dry and absorbent … having to insert them when you’re a few days into your flow is so uncomfortable.”

This over-absorbancy can create abra-

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Drug abusers and compulsive overeaters have similar neurochemistry.

t h r o u g h C i r C u i t ry d rized by your brain, so much so that even the environment where the drug or food experience happened makes your brain react, signaling you to eat or use.

“That’s why I say it’s almost like science fiction,” Volkow continued in her lecture. For drug users, Volkow says, just seeing a video of the place where they use drugs lights up the same pleasure area of the brain as taking the drugs.

Think about how malignant that cue is to get that drug now, and consider how that relates to food.

“We are constantly being bombarded with advertisements for food,” Molina says. “We are constantly being exposed to larger portions at whatever restaurant we go to and now we are starting to understand the neurochemistry that is underlying these behaviors.”

Now here comes the third and final blow: In people who compulsively overeat or use drugs, the area of the brain that puts on the brakes to stop this behavior cannot do its job as well. Those brains can’t grab and use as much of the pleasure chemical. In fact, in compulsive overeaters, smokers, drug and alcohol users and with age, the brain has fewer places for the pleasure chemical to lock on and do its job. These places are called receptors for the brain chemical or neurotransmitter called dopamine.

Here’s what is so interesting: In animals, when doctors temporarily added places or receptors in the brain to grab and use the pleasure chemical, the animals instantly and voluntarily wanted far less alcohol or drugs or food.

How do you fight biology when your brain is demanding you overeat and rewards you for overeating and the person sitting next to you doesn’t have that problem? How do you go against such powerful primal urges? “(The research) will probably lead to development of new medications,” Molina says.

One medication being studied for weight loss blocks the brain from grabbing onto the powerful chemical in marijuana. It is approved in Mexico but not in the U.S. So in the meantime, while scientists try to find the coveted pill for people whose brains drive them to overeat, Molina recommends finding substitutes

that can stimulate pleasure chemicals in the brain.

The first is exercise. While not as powerful as drugs or food, it produces pleasure chemicals in the brain for days and helps intensify pleasure from other activities. It even makes drug abusers use less.

Video games are another way to stimulate the brain pleasure circuits, as long as you keep their use in check.

“China has a tremendous problem with children addicted to video games — kids that will not eat (or) go out of a room.” Molina says. “(They) refuse to go to school because they are so addicted to the video games.”

Something to think about while you exercise on your Wii: Just as we are born with completely different looking eyes, noses, mouths and hair, now we know our brains are different, too.

Dr. Henri Roca, a family and integrative medicine expert at LSUHSC, says if you have the genetic tendency to be addicted to food, it will always be a challenge to not overeat. But he says with hard work in a 12step program like Overeaters Anonymous, that tendency can be managed.

“That biological tendency will always be the case and you can’t live without food, so it’s always going to be a challenge,” Roca says. “It’s not about being on your best behavior; it’s about changing so new behaviors that you choose are ones you enjoy and will do long term.

“For those of us who have worked in the field, it’s been very clear that you can be addicted to food. You can also be addicted to taste. But you can overcome it. Now that takes work ... and there may be some people (whose tendency is) so severe that they will have difficulty overcoming it, but we can usually choose to behave differently. Look at all the 12-step programs. All the 12-step programs are essentially mind, body and spiritual techniques to really help the person overcome that perhaps genetic predisposition.”

Look for Meg Farris’ Medical Watch reports, including “Weight Loss Wednesday” and “Wrinkle Free Friday” stories, weeknights on WWL-TV Channel 4 and anytime on www.wwltv.com.

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o you ever find yourself wondering why you overeat when you know it’s hurting your health and figure? Or do you ever wonder why someone who takes drugs or drinks too much alcohol just won’t stop, even though it’s hurting a career and family?

A look inside the brain could change the way you see people who do just that.

Is this breakthrough science?

“It really is. It is a brand-new concept and idea that obesity and drug abuse might have so many commonalities,” says Dr. Patricia Molina, chairwoman of the Department of Physiology at LSU Health Sciences Center (LSUHSC).

In late January, doctors and scientists from LSUHSC gathered to hear a new discovery from Dr. Nora Volkow, director of the National Institute on Drug Abuse. Scientists from several other institutes around the U.S. were listening by live video teleconference.

“When dopamine goes up, something extraordinary happens. It’s actually almost magical when you think about it,” Volkow said as she presented her research.

Rated by Newsweek, Time and U.S. News and World Report as one of the most influential people of our time, Volkow discovered what is going on in the brain that makes certain people need to keep using drugs is similar to what makes others need to keep overeating.

Molina was at the video conference listening to the lecture. “What the research has begun to show is what areas of the brain turn on when somebody sees an image of a Big Mac or an image of a huge Slurpee or a big order of fries,” Molina says.

Here’s what the research found. First: Food and even more powerful drugs activate circuits in the brain that make us feel good, reward us and motivate us to keep doing the behavior. It’s nature’s built-in system to make sure we keep eating. Deprive yourself of food, and the pleasure-reward circuit will be stimulated even more when you finally eat.

Drugs, including nicotine, do the same thing in a more powerful way. But this seduction process is only the beginning.

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Endometriosis is linked to infertility and affects 5 percent to 10 percent of women of child-bearing age. Dr. Jennifer Mills, an obstetrician/gynecologist at Touro Infirmary, discusses the condition, its symptoms and treatment options.

What is endometriosis?

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Endometriosis is a chronic gynecological condition where the uterine lining — or endometrium — gets outside the uterus. It can stick to the ovaries, bowels or the lining of the pelvis, a tissue called the peritoneum. The endometrium is a very inflammatory type tissue. Think of how bloated and crampy you feel when you have your period. The tissue can cause an inflammatory response locally, and it can also cause scar tissue and form cysts, especially on the ovaries. There are several proposed theories (as to its cause), but retrograde menstruation is the most probable one. It affects between 5 and 10 percent of women.

What increases a woman’s risk for endometriosis?

It does tend to run in families. If you have an affected first-degree relative, then your chance is increased 7 to 10 percent. There are other risk factors: If you start your period before age 11, have short cycles of less than 27 days, are prone to heavy, prolonged periods (bleeding for seven days). Some things that decrease your risk are having babies and breastfeeding, as well as exercise.

What are symptoms of endometriosis, and how is it diagnosed?

There are variable symptoms, and they are unpredictable.

Some women have severe endometriosis and have no symptoms at all, and some have extensive symptoms and not a lot of endometriosis. Dysmenorrhea (menstrual pain), menstrual cramps, daily pelvic pain, pain during intercourse and

ovarian cysts are some symptoms. The only way to ever know if you have endometriosis is to have surgery, a laparoscopy where a camera is inserted in your belly button, and the endometriosis is seen and removed by a surgeon, and a pathologist confirms that it is endometriosis.

How long does it take to recover from a laparoscopy?

It varies depending on the extent of the disease. Recovery is anywhere from one to two weeks, but the laparoscopy is a one-day surgery where you come in that morning and go home that afternoon.

Can endometriosis affect your fertility?

Unfortunately, it could.

Although there’s not a lot that is understood about the fertility link, it is probably twofold and has to do with the inflammatory effects of the tissue. Advanced endometriosis can cause scarring of the fallopian tubes, which causes infertility, or anatomic abnormalities that result in abnormal tubal function.

If you have a laparoscopy to remove endometriosis, does that increase your fertility?

It definitely does increase your fertility rate by about 60 percent. For women who are having trouble with infertility, endometriosis is a reason in 38 percent.

And again, endometriosis doesn’t always lead to infertility, but it is a risk factor. I know a woman who was diagnosed with endometriosis as a

By missy wilkinson

e x e r ci s e fo r li f e

go with the

flow

these yoga Poses alleviate menstrual cramPs and inflammation.

T

Are there any alternatives to surgery for treating endometriosis?

A lot of times we use birth control pills and Depo-Provera as the first line for women who have heavy, painful periods, but taking birth control pills is not going to prevent you from getting endometriosis. There is something called Lupron that can actually treat endometriosis — it tricks your body into thinking you are going through menopause. Endometriosis is fed by estrogen, and what Lupron does is turn off your body’s ability to make hormones, so the endometriosis that is present withers and dies. It has pretty rotten side effects — hot flashes and mood swings — but women who are having side effects can take small doses of hormone pills. And after you go through menopause, endometriosis completely resolves because it is fed by estrogen.

Conservative management is always best, and for women who are having symptoms that might be endometriosis, if they are able to resolve those by taking birth control pills or anti-inflammatory medications like ibuprofen, then that is definitely what they should do.

moves your energy up,” Bryan says.

“So the first one to three days may not be the best time to be doing inversions, because you want your energy to flow down. But this is not a rule.” Swan River Yoga founder Michele Baker, who co-owns the business with Keith Porteous, explains that every cycle is different, and women should learn to listen to the unique needs of their own bodies.

During menstruation, poses that open the hips are especially helpful. Hip opening poses reduce the inflammation and contractions that cause cramps by opening the base of the pelvic floor and creating space between the uterus and other

reproductive organs. Additionally, yoga activates the endocrine system, which helps bring the body’s chemistry and hormones back into balance. In addition to relieving physical symptoms of menstruation and promoting relaxation, yoga eases mood swings. “It is possible to have no cramps and no drastic mood swings, as well as a mild menopause and healthy aging process ... with the benefits of yoga,” Baker says.

Swan River Yoga instructors suggest the following two poses for cramp relief. Both are good alternatives in a yoga class when inversions are presented, or to practice on your own.

reclined angle Pose (Supta Baddha Konasana)

Lying on your back, bend your knees. Open the knees, allowing the outer legs to rest on the ground. If your legs don’t meet the floor, support the thighs by placing rolled-up blankets underneath them. Lay your arms on the floor with palms facing up, and allow the shoulders to find their way to the floor.

The arms can also rest outstretched on the floor behind the head with palms together or fingers interlaced. It can feel very comfortable to place a soft, weighty object (like a folded blanket) on the hips or upper chest while in this posture. Allow the front of your body to remain open to the sky and the back to feel supported by the earth. Hold the pose for 10 minutes.

seated squat Pose (Malasana)

Open your feet just a bit wider apart than outer hip distance and ground all four corners of the feet. If they do not ground completely, place a blanket underneath the heels. Place your arms inside the inner thighs and bring the hands into a prayer position, which balances out the polar energies in the body. Press the arms into the legs, and isometrically squeeze the inner thighs toward each other. Hold for at least 10 to 20 breaths.

HealtH & Wellness > bestofneworleans.com > aPrIl 05 > 2011

teen and was told she would have difficulty conceiving, but she went off birth control pills and conceived the first time she tried at age 37. So it is not necessarily going to cause you bad problems in the future.

hough women often experience cramps during menstruation, exercise can help alleviate those and other symptoms of discomfort, like inflammation and mood swings. According to instructors at Swan River Yoga (citywide; www.swanriveryoga.com), regular yoga practice offers a multitude of benefits. “With a consistent practice, periods can be lighter, shorter and more comfortable,” says instructor Libby Bryan, who co-owns the Mid-City location.

Some teachers recommend menstruating students refrain from inverted poses (any pose where your heart is above your head). “Yoga

By Lee Cutrone

11

Primary Care at Ochsner Baptist.

6 5 5 3 conditions were detected early last year at Ochsner.

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When was the last time you had a checkup? Early detection is the best protection against any health problem. Exams and health screenings can reveal problems before they start and play a key role in your health and well-being. So for your peace of mind, call to schedule a checkup today with one of our experienced Primary Care physicians.

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Internal Medicine at Ochsner Baptist

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ochsner.org/baptist ©2011 Ochsner Health System (ochsner.org) is a non-profit, academic, multi-specialty, healthcare delivery system dedicated to patient care, research and education.

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