July 2001, Volume 1, Issue 1
Special Points of Interest
Polycystic Ovarian Disease and Obesity: The Link and a Strategy
Clinical Research Studies - Do you qualify?
__________________________
Suzanne Trupin, MD, FACOG
2125 South Neil Street, Champaign, IL 61820
PHONE (217)356-3736
FAX (217) 356-5849
www.womenshealthpractice.com
Women's Health Practice (WHP) is a full service private practice focusing on obstetrics, gynecology, infertility, and women's wellness care. Patient care with a strong commitment to education and advancement of women's health knowledge is the primary focus of the practice. The mission of WHP is to promote and assure high-quality, comprehensive women's health care, including reproductive choices, in a safe environment. WHP keeps abreast of the new technologies and medical advancements in order to offer state-of-the-art medical care to our patients. We participate in research studies, both at the University of Illinois and as a privately contracted concern.
We're on the Web
www.womenshealthpractice.com
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Polycystic Ovarian Disease and Obesity: The Link and a Strategy
Polycystic ovarian disease (PCOS), an endocrine condition, affects approximately 1 in 10 Caucasian women, and of women affected, approximately 50% are obese. Menstrual cycle consequences of PCOS are varied, but an important cause of infertility, irregular bleeding, increased pregnancy loss, increased pregnancy complications, acne, seborrhea, excessive male-patterned hair growth, and anovulation (failing to ovulate). Abnormal male hormones probably cause many consequences of PCOS. The ovary produces potent testosterone and weaker male hormones (like DHEA), which mostly come from the adrenal gland hormone. Almost 99% of testosterone, the major male hormone produced in the female body, circulates and binds to Sex Hormone Binding Globulin (SHBG).
Diagnosis – Pelvic transvaginal ultrasound, enhanced with 3-D ultrasound imaging, can help diagnosis PCOS by measuring the size of the ovary and presence of the ìringî of pearls look. Hormone testing is important; you may be offered insulin level testing, male hormone testing, SHGB, and pituitary hormone testing. Hirsutism, excess hair growth, indicates a 50/50 chance of showing abnormal hair growth. Hair growth patterns can help diagnose PCOS. For instance, hair growth just on the face and disappearing hair on the rest of the body is more typical of menopauseónot PCOS. Making sure no medication is causing the new abnormal hair growth is important as well. Grading hair growth can determine the degree of abnormality; a score of 8 on the Ferriman & Gallwey Scale is abnormal. Other signs of male hormone endocrine disorders can include Acanthosis Nigricans, which is thick and dark skin, particularly in the skin folds.
Obesity – Approximately 40% of obesity is hereditary. When a woman with PCOS becomes obese, SHBG levels increase, and she is more likely to show a tendency towards the blood sugar abnormalities (such as those of a diabetic). Adrenal steroid levels may be normal, and fat is more likely to be stored in the waist. The most worrisome concern with obesity is a woman's long term risk for cardiovascular disease. Women with PCOS have higher cholesterol, more risky LDL cholesterol, hypertension, hypertriglyceridemia, and other abnormalities, such as abnormal Cardio-CRP or abnormal homocysteine levels.
Solutions – Control irregular bleeding. Oral contraceptives and appropriate sampling of the endometrium with an endometrial biopsy or hysteroscopy are an important part of long-term care. Pap smears alone cannot detect precancerous or cancerous conditions of the uterine lining. Modify your lifestyle and lose weight, which includes dieting and exercise. Some abnormal male hormone levels will decrease, and body fat distribution will improve as well. Treatments, such as those given to diabetics, including the drug metformin, can improve abnormal hair growth and regulate menstrual cycles, as well as enhance weight loss.
Individualized Approach to PCOS – Deciding how and when to use hormonal testing is strictly determined on an individual basis. Although most women may be able to be diagnosed with certain hormonal abnormalities, if this abnormality will not change the management of your PCOS, it is probably unnecessary to undergo in depth hormonal tests. Determining which oral contraceptive is right for you is an important part of individualized care. Some women may actually benefit by treatment with antiandrogens; one popular antiandrogen can help with water retention if that is an issue for you.
Ultrasound Case of the Month
The natural history of polycystic ovarian disease/syndrome (PCOS) is not yet known. Many patients have no symptoms, yet 50% of patients presenting to infertility clinics are diagnosed with PCOS. PCOS is a complex endocrinologic disorder associated with anovulation. To help diagnose PCOS, ultrasound may be one of many tests that can be used. With ultrasound, the ovary appears with what looks like a "string of pearls" around the edges. Thus, the ovary is diagnosed PCOS.
Insurance Tip
Having an insurance claim rejected is extremely frustrating and infuriating for both you and your physician. However, you do not necessarily have to take no for an answer. Following are a few points to assist you regarding insurance claim submissions:
1) Know Your Policy: All too often, it is a case of not knowing your policy coverage (annual deductible, copay, coverage limitations, etc.).
2) Check The Codes: Current Procedural Terminology (CPT ) codes reflect the medical treatment received. A common problem involves an incorrect CPT code. Make sure the CPT codes are the same on both the doctor's bill and rejected claim form.
3) Provide More Detail: If your claim has been denied, ask your physician to provide additional documentation (for example, were you referred to a specialist, additional tests done due to your symptoms).
4) Ask For A Review: If you think a mistake was made by your insurer in processing or if the claim continues to be dismissed, ask for a formal review by a supervisor.
5) File A Complaint: State insurance departments will investigate whether an insurer is using current data and reimbursing fairly. The National Insurance Consumer Help Line at 800-942-4242 provides advice on resources and referrals.
WHP Administrative Office (217-356-3736, extension 105) can help answer questions you may have regarding your insurance, submitted claims, explanation of benefits, etc.
Women's Health Practice is a preferred provider for the following insurance plans: Blue Cross Blue Shield, Cigna, Medicare, PersonalCare HMO/POS/PPO, Tricare/Champus, and Unicare. If you would like your plan to be considered, please contact Women's Health Practice Administrative Office.
Medical Abortion
To give our patients more options, WHP has expanded our medical abortion services. Medical termination using RU-486 is now offered to women up to 63 days (9 weeks) from the first day of the last menstrual period. Ultrasound is always done to confirm dates of gestation. After the counseling and informed consent process, the FDA-approved regimen involves Mifeprex (RU-486) to be taken orally followed by an oral administration of misoprostol (typically scheduled to be given 2 days later). A follow-up appointment is scheduled approximately 14 days after the first visit. Additionally, WHP allows patients living farther away the option of a medical abortion, and we will be lowering the cost from $750 to $600. Along with this option, WHP still offers 1st and 2nd trimester surgical terminations under local sedation and general anesthesia.
Over the past 15 years, WHP has participated and continues to participate in clinical research studies, both as a privately contracted entity and in collaboration with the University of Illinois at Urbana-Champaign. To date, grants awarded include a variety of obstetric and gynecologic states (estrogen replacement therapy, uterine fibroids, sexually transmitted diseases, vaginal yeast infection, contraception, stress management, fibrocystic breast condition, bone density, endometriosis, urinary tract infections, and human papilloma). Collaborative research projects with the Physiology, Biophysics, Nutrition, and Community Health Departments at the University of Illinois include magnetic resonance imaging and spectroscopy, gynecologic tissues, maternal exercise and nutrition, bone densitometry, pelvic ultrasonography, and relaxin. WHP is currently enrolling for the following clinical research studies:
Birth Control: Looking for a new form of birth control? Tried of trying to remember a pill a day? You may be eligible to participate in a clinical research study of an investigational form of birth control. You must be at least 18 yeas of age, menstruating regularly for the past three (3) months, willing to have injections every three (3) months for up to two (2) years. Participants receive study medication, study-related physical exams, and compensation for time and travel.
Urinary Tract Infection: Do you think you have a urinary tract infection? You may be eligible to participate if you are not pregnant, over age 18, had symptoms of urinary tract infection in the past seventy-two (72) hours, had less than three (3) urinary tract infections in the past year, and more than one (1) month has passed since your last urinary tract infection. Get your confidential screening by contacting the WHP Research Department.
Endometriosis: Do you have a diagnosis of endometriosis? You may be able to participate in a research study if you are 18-49 years old, have chronic pelvic pain, and not taking hormonal medicine. Study features include pelvic ultrasound, bone mineral testing, sexually transmitted disease screening, and mammography if or age 35.
HGSIL: Are you a woman who has recently been diagnosed with an abnormal Pap smear (HSIL/CIN I/III/HPV)? Eligible participants may receive investigational study medication, study-related medical care, and compensation for time and travel. Contact the WHP Research Department if you would like information about this ìcutting edgeî clinical trial.
If you would like to meet our staff, find out more about our studies, or are interested in participating in any of our clinical research trials, please contact WHP Research Department (217-356-3736, extension 118) for further information (including study inclusion and exclusion criteria).
If interested in participating in Women's Health Practice clinical research studies, please contact our Research Department at 217-356-3736, extension 118.
When transferring medical records, many individuals are under the assumption that the original medical record is sent. The originating physician maintains the original record and "transfers" a copy. All requests for transferring medical records must be made in writing. Written authorization should include your name, address, birth date, social security number, and telephone numbers, and transferring physicianís name (or healthcare facility) and address. You may be charged a reasonable fee to reflect the cost of materials used, the time required to prepare the materials, and the direct cost of sending the material to the requested physician. Please note that it can take up to 30 days for medical records to be transferred. Therefore, if your records must be transferred by a specific date, please note this date on your written authorization, and check with the transferring physician that a copy of your record has been received.
If you have additional questions specifically regarding medical records, please contact WHP Medical Records Department at 217-356-3736, extension 113.
Ultraviolet Radiation (UV)
Ultraviolet radiation (UV) is known to damage skin and cause skin cancer. To limit UV exposure:
1) Limit direct sun exposure during midday.
2) Cover up!
3) Wear a hat.
4) Use a sunscreen with an SPF of 15 or higher.
5) Weaver sunglasses that block UV rays.
6) Consider your activity.
7) Avoid sunlamps and tanning booths.
8) Check your skin regularly.
For more information, check out the American Cancer Society website at www.cancer.org.
