January 2002, Volume 2, Issue 1
Special Points of Interest (click topic)
Growing Numbers of OB/GYNs Seek Accreditation
Emergency Contraception Offered Via Telephone Triage
Discontinuing Herbal Products Prior to Surgery
Dr. Trupin's Article Published on Medscape.com
Currently Enrolling Clinical Research Studies
__________________________
Suzanne Trupin, MD, FACOG
2125 South Neil Street, Champaign, IL 61820
PHONE (217)356-3736
FAX (217) 356-5849
www.womenshealthpractice.com
Vaginal Infection? Don't Self Treat . . . It May Be "BV"
Bacterial vaginosis (BV) is the most common and potentially a serious vaginal infection to affect women of reproductive age. Prevalence estimates range from 10% among low-risk population to 64% among women at high risk. As many as 16% of pregnant women in the United States have BV.
The exact mechanism by which BV infection occurs is unknown. It can be associated with sexual intercourse, but is not sexually transmitted. The principal argument against sexual transmission of BV is the reported lack of benefit from treating male partners.
BV is implicated in recurrent urinary tract infections, preterm labor, postpartum endometritis, post-hysterectomy and post-abortion infections, and pelvic inflammatory disease. Predisposing factors to BV include non-white ethnicity, prior pregnancy, IUD use, sexual activity, new sexual partners, recent antibiotic use, and concurrent trichomoniasis.
Though potentially a serious, condition, about 50% of women with BV may have no symptoms. Typical symptoms, however, include increased vaginal discharge with an unusual foul or "fishy" odor-which may be more noticeable after intercourse and/or during menses when vaginal pH is elevated. Less common symptoms include mild vulvar burning and/or itching. When upper genital tract infection is involved, a woman may experience classic symptoms of pelvic inflammatory disease or more subtle symptoms of painful intercourse, dysfunctional uterine bleeding, and new onset painful periods.
On physical examination, white discharge is commonly found, and vaginal malodor confirmed with KOH amine testing. Mild vulvar erythema (swelling) is possible, but far less common-unless infections are mixed. In the presence of PID, mucopus and cervical and/or uterine tenderness may be noted. The best tests are a wet pre exam and a new specific probe test (like a culture). Experts advocate vaginal pH testing with all pelvic examinations in women of reproductive age.
If diagnosed with BV, treatment regimens include oral and topical agents. Initial therapy may be effective; however, BV recurs in approximately one month in approximately 30% of women. This may be reflective of the current lack of understanding of how the infection originates. Risk of recurrence can be reduced with several management strategies, one of which is performing "test of cure" about 3 weeks after therapy.
In conclusion, bacterial vaginosis is an infection that is common and potentially serious. Proper diagnosis can be difficult since approximately half of the women with BV have no symptoms. Due to the significant implications of BV that may occur, it is extremely important that women have access to the best diagnostic tools and treatment regimens available.
For additional information regarding bacterial vaginosis, please inquire with the physician and staff of Women's Health Practice.
Source: BD Diagnostic Systems
The Society for Women's Health Research reports that many studies find differences in men and women that may have a bearing on medical practice. Examples from the past ten years:
• Women mount more aggressive immune responses to infections and are more likely to develop autoimmunie disease.
• Nicotine replacement therapy is more effective in male smokers. The risk of developing lung cancer from smoking might be higher in women.
• Women might be better protected than men against language impairment from a left-sided stroke. Men rely on the left side of the brain for language while women use both sides.
• Women will progress to AIDS with about half the viral load counts required for men.
• Women are much more likely to develop life-threatening ventricular arrhythmia or torsades de pointes from a vareity of drugs, including antihistamines, antibiotics, antimalarial drugs, cholesterol-lowering agents, and antiarrhythmia drugs.
• Women's blood alcohol levels are higher than men's after consuming comparable amounts of alcohol. Women breakdown alcohol more slowly because they produce less gastric alcohol dehydrogenase. Ethanol has a more sedating effect in women.
• Men synthesize serotonin at a rate 50 percent higher than women. This could partially explain why women are two to three times more likely to expeience depression.
• Ibuprofen is a more effective painkiller for men than women.
• Pentazocine, acting at the kappa opioid receptor, provides more post-operative pain relief in women than men.
• The sexes tend to have different heart attack symptoms. Chest pain is most common in men while women's symptoms can be subtler-abdominal pain, fatigue, and nausea. Cardiovascular disease deaths are declining in men and increasing in women. Men have heart attacks nearly 10 years earlier than women, yet have a better 1-year post-attack survival rate than women.
• A liver transplant is significantly less likely to be successful when the liver is donated by a woman.
Source: Society for Women's Health Research
"We never understand a thing so well and make it our own, as when we have discovered it ourselves."
Accreditation Sought by Growing Numbers of OB/GYNs for Ambulatory Surgery Facilities
According to Fellows who have been accredited by the Accreditation Association for Ambulatory Health Care (AAAHC) or are involved with its evaluation, accreditation of ambulatory surgery facilities offers numerous advantages to OB/GYNs. Thus far, only a small number of OB/GYNs have applied for AAAHC. AAAHC has now accredited 1,352 organizations, of which 18 specialize in OB/GYN, and 187 are multispecialty facilities that list OB/GYN as one of their specialties. Women's Health Practice was accredited by the AAAHC in May 2001.
Source: ACOG Today 45(9), October 2001.
WHP Now Offering Emergency Contraception Via Telephone Triage
Women's Health Practice now offers emergency contraception (EC), often called the "morning-after-pill", as a telephone visit or an office visit. EC treatment is most effective if taken within 72 hours of unprotected intercourse, but may be used for up to 5 days post intercourse. The pills used in EC contain the same hormones as ordinary birth control pills, but at a higher dose. Currently, these medicines are only available by prescription in Illinois although they will be over-the-counter in California sometime this year.
Women wishing to use the telephone visit system should call 217-356-3736. Inform the receptionist that you are interested in or requesting the morning after pill. You will be asked if you would like to come in as an office visit or be treated via telephone. If you select telephone treatment, the fee is $29, which will be charged via credit card telephone authorization (you will need to provide us with your Visa, MasterCard, or DiscoverCard number). Your call will then be forwarded to one of our nursing staff, who will ask you various questions regarding your specific case, medical history, treatment regimen, plan, and follow-up. A prescription will be called into your pharmacy.
At the present time, emergency contraception services will be limited to weekdays from 8 AM to 5 PM CST. We welcome referrals of non-Women's Health Practice patients.
"Choosing the course of one's own life and health is a scared right, transcending the culture and politics of life."
High Blood Pressure — Did You Know . . .
Hypertension (high blood pressure) is known to affect 1 in 4 adults, and over 1/3 of women with hypertension (HTN) are not receiving treatment because they do not even know they have it . . . almost as many women are treated but their blood pressure is not as tightly controlled as it should be!
Control of HTN is important as it affects your heart, brain, kidneys, peripheral vasculature, and eyes. As the risk of target organ damage increases, so does your risk of cardiovascular disease (CVD), morbidity and mortality. One study found 40% of males with diastolic blood pressure levels of 115-129 developed target organ complications.
In individuals with untreated HTN, it is expected that:
• 70% will die from coronary heart disease and congestive heart failure;
• 15% will die from cerebral hemorrhage or cerebrovascular failure;
• 10% will die from uremia or renal insufficiency.
Less than 5% of HTN cases have secondary causes, the most common of which are renal diseases and renovascular hypertension.
It is also estimated that hypertension occurs in 4% of women with polycystic ovarian syndrome. Drugs that increase sensitivity to insulin also cause a decrease in blood pressure levels.
Risk factors for developing HTN are lifestyle (obesity, physical inactivity, smoking, alcohol consumption), age, race, family history, and medical conditions (i.e., diabetes mellitus and kidney disease). Lifestyle changes (weight control, restricted sodium intake, reduced alcohol consumption, increased aerobic activities) are effective nonpharmacologic approaches to preventing and treating hypertension. Treatment goals are to prevent hypertensive-related morbidity and mortality by achieving normal blood pressure levels. Yearly blood pressure check-ups are essential for good health.
If you feel that you are at risk for developing, or think you may have high blood pressure, consult your WHP health care provider for screening and evaluation.
Source: Clinical Updates in Women's Health Care: Hypertension, Volume 1(1), Winter 2002, American College of Obstetricians and Gynecologists
Fish Can Be A Healthy Food Choice
It is widely known that fish are an important part of a nutritious diet because they are a lean, low-calorie source of protein. What you may not know is that fish caught in lakes, rivers, oceans, and estuaries may contain chemicals that pose health risks, especially to pregnant or nursing women or small children. Pollutants like mercury can cause damage to the brain and nervous system of a developing baby or small child.
The most important step in reducing health risks is to call your local or state environmental health department to find out if there are any advisories in areas where you want to fish. If there are no advisories, you should still follow basic guidelines to protect your children and yourself if you are pregnant, may become pregnant, or are nursing. Limit consumption of freshwater fish caught by family and friends to one meal a week. It is also possible to reduce your risk by choosing to eat smaller, younger fish, or pan fish, such as bluegill, perch, and stream trout that feed on insects and are less likely to build up pollutants. Cleaning and cooking fish properly may also help to reduce the levels of chemical pollutants in the fish.
The guidelines for ocean fish, or fish purchased in stores or restaurants are a bit different. These fish usually have less mercury than freshwater fish, so it is possible to safely eat more-an average of 2 meals per week. The FDA also advises against eating shark, swordfish, king mackerel, and tilefish.
For more information about protecting yourself from health risks from eating fish containing chemical pollutants, call your local health or environmental protection department; you can find the number in the government section of your local telephone book, or www.epa.gov/ost/fish.
Source: Agency for Toxic Substances and Disease Registry
COMPUTER CONVERSION
Women's Health Practice is currently undergoing a computer conversion. This new system provides electronic medical records (EMR) and complete practice management.
The medical records feature will allow us to store your medical record documents (including images, x-rays, lab data, etc.) electronically. The system is specifically designed to both organize and help make your medical records more complete. This will eventually make sharing information with your other physicians easier, and it is our long range goal to make specific parts electronically accessible; for instance, you will be able to check your own lab report!
The office management feature includes sophisticated patient scheduling, point of service billing, electronic claims processing, and other up-to-date billing and accounting capabilities. During this transition period, we ask for your understanding should an inadvertant error occur.
PREFERRED PROVIDER CONTRACTS
Women's Health Practice has recently contracted with Service Employees International Union Local #4, Preferred Plan, BCE Emergis, and MCS as a prefererd provider. This is in addition to being a preferred provider for Blue Cross Blue Shield, Cigna, PersonalCare HMO/POS/PPO, Tricare/Champus, and Unicare. We have submitted preferred provider applications to several other insurance companies, and these applications are pending as they undergo the credentialing process. We welcome insurance referrals. Check future newsletters for updates.
WHP WEBSITE
Our website address is the same, but our look has changed! Visit our reformatted and updated website at: www.womenshealthpractice.com.
If You Are Taking Herbal Products, Tell Your Doctor Before Surgery
The American Society of Anesthesiologists (ASA) (www.asahq.org) is cautioning those who use herbal medications to stop taking these "natural" products prior to surgery. Recent findings disclose that 7 out of 10 herbal medicine users never tell their physicians about the herbal medications they are taking because most believe since the products are "natural", they must be safe.
The ASA does not take a formal position on therapeutic properties of herbal medications. "All we want to do is make the public aware that these products could pose a serious health risk if they are taken prior to surgery", said Dr. John Neeld, Jr., M.D., ASA President. The herbal products include:
St. John's Wort, which is taken by more than 7.5 million Americans to treat anxiety, depression, and sleep disorders, may itensify or prolong the sleep effects of some narcotic drugs and anesthesthetic agents.
Ginko biloba, used to improve memory and increase blood circulation, may reduce platelets, which are needed for blood to clot.
Ginseng, one of the most popular herbal preparations in the world believed to boost vitality, has been associated with episodes of hypertension (high blood pressure) and tachycardia (rapid beating of the heart).
Echinacea, commonly used to boost the immune system, may cause inflammation of the liver if used with certain medications, such as anabolic steroids, steroids, methotrexate, or others.
Ephedra used in many over-the-counter diet aids as an appetite suppressant, may interact with certain antidepressant medications or high-blood pressure medicines to cause dangerous elevations in blood pressure or heart rate.
Herbal medicine is an important part of our health care. Women's Health Practice is committed to helping you use them safely and wisely.
It is advised that herbal medicines should be stopped at least 2-3 weeks prior to surgery.
If you have questions regarding herbal products, the WHP staff is available to answer your questions.
Source: American Society of Anesthesiologists
Dr. Trupin's Article Published on Medscape.com
An article authored by Suzanne Trupin, M.D., and Carey Moreno, B.S. ,has been published on www.Medscape.com. Carey has been one of Dr. Trupin's medical students and graduate research assistant for four years, and will be graduating from the University of Illnois College of Medicine at Peoria in May 2002.
The article, entitled, "Medical Abortion: Overview and Management," discusses the history of drug development, mechanism of action and pharmacology of mifepristone, misoprostol, and methotrexate, physician requirements, patient selection criteria, medical termination protocols, patient counseling, patient instructions, telephone triage for potential complications, patient follow-up, contraception, complications, and legal issues.
The entire article can be accessed at website: http://www.medscape.com/Medscape/WomensHealth/journal/2001/v06.n06/wh7840.trup/wh7840.trup-01.html.
NOTE: If you are not already a member of Medscape, you'll have to register before you can view the article. Registration is free, confidential, and takes just a moment. If you are not prompted when you click on the URL site, just go to www.medscape.com.
Currently Enrolling Clinical Research Studies
WHP is currently enrolling patients in clinical research studies in the following areas: osteoporosis, stress urinary incontinence, bacterial vaginosis, hormone replacement therapy/endometrial hyperplasia, and breast cancer precaution trial. For inclusion and exclusion criteria and to see if you qualify, to refer a friend, or to receive information about doing research, contact Louise Adam, Research Coordinator, at Louise.Adam@womenshealthpractice.com, visit our website at www.womenshealthpractice.com, or by calling 217-356-3736, extension 118.