November 2002, Volume 2, Issue 3
Special Points of Interest (click topic)
WHP Clinical Trials
Conventional, ThinPrep™, and AutoCyte Pap Smears
Migraine Headaches
Female Athletes & Contraceptive Hormones
Postpartum Depression
Mammography Screening Debate Continues
Updates to WHP Website
Staff Certifications
Special Thanks from WILL Radio to Suzanne Trupin, M.D.
__________________________
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 is currently enrolling volunteers for clinical research in the following areas:
- Stress urinary incontinence
- Osteoporosis
- Severe PMS
- Treatment of menopausal symptoms
- Low sex drive after menopause
- Contraception
- Coming soon, a study to evaluate a HPV (human papilloma virus) vaccination
Informational (walk-in) meetings regarding clinical research studies are normally scheduled at 5:00 PM on specified weekdays at Women's Health Practice.
If interested in any of these studies, to inquire about upcoming informational meetings, or if you want to know more about what participating in a clinical trial involves, please contact Louise Adam, Clinical Research Coordinator, or Kathleen Snyder, C.A.N.P., at 217-356-3736. Study participants receive study-related clinical exams, laboratory testing, and study medications at no cost, and are compensated for their time and travel.
As a volunteer in a WHP clinical trial, you are contributing to the search for new medical treatments and aiding in the development of cures for illness and medical conditions. WHP has been conducting studies for almost twenty years, and we are proud of the advances we have been involved in. We are excited about the bright future of medical advances, and we welcome your interest in our work.
Conventional, ThinPrep™, and AutoCyte Pap Smears
Over the past 50 years, the Pap test has helped reduce cervical cancer deaths by 70%. The Pap test is the most widely used cancer-screening test in the world. Regular, routine examinations can increase the chances of detecting a problem before it progresses. The internal exam performed by your doctor as part of the Pap test process is an important part of your regular check-up.
You should have your first Pap test by age 18 or when you become sexually active—whichever comes first—and you should continue to have routine exams even after you reach menopause.
At WHP, we offer three different Pap tests—the conventional Pap smear, the ThinPrep™, Pap test, and the AutoCyte Pap test. Each test is effective for detecting early signs of cervical abnormalities. Different insurance plans cover different tests, and we use all three tests so that you will be able to receive the highest coverage under your plan.
ThinPrep™ and AutoCyte Pap tests are both liquid-based tests. Blood, mucus, and inflammatory cells are filtered out, while the important cells remain. The result is a clear view of the cervical cells, which makes it easier to see abnormalities. In the conventional Pap, cells are smeared onto a slide for viewing. This test is cost effective for patients without insurance, or for those whose insurance does not cover other types of Pap smears. These tests are more expensive, but many insurance plans cover either one or the other. At WHP, we believe it is important to get a Pap test every year, whether it is the regular Pap smear, ThinPrep™, or AutoCyte. We will be able to help you determine which test is covered by your insurance plan. If you have further questions regarding Pap tests, please discuss with your WHP healthcare provider.
Migraine headaches are defined as severe to moderate debilitating headaches, often occurring in one side of the head, which can last from several hours to three days. Sometimes migraines are associated with nausea, vomiting, and extreme sensitivity to light and noise. Ten to twenty percent experience migraine with aura (MA)—colors, flashing lights or fine spots that occur before the onset of the migraine.
The essential mechanisms responsible for migraine are still unknown. It is believed that during the migraine blood vessels and membranes in the skull become swollen, causing nerve endings to transmit pain sensations to the head and skull. There also seems to be an inherited susceptibility to migraine.
Although migraine appears to occur randomly, certain triggers may precipitate migraine, including: alcoholic beverages; caffeine; chocolate; monosodium glutamate; vinegar (except white); sour cream; nuts; pizza; peas; onions; avocados; herring; ripened cheeses, fermented, pickled, or marinated foods; yogurt; peanut butter; hot, fresh, yeast-raised breads, coffeecakes, and doughnuts; beans (any kind except green or wax); canned figs; citrus fruits; pork; emotional stress; changes in eating or sleeping habits; bright lights; loud sounds; smoke; temperature or weather changes; medicine (particularly oral contraceptives); and strong smells.
Menarche, pregnancy, oral contraceptive use, menopause, and the use of hormone replacement therapy (HRT) can influence migraines. Migraines are associated with high levels of estrogen and drops in progesterone in 60% of women who suffer from migraine.
Hormone changes may be natural or may follow drug(s) administration, such as oral contraceptives (OCs) or HRT. For a minority of women, migraines occur only in relation to their menstrual cycle, termed “menstrual cycle-related migraine”. Menstrual onset is associated with estrogen withdrawal, the most marked fluctuation during the menstrual cycle. High estrogen levels during pregnancy, fluctuating levels of estrogen in the perimenopause, and low estrogen levels at menopause can affect the frequency and severity of headaches.
Because of this correlation between migraines and hormones, it is often helpful to involve your OB/GYN in migraine treatment. At WHP, we will work with you to determine the cause of your migraines as well as treatment options.
Migraine treatment is challenging; it may take months of trying different medications. Keep a migraine diary to help identify your individual triggers:
- Food and drinks consumed prior to the migraine
- Changes in eating/sleeping habits
- Date of your menstrual cycle
- Stress levels
Menstrual migraine treatment may include an attempt to stabilize hormone levels by administrating exogenous
hormones. If OCs are used, a low-dose combined estrogen and progestin is
recommended, and is best taken without interruption for three months to allow continuous estrogen delivery. Another possibility is a low-dose HRT patch applied premenstrually. Non-steroidal anti-inflammatory drugs (ibuprofen, naparoxen) may relieve pain.
If taken before the onset of menses, there are reports that the following offer limited effectiveness:
Magnesium (200-600 mg/day)
Vitamin B2 (400 mg/day)
Vitamin B6 (50-100 mg/day)
Vitamin D
Calcium
Combined stroke risk is also considered to be higher for MA. Many clinicians will not prescribe estrogen preparations for women with MA older than 40—we do, but urge patients to watch for unusual neurologic signs (increased headaches, dizziness, vision changes).
Female Athletes & Contraceptive Hormones
It is unclear what effects the menstrual cycle has on athletic performance, and less clear what effects the control of that cycle through the use of hormones has on athletic performance. Hormone levels fluctuate greatly through the menstrual cycle, but this fluctuation has not been linked to changes in performances. Furthermore, it is thought that individual athletes vary tremendously in their responses to their own hormonal fluctuations.
Most athletes are interested in hormonal contraceptive use for two reasons: 1) contraception protection, and 2) control the timing of menstrual bleeding to not coincide with major competitive events. Additional interests are the preservation of bone, which is known to lose density if women are too low in estrogen. This would primarily be important in the very thin, not regularly menstruating athlete. The easiest way to control the menstrual cycle is to extend the use of active pills, and some female athletes can almost eliminate cycles completely by continuously using active pills and not using any inactive pills that are likely to trigger a withdrawal bleed. With such use, the levels of estrogen in the body are typically sufficient to maintain bone health. For this reason alone, most physicians do not favor progesterone-only methods. If they are to be used, it is important to follow the levels of estrogen and supplement if the estrogen levels get too low.
More complex questions include the effects of the menstrual cycle and the hormones to control those cycles have on various aspects of competitive fitness including cardiac performance, respiratory fitness, heat regulation, metabolic regulation, coordination, timing, and muscular strength. Studies have shown conflicting results. One study of high dose pills showed some decrease in the body's ability to exert maximal oxygen uptake, but such changes were not noticed with the standard 35 mcg. dose pills. Another study showed an interesting trend towards less muscle soreness 48 hours after exercise and less lower back pain in women on oral contraceptives, compared to women having regular cycles.
For additional information regarding athletic performance and contraceptive hormones, ask your WHP healthcare provider.
Having a baby is one of the most exciting and joyous events in a woman's life. Life with a new baby can be thrilling and rewarding, but it can also be stressful and difficult for the new mom. The physical and emotional turmoil associated with pregnancy and childbirth leaves many new moms feeling sad, anxious, afraid, or confused after delivery. These feelings are common and often dismissed as “normal”. However, many women who are experiencing these emotions have postpartum depression and need medical treatment.
The term postpartum depression describes the range of physical, emotional, and behavioral changes experienced by many new moms following delivery, and the exact cause is still unknown. “Baby Blues” occur in many new moms in the days immediately following childbirth, and is characterized by sudden mood swings ranging from euphoria to intense sadness. Symptoms may include crying for no apparent reason, impatience, irritability, restlessness, anxiety, feelings of loneliness, sadness, low self-esteem, increased sensitivity, and heightened feelings of vulnerability. The “Baby Blues” may last only a few hours or as long as one to two weeks after delivery. This condition may disappear as quickly and suddenly as it appeared without medical treatment.
Postpartum Depression (PPD) can occur a few days or even months after delivery, and roughly 10% of pregnancies result in PPD. It can occur after the birth of any child, not just the first, and is characterized by more intense feelings of sadness, despair, anxiety, and irritability. Often it disrupts a woman's ability to function, which is the key sign that medical attention is necessary. Left untreated, symptoms may worsen and linger for as long as a year. This physical disorder, however, can be diagnosed and its symptoms alleviated.
Postpartum Psychosis, a serious mental illness, affects approximately 1 in 500-1,000 new moms. Onset is severe and quick, usually within the first three months after delivery. Women who suffer from postpartum psychosis may completely lose touch with reality, often experiencing hallucinations and delusions. Other symptoms may include insomnia, agitation, and bizarre feelings and behavior. Postpartum psychosis should be treated as a medical emergency and immediate medical assistance, which almost always includes medication. In many cases, women who are suffering from this condition are hospitalized.
WHO IS AT RISK FOR PPD? Any woman who is pregnant, had a baby within the past several months, miscarried, or recently weaned a child from breastfeeding can suffer from PPD. PPD can occur regardless of a woman's age, socioeconomic status, or the number of children she has borne. PPD is more likely to occur if a woman has had any of the following: previous PPD, depression not related to pregnancy, severe PMS, non-supportive partners and stress related to family, marriage, occupation, housing, and other events during pregnancy or after childbirth. Symptoms of PPD include:
- restlessness, irritability, or excessive crying;
- headaches, chest pains, heart palpitations, numbness, hyperventilation;
- inability to sleep or extreme exhaustion or both;
- loss of appetite and weight loss, or conversely, overeating and weight gain;
- difficulty concentrating, remembering, or making decisions;
- excessive amount of concern or disinterest in the baby;
- feelings of inadequacy, guilt, and worthlessness;
- fear of harming the baby or one's self;
- loss of interest or pleasure in activities, including sex.
PPD is treated much like other types of depression. The most common treatments are antidepressant medication, psychotherapy, and participation in a support group, or a combination of these treatments. However, some anti-depressants can contaminate breast milk, and women who breastfeed should talk to their doctors to determine the most suitable treatment option.
New moms with PPD can practice a number of self-care strategies: good, old-fashioned rest, relieve some of the pressure you may be feeling—ask your husband or partner to share night-time feeding duties and household chores, seek emotional support—isolation perpetuates depression—get dressed and leave the house for a short time daily, make an effort to spend time alone with your partner, ask your doctor's advice on possible medical treatments, talk with other mothers, join a support group.
At WHP, we believe in focusing on your mental and physical well being… before and after the delivery. If you are concerned about PPD, please discuss it with your WHP provider and she can help you get the care you need.
-Adapted from depressoinafterdelivery.com
Mammography Screening Debate Continues
Office Anesthesia Rules
The Illinois Department of Professional Regulation rules governing the administration of in-office anesthesia (deep sedation, regional and/or general anesthesia) state that physicians performing in-office anesthesia must complete 34 hours of continuing medical education (CME) in anesthesia within a 3-year license renewal period. Sixteen of the 34 hours must be completed by July 31, 2003, with the remaining hours completed by July 31, 2005. In compliance with these rules, Dr. Suzanne Trupin has completed the required CME hours.
Recent Publications
Hochwald L, and Walch A (Trupin SR et al [panelists]). “The Guide—Women’s Health”, Health. April 2003, pages 173-182.
Tune in to Focus 580
Dr. Suzanne Trupin is a monthly guest on WILL Focus 580 (call-in radio talk show), which addresses women’s health topics. She can generally be heard the fourth Monday of each month at 10 AM on WILL Radio (580 AM) or tune in on Internet radio at www.will.uiuc.edu. Call in to ask Dr. Trupin questions at 217-244-9455, 217-244-WILL, or 1-800-244-WILL. Mark your calendar for these upcoming dates: May 19, June 23, July 21 (11 AM), August 25, September 22, October 27, November 24, and December 22.
In order to better serve our patients and offer easier access to our services, we've added the following links to our website:
MAKE AN APPOINTMENT:
Instructions on how to make an appointment, and includes “Patient Information Form” and “Referral Form”, if being referred by a healthcare provider or facility, to download.
www.womenshealthpractice.com/appointment.htm
EMAIL US:
Access email addresses to schedule an appointment, speak to a nurse, speak to the doctor, and billing questions.
www.womenshealthpractice.com/contactwhp.htm
INSURANCE INFO:
Current list of insurance plans that WHP currently contracts as a preferred provider.
www.womenshealthpractice.com/insurance.htm
RESEARCH:
Contains list/ads of WHP currently enrolling research studies.
www.womenshealthpract.com/all_research.htm
NEWSLETTERS:
All published WHP newsletters available online.
www.womenshealthpractice.com/news.htm
SITE MAP:
Contains links to relevant pages of the entire website all in one place.
www.womenshealthpractice.com/sitemap.htm
MORNING AFTER PILL:
Information and instructions regarding the morning after pill.
www.womenshealthpractice.com/ma_pill.htm
BIRTH PLANS:
We are currently developing a birth plan. Since it is not yet available, this site offers links to a birth plans.
www.womenshealthpractice.com/birthplan.htm
We welcome your comments and suggestions regarding our website.
Blood Pressure Measurement
Kathleen Snyder, C.A.N.P., has completed Standardization of Blood Pressure Measurement as taught by Shared Care following Techniques and Guidelines recommended by the American Heart Association. In order to receive this recognition, Kathleen underwent an intensive three and a half hour course and testing.
Annual Board Certification for Certificate Renewal/Voluntary Recertification
Suzanne Trupin, M.D., F.A.C.O.G., and Elizabeth Campbell, M.D, F.A.C.O.G., have been recertified annually by The American Board of Obstetrics and Gynecology, Inc (ABOG). In order to achieve recertification, 180 questions corresponding to reading assignments in refereed articles encompassing the topics of gynecology, obstetrics, and office practice must be answered and submitted to the ABOG.
Special Thanks from WILL Radio to Suzanne Trupin, M.D.
In their “Special Thanks to Our Colleagues at the University of Illinois”, WILL radio recognized Dr. Suzanne Trupin for her contribution and willingness to enrich their programming services. Dr. Trupin is a featured guest on WILL Focus 580 (call-in radio talk show), which addresses women's health topics. She can be heard the fourth Monday of each month at 10 AM on WILL Radio (580 AM) or tune in on Internet radio at www.will.uiuc.edu. Call in to ask Dr. Trupin questions at 217-244-9455, 217-244-WILL, or 1-800-244-WILL. Her next scheduled radio shows are November 25 and December 23.