September 2003, Volume 3, Issue 3
Special Points of Interest (click topic)
Bone Densitometry
Ongoing Clinical Trial
ACOG Summary of Recommendations
Breast Density
In The News...
Unintended Pregnancy Among Married Women
Your Child's Sleep
WHP Lecture Series
Direct Patient Access to Laboratory Results
Health Highlights
ACLS Certification
__________________________
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) recently acquired a new, state-of-the-art LUNAR® bone densitometer. The PRODIGY™ is the premier device for axial measurement of bone density. Previously, evaluating bone density using conventional x-ray systems did not reveal a potential problem until 25-30% of bone density had been lost. This highly sensitive densitometer identifies bone loss at an earlier stage. One in three Caucasian women over the age of 50 has osteoporosis. A 50-year-old woman has a 40% chance of suffering an osteoporotic fracture in her lifetime. Osteoporosis is a debilitating disease that affects millions of people every year. However, early detection of this disease can lead to effective treatment.
Following are risk factors for osteoporosis:
- Small, thin frame
- Female
- Asian ancestry
- Never taken estrogen
- Excessive caffeine intake
- Family history of osteoporosis
- Avoidance of dairy foods
- Low vitamin D intake
- Rheumatoid arthritis
- Excessive alcohol intake
- Smoker
- Caucasian ancestry
- Sedentary lifestyle
- Early menopause
Our new PRODIGY™ bone densitometer measures changes in bone density precisely, providing invaluable information in the assessment of metabolic disease. The exam is comfortable, fast, and safe. You typically spend only minutes reclining fully-clothed on the densitometer. Radiation exposure is very low-equivalent to 1/10th of the dosage received in a normal chest x-ray. Our densitometer measures common fracture sites (proximal femur, spine). A WHP staff member is with you at all times. The immediate results include comparison to reference populations and assessment of the risk of fracture. Immediately following the exam, you will have a direct consultation with the physician to discuss your results. In addition to hard copy results, you can receive an email of your results if you wish.
Example: Spine bone densitometer results
WHP will contact your insurance prior to the test regarding precertification requirements, and honors preferred provider contracts with BCBS, Cigna, PersonalCare, Healthlink, Consociate Preferred Plan, Integrated Health Plan, Fortified Provider Network, PHCS, BCE Emergis, MCS, Tricare/Champus, United Healthcare, and Medicare.
We also offer wrist scans, which are less expensive for patients who may not have insurance coverage for full DEXA scans.
Additionally, WHP offers body fat analysis, which is an excellent tool to assess weight loss therapies, endocrine/growth disorders, and secondary osteoporosis. However, this analysis is not usually covered by insurance but is useful for patient management.
Dr. Suzanne Trupin, Judy Gallivan, R.D.M.S., and Jan Dedrick, C.M.A. successfully completed the enCORE™ APPlaud Applications Training Guide as designated by the American Society of Radiologic Technologists, which recognizes that they have passed a comprehensive exam, including proper patient handling and positioning, measurement and analysis procedures, scanner familiarization, and system safety.
We are excited to offer the convenience of in-office bone densitometry to our patients. For more information or to schedule your bone densitometry, please contact Women's Health Practice.
Enrolling Clinical Research Study
Pelvic Pain and/or Infertility
Women's Health Practice is currently enrolling patients for a research study to evaluate the safety and effectiveness of a study material used to reduce post-operative adhesions (scar tissue), a common cause of infertility and possibly pain.
If you are a female, aged 18 years or older, and willing to have a second laparoscopy (surgery by small incision) performed in addition to the initial laparoscopic surgery, please call us to see if you qualify. Qualified participants will receive:
- Study-related medical exams
- Laboratory tests
- Study material
- Second surgery at no cost
For more information regarding specific study enrollment criteria, to receive a brochure about being a research participant, and/or to see if you qualify, please contact Louise Adam, Clinical Research Coordinator, or Kathleen Snyder, C.A.N.P., at:
Louise.Adam@womenshealthpratice.com
Kathleen.Snyder@womenshealthpractice.com
or call 217-356-3736, ext. 118 or 127.
ACOG Summary of Recommendations
CERVICAL CYTOLOGY SCREENING:
Both the incidence and mortality from cervical cancer have decreased by almost one half since the early 1970s, which is largely attributable to widespread screening with the Pap test. New recommendations for classifying and interpreting the results are evolving.
The following recommendations are based on good and consistent scientific evidence (Level A):
- Annual cervical cytology screening should begin approximately 3 years after initiation of sexual intercourse, but no later than age 21.
- Women younger than 30 years should undergo annual cervical cytology screening.
- Women aged 30 years and older who have had three consecutive negative cervical cytology screening test results and who have no history of CIN 2 or CIN 3, are not immunocompromised and are not HIV infected, and were not exposed to diethylstilbestrol in utero may extend the interval between cervical cytology examinations to every 2-3 years.
- Evidence-based data indicate both liquid-based and conventional methods of cervical cytology are acceptable for screening.
- Women who have undergone hysterectomy with removal of the cervix for benign indications and who have no prior history of CIN 2 or CIN 3
or worse may discontinue routine cytology testing.
The following recommendations are based on limited and inconsistent scientific evidence (Level B):
- The use of a combination of cervical cytology and HPV DNA screening is appropriate for women aged 30 years and older. If this combination is used, women who receive negative results on both tests should be rescreened no more frequently than every 3 years.
For further information regarding cervical cytology screening recommendations for your individualized care, please contact or speak to your Women's Health Practice physician or nurse.
Pelvic exams are more than just a Pap test. Discuss with your WHP provider what is best.
Cervical Cytology Screening, ACOG Practice Bulletin 45:102(2), August 2003.
BREAST CANCER SCREENING:
The most common malignancy among U.S. women (excluding skin cancer) is breast cancer.
The following recommendations are based on limited and inconsistent scientific evidence (Level B):
- Women aged 40-49 years should have screening mammography every 1-2 years.
- Women aged 50 years and older should have annual screening mammography.
The following recommendations are based primarily on consensus and expert opinion.
- Despite a lack of definitive data for or against breast self-examination, breast self-examination has the potential to detect palpable breast cancer and can be recommended.
- All women should have clinical breast examinations annually as part of their physical examination.
Breast Cancer Screening, ACOG Practice Bulletin 42:101, April 2003.
Breast Density Can Affect Cancer Screening
Density on mammograms is due to a high proportion of stromal, ductal, and glandular tissue. There is less breast density because of aging, and increasing body weight with the glandular tissue being replaced by fatty tissue.
Denser breasts are correlated with a 4-6 fold increased risk of breast cancer and an additional worry as density might obscure detections of breast masses on mammography. In turn, density can cause false positive read outs on mammograms.
In general, women who use hormones are more likely to have dense breasts. About 50% of women who use hormones will have "dense" breasts on mammography as compared to about 1/3 women who do not use hormones. It is more likely to become an issue in older women on combined estrogen and progesterone therapy, and occurs within the first year of hormone use. The effect rapidly disappears with discontinued hormone use. It is thought, therefore, that density caused by hormone use is not really the same thing as a woman with naturally dense breasts. The naturally denser breasts probably have some epithelial cell proliferation whereas the woman on hormone therapy probably has a combination effect of tissue edema and vasodilatation.
For a difficult to read mammogram, it could be recommended to discontinue hormone use and repeat the test in two weeks. Many alternatives to hormone therapy exist.
If you have questions regarding mammography recommendations, mammography itself, or hormone therapy, please ask your WHP healthcare provider.
In The News...
Rapid HIV Test Approved
The Food and Drug Administration recently approved a new test designed to detect HIV-1 antibodies. The finger stick blood sample test will provide test results in approximately 20 minutes and yields a 99.6% accuracy rate. Prior to the rapid HIV test, patients were required to go to their physician's office or health clinic for test results; however, many individuals did not actually return for their results. The rapid HIV test is hoped to significantly impact the U.S. epidemic. The availability of a quick, easy, accurate HIV test will allow broader access to HIV diagnostic testing, help link those already infected to treatment and care services, and will allow those who are uninfected but at risk to avoid infection through prevention services. In an ongoing effort to offer progressive and convenient healthcare, WHP now offers the rapid HIV test; the fee is $45.
For more information regarding this test or other laboratory tests offered by WHP, please ask your WHP healthcare provider.
Illinois Contraceptive Equity Law
In July 2003, Illinois became the 21st state to pass contraceptive equity legislation. The new Illinois Contraceptive Equity Law, which was signed into law by Gov. Rod Blagojevich on July 7, prohibits insurance companies that already cover prescription drugs and devices from excluding coverage for FDA approved prescription contraceptive drugs. In addition, the bill requires plans that cover outpatient medical services to also cover contraceptive services such as consultations, examinations, and procedures related to pregnancy. The law takes affect on January 01, 2004.
Unintended Pregnancy Among Married Women
The typical American woman marries at age 25, has her first child at age 26, and achieves her desired family size of two children by age 31. Thus, she potentially spends at least 20 years of her married life trying to avoid additional pregnancies.
Government policies promoting “healthy marriage” should include family counseling to help couples avoid unintended pregnancy. Large numbers of married women in the United States experience unintended pregnancies, abortions, and unwanted births each year-stressful events with emotional and financial costs that potentially undermine marital stability. Most recent data shows:
- 30 million women of reproductive age are currently married.
- Nearly 1 million married women in this country experience an unintended pregnancy each year.
- Almost 4 in 10 unintended pregnancies to married women end in abortion.
- 17% of all abortions occur among married women.
- 56% of married women who had an abortion in 2000 were practicing contraception in the month they became pregnant; most women cited inconsistent use as the reason they became pregnant.
- 2.5 million married women and their husbands are potentially at risk of sexually transmitted diseases (STDs) because of infidelity.
All couples, married and unmarried, need accurate information about the probability of pregnancy when contraceptives are not used, as well as the importance of consistent and correct use of methods to avoid unintended pregnancy and STDs.
WHP offers all types of contraception, including pills, patches, IUDs, and tubal ligations. Talk to your provider to find the best option for you.
Adapted from The Guttmacher Report 6(2):May 2003.
How Much Sleep Does Your Child Need?
With the new school year upon us, summertime sleep habits die hard. Early school start times can deprive your child/children of essential sleep.
Research studies have demonstrated sleep deprivation, which results in daytime sleepliness, has significant effects. Sleep deprivation may present itself as inattention, poor concentration, moodiness, behavioral problems, and poor academic and social skills.
From preschool through high school (and beyond), many children are chronically sleep deprived. More than one third of elementary school-age children have some type of sleep problem and many adolescents do not get enough sleep. Many will, therefore, struggle to meet the challenges, demands, and emotions of school. How much sleep do children need?
Given that children do not outgrow sleep problems, the sleep problems of childhood can persist into adulthood. Teaching your child good sleep habits may improve their grades and behavior.
Women's Health Practice will sponsor a monthly women's health lecture series beginning February 2004. Topics include weight loss, PMS, new developments in contraception, herbal preparation, and hormone imbalance. Further information will be available in upcoming newsletters or by contacting Women's Health Practice at 217-356-3736.
WHP Offers Direct Patient Access to Test Results
In order to increase communcation with your Women's Health Practice provider, we have implemented LabCalls®, a personalized laboratory-test-result system. This system allows you to retrieve your laboratory results 24 hours a day, 7 days a week, at a time most convenient for you.
We have implemented this system because we understand your time is valuable and believe it is the most accurate and effective way for you to retrieve confidential information. We will update test results and leave personal messages for you with LabCalls®.
How does LabCalls® work?
After your scheduled appointment, you will receive a card with your Personal Identification Number (PIN) and a designated LabCalls® phone number (866-662-3045) and web address mytestresults.com. This card will have a date and time (approximately 10 days after your laboratory test(s) are performed) when you can retrieve your lab results. LabCalls® will document and confirm that you have received your test results. After receiving your test results, if you have additional questions or need more information, please contact a Women’s Health Practice staff member.
We would also appreciate your feedback or comments-positive or negative-regarding the LabCalls® system.
U.S. birth rate falls to record low.
The Health and Human Services Department announced that the 2002 U.S. birth rate was 13.95 per 1,000 persons. The major factor in the decline is the reduction in births to teenagers. Another factor is the aging population. The latest figure is the lowest in government records that go back to the turn of the 20th century. The percentages of premature and low birth weight babies, however, climbed to the highest level in more than 30 years despite greater access to prenatal care.
The world’s first test tube baby turns 25!
In July 1978, Louise Brown was born as the world's first test tube baby as the result of the intertility treatment in vitro fertilization (IVF). According to the American Society of Reproductive Medicine, an estimated 114,000 babies have been born in the United States alone since then by IVF. Initially, IVF offered a 3-6% chance of pregnancy, but with medical advances, the rate has increased to nearly 23%. The cost of IVF can range from $5,000-$8,000, with an additional $2,000 for drug costs, per cycle, which still to date may or may not be covered by health insurance.
Historical Health Fact - Sister J. Ward, charge nurse of the Premature Unit of Rochford General Hospital, Essex, England, was a firm believer in the health benefits of sunshine and fresh air, and would wheel her infants out for sunning daily. One afternoon in 1956 she discovered that the yellow jaundice in an abdominal area of the skin, which inadvertently remained covered during the sunning, was much darker. It came to be understood that the photo-oxidation activity in the skin was beneficial for jaundiced infants.
In May 2003, Dr. Suzanne Trupin and Jan Dedrick, C.M.A., were recertified in Advanced Cardiovascular Life Support by the American Heart Association. In order to receive recertification, Dr. Trupin and Jan underwent an intensive two-day course. Congratulations for their achievement and commitment to continuing medical education and patient care.
