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Shrinking Vacation Syndrome - it could happen to you! 2007-07-13 12:45:16 Talking to people about their summer plans, I've come up with a new term that I think could become a new diagnosis if the trend continues: ShrinkingVacationSyndrome
, or SVS.
Sadly, people do not seem to put a priority on family vacations any more.The answers are always similar variations of the same few themes:
no time, no money, kids too young, kids too old. Work needs me too much. (I love that one!) No one to watch the kids.
We earn vacation yet don't take it, unlike every other country in the world. At the same time, we are also the only civilized country that doesn't guarantee vacation to employees. No wonder we are all so stressed.
Vacation is as vital to our beings as breathing, eating and sleeping. Vacation is how we regroup as individuals and family. Vacation is not frivolous or a waste of time. In fact, vacation is how we sharpen our senses so we can become more efficient when we do work.
For families, vacations allow for reconnection which is so important with liv
The Latest on Selenium Supplements 2007-07-10 12:24:15 If a little is good, more must be better, right?
Unfortunately too many people believe this when it comes to taking dietary supplements. Some vitamins and minerals are actually harmful when taken at high dosages.
Take selenium for example. Selenium
functions as an antioxidant in the body, working with vitamin E and thyroid hormone. The daily requirement for adults is 55ug per day, however toxicity can develop with intakes over 400ug per day. Toxicity symptoms include loss and brittleness of nails and hair, irritability, fatigue, nervous system disorders and garlic breath odor.
You can also add increasing the likelyhood of developing Type 2 diabetes to the list if results of a recently published study prove to be accurate. I'll spare you all the details of the study (however if you are interested, click here), but essentially what these researchers found was that long term doses of 200ug per day of selenium raised a person's chances of developing Type 2 diabetes.
As in an
Miscarriage and the Immune System (antibodies) 2007-07-05 19:16:08 As many of you have noticed, I have been avoiding this one. It s just too controversial. Actually, there are many known facts but very little data.
Let s start with what we know. We know that there are people out there who have high levels of antibodies who have miscarriages. Who are these people? They have the anti-phospholipid syndrome . Which is? A condition whereby the body makes antibodies against its own cells. We all have antibodies that help us fight disease and none of us would be here if it were not for antibodies. Some, probably many of us, have extra antibodies that don t fight disease, but rather fight ourselves. These are auto-antibodies. Probably the most common are the thyroid antibodies; antibodies that the body makes that attack the thyroid gland. Up to 10% of women have thyroid disease, and the vast majority is due to antibodies against the thyroid that slowly destroy the gland making it under-active (Hashimoto s Thyroiditis). Grave s Disease is thyro Read more:Immune
, System
Mr. Orszag's Surprise 2007-07-03 17:02:43 by Brian Klepper
Over at the always excellent and entertaining Health Care Blog last week, my pal Matthew Holt pointed out a new report on the nation s health care spending dynamics by the Director of the traditionally non-partisan Congressional Budget Office (CBO), Peter Orszag. Unlike political appointees on the right or left, Mr. Orszag appears to be, as you d hope, a straight shooter who is deeply appreciative and fearful of the impending impact of publicly-financed health care s runaway spending practices. Part of what makes his message so compelling is that it is absent partisanship. He's clearly interested simply in what is good for America.
In addition to the obvious trends that are breathing down our pocketbooks the graying and plumping of America he focuses particular attention on the cost explosion and one of its principle drivers: rampant, huge practice variation. For example, he notes:
Over the past four decades, Medicare s and Medicaid s costs per be Read more:Surprise
Deciphering Organic Food Labels 2007-07-03 11:24:54 Its no secret that sales of organic foods are booming. In 2004 alone, $20 billion was spent by American consumers for organics, and this figure is expected to rise to $30 billion in 2007.
Its no secret that organic foods cost more than their non-organic counterparts, but apparently consumers are willing to pay more for the perceived benefits of these foods.
What seems like a secret is how to read organic food labels.
What does the Certified Organic
seal actually mean?
Any food that bears the seal must meet certain criteria. First of all the seal guarantees that the food grower has been inspected by a US Dept. of Agriculture (USDA) - accredited agency. This ensures that no synthetic herbicides, pesticide Read more:Labels
Believing In Wellness 2007-07-02 11:08:41 Getting ready for work the other day, my 12 year old developed an ear ache. I knew it was nothing serious given her age and the fact that only minutes before she was fine. Yet, the temptation was too great to not take a quick peek. That is the blessing and curse of being a doctor-mom! So, peering in I confirmed what I already knew: nothing was going on. True, she had a tad of fluid from allergies but I didn't need an otoscope to know that since she was a known hay fever sufferer and the pollen count was through the roof that week. A touch of over the counter ibuprofen and allergy meds later, she was on the road to feeling better and without a real doctor's visit.
It occurred to me as I was driving to work that my day would likely be filled with similar complaints, as typical. Despite the fact that most kids truly are well, parents often have times believing in that wellness and come in very quickly at the first sign of trouble, or perceived trouble. You may think that Read more:Believing
, Wellness
Phthalates and Sexual Development 2007-06-30 23:57:39 The shampoos, lotions, and deodorants you are using may be eroding the health of your children and of yourself. Research continues to mount regarding the harmful effects of phthalates on male development.
Phthalates have been shown to:
Increase the incidence of cryptorchidism (failure of testicles to descend)
Increase the incidence of hypospadias (an abnormal condition in males in which the urethra opens on the under surface of the penis)
Increase the incidence of testicular cancer
Decrease fertility
The effects of phthalates are most pronounced when exposure occurs to the fetus. Phthalates are a group of chemicals used primarily as a preservative in personal care products such as deodorants, shampoos, lotions, and creams. Most often, phthalates are listed in the ingredients of these products.
Reducing your exposure is very simple do not buy any products containing phthalates (if the word phthalate is in the ingredients section, do not buy it the word will often c Read more:Sexual
, Development
Building a Better Brain 2007-06-30 23:39:43 Memory is a skill that most of us would like to sharpen. In addition to providing us with convenience and confidence, memory is a sign of our overall health. Your brain is not separate from the rest of your body it is totally integrated with each and every one of the ten thousand trillion cells that make up your body.
All of the same strategies that help to develop our memory develop the rest of our brain function as well; our ability to learn new skills, assimilate new information, and to make better decisions can all be improved with effort.
There are several crucial factors that result in excellent memory, here are the major ones:
Excellent Blood flow is essential for optimal memory. Much of what we know to be senile dementia , or forgetfulness due to aging, is do to tiny obstructions in blood flow. In fact, we now know that even in people over 50 with normal memory, nearly half have silent brain infarcts . These are small areas of the brain that have a Read more:Building
, Brain
Three Reasons to Buy Organic 2007-06-30 23:30:27 Investing in organic foods is a choice that benefits you, your children, and the planet.Setting aside the environmental and planetary reasons for choosing organic, consider the following:
Organic
foods are higher in nutrients, far higher. Putting theory aside and actually testing produce for its nutritional content is the only way to settle the question, is organic food higher in nutrients? Over and over again researchers who perform such tests come up with the same answer; YES! Consider the graph below[i]:
Other research has confirmed these findings, and more recent findings demonstrate higher
levels of health-giving nutrients in addition to vitamins and minerals.
Total Phenolic (TP) content of food has demonstrated a beneficial role on human health. Researchers recently reported Statistically higher levels of TPs were consistently found in organically and sustainably grown foods as compared to those produced by Read more:Three
, Reasons
Antioxidants: What and Why 2007-06-30 23:24:37 What s all the buzz about antioxidants? What s a free radical? What s oxidation? Why should I care and what should I do about it? This article will answer these questions.
The number one reason you should know about antioxidants, free radicals, and oxidation is that you will sound extremely intelligent at dinner parties. The number two reason is that oxidation is involved in the major epidemics of our time cancer, heart disease, and dementia. Learning how to combat the oxidative process will allow you to make excellent decisions about your health!
We ll begin with oxidation. Oxidation can mean several things the scenario we re concerned with here is the process whereby a molecule either contains oxygen or is combined with oxygen, and the oxygen loses an electron. When the oxygen loses an electron it becomes an unstable substance known as a free radical. This unstable molecule tries to steal an electron from another molecule. This can set up a cha Read more:Antioxidants
Curcumin for Scleroderma 2007-06-30 23:10:38 Recent research shows that curcumin, a component of turmeric, may benefit people who suffer from scleroderma. Scleroderma is a disorder where the body produces excessive amounts of connective tissue called collagen. This fibrous tissue builds up in the skin and other organs and can disrupt their function. Researchers in South Carolina found that curcumin causes cell death in scleroderma lung fibroblasts--the cells that produce too much collagen in the lungs, but not in normal fibroblasts. This means that the herb interferes with the bad fibroblasts, but not the normal ones.
The researchers concluded curcumin may have therapeutic value in treating scleroderma . This is especially appealing as a treatment modality because curcumin is extremely non-toxic and is beneficial for a host of other disorders including many cancers, heart disease, and Alzheimer's disease.
Many people with scleroderma also suffer from Raynaud's syndrome, and can greatly benefit from taking a high q
Meeting Your Doctor: What are You Thinking, What is the Doctor Thinking? 2007-07-26 17:58:10 This topic was suggested by a woman who had been my patient years ago. We continue to communicate regularly and she recently told me of the thoughts and feelings that she brought into my office at the first visit. She told me that she had a number of beliefs that made her at first very uncomfortable. They had nothing to do with me as she had them before we met.
I was surprised by what she now said, and I explained that her assumptions were really off the mark, but she insisted that she was not alone in her thoughts. So let s see what you think.
She thought:
1) She felt that she was going to be a burden on me. She figured I was really busy doing important things, and seeing her was just an interruption to my demanding day.
2) She was worried I was going to make her feel foolish.
3) And of course, if she were to foolish, she would by default go on to feel guilty for being a fool.
I thought:
1) I probably checked my schedule a week in advance to see who was coming to see me. I re Read more:Doctor
Don't touch that Dora! 2007-08-02 17:56:41 A huge Fischer-Price toy recall was announced yesterday. Over 1 million toys made in China may contain excessive amounts of lead paint which as you know is toxic to small children and infants. The toys were sold between May and August, 2007 and represent Nickelodeon and Sesame Street characters.
Here are the key links to sort out if you have the toys being recalled:
Mattel Recall Information Page
List of Nickelodeon and Sesame Street Toys with the Lead Paint Hazard
The American Academy of Pediatrics recommends that all kids get screened for lead between the ages of 1-2. Some kids may get screened again if they live in older homes depending on their risk. If you have these toys at home, and your kids have not played with the toys, you have little to worry about. However, if your kids have been playing with these toys, there still may be nothing to worry about. If your kids have been playing with the toys properly, there is little risk to them. The risk comes when they ingest the Read more:touch
Let s Go Over Some Questions3970 2007-08-08 14:43:12 Some of you have asked about DHEA, Sperm Fragmentation, and Varicocele. Eventually I will get to these, but don t hold your breath waiting. The problem is I will not give high marks to any of these. If I write about each one in succession, I am afraid that all of you will say, That Dr. Licciardi, he doesn t believe in anything! I do believe in time tested things that have been shown to work, of which there are many, although I realize you are reading this because nothing has worked well so far.
Cathi had a killer response to my 7/22/07 blog. I am sorry that you had to hear all of those remarks.
Luteal Phase Defects, I ll get to this. If you had 11 miscarriages, why not take progesterone?
Side effects of ICSI: We are not sure. We know that there are many children alive today that would not be here if it were not for ICSI. So clearly there is an indication for ICSI. Is it more risky? WE don t know (which is likely to mean no). We do know t
Too Young To Treat4035 2007-08-17 09:26:29 With cold and flu season upon us (yes, I know, you are still wearing shorts but before long that will change!), there is no time like the present to remind ourselves that small children should not use cold and cough medications. I talked about this a few months ago after the FDA warned us of the dangers of popular over the counter cold and cough medications in infants and toddlers.
In October, the FDA is convening an advisory panel to look into the safety of these drugs much more closely. The FDA is particularly concerned with drug dosing and helping parents give the proper medication doses to their children. To this end, this week, the FDA released a Public Health Advisory on Nonprescription Cough and Cold Medicine Use in Children emphasizing the need for parents to follow the labels closely, especially the Drug Facts box. The goal is to give the proper dose of medication and to avoid giving too much of a dose to a child.
Additional FDA recommendations from the advis
The Follicular Phase and the Luteal Phase1456 2007-08-17 07:06:09 So you ve been to the doctor and you were told you have some sort of defect, and you feel so happy that despite all you have been through some joker is now saying you re defective: super.
Are you defective? Possibly, but probably not. Luteal Phase Defect, what does it mean? It has to do with the functioning of the menstrual cycle, so let s go over that first.
The typical menstrual cycle, from the first day of bleeding to the next first day of bleeding, is divided into 2 parts. The first is from day 1 till ovulation. It s called the follicular phase, because the most important thing is the growing follicle (the fluid filled cyst that holds the egg). If you are taking fertility drugs it s the same, except that there may be more than one follicle developing at the same time. Here the main and most important hormone is estrogen, which comes from ovarian cells that surround the egg in the follicle (these are called granulosa cells). So estrogen does not come from the egg itself.
What's In Your Toy Box 2007-08-15 14:11:30 This is getting really scary. First Fisher-Price. Now Mattel, the parent company itself. The Mattel scare announced today is even more alarming because the risk to kids more immediate and potentially fatal. Thankfully, no child has been injured by any of these toys but the toys being recalled have elements that have caused fatalities in the past so this is not a false alarm. According to the official press release from Mattel's website, there are two groups of toys being recalled that are actually expansions of past recalls: Mattel, Inc. announced today that the company has voluntarily recalled one toy from the CARS die-cast vehicle line ( Sarge character), manufactured between May 2007 and July 2007, containing impermissible levels of lead. The recalled vehicles include 436,000 total toys, including 253,000 in the U.S. and 183,000 outside of the U.S. ...Additionally, Mattel announced the voluntary recall of magnetic toys manufactured between January 2002 and January 31, 2007,
Luteal Phase Defect47843731 2007-08-25 19:52:24 As the cycle progresses there are changes that we can see in the endometrium. To see these changes, an office biopsy must be performed and the tissue needs to be examined under the microscope. This is the endometrial biopsy . Through the follicular phase, the only change is that the tissue gets a bit thicker, so we don t biopsy here, we wait till after ovulation (the luteal phase). In the luteal phase the changes are very real. From day to day (or every couple of days) we can see changes in the cells. On day 16 the cells of the endometrium look different than they will on day 19, 22, 24 etc. In references books there are pictures of what the cells should look like on certain days, and your infertility doctor may have been trained (I was) to look at the cells and figure out what day in the cycle the cells were taken. How are we counting the days? Day 14 is the day of ovulation. It does not matter if ovulation occurred 9, 11, 14, 18 days from your last period, ovulation day we art
Four Simple Clicks Will Help You Have a Baby 2007-09-17 14:24:18 This article was written by one of my patients, Debbie Denenberg, a Choice Mom of 4 year old twins. It will appear in Choice Mom Guide to Fertility by Mikki Morrissette, available for purchase in November 2007 on www.ChoiceMoms.org. My patient is right on about using the SART statistics to help chose a doctor and she shows you how. Here it is:
I was a lucky one. Because I found Dr. Frederick Licciardi at NYU Fertility Center, I gave birth at age 42 to boy/girl twins. My experience taught me one of the most important first steps in seeking infertility treatment: all doctors are NOT created equal, and with a few easy clicks you can find the best doctor in your area.
Infertility is one of the ONLY fields of medicine where the lay person can actually compare medical results, because success rates of infertility clinics nationwide are reported and accessible. This fact is exquisitely, crucially helpful to the woman seeking to become pregnant.
Here s how easy it is. Go to www.sart Read more:Simple
, Clicks
Luteal Phase Defect 3 2007-09-05 19:10:46 So we thought we had it all figured out. There were many studies establishing what the ideal biopsy should look like for each day. But then science started changing for the better and some important issues were raised.
First, the original studies of luteal phase defect were done using the day of temperature rise as the day of ovulation (LH kits and fancy automated blood test machines were not yet invented). It is true that in many women the temp rise signifies ovulation and there are plenty of web sites dedicated to the temperature rise. However, the temperature rise is not completely accurate and could be off by a day or 2. So if luteal phase defect is all about timing (the day in the cycle after ovulation) the original studies were flawed because they used a less reliable method for timing the day of ovulation.
Second, even highly trained reproductive endocrinologists differ on their opinion on what the biopsies for each day should look like (even using the book) . If you giv
Elmo Helps Kids Touched By War9082 2007-10-09 14:49:55 There was a poignant line in Brothers and Sisters last night. Senator McCallister's campaign director felt he needed to be more positive and asked suggested he stopped attending funerals of soldiers. At the end of the show, McCallister turned to his campaign director and said: To answer your questions about when I'll stop going to funerals. I'll stop when the last soldier is home.
It is easy to forget that the Iraqi conflict is about real people and real families but that is what we have to keep our focus on. The show last night aired some serious issues about the battles soldiers face when they return home - the medical and emotional issues and the toll on the family including the lost feeling they feel.
Sesame Street last week announced that they are developing a DVD to help children whose parents have been injured during war. In the DVD, Rosita's daddy loses a leg and comes home an amputee and is seen in the DVD in a wheelchair. The children of soldiers are soldiers themsel Read more:Touched
More About Pregnancy Rates 2007-10-06 20:59:31 The pregnancy rates issue raised a few important questions. I agree, there are some programs who try to stack their numbers by rejecting patients who are very difficult. I do think this happens less often than you might think. Can you figure out who these clinics are? The rumor mill helps but it s not the best system. The program's numbers may give you hints.
Look at the pregnancy rates for the women under 35. Yes, there are some women in this age group who have high FSH and/or are poor responders but the vast majority of women in the age group are ok. So if a program takes hard patients in this age group, there should be enough easier patients to still give the group as a whole a high pregnancy rate. If a center has high rates in the younger patients but lower for the older patients, they are probably not selecting.
Even better, go to the donor egg stats. There is no selection when it comes to donors. If the program has low pregnancy rates in the donor egg patients, they probably Read more:Pregnancy
, Rates
Why is Progesterone Used for IVF? 2007-10-19 08:50:08 Thank you Kami for the question.
In a natural cycle, progesterone is made by the corpus luteum(CL)(see blog from August 17, 2007). In most cases it s just one, and for many millions of women around the world, this one little CL puts out enough progesterone get the job done. During IVF, there are usually many more than one CL, and therefore one might expect that there should be plenty of extra progesterone produced and available for the pregnancy. So why give more? There are 2 reasons.
The first is that the natural CL and the extra CLs that are produced during ovulation induction with insemination are different than the CL of IVF. The CLs of IVF were all disturbed by the IVF needle. The CLs from IVF all started as follicles containing eggs. At the retrieval, the needle is placed into the follicle, the egg is removed, and other cells can also be removed. The follicle is mostly fluid, but it also contains tons of cells that make up the follicle and surround the egg. These are called t
Some More Fertility Quick Answers 2007-10-30 18:48:20 The questions was: is it necessary to take progesterone if you are doing clomid or FSH injections with iui? The answer is that you may not need progesterone for these cycles because the ovary can do a great job of producing high levels of progesterone. The corpus luteum is not disturbed by an IVF needle. Also, we usually do not give lupron or antagon or cetritide for an IUI cycle. Personally, I usually do not give progesterone for IUI, but I will in some select cases. Some doctors give progesterone because of the high estrogen levels produced by the fertility drugs. They feel that if the estrogen is high, the progesterone needs to be high too. This is a theoretical concept and has not been shown to be valid for women on fertility drugs. Certainly if the period is coming early after the iui, progesterone should be considered.
HA stands for Hypothalamic Amenorrhea, which is when there are no periods due to extreme exercise, stress, etc, despite a good number of resting foll Read more:Fertility
, Quick
What s a Fibroid? 2007-11-20 06:55:21 A fibroid is an abnormal growth in the uterus. We also call them myomas. I say abnormal because a fibroid shouldn't be there, however so many women have fibroids we consider them common. How common are they? At least 30% of women have fibroids. I have recently heard that some say that up to 60-70% of women have fibroids, although that sounds a little high to me.
How do they get there? We don t know how they start. We do know that they grow in response to estrogen. They are not seen prior to puberty and get smaller after menopause. It seems that each fibroid starts as one fibroid cell, and this cell keeps dividing resulting in a large fibroid. Even though they come from the cells of the uterus, they do look different than the normal uterine muscle. They are whitter because they have few blood vessels, and they are firmer, about the consistency of a potato. We don t know why some women have only one; some have 40.
Fibroid
size and a word about centimeters. Most medical things are
Fertility and Diet 2007-12-06 08:22:52 As I walked from the elevator at my usual 7:00 am, I glanced through the waiting room and something caught my eye: a pregnant woman on the cover of Newsweek captioned by Fertility
and Diet. Oh no, I said to myself. Here come about at million questions! So I figured I would read the article and take the time here to go through some things; beat you to the punch.
According to the article, diet the recommendations are aimed at preventing and reversing ovulatory infertility. This goes back to my blogs on PCOS. Therefore if you already ovulate regularly, the diet issue does not apply to you.
It appears that women with better diets had more regular ovulation. Brilliant. Lets start with carbs. The article shows that carbs are fine, but women who ate more healthy carbs , such as brown rice, pasta and dark bread, whole grains, beans and vegetables, and whole fruit, ovulated more than those who loaded up on white rice and potatoes. Sounds familiar. For any medical
This Just In....Teens Are Moody and Tweens Swear!46199740 2008-02-26 14:31:54 From the files of tell me something I don't already know , comes this study. The headline is sure to catch the attention of every parent of a teen, or tween for that matter: Teen Brain May Be Wired for Moodiness .
I could have told them that! In fact, they could have videotaped my morning today for a wonderful example. One minute we are happily eating breakfast and the next my 13 year old is grabbing her backpack and huffing out the door as her friend arrived to walk to school. The instigating event: her sister had asked her to move her backpack from the breakfast bar so she could have room to eat, and my 13 year old felt that request was inconvenient . It was a lovely family moment.
Softpedia has a great summary of other brain changes in teenagers that explain just about every behavior Read more:Teens
, Moody
, Swear
Fertility Questions: SCSA 2008-02-19 09:31:12 I am going to continue with the response to questions for a bit more. This time I will start with the most recent and work backwards. Here I will address the SCSA question. I will continue to get to the other questions as the blogs roll out.
The SCSA: I do not order this test. Maybe someday I will, but I need more science. When a new test comes out (I know it s been out for years, but it s relatively new and not universally performed), there are a few reasons that it becomes popular.
One is that it is a great test and can really distinguish between who is fertile and who is not. Another reason is that some company is making tons of dough and can afford to spend a lot of money convincing your doctor this is a must do test. Another is that some doctors do some quick and dirty research, Read more:Fertility
More Fertility Questions Answered 2008-02-08 12:47:42 I have not answered questions since October, so here we go.
Because it s been a while, sorry if my answers are a little late for those asking, but I hope other readers will have the same questions and learn from the dialogue.
A woman wrote in frantically about her new experiences using Clomid. In fact she was do distraught, she was really concerned about getting pregnant with her second child even though she was not yet pregnant with her first. Yes Clomid can make you extremely emotional, but no one should really be over the edge. If you feel like this woman, get counseling (which more people really should do) or get off Clomid, or both.
Antral follicle counts are only a guide. If you have a total of 11, you don t really know how the cycle will work out. 11 is a very adequate number Read more:Fertility
Minimal Stimulation 2008-01-21 09:00:58 Does taking a lower dose of fertility drugs improve your chances of becoming pregnant with IVF? I think not, but I can tell you of some exceptions. Mostly I have had some very good experiences with patients confirming that lower is not better.
How do I know?
Well, as it turns out over the past few years I have been seeing more patients from Europe. There are a few things that have contributed to this. One is the blog. It s been fun getting e-mails and seeing patients from around the world. The second is the exchange rate: for some, New York is now a reproductive tourism destination. The third has to do with laws in Italy, Germany and other countries that restrict IVF and donor egg.
Anyway, the European doctors give their patients a much lower dose of drug that we do in the US. P Read more:Minimal
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