February 2015 - Page 2 of 3 - Comprehensive Women's Healthcare Comprehensive Women's Healthcare

Ling Chow

February 27, 2015

Osteoporosis

Osteoporosis is a disease in which bones become fragile and more likely to fracture. Usually the bone loses density, which measures the amount of calcium and minerals in the bone. Causes, incidence, and risk factors Osteoporosis is the most common type of bone disease. About half of all women over the age of 50 will have a fracture of the hip, wrist, or vertebra (bone of the spine) during their lifetime. Bone is living tissue. Existing bone is constantly being replaced by new bone. Osteoporosis occurs when the body fails to form enough new bone, when too much existing bone is reabsorbed by the body, or both. Calcium is one of the important minerals needed for bones to form. If you do not get enough calcium and vitamin D, or your body does not absorb enough calcium from your diet, your bones may become brittle and more likely to fracture. Sometimes bone loss occurs without any cause. White women are more likely to have bone loss. Sometimes the tendency to have bone loss and thin bones is passed down through families. A drop in estrogen in women at the time of menopause and a drop in testosterone in men is a leading cause of bone loss. Other causes of bone loss include:

Being confined to a bed

Certain medical conditions

Taking certain medications

Other risk factors include:

Absence of menstrual periods (amenorrhea) for long periods of time •A family history of osteoporosis

Drinking a large amount of alcohol

Low body weight

Smoking Symptoms

There are no symptoms in the early stages of osteoporosis. Many times, people will have a fracture before learning that they have the disease. Pain almost anywhere in the spine can be caused by fractures of the bones of the spine. These are called compression fractures. They often occur without an injury. The pain may occur suddenly or slowly over time. There may be a loss of height (as much as 6 inches) over time. A stooped posture or kyphosis (also called a “dowager’s hump”) may develop. Signs and tests Bone mineral density testing (most often with a DEXA scan) measures your bone mineral density. Your health care provider uses this test to:

Diagnose bone loss and osteoporosis

Predict your risk of future bone fractures

See how well osteoporosis medicine is working A spine or hip x-ray may show fracture or collapse of the spinal bones. However, simple x-rays of other bones are not very accurate in predicting whether you are likely to have osteoporosis. You may need other blood and urine tests if your osteoporosis is thought to be due to a medical condition, rather than simply the usual bone loss seen with older age.

Treatment for osteoporosis may involve:

Lifestyle changes, such as diet and exercise

Taking calcium and vitamin

Using medications Medications are used to strengthen bones when:

Osteoporosis has been diagnosed by a bone density study, whether or not you have a fracture.

A bone fracture has occurred and a bone density test shows that you have thin bones, but not osteoporosis.

Medicines used to treat osteoporosis include:

Bisphosphonates (the main drugs used to prevent and treat osteoporosis in postmenopausal women)

Estrogens, teriparatide, raloxifene, and calcitonin Exercise plays a key role in preserving bone density in older adults.

Some of the exercises recommended to reduce your chance of a fracture include:

Weight-bearing exercises — walking, jogging, playing tennis, dancing

Free weights, weight machines, stretch bands

Balance exercises — tai chi, yoga

Rowing machines

Avoid any exercise that presents a risk of falling, or high-impact exercises that may cause fractures in older adults.

Your body needs calcium and vitamin D to keep your bones strong. Vitamin D helps your body absorb calcium.

Adults under age 50 should have 1,000 mg of caclium and 400 – 800 IU of vitamin D daily.

Women ages 51 to 70 should have 1,200 mg of calcium and 400 – 800 IU of vitamin D a day; men ages 51 to 70 need 1,000 mg of calcium and 400 – 800 IU of vitamin D a day.

Adults over age 70 should get 1,200 mg of calcium and 800 IU of vitamin D daily.

Your doctor may recommend a calcium supplement.

Follow a diet that provides the proper amount of calcium and vitamin D. Stop unhealthy habits:

Quit smoking, if you smoke.

Limit your alcohol intake. Too much alcohol can damage your bones, and put you at risk for falling and breaking a bone. It is critical to prevent falls. Avoid sedating medications and remove household hazards to reduce the risk of fractures. Make sure your vision is good.

Other ways to prevent falling include:

Avoid walking alone on icy days

Leave lights on at night so you can see better when walking around your house

Remove slippery rugs from your house

Use bars in the bathtub, when needed

Wear well-fitting shoes

Ling Chow

Osteopenia

Osteopenia refers to bone mineral density (BMD) that is lower than normal peak BMD but not low enough to be classified as osteoporosis. Bone mineral density is a measurement of the level of minerals in the bones, which shows how dense and strong they are. If your BMD is low compared to normal peak BMD, you are said to have osteopenia. Having osteopenia means there is a greater risk that, as time passes, you may develop BMD that is very low compared to normal, known as osteoporosis.

What causes osteopenia?

Bones naturally become thinner as people grow older because, beginning in middle age, existing bone cells are reabsorbed by the body faster than new bone is made. As this occurs, the bones lose minerals, heaviness (mass), and structure, making them weaker and increasing their risk of breaking. All people begin losing bone mass after they reach peak BMD at about 30 years of age. The thicker your bones are at about age 30, the longer it takes to develop osteopenia or osteoporosis.

Some people who have osteopenia may not have bone loss. They may just naturally have a lower bone density. Osteopenia may also be the result of a wide variety of other conditions, disease processes, or treatments. Women are far more likely to develop osteopenia and osteoporosis than men. This is because women have a lower peak BMD and because the loss of bone mass speeds up as hormonal changes take place at the time of menopause. In both men and women, the following things can contribute to osteopenia:

Eating disorders or metabolism problems that do not allow the body to take in and use enough vitamins and minerals
Chemotherapy, or medicines such as steroids used to treat a number of conditions, including asthma
Exposure to radiation
Having a family history of osteoporosis, being thin, being white or Asian, getting limited physical activity, smoking, regularly drinking cola drinks, and drinking excessive amounts of alcohol also increase the risk of osteopenia and, eventually, osteoporosis.

Osteopenia is treated by taking steps to keep it from progressing to osteoporosis and, for a few people, by taking medicine. Lifestyle changes can help reduce the bone loss that leads to osteopenia and osteoporosis.

What you eat is very important to bone development. Calcium is the most critical mineral for bone mass. Your best sources of calcium are milk and other dairy products, green vegetables, and calcium-enriched products.

Your doctor may also want you to take a calcium supplement, often combined with vitamin D. Vitamin D helps your body absorb calcium and other minerals. It is found in eggs, salmon, sardines, swordfish, and some fish oils. It is added to milk and can be taken in calcium and vitamin supplements. In addition to what you take in from food, your body makes vitamin D in response to sunlight.

Exercise is important for having strong bones, because bone forms in response to stress. Weight-bearing exercises such as walking, hiking, and dancing are all good choices. Adding exercise with light weights or elastic bands can help the bones in the upper body. Talk to your doctor or a physical therapist about starting an exercise program.

In addition to diet and exercise, quitting smoking and avoiding excessive use of alcohol and cola will also reduce your risk of bone loss.

There are medicines for treating bone thinning. But these are more commonly used if you have progressed past osteopenia to the more serious condition of osteoporosis. Medicines that may be used for osteopenia include bisphosphonates, raloxifene, and hormone replacement. For more information on these medicines, see the topic Osteoporosis.

How can osteopenia be prevented?

Whether you will tend to develop osteopenia is, in part, already determined. Things like whether you have any family members who have had osteoporosis or osteopenia, whether you have chronic asthma that requires you to take steroids, and how much calcium and vitamin D you got while you were growing up are beyond your control now. But if you are a young adult or if you are raising children, there are things you can do to help develop strong bones and help slow down osteopenia and prevent osteoporosis.

Your bones don’t reach their greatest density until you are about 30 years old, so for children and people younger than 30, anything that helps increase bone density will have long-term benefits. To maximize bone density, make sure you get plenty of calcium and vitamin D through your diet and by spending a little time in the sun, get weight-bearing exercise on a regular basis, don’t smoke, and avoid cola and excessive alcohol. If you have children, teach them to eat healthy, get regular exercise, and avoid smoking and alcohol. Also, get them to play a little in the sunshine to help their bodies make more vitamin D. Talk with your doctor about how much and what sources of vitamin D are right for your child.

If you’re older than 30, it’s still not too late to make these lifestyle changes. A balanced diet and regular exercise will help slow the loss of bone density, delay osteopenia, and delay or prevent osteoporosis.

Ling Chow

Laboratory, Radiology and Hospital Charges

Due to the requirements of some insurance companies or the nature of certain laboratory studies, your lab tests may be sent from our office to a reference laboratory. Reference laboratories are independent of our practice and will bill separately for their services. For all laboratory, radiology and hospital charges, it is the patient’s responsibility to determine if these providers are covered by your individual plan. Most will bill your insurance directly. If you have questions about bills and cannot resolve them with insurance company or other provider directly, please talk to a member of our billing staff.

Ling Chow

Insurance Plans Accepted

We are a participating provider with the following insurance companies. If you have questions regarding billing, please call the office during normal business hours for referral to the billing department.

Ling Chow

Insurance And Office Payment

Our practice participates in many insurance plans. An updated list is available on this web site or by contacting our office. Since each plan has different requirements and coverage limitations and exclusions, it is the responsibility of the patient to understand and meet the requirements of their individual plan. Most patients will have a “co-pay” (a portion of their charges which is not covered by insurance). Those covered by Medicare and some other insurance plans may have “deductibles” as well. Many insurance plans and Medicare do not consider “routine” check-ups (those performed without regard to a specific medical problem) or “screening” laboratory studies to be covered services. Co-pays, co-insurance, deductibles and non-covered charges are payable at the time services are rendered. Our billing staff is available to assist you with questions you may have about coverage conditions and payment arrangements. We accept payment by cash, personal check, Visa, MasterCard, Discover and American Express.

Ling Chow

In Case of Emergency

In the event of a life-threatening emergency, please go directly to the nearest emergency room, (by ambulance if appropriate), and advise the staff that you are our patient. If you are having a medical problem after hours or on Weekendss and Holidays, please call the regular office number. The doctor on call will be contacted through the answering service.

Ling Chow

Health Tips Young Adult

Your Prescription for Health

Eat Right – 5 a day of fresh fruits and vegetables, lots of fiber, lean meats, chicken, turkey and fish. No junk food, no fast food (salads are a great substitute for French fries). If you do not feel well, chances are you are not eating well!! Do not underestimate the power of healthy eating, or the ability of eating the wrong thing to make you feel badly!! Please visit Healthy Approach Market for nutritional counseling with Bryan Bradford CN (817-399-9100)

Drink lots of water – it should be your main beverage of the day. Limit caffeine to one a day if you must. Avoid artificial sweeteners, they are thought to increase PMS as well as other health problems

Weight loss – If you are doing the top 3 you WILL lose weight. In a nutshell, eat protein at EVERY meal, moderate carbohydrates and fats, and fruits, veggies and water at EVERY meal. If you can do this, you will lose weight.

Exercise – 30 minutes of cardio a day to maintain weight, 1 hour a day to lose weight. Pilates and Yoga are great for sculpting and toning. Exercise On Demand with cable and satellite – lots of great options for quick workouts.

Safety – wear your seatbelt, drive the speed limit, wear sunscreen, pick good friends, no drinking and driving, no smoking, don’t walk alone at night

Safer Sex – abstinence is best, but use condoms every single time if sexually active. Remember, you are with every partner your partner has been with, and every partner they have been with and so on. ….That’s a lot of exposure to warts, herpes, chlamydia, HPVand don’t forget HIV!!

HPV – Human Papilloma Virus. It is sexually transmitted. Over 100 strains of the virus. A few strains cause abnormal pap smears, a few strains cause genital warts. Guys pass it to you not knowing they have it. A vaccine for the four main strains of the virus is available for women ages 9-26. It takes 3 injections over 6 months total. It provides 99% protection in preventing pre-cancer and cancer of the cervix and 100% protection against genital warts.

Pap smears – every year once sexually active or age 18 whichever comes first. Papsure it optional, it allows us to see your cervix with a special light and microscope. It can pick up things a pap can miss. Probably worth the money.

Birth Control Options – The pill, patch, ring and shot can be used for birth control or to help control heavy or painful periods, or acne. This is a personal as well as medical decision. Side effects also can include weight gain, breast tenderness and headaches. The weight gain is caused from increased eating, so if you eat right, you won’t necessarily gain weight. If you are on Depo Provera you must take Calcium every day to prevent bone loss.

Vitamins – a good multivitamin, calcium 1000mg a day total (diet and supplements in divided doses), Fruits & Veggies if not obtained from diet (Juice Plus, Nature’s Way). B Complex for energy, essential fatty acids (fish oils) for helping with brain function, Vitamin C 1000mg a day for anti-oxidant.

Ling Chow

Health TIps Over 50’s

Your Prescription for Health Over Fifties

Eat Right -5 a day of fresh fruits and vegetables, lots of fiber, lean meats, chicken, turkey and fish. No junk food, no fast food . If you do not feel well, chances are you are not eating well!! Do not underestimate the power of healthy eating, or the ability of eating the wrong thing to make you feel badly!! Please visit Healthy Approach Market for nutritional counseling with Bryan Bradford CN (817-399-9100). Read the Eat Clean Diet book. It is awesome at explaining nutrition and helping with weight loss. (www.eatcleandiet.com)

Exercise – For weight loss you need 45-60 minutes a day, 5 times a week. To maintain weight and bone health, 30 minutes a day 5 times a week. Yoga and Pilates are great, I like Leslie Sansone walking for weight loss; fun and easy to fit in a busy schedule. Exercise On Demand with cable and satellite – lots of great options for quick workouts.

Menopause – the absence of a period for one year is menopause, peri-menopause are the 5-10 years prior to that. In the female body, balance of hormones is key. Women need a balance of estrogen, progesterone, testosterone, thyroid hormones and cortisol. When this balance is not in place, women can feel symptoms such as hot flashes, night sweats, forgetfulness, foggy thinking, unwanted weight gain, declining interest in sex, PMS, sleep disturbance…. the list is endless.

This testing includes estrogen, progesterone, testosterone, DHEA and cortisol. Saliva testing can accurately measure your free and available hormone levels, eliminating the guessing from your treatment. If we discover a deficiency or imbalance we can monitor your hormone levels after starting bio-identical hormone treatment, which allows us to individualize your hormone therapy.

Blood testing can evaluate your thyroid hormone, fasting sugar, insulin and cholesterol.

There are 2 options for treatment, non-hormonal relief such as soy, black cohosh and other herbs, or estrogen and progesterone. You can use synthetic hormones, or bio identical hormones compounded at the pharmacy. These are personal as well as medical decisions, and the facts keep changing as studies are being conducted. Hormones won’t give you cancer, but if you have one, it will cause it to grow and sometimes aid in earlier detection. If you decide on hormone therapy, there are a lot of options, pills, patch, ring, creams, which we can discuss and try. We work with several compounding pharmacies that can make your hormone preparation based on your individual needs.

Pap smears, mammograms and fasting lab work every year. Have a good family doctor or internist follow your high cholesterol, high blood pressure or diabetes. They are more familiar with changes in research and medication options. • Bone Density every 1-2 years. If you have normal bones, continue your weight bearing exercise and calcium 1500 mg a day. If you are on Fosamax or Actonel, we probably don’t need to check your bones every year, as changes of improvement are very subtle. • Colonoscopy – begin at 50 unless family history dictates earlier, and repeat every 3-10 years. Your GI will tell you when to return. • Vitamins – a good multivitamin, calcium 1500mg a day total (diet and supplements) in divided doses, Fruits & Veggies if not obtained from diet (Juice Plus, Nature’s Way). B Complex good for energy and cholesterol, essential fatty acids (fish oil), baby aspirin if appropriate. Vitamin C 1000mg a day for anti-oxidant. • Recommended Reading: You, The Owner’s Manual by Dr Michael Roizen & Dr Mehmet Oz is a must read. It really hits the high points on every body system, how it works, and what to do to help your body feel great. Also Dr. John Lee’s Hormone Balance Made Simple is an easy read and makes sense of complicated hormone explanations. The Eat Clean Diet by Tosca Reno is a must read. Also, CW Randolph’s From Belly Flat to Belly Fat is a great, easy read and hits on vitamins, eating right, thyroid balance and hormone balance for weight loss and feeling great. The 30 day diet plan in this book is a guarantee to lose weight.

Ling Chow

Health Tips 40’s – 50’s

Your Prescription for Health Forty’s & Fifties

Exercise – For weight loss you need 45-60 minutes a day, 5 times a week. To maintain weight and bone health, 30 minutes a0 day 5 times a week. Yoga and Pilates are great, I like Leslie Sansone walking for weight loss; fun and easy to fit in a busy schedule. Exercise On Demand with cable and satellite – lots of great options for quick workouts.

Hormone Balance – In the female body, balance of hormones is key. Women need a balance of estrogen, progesterone, testosterone, thyroid hormones and cortisol. When this balance is not in place, women can feel symptoms such as hot flashes, night sweats, forgetfulness, foggy thinking, unwanted weight gain, declining interest in sex, PMS, sleep disturbance…. the list is endless.

Do you have any of these symptoms? Lab tests are not very sensitive for detecting these hormone levels because hormones are protein bound and not free floating in your plasma, therefore we recommend saliva testing for detecting hormone imbalances. This testing includes estrogen, progesterone, testosterone, DHEA and cortisol. Saliva testing can accurately measure your free and available hormone levels, eliminating the guessing from your treatment. If we discover a deficiency or imbalance we can monitor your hormone levels after starting bio-identical hormone treatment, which allows us to individualize your hormone therapy. Blood testing can evaluate your thyroid hormone, fasting sugar, insulin and cholesterol. There are 2 options for treatment, non-hormonal relief such as soy, black cohosh and other herbs, or estrogen and progesterone. You can use synthetic hormones, or bio identical hormones compounded at the pharmacy. These are personal as well as medical decisions, and the facts keep changing as studies are being conducted. Hormones won’t give you cancer, but if you have one, it will cause it to grow and sometimes aid in earlier detection. If you decide on hormone therapy, there are a lot of options, pills, patch, ring, creams, which we can discuss and try. We work with several compounding pharmacies that can make your hormone preparation based on your individual needs. • Decreased libido is also a common complaint. If intercourse is painful due to vaginal dryness we can treat that with lubrication or vaginal estrogen. There are also some creams available at the compounding pharmacy that can help increase sensation down there. If hormones are out of balance, this could be a symptom. I don’t have a magic pill for libido itself, I think today’s woman is very stressed with work, husbands, kids…and this is the area we put on the back burner. I think attitude is key here. • Safer sex – Based on your personal situation, remember to protect yourself if you are sexually active. There are numerous STD’s out there. • HPV – Human Papilloma Virus. It is sexually transmitted. Over 100 strains of the virus. A few strains cause abnormal pap smears, a few cause genital warts. A vaccine is available for women ages 9-26. It takes 3 injections over 6 months. Tested every year with your pap smear in women over 30. Together a pap and HPV status predict your risk for pre cancer of the cervix. • If you are done with children and experience heavy or painful periods please talk to us about options such as an endometrial ablation. • Pap smears every year. Papsure is optional; it allows us to look at your cervix with a special light and microscope. It can pick up things a pap smear can miss. Probably worth the money. • Mammograms yearly after 40. Breast self exam monthly. • Fasting lab work every few years. Have a good family doctor or internist follow your high cholesterol, high blood pressure or diabetes. They are more familiar with changes in research and medication options. • Bone Density every 1-2 years after 50 or menopause (sooner if smoker, history of asthma, or thyroid disorder). If you have normal bones, continue your weight bearing exercise and calcium 1500 mg a day. If you are on Fosamax or Actonel, we probably don’t need to check your bones every year, as changes of improvement are very subtle. • Colonoscopy – begin at 50 unless family history dictates earlier, and repeat every 3-10 years. Your GI will tell you when to return. • Vitamins – a good multivitamin, calcium 1500mg a day total (diet and supplements) in divided doses, Fruits & Veggies if not obtained from diet (Juice Plus, Nature’s Way). B Complex good for energy and cholesterol, essential fatty acids (fish oil). Vitamin C 1000mg a day for anti-oxidant. • Recommended Reading: You, The Owner’s Manual by Dr Michael Roizen & Dr Mehmet Oz is a must read. It really hits the high points on every body system, how it works, and what to do to help your body feel great. Also Dr. John Lee’s Hormone Balance Made Simple is an easy read and makes sense of complicated hormone explanations. The Eat Clean Diet by Tosca Reno is a must read. Also, CW Randolph’s From Belly Flat to Belly Fat is a great, easy read and hits on vitamins, eating right, thyroid balance and hormone balance for weight loss and feeling great. The 30 day diet plan in this book is a guarantee to lose weight.

Ling Chow

Health Tips 20’s-30’s

Your Prescription for Health

Twenty’s – Thirty Somethings

Eat Right – 5 a day of fresh fruits and vegetables, lots of fiber, lean meats, chicken, turkey and fish. No junk food, no fast food. If you do not feel well, chances are you are not eating well!! Do not underestimate the power of healthy eating, or the ability of eating the wrong thing to make you feel badly!! Please visit Healthy Approach Market for nutritional counseling with Bryan Bradford CN (817-399-9100). Read the Eat Clean Diet book. It is awesome at explaining nutrition and helping with weight loss. (www.eatcleandiet.com)

Fertility – If trying to conceive, make sure you are taking a prenatal vitamin, or a multi vitamin and extra folic acid (total 800 mcg a day). If your cycles are regular, you ovulate about 14 days before your cycle starts, so a perfect 28 day cycle this is day 14, 30 day cycles it is day 16…The egg is there for 24 hours, sperm live about 48, so timing is key. Home ovulation kits are very helpful for timing. If you have not conceived in 1 year of timed intercourse, or you are not ovulating by the kit, please come see us.

Safer sex – Based on your personal situation, remember to protect yourself if you are sexually active. There are numerous STD’s out there.

HPV – Human Papilloma Virus. It is sexually transmitted. Over 100 strains of the virus. A few strains cause abnormal pap smears, a few strains cause genital warts. Guys pass it to you not knowing they have it. A vaccine for four strains of the virus is available for women ages 11-26. It takes 3 injections over 6 months. Tested every year with your pap smear in women over 30. Together a pap and HPV status predict your risk for pre cancer of the cervix.

Pap smears every year – Papsure is optional; it allows us to look at your cervix with a special light and microscope. It can pick up things a pap smear can miss. Probably worth the money, it just depends on your risk factors.

Screening mammograms baseline at 35, yearly at 40, or 10 years prior to your mother or sister’s age at breast cancer diagnosis. Breast self-exam monthly.

If you are done with children and experience heavy or painful periods please talk to us about options such as an endometrial ablation.

Labs– Depending on your family history, get fasting labs to check cholesterol and sugar at least every few years. Women need a thyroid test as well. Every year is great if you have insurance coverage.

Vitamins – a good multivitamin, calcium 1200mg a day total (diet and supplements), Fruits & Veggies if not obtained from diet (Juice Plus, Nature’s Way). B Complex good for energy and cholesterol, decreasing PMS and essential fatty acids (fish oil). Vitamin C 1000mg a day for anti-oxidant.

Recommended reading: What to Expect When You Are Expecting, What to Eat When You are Expecting, You, The Owner’s Manual. Also Dr. John Lee’s Hormone Balance Made Simple is an easy read and makes sense of complicated hormone explanations. The Eat Clean Diet by Tosca Reno is a must read. Also, CW Randolph’s From Belly Flat to Belly Fat is a great, easy read and hits on vitamins, eating right, thyroid balance and hormone balance for weight loss and feeling great. The 30 day diet plan in this book is a guarantee to lose weight.

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