July 6, 2010

Osteoporosis – The Other Disease

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Dr. Ngozi Osuagwu

Most times when during discussions about diseases that affect women, all we hear about are breast cancer and heart disease. However, there is a disease that will affect at least fifty percent of women who live past the age of 50 years. 

Osteoporosis is a disease in which the bones become fragile and more likely to break. If not prevented, or if left untreated, osteoporosis can progress painlessly until a bone breaks. These broken bones occur typically in the hip, spine and wrist. Hip fractures require surgery and can impair your ability to walk. It may cause permanent disability and even death. Spinal fractures can cause loss of height, severe back pain, and deformity.

What are we do to about this ailment that affects one of every two women older than fifty years in the remaining periods of their life?  There are five steps to bone health and osteoporosis prevention that can help all women at any age.
  • Proper Nutrition  Get your daily recommended amounts of calcium and vitamin D. If you are under the age of 50, you want at least 1000 mg of calcium daily and 400 – 800 IU of vitamin D. If you are over 50, you want at least 1200 mg of calcium and 800 – 1,000 IU of vitamin D.
  • Exercise  Engage in regular weight-bearing and muscle strengthening exercises. Examples of these exercises include yoga, Pilates, weight training, walking, jogging, running, jump roping, and dancing.
  • Maintain a Healthy Lifestyle  Avoid smoking, street drugs and excessive alcoholic beverage intake.
  • Talk to your Physician  Discuss your bone health with your physician during your annual gynecological exams and physical exams.  
  • Get Tested  Have a bone density test performed and take medicines, if necessary.

If you are over 50 and menopausal, you can take the questionnaire FRAX (WHO Fracture Risk Assessment tool) to find out your 10 year risk of having a fracture – www.shef.ac.uk/FRAX. For more information on the topic of this blog, please visit the National Osteoporosis Foundation website at www.nof.org.

 

June 1, 2010

Hope is not a Birth Control

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Dr. Ngozi Osuagwu

During a recent visit to my office by a young woman who told me she was sexually active, I asked her whether she was using any form of birth control. She replied in the negative. Was she trying to get pregnant, I asked? Her answer was that she was not. She hoped that she would not become pregnant. I was confused by her answer. Could I be blamed for being confused at hearing two widely divergent answers? It did not make any sense to me that she was having sex without any form of birth control and not planning on getting pregnant. She was hoping that she would not get pregnant. For those of you out there who are hoping not to become pregnant, remember that fifty percent of pregnancies are unintended. There is no birth control that I am aware of that is called ‘Hope’.

Contraception or birth control is used so that you do not become pregnant. The best birth control for you is the one that you will use regularly so that it would be effective. There are some that will require daily participation from you and there are others that will not require much effort.

Birth control can be divided into two categories – those with hormones and those without. Those with hormones contain estrogen and progesterone or just progesterone. They can enter your body through various ways-by mouth, through the skin or through the vagina. These include birth control pills, the patch (OrthoEvra), the single rod implanted under the skin (Implanon), Nuvaring (inserted into the vagina), intrauterine device (Mirena) and the shot. There are several advantages to being on contraceptives that have hormones other than preventing pregnancy. They can help decrease menstrual flow, menstrual cramps and reduce the chance of endometrial and ovarian cancers. The major downside is that they do not protect against sexually transmitted infections.

The non-hormonal methods include condoms (male and female), intrauterine device (Paraguard), sponge, diaphragm, withdrawal method and periodic abstinence (rhythm method). Condoms and the diaphragm may help decrease the risk of sexually transmitted infections. Another option not often discussed that is 100% effective in preventing pregnancy is abstinence. Yes, this is an option. There are other ways to be intimate other than intercourse.

Since none of the methods discussed other than abstinence are 100 % effective, all women of reproductive age (women capable of becoming pregnant) should take a multivitamin specific to women. This is because they have the recommended amount of folic acid. Taking the multivitamins with folic acid will help decrease the risk of neural tube defect (problems with the spine of the baby) in the unborn child, if you become pregnant.

Let us all make babies when we are prepared to have them. The only hope I have is that you schedule an appointment to talk with your physician to discuss the options that are available.

 

May 4, 2010

Celebrating Mother’s Day and Women’s Health Week

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Dr. Ngozi Osuagwu

On Sunday, May 9, we celebrated Mother’s Day.  Our mothers are constantly taking care of us. Even when they do not have the time for themselves, they make time for us. During the Women’s Health Week, which comes after Mother’s Day, let us try and give our mothers, biological, step, surrogate or otherwise, a priceless gift.  This gift may not necessarily involve the expenditure of money, but even if it does, it should be considered money well spent. As you celebrate your mother, consider engaging her in a conversation and asking a few questions:

Mom, when was the last time you saw your physician? Has it been over a year? Mom, when did you have your last pap smear? The Pap smear is a screening test for cervical cancer. Have you ever gotten a human papillomavirus (HPV) test along with your pap smear? The HPV test is offered after the age 30. The combination can tell us whether you are at increased risk of getting cervical cancer. 

Mom, have you had a mammogram? Yes, there have been a lot of discussions regarding when one should have a mammogram, but what all agree is that it is an important tool in finding breast cancer early. Most experts want you to get a mammogram starting at age 40. 

Mom, have you been screened for colon cancer? Women age 50 and above are advised to get this screening test. Colon cancer is one of those cancers which when found early can be treated.

 Mom, have you had your bone density scan? This scan screens for osteoporosis-thinning of the bone that is associated with fractures. By age 65, you should have had a bone density scan. Remind Mom that she should be getting at least 1200 mg of calcium and between 800 to 1000 IU of Vitamin D. 

Along with taking Mom to dinner, have you thought about a date on the track field or the gym? Walking a couple of miles and talking about life or any topic that comes to mind is great for the body and the spirit.  Have you thought about buying her a pedometer, a heart rate monitor or a blood pressure monitor for that matter, if she has hypertension? Instead of chocolates how about bringing a fruit basket? Have you thought about having a meatless dinner for Mother’s Day? If you know Mom has any chronic medical problems, have you asked her about her medicines?

 A frank conversation around the area of health once a year is guaranteed to bring about a healthier mother for all us and will definitely guarantee they get their medical checks.  The answers you get to your questions may require you to incur some expenses, but the rewards will be priceless. So start the conversation, foot the bill for the test or tests, buy the monitors, if mother needs them, and you will discover that a gift does not have to be as pricey as a piece of jewelry to be priceless.

Dr. Ngozi Osuagwu is the Clinical Director of the OhioHealth Women’s Health Center and Doctor’s Hospital

 

February 4, 2010

LOVE WITH YOUR EYES WIDE OPEN

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February is the month of Valentine’s Day. Love is in the air, which sometimes makes us throw caution to the wind. In most cases, the celebration of this day leads to sexual union with your partner. It also happens to be the time when most lovers engage in liaisons the first time, and I ask that you love with your eyes wide open.

Loving with your eyes opens implies that you ask questions of your partner and both of you get checked for infections that can affect your health status. Visit your gynecologist and get a thorough examination.

The mistake that most women make is assuming that every time they go to a gynecologist, they are automatically tested for sexually transmitted infections. There are more than 25 recognized types of sexually transmitted diseases and it is impossible to test for all of them at a visit. You might need to ask to be tested for the infections that are most common.

Last year more than 19 million new cases of sexually transmitted infections were diagnosed in the United States. The common sexually transmitted infections are chlamydia, gonorrhea, herpes, HIV/AIDS, hepatitis B, human papillomavirus (HPV), syphilis and trichomoniasis. Unfortunately, the symptoms are misleading which makes them hard to diagnose and can lead to serious health problems.

There are several ways that you can reduce your risk of contracting these infections:

  1. Know your status: Get checked for the most common sexually transmitted infections. The CDC encourages everyone from ages 13 to 64 years old to know his or her HIV status.
  2. Ask your partner about their sexually transmitted disease history – If you do not ask, chances are some people will not tell
  3. Protect yourself – condoms and dental dams can be helpful, however none of these offer 100 percent protection.
  4. Love with your eyes wide open – Who says that lovemaking has to take place in the dark? Have the lights on and check out your partner. If you notice anything unusual – discharge, ulcers, et cetera, discontinue the act until medical attention is sought and the issue or issues are resolved.

For more information on sexually transmitted infections, you can visit the website of the American Social Health Association at www.ashastd.org

Happy Valentine’s Day

 

 

January 20, 2010

Cervical Cancer Awareness Month

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January is Cervical Cancer Awareness month. The good news is that cervical cancer is one of those cancers that we have been able to catch early with pap smears.  With other gynecological cancers, it is more difficult to diagnose them early. Most people that have been diagnosed with cervical cancer have never had a pap smear within the past 5 years or have never followed up with their physician after having an abnormal pap smear. Make sure that you are up to date with your pap smear.

There are several myths about a pap smear that I would like to dispel. A pap smear is a screening test for cervical cancer. It is not a screening test for other forms of gynecologic cancer like ovarian cancer or endometrial cancer. Recently there has been some confusion with the introduction of new guidelines governing the frequency of having pap smears. The new guidelines suggest having a pap smear less frequently than once a year. Every individual has a different set of circumstances and my view is that you talk with your doctor about what is best for you. Guidelines are developed for a large group of people and often direct physician on what is the minimum care that should be provided to an individual. The frequency of pap smears you require will be based on your individual history and whether your physician has performed additional tests like the human papillomavirus (HPV) test.

Let me be very clear. You still need to get an annual gynecological examination performed by your doctor, even if it has been determined that you are not a candidate for pap smears every year, or more frequently. A pap smear is just one of the tests performed by your gynecologist during your annual examination. A pelvic exam encompasses much more than the pap smear. It involves screening for sexually transmitted infections and other infections. The gynecologist also performs a clinical breast examination during your annual. They use the annual exam to check your weight and your blood pressure. They will provide contraceptive counseling and make sure you are up to date with your immunization. There are many other tests that are performed in an annual gynecological exam, and you do a disservice to yourself if you fail to see your doctor at least once every year, regardless of whether you need a pap smear or not.

Let this month be a reminder to schedule you annual gynecologic exam. It does not end when you stop having children or if you have had a hysterectomy. This exam can begin in adolescence. You can visit your gynecologist for your yearly checkup, even if you have not had sex, or not sexually active. For the young people coming for the first time it does not mean a pelvic exam needs to be performed. It can be an opportunity to talk to a physician about issues you may not feel comfortable discussing with your pediatrician.

Keep healthy and happy in 2010.

NB: Happy New Year! I hope all is going well with you and those who hold your affection. My sincere apologies for not getting out the blog in time, but one of my resolutions is to do better the rest of this year. I hope to post new ones by the first Monday of every month.

 

December 17, 2009

Document Your Medical History

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Ngozi Osuagwu, MD, Women's Health Center, Doctors Hospital, OhioHealth

A recent assignment given to my daughter got me thinking. Her assignment was to create a family tree and try to find out whether any diseases, genetic or otherwise ran in the family. In my practice, I have found that most of my patients have very sketchy or limited personal and family medical history. It struck me that this holiday season was as good a time as any for individuals to try to collect and collate family medical history. This is because more than at any other time during the year, most families will congregate to celebrate the holidays together.

When she asked me, I simply went to my computer and reviewed the medical history that I had completed recently. As a physician, the value of such information was not lost to me, and just before a surgery I had in the summer, I had typed up and saved a detailed medical history, which I shared with my physicians. In caring for patients, the value of such medical information about the family is of enormous value. Having such information compiled and readily available is actually an excellent idea.  You will be surprised about how happy it can make your doctor and it actually saves time during your visits, which can be put to use discussing more important matters rather using up most of the time trying to remember aspects of your medical history.

Buy a small journal or create an electronic file on your computer to document your medical history. It is preferable to do it with a computer, but you should not be deterred from doing this exercise just because you do not have access to one.  The computer allows you to output the information easily for whoever has need of the information. These document should include, but not limited to the under-listed bits of information

Medical history:

o    List all medical problems and date/s of diagnosis and recommendation by the treating doctor, e.g., high blood pressure diagnosed in 2000. Taking Avapro 150 mg once a day. Exercise and low salt, low fat diet rich in vegetables and fruits.

Surgical history:

o    List all surgeries and reasons for them. Also list hospitalization and dates, e.g., Total Abdominal Hysterectomy performed for large fibroid tumor at Doctors Hospital in March 2000

Allergies: List all food and medication allergies and the reactions to the allergens, e.g., Penicillin – rashes and difficulty breathing

Medications: Name all medications (both prescribed and over the counter) with doses. Also list any herbal supplements and vitamins

Obstetric and Gynecologic History:

o    Date of last Pap Smear and results

o    Date of last Mammogram and results

o    All sexually transmitted infections

o    Date of deliveries and complications, if any

Family History:

o    Parents, Grandparents, Brothers, Sisters, Aunts, and Uncles. Provide as much detail as possible about ailments. If they are deceased, please provide cause of death and age at the time of death.

If you are able to document the above items about yourself in the order outlined, you have put yourself in a much better position to get excellent care from your physician. The time spent doing this is a good investment on your way to getting and maintaining your well being, and as mentioned earlier, this is a good time of the year to engage in this activity with family members likely to be around. Keep happy and healthy. Good luck and the Almighty’s blessings in the coming year.

 

November 2, 2009

Food, Exercise, and the Holiday Season

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Dr. Ngozi Osuagwu

As the Holiday Season approaches, there are ample opportunities to eat and unfortunately most people forget or do not care about having a good balance when it comes to their food intake. A proactive approach to what we consume during this season makes it easier for us to stay healthy and not have to work too hard in January as we make resolutions to get back to a healthy weight. Remember that the colder season makes it a lot easier to accumulate the weight. We can still enjoy the variety of offerings, but we have to adopt a common sense approach with our nutrition.

In 2005, the United States Department of Agriculture launched Mypyramid. MyPyramid is an illustration that shows graphically the number of servings of different food types. It emphasizes a personalized approach to healthy eating and physical activity. Information about this program is available at www.mypyramid.gov and it contains lots of information that can be printed or used interactively.

MyPyramid_4c

The pyramid was designed to make it easier for people to select items necessary for a balanced meal. There are six parts to the pyramid.

o Activity: Represented by the person climbing the stairs. It is a reminder that daily activity is important.

o Variety: The 6 color bands representing 5 food groups of the Pyramid and oils. Items from all these groups of food are needed each day for good health.
• Orange: Grains
• Green: Vegetables
• Red: Fruits
• Yellow: Oils
• Blue: Milk
• Purple: Meat and Beans

o Moderation: This narrowing of each food group from bottom to top represents the need for moderation. The wider base stands for the foods that should be selected more often. These are foods that contain little or no solid fats or added sugars. The narrower top areas stand for foods containing more added sugars and solid fats. The more active you are, the more these foods can fit in your diet

o Proportionality: This is shown by the different widths of the food group bands. The width suggests how much food a person should choose from each group. Eat more of some foods (fruits, vegetables, whole grains, fat-free or low fat milk products) and less of others (foods high in saturated or trans fats, added sugars, cholesterol, salt and alcohol)

o Personalization: This is represented by the person on the stairs. One size does not fit all. You can go on the website to design a program for you and your family.

o Gradual improvement: The slogan ‘Steps to a healthier you’ signifies the need for exercising in incremental steps. Everyone can benefit from taking small steps to improve their diet and lifestyle each day

While admittedly life can be a little hectic during the holiday season, we should not use that as an excuse to stop exercising or overindulging when we eat. Fellowship and time spent with family and friends are what make the holidays pleasant, not overeating and stopping to exercise. We can enjoy this season and maintain good health at the same time. Below are a few suggestions to help you get started or help you overcome the temptation to lapse in keeping the focus on a healthy you.

1. Go to http://www.mypyramid.gov to learn more

2. Do not get hung up on the thirty minutes a day of exercise. If all you can manage is five minutes, it is better than nothing. Inclement weather should not be an excuse either. There are many exercises that can be done indoors. Stair stepping can be a wonderful aerobic exercise, and so is jumping rope or using the hula-hoop.

3. Preparing meals: If you are hosting, you have all the control. You can make sure that your menu contains items from the various food groups. I recently had a movie night with some friends. Munchies included cut apples, grapes, sliced oranges and nuts.

4. For potlucks in our place of work, be the one that volunteers to bring the vegetable tray or the fruit tray

Let us make this holiday season a memorable one not for the food we eat, but because we are able to go through it without any weight gain or change in our health status because of what we consumed and lack of exercise. If we stay determined, we will realize the euphoric feeling of well-being that comes from being light on our feet as we start a new year. Have an excellent holiday season and be happy. May the Almighty bless you and those who hold your affection.

 

October 5, 2009

Educate yourself and make a difference in breast health

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As most of you know October is National Breast Cancer Awareness month. However, that knowledge must translate into action if it is going to be meaningful. When was the last time you looked at your breasts and did a self-breast examination? When was the last time a physician examined your breasts? If you are 40 years old, when was your last mammogram? I hope the answer to the first question, was within the past month and the answer to the last two questions were within the past year. If this is true for you then I hope the same is true for your female relatives and your friends.

Breast cancer is the most common cancer among American women, except for skin cancer. In 2009, it is estimated that over forty thousand women will die from breast cancer. The good news is that there are over 2.5 million breast cancer survivors in the United States. The primary reason for the reduction in breast cancer mortality is early detection. If discovered early, most breast cancers can be treated successfully.

There are three major methods for the early detection of breast cancer:

1. Know your body. You need to feel comfortable exploring your body. In my practice, the most common reason my patients give has to do with being afraid of discovering something or lack of knowledge. The fear of early discovery has to be superceded by the fear of the actual disease when we choose to behave like the ostrich and put our heads in the sand. If your reason has to do with not knowing how to perform the exam, a visit to the American Cancer Society website at http://www.cancer.org from your home computer or using computers available in your local library will provide you with the necessary instructions on how to perform self-breast exams. Dilly-dallying about getting the information that you definitely need however should not prevent you from being vigilant about the changes in your body, and scheduling and visiting a visit to your doctor immediately to have the noticed changes evaluated.

2. You should have a physician examine your breasts yearly as part of your annual exam. This requires you scheduling your yearly exam. Do not use the excuse that you have no time to schedule an annual exam and visit your doctor. You must find the time to take care of yourself. If you do not find the time to take care of your self, you are unable to take care of the loved ones that you constantly put in front of you.

3. Get a mammogram. A mammogram is an x-ray of the breast. Most people are afraid because they have heard that it is painful. There is some discomfort but that discomfort usually last for seconds and not minutes or hours. Mammogram saves lives.

If any of the above examinations is abnormal, you will need additional testing. It is possible to feel a lump in the breast and have a normal mammogram. This does not mean that everything is okay. You still will need to have a biopsy to obtain a tissue sample to be sent to the lab to make sure everything is good. No one can pat you on the back and tell you that a lump is not cancer. It requires further testing. A mammogram is not a substitute for a breast exam.

Money should not be a barrier to getting the help you need. Through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), women without health insurance can be screened for free or at a very low cost. To learn more about this program, you can visit www.cdc.gov/cancer/nbccedp or call 1-800-CDC INFO. You can also get more information on breast cancer at www.cancer.org or www.nbcam.org.

Use this month to make a difference in the lives of the people around you – your siblings and family, your friends, your neighbors and your colleagues at work. Peer pressure works. Use it positively to inform and educate the people around your about the importance of doing the right things when it comes to taking care of themselves. An ounce of prevention is worth a pound of cure.