We are sending this e-mail as a reminder to our patients that may be returning to school within the next month. If you need to schedule an appointment with your doctor before you return to school, please call our office at 804-897-2100 at your earliest convenience. Also, we have a USB jump drive of your electronic medical records in case you wish to have a copy to keep with you.
Over the years we have received many requests from patients for an electronic copy of their medical record. Patients who travel frequently or who have children away at school often would like a copy of their medical record in case of emergencies or the need for medical care in a different environment.
The record will be provided to patients though a standard USB jump drive, provided by VPFW, in a PDF format. That means that the record can be read by virtually all computers since this software is typically installed on all computers. Simply place the USB drive in a computer and the information will be read from the drive and will be available for viewing.
The cost of the service is $15 if the electronic record is picked up at one of our six office locations or $20 if you would like us to mail the electronic record to you. Please note that the mailing address must be the same address as contained in your medical record in order for us to mail it to you. We will update your record once a year for a $10 fee provided we use the existing USB drive. If you require a new drive the cost will be $15.00.
As the debate on health care continues, one central non-debated theme is the availability of electronic medical records for all patients. We believe that this initial step helps us meet that objective for our patients.
To order your record please go to the following address www.vpfw.com/pdfs/Medical_Records_Request.pdf . There you will find the form to request an electronic copy of your medical record.
We hope that you find this new service to be beneficial.
Electronic Medical Records
July 28th, 2010Women’s Heart Health
July 16th, 2010Often unfortunately overlooked in women’s preventive health care is the large role of heart and blood vessel disease. Women are accustomed to thinking of themselves as relatively protected against heart trouble by their estrogens. It is true that in the first 5 decades of life a woman has far less chance of having a heart attack than a man her age. But by age 60, women catch up with men their age and have exactly the same chance of a heart attack.
Unfortunately for those women (and their families!) who do have a heart attack, the chance of surviving and even of surviving without a residual of disability is far poorer than for a man. There is lots of debate as to why this is true but theories include that some women with heart attacks are being hurt by spasm of the walls of arteries. Another scientific observation is that the fatty plaque that builds up inside arterial walls in women with heart disease is more evenly distributed than is true in men. This may make it harder to successfully run a bypass graft around a local area of blockage. And it may make it harder to use a tiny catheter balloon to open up a small area of blockage and to put a mesh tube called a stent into the narrowed area of the artery to keep it open.
Women are often to have a different symptom picture from their heart disease than is true of men. The typical man experiences angina (heart pain) in the central part of the chest under the sternum bone. Women often don’t feel discomfort in that spot but may instead feel pain off to the side or up into the neck or even shoulder. Some women just notice extra heartburn or burping and assume that the stomach or esophagus is acting up when the heart is the real problem.
Diabetes, which is more common in women than men, is particularly hard on the heart. Most cardiologists now consider diabetes in a patient to be the equivalent of having had a heart attack already. The sugar fluctuations, inflammatory changes in blood vessels, and skewing of the cholesterol and triglyceride patterns associated with diabetes causes stiffening and narrowing of the arteries including those that supply the heart.
More and more women are being found to have Polycystic Ovary Disease and/or Metabolic Syndrome. Both of these conditions are often associated with blood fat patterns that cause atherosclerosis (hardening of the arteries). Tight control of sugars and insulin levels along with improvement in blood lipid (fat and triglyceride) patterns is extremely important in preventing these patients from severe cardiac disease.
Smoking, which has increased in young women in recent decades, has a bad impact on the heart. This is especially true as the estrogen level falls near menopause. And women who have had their ovaries removed and smoke are at particularly high risk.
So, what can be done to protect your heart? Start with healthy life style: exercise regularly and keep weight under control. Exercises that use your large body muscles like the thighs and gluts are very helpful in building up good cholesterol (HDL). Get regular blood pressure checks and correct an elevated pressure. Avoid or cease smoking. Eat foods with low saturated fats, low transfats, very low in high fructose corn syrup, and low glycemic index (foods not prone to shoot your sugar way up – melons, grapes and peaches for instance shoot sugar through the roof). Include almonds in your diet; these are good for the cholesterol. Walnuts are especially helpful in building up your good HDL cholesterol and in lowering the inflammation in the body that makes the artery lining prone to attract cholesterol plaque. Red wine (and to a lesser extent grape juice and white wine) and especially port (all taken in moderation) are helpful in building up good cholesterol. The ingredient in these beverages that helps cholesterol is available in much more concentrated and nonalcoholic form as Resveretrol, available as a liquid food supplement but hard to find-try Sam’s. If you know that your cholesterol profile is not ideal, eating oat meal and taking fish oil or Omega 3 or DHA or EPA or krill oil supplements (all basically help in the same ways) can improve the fat pattern and help your health.
If your blood lipid pattern fails to improve with diet and exercise and the above supplements there are presciption medications that can improve the pattern and protect your heart. These include ‘Statin’ drugs like Zocor, Lipitor, Crestor. Other types of prescription medications include long lasting versions of Niacin (a B vitamin) and Zetia (which blocks dietary absorption of fats) and pharmaceutical grade Omega 3 products.
It is wise if you’re over 40, and probably even at a younger age, to check cholesterol at least every couple years. Ideally this would be a test that breaks down the blood fats into their types, both good and bad.
For people with a strong family history of heart disease or a high personal concern, some screening tests include the EBT (also known as ‘Calcium Score’ of the heart) test, available through cardiology offices. Even more sophisticated is 64 slice CT imaging of the heart, also available through certain cardiology offices.
Women should keep alert for possible heart related symptoms and seek urgent, prompt evaluation if they suspect a problem. Delay could be very costly.
Virginia Physicians for Women encourages you to take your heart health to heart, to do screening and preventive measures so that you will never face a day when you really have a heart attack. We will be happy to do cholesterol screening for you at your visit with us and to discuss individual programs to help keep you healthy and vigorous, able to do the things you want to do, able to ‘be there’ for your family!
John R. Partridge, M.D., F.A.C.O.G.
Hereditary Breast and Ovarian Cancer Syndrome
July 12th, 2010Today’s media is filled with information about breast and ovarian cancer. A woman’s risk of breast cancer by the age of 70 in the general population is 8% or 1 in 12 women. In the past year there has been some controversy regarding breast cancer screening protocols, but the majority of health organizations call for screening with mammography to begin at age 40. Annual breast exams by a health care professional are also recommended. Ovarian cancer in the general population is a rare event with <1% or 1 in 70 women diagnosed by age 70. Unfortunately, the majority of ovarian cancers are discovered at an advanced stage and there are no screening tests or protocols found to be successful at finding ovarian cancer at earlier stages.
When screening protocols are either nonspecific or in the case of ovarian cancer not significant the challenge has been to identify the patient’s who may be at greater risk. A thorough family history is an important weapon in the fight to identify those at greater risk for breast and ovarian cancer. It is equally important for a woman to have knowledge of both her maternal and paternal family history. In particular the history of close relatives defined as first-degree relatives (mother, sister, daughter) and second-degree relatives (grandmother, granddaughter, aunt, niece) is pertinent.
In recent years with mapping of the human genome a number of genes have been discovered that have relevance to human cancers. Two genes in particular, BRCA1 and BRCA2, have been linked to hereditary breast and ovarian cancer. Approximately 10% of ovarian cancers and 3-5% of breast cancers are due to mutations in BRCA1 and BRCA2. Women with mutations of one or both of these genes are at significantly greater risk of developing breast or ovarian cancer than the general population. The lifetime risk of a woman with either a BRCA1 or BRCA2 mutation for developing breast cancer is about 70%. A woman’s lifetime risk for ovarian cancer with a BRCA1 mutation is 40% and BRCA2 is 15%.
The American College of Obstetrics and Gynecology recommends genetic risk assessment for women who have a 20-25% chance of having an inherited predisposition for breast or ovarian cancer. This includes women with:
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A personal history of both breast and ovarian cancer
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Ovarian cancer and a close relative with ovarian or premenopausal breast cancer
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Ashkenazi (Eastern European) Jewish women with ovarian cancer or breast cancer at age 40 or younger
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Breast cancer at age 50 or younger with a close relative with ovarian cancer or male breast cancer
This list is not all inclusive and women with breast cancer before the age of 40, or ovarian cancer at any age have a 5-10% chance of carrying a BRCA1 or BRCA2 mutation as well.
The take home message here is that by far most breast and ovarian cancers are not due to BRCA1 or BRCA2 mutations. If your personal or family history of cancer is highly suggestive of a BRCA mutation than an assessment including genetic counseling, education, and possible genetic testing may be indicated. There are a number of commercially available BRCA tests. Although they do not cover all possible mutations of BRCA1 and BRCA2, they can be useful in showing who is at greatest risk. Please schedule an appointment and consult with your physician if you have additional questions.
Christopher E. Paoloni, M.D., F.A.C.O.G.
VPFW da Vinci
July 1st, 2010Urinary Incontinence – A Note From Mark P. Hyde, M.D., FACOG
June 23rd, 2010A very common and yet embarrassing problem that we see every day is urinary incontinence. Although very common, it is often not discussed openly even with a woman’s physician unless directly inquired about. It is not, as many people think, a problem of elderly women alone. Many women are troubled with this even as early as their 20’s. A conservative estimate places expenditures on incontinence products in the billions of dollars per year in this country. Urinary incontinence impacts patients’ ability to function in the workplace, enjoy recreation, and even a normal sex life. Many secondary problems including frequent urinary tract infections, skin disorders, and depression to name a few, are seen quite often.
There are basically 3 types of urinary incontinence. First, stress incontinence which is responsible for the majority of diagnoses, is caused by loss of the supporting structures surrounding the lower urinary tract (bladder and urethra). This is exaggerated by vaginal deliveries of children, time, gravity, genetic predisposition, and chronic coughing like that seen in smokers. Second, urgency incontinence occurs secondary to uncontrollable bladder spasms that often lead the bladder to empty large volumes of urine with very little warning. A common scenario is the feeling of a full bladder and an inability to get to the bathroom before leaking occurs. Many contributing factors lead to this kind of incontinence including medications, infection, caffeine intake, neurologic disorders, and behavioral problems. The third type of incontinence is a combination of the first two and is termed “mixed” incontinence.
The good news is that there is treatment available for most cases of urinary incontinence. Stress incontinence is usually managed with restoring the normal anatomy either by surgery or the use of a pessary (a diaphragm type device placed within the vagina). Surgery for this problem used to be a major operation but now with modern, minimally invasive procedures, outpatient surgery is the norm. Most patients are back to work within a few days. Physical therapy/biofeedback has been shown to be helpful as well. Medication is the mainstay of therapy for urgency incontinence although behavioral modification plays a large role as well. Biofeedback is another avenue that may be explored. Mixed incontinence is a bit more of a challenge to manage and involves an individualized treatment plan often incorporating the treatment of both diagnoses.
In summary, urinary incontinence is a very common problem, not often discussed outside of a physician’s office but can be managed quite effectively in most cases. There is simply no excuse to allow this problem to modify one’s active lifestyle.
Mark P. Hyde, M.D., FACOG
A Note From Kenley W. Neuman, D.O., FACOG
June 14th, 2010Yeast infections are a common type of vaginal infection. They most commonly present with itching or burning of the vulva. These infections are often also associated with a thick, white and lumpy discharge. Yeast infections are caused by a fungus called Candida. Although this type of infection occurs most commonly in patients who have been on a recent course of antibiotics or in women whose immune system is suppressed such as in pregnancy, diabetes or HIV, in many cases the cause of yeast infections is unknown. Yeast infections can be treated with medication that can be applied to the vagina or as a pill taken by mouth. There are many medications to treat yeast infection which are available over the counter as well. However, it is important to be sure you are treating the right type of infection. There are other types of infections and vulvar skin conditions that can have similar symptoms. If you have not been diagnosed with a yeast infection before, or you have tried a store-bought treatment but are still having symptoms, it is important to see your doctor. Be aware that the use of vaginal creams prior to an office visit can make diagnosis difficult.
Kenley W. Neuman, D.O., FACOG
Health Care Solutions: News, Analysis & Helpful Links
June 10th, 2010
Get perspective on the latest health headlines at Virginia Physicians for Women.
Talk to your doctor. Every health news article you read or broadcast report you see or hear should stress that you and your doctor are the people best qualified – in fact, the only people qualified – to make decisions about your medical care.
It’s particularly critical advice in the fast-moving field of women’s health, where every day produces a headline that seems to contradict the banner news of the day before. From Hormone Replacement Therapy and dietary supplements to genetic screening, mammograms, even fetal cognitive development, the debates are as diverse as women themselves…and opinions vary wildly.
On these pages, Virginia Physicians for Women brings you the latest health headlines and, when warranted, our analysis of the news. We’ve also included some links of interest, should you care to research a topic or contact an organization (we neither support nor endorse any particular group), all with the caveat: Talk to your doctor.
Endometrial Ablation
May 26th, 2010Approximately 1 in 5 women has heavy bleeding at some point during her lifetime. This is often more common as we age, particulary in our 40s and 50s as we approach menopause. This can be caused by hormonal conditions, other medical conditions, and/or physical changes with the uterus such as fibroids. Having irregular or heavy periods can not only lead to one losing too much blood and becoming anemic, it can also be lifestyle altering – keeping you from participating in certain social events, exercise, work – not to mention constantly worrying about having tampons, pads, and extra clothes on hand.
Sometimes heavy bleeding can be improved with diet and exercise and by controlling other medical problems. Sometimes it can be controlled with hormonal options, such as any number of “birth control” options. However, for some, these methods are unsuccessful. And, for some, pleading with their GYN to “take it all out” becomes the next logical step. Fortunately, there is a middle ground, a less invasive option.
Endometrial ablation is a short outpatient procedure that works by destroying a thin layer of the lining of the uterus. For most women, this significantly reduces the amount of blood loss and shortens the length of the period. There are several different methods of ablation and your physician can help determine which may be the best based on the situation. Patients are given some sort of pain relief and sedative to help them relax before the procedure. On average, the procedure takes about 10 minutes, depending on the the type of ablation and the patient’s uterus. Although there are risks to all surgery, endometrial ablation is overall very safe and side effects during recovery are very mild.
After ablation, most women still have light bleeding or spotting. For some, all menstrual flow is stopped and for some, regular periods continue. If ablation does not control the heavy bleeding, further treatment may be required. It is important to remember that all reproductive organs are still in place after ablation, therefore it is important to continue to have yearly gyn exams.
Talk with your doctor to see if endometrial ablation would benefit you!
Maria Muessling, M.D.
VPFW’s Bridget Blakemore talks about the Race for the Cure
April 30th, 2010VPFW’s Favorite 2010 Spring Photos
April 26th, 2010Spring is here and so are VPFW’s favorite Spring photos! Be sure to check them out and share them with your friends and relatives!
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