Mindful Holiday Cheer

By Diana Leave a Comment

Being mindful during the holiday season can actually be achieved – with a little moderation and helpful tips. Tis the season to be jolly and imbibe responsibly in holiday spirits.  As women, this is especially critical because we metabolize alcohol much more slowly than our male counterparts.

 

As William Shakespeare so eloquently wrote in Mac Beth, Act II, Scene III:

 

“ Drink, sir, is a great provoker….Lechery, sir, it provokes, and unprovokes; it provokes the desire, but it takes away the performance.- “

 

Women need to be especially mindful when consuming alcohol.  There are various reasons for this:  their smaller body size, different % of body fat and slower enzymatic metabolism of alcohol.  All of these create a higher blood alcohol level in women compared to men. 

 

A “standard” drink means any alcoholic drink that contains approximately 0.6 fluid ounces or 14 grams of “pure” alcohol.  This equates to:

 

  • ·        12 fluid ounces ( fl.oz)  of regular beer
  • ·        8 fl.oz. of malt liquor
  • ·        4-5 ounces of table wine
  • ·        3 ounces of fortified wine ( sherry or port)
  • ·        2 ounces of cordial, aperitif
  • ·        1.5 fl.oz of “hard” liquor – 80-proof ( 40% alcohol content).

 

5 Holiday tips to stay mindful (and not hung-over the next day!)

 

1)      Drink lots of water.  Before ordering that glass of cabernet or margarita on the rocks, remember to drink a glass of water.  Have one glass of water per each alcoholic beverage.  Hydration (and moderation) is key!

 

2)      Eat food:  Choose healthy options, if possible.  Skip the salted chips with onion dip and go for the veggies with hummus dip.  By eating food, you will slow the rate of alcohol absorption into your body.

 

3)      Alternate with water or non-alcoholic drinks.  This will keep your hands busy as well as keeping you hydrated.

 

4)      Don’t cave into peer pressure.  If you don’t want to have that extra drink, politely say “No”.  You’ll be happy for it in the morning.

 

5)      Have a plan to get home safely.  Designate a driver for the evening who agrees not to drink during the evening’s festivities and is responsible for getting everyone home safely.  Or, take a cab if needed.    The cost of fare is well worth it!

 

For tips on how to stay mindful with all parts of life, please register for the Vibrantly You Well Being Symposium.   For the month of December, we will be cutting the price for each ticket, from $97 to $75!

 

Please see discount code: R & C to obtain discounted price.

 

A savings of $22 dollars a ticket!  Invite some friends and celebrate January with a boost of healthy energy and excitement!  To register, go to: www.vibrantly-you.com 

 

 

 

 

 

Lighting the way…

Dr. Diana

 

Filed Under: Being Present (Focus), Benefits, Brain-Memory, Challenges, Diet-Nutrition, Immune System, Mindfulness, Self-Care, Uncategorized Tagged With: , , , , , , , , , , , , , , , , , ,

Hot Flashes? Can’t take Hormones? Here’s some help with the Heat!

By Diana Leave a Comment

Hot flashes occur in over 85% of women during the years around menopause.  For many women, hormone therapy may not be an option for turning down the heat from night sweats and hot flashes.  After release of the Women’s Health Initiative (WHI) in July 2002, many women abruptly stopped their hormone therapy (HT) while others questioned their  safety.    Initial results from WHI showed an increase in breast cancer, heart attack, and stroke.  With a decade of hindsight we now better know the true risks and benefits of HT.  Even with this new evidence showing a major benefit in women starting hormone therapy near the time of menopause (within 10 years), there may still be many women who may not be able to take estrogen.   What are some of their options? 

Hot flashes, also known as hot flushes are very common.  These are commonly known “vasomotor symptoms” in the research and are categorized by severity and frequency:

  •  Mild: a feeling of warmth in the face, neck and chest.
  •  Moderate: feeling of warmth with sweating
  •  Severe: feeling of warmth, with sweating and loss of concentration

 

 

What are the options available for women who cannot take HT?

After reviewing numerous studies, I have compiled a list of non-hormonal prescription  and non-prescription medications which have been shown to decrease hot flashes.   Interestingly, many of these clinical trials were done in women with a history of breast cancer, receiving tamoxifen.  Furthermore, many of these trials had a very high placebo rate, i.e. those women not receiving the study medication   (placebo pill) showed  a high rate of benefit compared to those receiving the actual study medication.  This is known as the “placebo effect”.  In these studies, the placebo response rate ranged from 18-40%.

 

 

Non-hormonal/ Prescription Medications                                         

1)      SSRI’s/SSNRI’s : Best results occurred with Venlafaxine ( Effexor)  with 63% reduction in hot flashes in patients receiving 75 mg dose, vs. 45% in those receiving lower dose ( 37.5 mg) compared to 20% reduction in placebo group.  The next best was Paroxetine (Paxil), followed by Fluoxetine (Prozac).

2)      Gabapentin ( Neurontin); 45% decrease in hot flashes vs. 29% placebo, at dose of 300 mg three times a day.

3)      Clonidine ( Catapres): very few studies with only short term use, up to 12 weeks, reduces hot flashes by 15-20%., with dose of 0.1 mg/day.

4)      Belladonna/ergotamine tartrate/Phenobarbital combination ( Bellergal): decreased hot flashes by 75 % vs. 68% in placebo, dose of one tablet three times a day.

   Black Kohash plant

Non-hormonal /Non-prescription Options

1)      Black Kohash: This is the most studied and popular herb for treatment of hot flashes.   Results of studies show inconsistent results and dosages varied.  American College of Ob/Gyn ( ACOG) states that black kohash may be helpful in the short-term ( less than six months) treatment of women with vasomotor symptoms.

 

2)      Soy isoflavones: Studies showed inconsistent results. Some showed significant reduction in women with moderate to severe hot flashes.    ACOG recommends that soy and isoflavones  be used in the short-term , less than 2 years and that they should be used with caution in women with an estrogen-dependent cancer,  given the possible interaction with estrogen (39).

 

3)      Red Clover, Ginseng, Evening Primrose oil, Wild Yam: In clinical trials, no significant difference in hot flash reduction compared to placebo.  I have included these because many patients  frequently do use these remedies and do find some relief, although for only a short period of time

Take Home Tips:

1)      Hot flashes occur very frequently in women around the time of menopause and can significantly affect a woman’s quality of life.

2)      A thorough medical history should be taken to rule out other causes for hot flashes, such as thyroid disease.

3)      Evaluation of current medications and conditions should be considered with you and your health care provider to determine the best option for you, be it hormonal, or non-hormonal. 

4)      There are prescription medications available as well as herbal remedies.

5)      Consult with your health care provider before initiating any treatment.

Then you too, can be lying in the green grass…calm, cool and collected!

 

Lighting the way…

Dr. Diana

 

Citations:

  1. 1.      Roussouw, JE. Et al.  (2002) Writing Group for the Women’s Health Initiative Investigators.  Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized control trial.  JAMA; 288: 321-33.

 

  1. 2.      Carroll, DG. (2006). Nonhormonal Therapies for Hot Flashes in Menopause. Am Fam Physician, Feb 1; 73 (3): 457-464.

 

 

 

Filed Under: Benefits, Brain-Memory, Diet-Nutrition, Hormones, HT-Testosterone, Immune System, Medications, Menopause, Relieving Pain (Emotional-Physical), Self-Care, Stress Relief, Uncategorized Tagged With: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Cranberry juice for Bladder Infections: Fact or Folklore?

By Diana 1 Comment

 

We’ve all heard it.  ”Drink cranberry juice to flush out a bladder infection!”  Is this really a medical remedy?

The answer is, Yes!

According to new research published in Archives of Internal Medicine, cranberry- containing products, especially cranberry juice, protect women against bladder infections, especially those prone to recurrent infections. (1)
Bladder infections, or urinary tract infections (UTI’s), are on the most commonly acquired bacterial infections, leading to approximately 7 million office visits and 1 million visits to emergency departments each year in the US, with estimated annual cost of $1.6 billion dollars. Approximately, 40-50% of women will experience at least one episode of UTI during their lifetimes.   Some of my patients experience many more!

Fact or folklore?
For years, cranberry juice, and its derivative tablets and capsules, were perceived merely as a folk remedy to prevent UTI’s. Now, findings indicate that cranberry-containing products legitimately do contain powerful substances which protect against UTI’s – in the general population of women, as well as highly susceptible women, such as pregnant women or elderly patients.
The research reviewed 13 different randomized, controlled trials involving over 1,600 men, women and children of different populations including the elderly. The majority of trials were conducted in North America with the remainder performed in Finland, Italy and the United Kingdom.
How do cranberries help prevent bladder infections?
Cranberry ( genus Vaccinium) has been shown to contain a specific substance, known as A-type proanthocyanidins (PAC’s) which interfere with the way bacteria attach to the bladder wall.

To get a bit more technical, the PAC’s inhibit the adherence of P-fimbriated Escherichia coli (or E. coli, the most common bacteria leading to UTI) to urogenital mucosa. Cranberry juice was more effective than capsules or tablets, most likely due to the fact the women drinking the juice consumed approximately 2-3 glasses of cranberry juice /day and thus were better hydrated. The exact dose of PAC’s to prevent UTI’s has yet to be determined, so limit your intake of juice and increase water intake.
Here are 5 tips to decrease your risk of UTI.

1) Stay hydrated. Drink 6-8 glasses of water every day. If you feel some symptoms of UTI coming on, such as burning when you urinate or urinating more frequently, add 1-2 glasses of cranberry juice to your daily intake. (One caution: cranberry juice contains a large amount of sugar so if you are diabetic, speak with your physician before this.)

2) Be careful with personal hygiene. Always clean your genital area from front to back to avoid spreading bacteria from your rectum to your vagina.

3) Urinate after sex. This will help flush out the bacteria that may be heading towards your urethra, which is the opening where urine comes out from your bladder.

4) Avoid the use of scented soaps, feminine deodorants and colored toilet paper. These may contain chemicals which can irritate your genital area.

5) Avoid prolonged activities that may increase urinary tract infections such as prolonged bicycle rides, horse riding or motorcycles. Instead, take a break every 1-2 hours and empty your bladder.
If you are persistently prone to UTI’s, especially after having sex, your physician may prescribe an antibiotic which will prevent these infections.

So stock up on some cranberry juice! Your bladder will thank you for it.

Lighting the way…

Dr. Diana

Dr. Diana

Citations:

1) Wang, CH., et al(2012).  Cranberry-Containing Products for Prevention of Urinary Tract Infections in Susceptible Populations:  A Systematic Review and Meta-Analysis of Randomized Controlled Trials.  Arch Intern Med; 172 (13); 988-996.

Please share any other tips you may have to reduce or treat bladder infections.  The Listen To Your Libido Community is waiting to hear from you!

Filed Under: Challenges, Diet-Nutrition, Medications, Medications, Physical Issues, Self-Care, Stress, Uncategorized Tagged With: , , , , , , , , , , ,

Unhealthy relationship…with your “in-box” ?

By Diana Leave a Comment

Unhealthy Relationship … with your “in-box’?  

Is e-mail bogging you down?

With so many social media networks, literally at our fingertips, it’s no wonder that we can’t keep up with them.  They are taking a toll on our nerves… as well as our libidos!  Every day we are bombarded by hundreds, or potentially thousands, of e-mails, texts, tweets and Facebook messages.

How are we supposed to juggle all of them?
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Filed Under: Anxiety-Depression, Being Present (Focus), Benefits, Challenges, Communication, Fun!, Life-Balance, Self-Care, Stress, Stress Relief Tagged With: , , , , , , , , , , , , , , ,

Talking S-E-X With Your Doctor

By Diana Leave a Comment

When the last time your doctor asked you about sex?

Well, if you’ve been seen at my office, it was probably at your very last visit!

It is estimated that approximately 43% of women in the United States today are experiencing some form of sexual problem, with lack of sexual desire as the leading issue. Yet, in exam rooms across our nation, physicians are not bringing up the topic of sex with their patients.

According to a new University of Chicago survey of more than 1,000 obstetricians and gynecologists in the United States, less than half of the physicians asked their patients about any sexual problems or dysfunction (1). Only two-thirds asked how sexually active their patients are and less than one-third asked their patients about sexual satisfaction. Results of the study were published in Journal of Sexual Medicine with specific results highlighting only 63% routinely asked patients about their sexual activities, with 40% asking about sexual problems, 28.5% asked about sexual satisfaction and approximately 14% asked about pleasure with sexual activity ( 1 in 10 never asked this question at all).

The study’s senior author and associate professor at the University of Chicago Pritzker School of Medicine, Dr. Stacy Lindau, states “sexuality is a key component of a woman’s physical and
psychological health. Simply asking a patient if she’s sexually active does not tell us whether she has good sexual function or changes in her sexual function that could indicate an underlying problem.”

Which physicians are most likely to bring us sexual issues?

Female physicians were more likely than male physicians to discuss sexual activity as well as sexual orientation and identity with female patients. Physicians practicing solely gynecology and not providing obstetrical services were also more likely to screen for sexual dysfunction. Physicians aged 60 years and older were found to be the least likely to discuss a patient’s sexual orientation or identity compared to their younger colleagues ( 11% vs 28% of those aged 46-59 vs. 32% aged 45 or younger.)

According to researchers, about 25 percent of the doctors said they have expressed disapproval of patients’ sexual practices; these were primarily doctors who were foreign medical graduates or ones
who considered religion the most important part of their lives. Those who indicated a Roman Catholic religious affiliation were significantly less likely than others in the survey to ask patients about sexual activities.

Why don’t patients bring up the topic?

“Patients are often reluctant to bring up sexual difficulties because of fear the physician will be embarrassed or will dismiss their concerns,” lead study author Dr. Lindau said. “Doctors should be taking the lead.”

What if your doctor isn’t taking the lead and bringing up sex?

5 Tips for Talking Sex with Your Doctor

1. Acknowledge your discomfort. Start the conversation with being honest about your uneasiness with this topic.

2. Approach it from the health perspective. Sexual issues can signal a larger health problem, such as thyroid disorders, depression, hormonal changes or issues with medications.

3. Write down your questions before your visit. By preparing ahead of time, you won’t forget what you want to ask or feel flustered during the exam.

4. Don’t be rushed. If you’re asking your physician about sexual issues as he/she is leaving the exam room, there won’t be enough time to discuss your concerns. Make a separate
appointment if you need to allow adequate time for this conversation.

5. Find the right doctor. This might be the most challenging of all of these tips. Ideally, you want a physician whom you can confide in, feel comfortable asking questions of, and feel “listened to”. Also, this physician should have the appropriate knowledge regarding sexual issues to help you. A physician who dismisses your concerns or makes you feel ashamed is not the health partner you desire.

You deserve the best quality health care and doctor available – don’t settle for anything less!

Citations:

1. Journal of Sexual Medicine. “What we don’t talk about when we don’t talk about sex”. DOI:10.1111/j. 1743-6109.2012.02702.x
Janelle Sobecki, MA, et al, March 22, 2012.

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Understanding Your Teenage Daughter’s Emotions

By Diana Leave a Comment

photo credit: C.G.P.Grey

Wonder why your teenage daughter seems to be on an emotional roller coaster? 
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Filed Under: Challenges, Communication, Hormones, Puberty, Stress Tagged With: , , ,

Can I use my husband’s Viagra?

By Diana Leave a Comment

photo credit: Paul-in-London

If your partner’s doctor diagnoses him with erectile dysfunction, he may be prescribed a medication such as Viagra.  While this little blue pill has done wonders for men, it has not panned out to be a panacea for women.  For men, Viagra causes smooth muscle relaxation, which increases blood flow to the penis, allowing it to engorge and become erect.  In women, the issue with
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Filed Under: Decreased Libido, Fun!, Mars-Venus, Medications, Medications, Partner Tagged With: , , , , , , , , , , , , ,

Lost your mojo? 5 ways to re-ignite those flames of desire.

By Diana Leave a Comment

photo credit: Herval

Has your sex life taken a dive even though you are still interested in your partner?  You are not alone.  According to the recent 2009 Sex, Romance, and Relationships Survey released by the AARP in May 2010, people’s sex drives have been dropping at an alarming rate(1).  The study, which included a random sample of 1,670 American men and women aged 45 and older, reveals some intriguing findings.  Between 2004 and 2009, the percentage of people in the 50s who say they have sex once a week dove nearly 10 points for both sexes (women dropped from 43 to 32% and men from 49 to 41%).  Other age groups also show similar decreases.

One alarming statistic of this survey shows how sex has definitely “cooled down” for many menopausal women.  Approximately 1 in 5 women in their 50s say they’d be quite happy to never have sex again.  About 1 in 50 men in their 50s agree.

Every day in my gynecological practice, I see perimenopausal and menopausal women concerned about their lost desire, or the “urge to merge” as I like to call it.

Let me share 5 ways that you can re-ignite those flames of desire:
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Filed Under: Challenges, Decreased Libido, Diet-Nutrition, Drive Differences, Life-Stages, Meditation, Mindfulness, Self-Care, Sleep, Stress Tagged With: , , , , , , , , , , , , , , , , ,

Sex preserves vaginal health – use it or lose it!

By Diana Leave a Comment

“Use it or lose it” is literally true in the case of vaginal health!

Many studies in postmenopausal women have shown that they suffer less vaginal pain and atrophy, and less thinning of the vaginal lining, when they are having consistent sexual activity.  Vaginal atrophy can lead to vaginal dryness and itching, as well as urinary tract infections.  In women, sex increases blood flow to the vagina, keeping vaginal tissues more supple and lubricated – all of which can lead to less pain with intercourse as we age.

Filed Under: Benefits, Menopause, Relieving Pain (Emotional-Physical) Tagged With: , , , , , , ,

New Year’s Resolutions to Increase Your Libido

By Diana Leave a Comment

 

 

Watch this clip from Fox 10′s “Arizona Morning” TV show – my suggestions for New Year’s Resolutions that you can put into place to increase your libido!

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