To do or not to do vaccinations as a child has become a big deal. Many parents are not giving their children vaccines because of fake news hypes about their problems. This is not good, because they are essentially setting their children up for worse problems as they get older. (more…)
Ever wonder where you are with your fitness status? Knowing you heart age can go a long way into assessing your fitness status. Doing so early in life, say your 40’s is probably best so you can do something about potentially bad results early with lifestyle modifications. However, 60 is the new 40, so finding out your heart fitness status is a good thing to do at any age.
What is heart age?
There are many risk factors that can increase your risk of cardiovascular disease and make your heart appear “aged”. There are also blood tests that can be used to evaluate this. Your heart age is essentially how fit your heart is compared to a fit and normal person at that age.
For instance, if you are 60 years old and you have a heart age of 80, then you have an increased risk of heart disease and an increased risk of having a coronary event, such as a heart attack, compared to others who have a normal heart age of 60.
How do I find out what my heart age is?
It’s easy to find out your heart age. All you have to do is a blood test and answer some questions about yourself. The blood test is called the PULS test. Basically, it is a battery of tests that have been shown to be predictive of whether you will have a coronary event within the next 5 years. Combined in an algorithm including your medical and family history and you get to know your heart age.
TrueMD offers patient the PULS blood test. We can draw your blood in the office and send the specimen to the lab for evaluation. You will fill out a questionnaire and all this data will be input into the test’s algorithm for evaluation of your heart age.
Why should I find out my heart age?
If your heart age is normal for your chronologic age in years, then you most likely are doing the right things to ensure your health. However, if it is older than your stated age, then you have a choice to improve the health of your cardiovascular system. In particular, you can improve the inside lining of your arteries, especially those of your heart. If you improve your heart health, you most likely will live longer and with better quality.
We all want to live longer, but we want to do so with quality. Improving your overall health and the health of the linings of your arteries can decrease your risk of developing heart disease, the number one killer of people. In addition, and many other chronic medical conditions a less likely to develop. All these can rob you of years from your life and disable you so the quality of your life is not as good.
How did they come up with this test?
The test has been developed over the last 20 years through highly reputable universities such as Stanford University and Kaiser Permanente in California. They evaluated hundreds of compounds and markers in the blood for their predictive value of heart health. They narrowed the list down to 9 different compounds that had the best predictive value when combined with risk factors in a benchmark algorithm format.
The algorithm was independently validated by the NIH NHLBI group in MESA which confirmed the findings to be valid. It carries a 98% accuracy (sensitivity) rate in its predictive value assessment of your heart health and the risk of you having a heart attack over the next 5 years.
What biomarkers are evaluated by the PULS test?
The PULS test evaluates a number of pathways responsible for free radical damage to the endothelium, which is the lining of every artery and capillary in your body. They evaluate inflammation and repair of this endothelium. Multiple biomarkers are required to adequately define the inflammatory process that may be happening.
As you age, if the linings of your blood vessels become inflamed, damage occurs to these that results in deposition of cholesterol and other lipids into the damaged areas (see photo). This can accumulate and become very inflamed and fragile. If they “pop”, the material can clog arteries. If this happens in the heart, a heart attack can happen.
The 98% sensitivity of the test can rather accurately predict when these inflammatory changes in the arteries might become unstable and prone to rupture over a 5-year period. If a rupture occurs when the vessel is in the heart, this could result in a heart attack, otherwise called acute coronary syndrome (ACS).
In an independent validation in MESA, the PULS test identified 61% of patients (when used in conjunction with lipid studies) who went on to have a cardiac event, and who would have been missed by established risk factors.
How does the PULS Cardiac Test compare with other heart tests?
The PULS Test is not intended to replace any current tests or diagnostic modalities, but can complement them characterizing your cardiac health assessment. Unlike traditional tests for Heart Disease, the PULS test can detect the early stages of endothelial injury, diagnose disease stage, and predict how likely you are to suffer an unstable cardiac lesion rupture in the heart, or a myocardial infarction.
It may also identify people who have silent damage to the coronary arteries. In other words, these are people who don’t have any signs of coronary artery disease such as chest pain, but do have some damage to the lining of their arteries but not to the point that it produces symptoms such as chest pain.
What can be done if the test is abnormal?
There are a lot of actions that you can do to get your body and heart in better health. A thorough evaluation and discussion of these are important. Testosterone therapy, lifestyle modifications, weight-loss, anti-inflammatories, supplements to improve the health of the endothelium (Arterosil, pycnogenol), and many more options may help. If you are interested in finding out about your heart health, schedule a consultation with us. Remember, health is a decision you make every day.
Where do I get this test done?
Our office is TrueMD, located in Colleyville, TX. It is easily accessible to everyone from the Dallas Fort Worth area as it is centrally located in the Mid Cities area, just south of Southlake, TX. Call us to make an appointment for the blood to be drawn for the PULS test. We can do other evaluation of your health status too, in addition to your hormone levels. Make an appointment for a consultation with our providers today.
 Cross DS, McCarty CA, Hytopoulos E, et al. Coronary risk assessment among intermediate risk patients using a clinical and biomarker based algorithm developed and validated in two population cohorts. Current Medical Research and Opinion, 28(11), Oct. 2012:1819-1830. https://doi.org/10.1185/03007995.2012.742878
Typically, the biggest problem with hormone therapy is the ups and downs in your body and mood. You take your hormone pill in the morning and feel great, but come night time, you’re irritable and drained. Hormone pellet therapy provides the body with a constant source of the hormones it needs all day long.
Pills and creams lack the consistent flow of hormones necessary to maintain you throughout the day. The hormone pellet slowly releases hormones throughout the body, allowing it to refuel whenever necessary, keeping your body in balance all day. You only need to visit your doctor four times a year to replace the pellets.
Cosmetic surgeon Dr. Robert True strives to provide his patients with the best medical care available and is adamant about the superiority of hormone pellet therapy for providing a better quality of life. Contact us to schedule an appointment.
Do you have chronic pelvic pain that has persisted over weeks to months? Do you experience pelvic pain whenever you have sex? If you suffer from acute or chronic pelvic pain issues, you should undergo an evaluation. There are many potential causes for your pelvic pain problem, and only a thorough evaluation can help diagnose and treat the causative condition. Pelvic anatomic conditions, urinary tract, psychological, atrophic and intestinal problems are just some of the issues that can cause pelvic pain.
Anatomic conditions that can cause pelvic pain include endometriosis, adenomyosis, large or ruptured ovarian cysts, pelvic tumors, pelvic adhesions, and many other female anatomic conditions. These problems can be diagnosed through many evaluations including pelvic exam, pelvic ultrasound, pelvic CT or MRI, and/ or Laparoscopy. Treatment can include medical therapy, but may also need an outpatient surgical procedures such as laparoscopy. Here, a scope is inserted into the abdomen and the pelvic area is examined. If a problem is identified, treatment may be also performed at the same time as the laparoscopy procedure through small poke holes in the abdomen.
Painful intercourse on first penetration into the vagina may be caused by an inflammation of the hymenal remnant on the outside of the vagina. Called a vestibulitis, it may be treated adequately by a simple excision of this excess tissue to allow for more comfortable penetration. Called a vestibulectomy, it can be performed as an out patient. The results can improve a woman’s sexual experience remarkably if she suffers from this problem.
Lack of hormones during menopause may cause a thinning of the vaginal mucosa resulting in pain with intercourse. Hormone therapy many times is all that is needed to take care of this problem. Sometimes prior trauma or emotional experiences can result in spasms of the vaginal muscles, called vaginismus. Biofeedback therapy may be necessary to treat this condition.
There are many other causes of pelvic pain that can occur in a woman. If you suffer from this problem, call our office for an appointment. Dr. Robert True has been helped hundreds of women in the Dallas Fort Worth areas solve their pelvic pain problem through multiple modalities. Located in Colleyville, TX, his office is right next to DFW airport. For an appointment, call 817-399-8783.
Options to evaluate and treat pelvic pain:
- Vaginal Ultrasound
- Hormonal Therapy
There is evidence to suggest that shorter telomeres are associated with increased inflammation. People with short telomeres have high levels of several factors that cause inflammation, specifically interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-alphs). These compounds are known as cytokines which cause inflammation. Cytokines have been shown to block telomerase, the enzyme that rebuilds your telomeres. ,  (See “Telomere Length: Extend your Lifespan”to learn more about telomerase)
Inflammation is most likely the root cause behind degenerative diseases, such as heart disease, diabetes, cancer and Alzheimer’s disease. This is such an important topic that TIME magazine dedicated a review of inflammation as a “Killer”. It has the ability to destroy tissues in its zeal to try to help heal tissues from damage. If we can decrease the development of inflammation, we can therefore decrease the risk of developing degenerative problems.
Since short telomeres are associated with worse inflammation, the key therefore is to keep your telomeres longer to decrease inflammation, which would therefore decrease your risk of developing these many degenerative diseases.
Inflammation occurs when your immune system becomes inefficient and overzealous, resulting in injury to your tissues. The question is which one came first? Did your telomeres get shorter, resulting in worsening inflammation? Or did the inflammation cause a shortening of your telomeres? The answer is still pending. For now, we should act on both to give us better health: actions to lengthen your telomeres and those that decrease inflammation.
Here is some ammunition that you can do today to boost your immunity and fight inflammation, resulting in less cytokine activity, less blocking of telomerase activity, and thus to potentially lengthen your telomeres.
Take Omega 3 Fatty Acids
Everyone should be taking Omega-3 free fatty acids of DHA and EPA, around 1,000 mg to 2,000 mg twice a day. This is a natural oil found in fish and some plants. Omega-3 FFAs are possibly the best nutrient to fight against cytokines. Studies show that if you ingest more of these, particularly DHA and EPA, you produce fewer of these inflammation inducer cytokines. This decrease in inflammation may be the reason why they decrease the risk of developing degenerative diseases, such as heart disease, Alzheimer’s disease and cancer.
Many people are fooled into thinking that just “fish oil” can do this. However, you need specifically DHA and EPA to do this, and the fish oil you take may not be high in this. Our TureMD brand of Omega-3 has over 1,560 mg of DHA and EPA per capsule in a lemon flavored preparation that doesn’t give you that “burpy fish taste” that others do. Taking one capsule twice a day is easy and palatable.
Taking potent immune boosters enhance your immunity efficiency. One powerful immune booster is Curcumin (Tumeric curcumin). The active ingredient is curcuminoids and it is derived from the spice curry. It is used extensively in India and the incidence of many degenerative disease there, such as Alzheimer’s disease, is very low compared to the U.S. 
Curcumin is thought to fight degenerative diseases, including many cancers, by its effect against inflammation. Its anti-tumor actions have been observed for many cancers including colon, breast, head and neck, lung, and prostate cancer. All have a unified mechanism of action: decrease in inflammatory compounds. Decreasing inflammation is key to keeping your telomeres longer.
You could eat curry to get the benefits of curcumin, but you’d have to eat a lot of it to help. You would have to eat around 1 ounce of curry spice to get 500 mg of curcumin that’s in a capsule of Tumeric Curcumin (TrueMD) per day. Thus it may be easier to just take the supplement. You should take Curcumin, 500 mg twice a day containing 95% of the active ingredient, curcuminoids, per assay.
Resveratrol is a natural immune booster found in red wine. It works on the genes to boost decrease inflammation and improve the efficiency of your immune system. It has been shown to be helpful in multiple degenerative conditions through its effect on decreasing inflammation including cancers, cardiovascular disease, cognitive decline and diabetes. By decreasing inflammation, telomere length may also be preserved.
Drinking a glass of red wine a night is now okay to do. It not only gives you health benefits, but also may help in decreasing stress. It has multiple polyphenols that contribute to its immune boosting properties. However, to ingest enough wine to give you the same amount of resveratrol in a concentrated capsule is quite difficult. You’d have to drink around a case of wine to get the same amount of Resveratrol as in one capsule of the concentrate.
Thus, it is easier just to take the supplement (and healthier!). You should take around 250 mg of Resveratrol once or twice a day to give you adequate amounts to boost your immune response and potentially lengthen your telomeres.
Quercetin is a flavonoid that can help in reducing inflammation. Onions are rich in quercetin as well as other health inducing compounds such as phenols. Studies have suggested that flavonoids may help to prevent coronary disease plus they exert properties to help fight cancer, called anti-carcinogenic properties. It is also found in red wine, green tea and berries. We all remember the jingle, “An apple a day keeps the doctor away”, and perhaps part of the reason for this is the anti-inflammatory properties of this flavonoid.
Quercetin has been used for multiple degenerative diseases, including atherosclerosis (cardiovascular disease, diabetes, cancer and chronic fatigue. It also is used to increase endurance and improve athletic performance. The mechanism of action of quercetin to providing these benefits most likely stems from its ability to fight off inflammatory compounds so they don’t damage your tissues. In turn, this immune boosting property may help preserve your telomere length.
You could eat a lot of onions, but your stomach (and others around you) may have a problem with that. Instead, consider taking a supplement of quercetin. You’d have to eat over three pounds of onions to get the amount of quercetin in one 500 mg capsule. The recommended dose is to take 500 mg of quercetin once to twice a day.
 O'Donovan A, et. al. "Cumulative Inflammatory Load Is Associated with Short Leukocyte Telomere Length in the Health, Aging and Body Composition Study." PLoS One. 2011; 6(5): e19687.
 Beyne-Rauzy O, Recher C, Dastugue N, Demur C, Pottier G, et al. "Tumor necrosis factor alpha induces senescence and chromosomal instability in human leukemic cells." Oncogene 23: 7507-7516, 2004.
 Beyne-Rauzy O, Prade-Houdellier N, Demur C, Recher C, Ayel J, Laurent G, Mansat-De Mas V. "Tumor necrosis factor-alpha inhibits hTERT gene expression in human myeloid normal and leukemic cells." Blood 2005;106: 3200-3205.
Endres S, Ghorbani R, Kelley VE, et al. “The effect of dietary supplementation with n-3 polyunsaturated fatty acids on the synthesis of interleukin-1 and tumor necrosis factor by mononuclear cells.” N Engl J Med 1989;320:265–71.
 Killian, P, et. al., “Curcumin Inhibits prostate Cancer Metastasis in vivo by Targetint the Inflammatory Cytokines CXCL1 and -2”, Carcinogenesis, Aug, 2012. http://carcin.oxfordjournals.org/content/early/2012/10/01/carcin.bgs312.full.pdf+html
 C Guo, B Sinnott, B Niu, MB Lowry, ML Fantacone, AF Gombart. “Synergistic induction of human cathelicidin antimicrobial peptide gene expression by vitamin D and stilbenoids.” Mol Nutr Food Res. 2013, September 14.
Joao Tome-Carneiro, Manuel Gonzalvez, Mar Larrosa, Maria J. Yanez-Gascon, et al. “One-Year Consumption of a Grape Nutraceutical Containing Resveratrol Improves the Inflammatory and Fibrinolytic Status of Patients in Primary Prevention of Cardiovascular Disease.” American Journal of Cardiology, April 23, 2012.
Fang Y, Herrick EJ, Nicholl MB. “A possible role for perforin and granzyme B in resveratrol-enhanced radiosensitivity of prostate cancer.” J Androl. 2012 Jul-Aug;33(4):752-60.
Howe et al. Presented at 24th Scientific Meeting of International Society of Hypertension, 22 Oct. 2012.
 A Movahed, I Nabipour, XL Louis, SJ Thandapilly, L Yu, M Kalantarhormozi, et al. "Antihyperglycemic effects of short term resveratrol supplementation in type 2 diabetic patients." Evidence-Based Complementary and Alternative Medicine. 2013. Article ID 851267, 11 pages. BJ Kumar, NM Joghee. "Resveratrol supplementation in patients with type 2 diabetes melitus: A prospective, open label, randomized controlled trial." International Research Journal of Pharmacy. 2013;4:245-249.
Vanesa Benitez, Esperanza Molla, María A. Martín-Cabrejas, Yolanda Aguilera, Francisco J. Lopez-Andreu, et al. “Characterization of Industrial Onion Wastes (Allium cepa L.): Dietary Fibre and Bioactive Compounds.” Plant Foods for Human Nutrition, 2011, Volume 66, Number 1, Pages 48-57.
 Comalada M, et al, “n vivo quercitrin anti-inflammatory effect involves release of quercetin, which inhibits inflammation through down-regulation of the NF-kappaB pathway” Eur J Immunol. 2005 Feb;35(2):584-92.
Would you like to live longer but live with an active mind? One potent action you can do to help you maintain your brain health is to boost the efficiency of your immune system.
Your immune system helps fight off outside toxins and invaders. It has the ability to recognize and destroy toxins, bacteria, viruses, etc. that might invade your body and are “foreign” to your body, thus protecting your cells from potential damage from them. However, if your inflammation goes wild and over-does-it, it can cause damage. This is that “silent” chronic inflammation that you hear about from Dr. Oz or you read about in Newsweek and Time magazine.
Unfortunately, as you get older and age, the ability of your immune system to fend off these foreign substances begins to deteriorate and is less efficient. The response of your body is to fight even more and put more immune soldier in there, which can potentially start damaging your tissues as “collateral damage”. This collateral damage can cause the degenerative disorders we all know about and include heart disease, joint disease, dementia, Alzheimer’s disease, cancer, and aging skin, to name a few.
An example of this inflammatory response can be seen when arthritis, or inflammation of the joints occurs. Here, there was some damage to your joint. The immune system tried to correct the problem. But, with age, the response isn’t so efficient so the response is increase, i.e. goes wild, because it wants to protect you. Unfortunately, sometimes it just damages tissues, resulting in painful, inflamed, swellen, sometimes red and hot areas that need treatment to resolve.
A similar response can occur microscopically all over your body, and particularly in your arteries, causing cardiovascular disease, and in your brain, resulting in poor brain function and weakening your ability to think, otherwise called cognitive function. As this inflammation progresses, worsening damage occurs and the result is dementia and potentially Alzheimer’s disease. This silent inflammation is rapidly becoming recognized as the root cause of cognitive decline and other serious medical conditions, as listed above.
There are many actions you can do that can boost your immune efficiency resulting in potentially decreasing collateral damage to your tissues and thus maintaining healthier tissues. You could call these tissue protectors since they protect your tissues, including your brain, heart, and joint tissue, from excessive inflammation and its potential destructive effects.
One of the most powerful protecting substances, especially protecting the brain, is a natural compound called curcumin. Curcumin is an antioxidant compound that is found in the root of a plant called turmeric. It is the familiar bright yellow spice commonly found in curry powder. It is consumed in high amounts in India and it is thought that it contributes to their longevity, as their lifespan tends to be longer than Americans. Interestingly, India also has the lowest incidence of cognitive decline worldwide, and it is thought that this high intake of curcumin contributes to this (1).
Unfortunately, it is estimated that 1 in 8 Americans will suffer from some sort of severe cognitive decline; and by age 80, up to 50%, 1 in every 2 Americans, will develop this (2). But don’t fear; there are actions you can do to decrease this from happening, and these are called anti-aging actions; i.e. actions you can take to help prevent the damages produced by degenerative processes that can occur as we age.
In a nutshell, here’s what you should do: take immune boosters, lose weight, exercise regularly, use your mind, replenish low hormones, ingest or supplement adequate nutrients. Regarding taking immune boosters, one of the most powerful immune boosters that you can take is curcumin. It is also an antioxidant to fight off free radicals that can destroy your tissues, and it boosts your immunity so there’s less collateral damage to your tissues.
If the excess inflammation gets to your brain, it can cause the deposition of abnormal protein on the nerves in your brain, called neurons, and decrease their ability to function. In Alzheimer’s, this protein is called amyloid, and partly causes the mental sluggishness and forgetfulness that goes along with that disease. Studies show that curcumin has the ability to bind to these proteins and break then down so your body can eliminate them better (3).
This was demonstrated in a study involving people with severe cognitive decline demonstrating the benefits of curcumin. Those participants taking curcumin had significantly higher levels of dissolved abnormal proteins in their blood compared to those in the placebo group (3). Removal of these abnormal proteins can therefore help protect the neurons and maintain their normal function. Curcumin is one of the only natural substances known to have this protective effect on the brain.
Curcumin’s ability to boost you immunity can not only help your brain, but it also has been shown to reduce joint pain and muscle soreness, plus help your arteries and support your cardiovascular system (4, 5, 6, 7, 8). It is easy to reap the benefits curcumin can provide for you: you can just take a pill.
The recommended dose is to take around 1000 mg of curcumin a day. To make sure you are taking the right stuff, make sure the curcumin has a large proportion of the active ingredient, cucunimoids (curcumin, demethoxycurcumin and bisdemethoxycurcumin). Best is to take one with75% to 95% active curcuminoids per standardized assay.
Let’s review how curcumin can help you
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Are you about to have a hysterectomy performed and are wondering if you should have your ovaries and tubes removed at the same time? Many women are faced with this dilemma and are confused about what to do. This may be due to conflicting ideas on the internet or from friends, or they are afraid of getting ovarian cancer and they believe this will eliminate their risk.
There has been a paradigm shift in the recommendations, and for good reasons. It used to be thought that removing your tubes and ovaries at the time of a hysterectomy eliminated or reduced your risk of developing ovarian cancer. This procedure is called a prophylactic bilateral salpingo-oopherectomy (BSO), and the recommendations for doing so have changed. There are many reasons why this concept has shifted in thought.
1. Ovarian cancer risk is very low for most women. In the general population, the lifetime risk of ovarian cancer is 1.4%. This varies per population. For white women with three or more term pregnancies and 4 or more years of oral contraceptive use, the lifetime risk is even less, at 0.3% (i.e. one in every 1,000 women). (1)
2. The risk of potential complications from doing a prophylactic BSO where the ovaries are normal is around 3%. Thus, the risk is greater than the benefit. For this and other reasons noted below, the ACOG (American Congress of Obstetrics and Gynecology), in their latest recommendations on this subject, do not advocate removal of ovaries prophylactically unless there is pathology of the ovaries or high risk factors. (2)
3. According to the 2009 Nurses’ Health Study (NHS, removing ovaries during a hysterectomy has been associated with more cases of coronary heart disease (CHD), stroke, and lung cancer compared with women who had hysterectomy with ovarian conservation. (3) A subsequent NHS confirmed these increases, but also added an increase in colon cancer. (4)
4. Studies do not support the goal of a reduction of ovarian cancer by prophylactic oophorectomy. Two studies confirmed that at no age was there a survival advantage in the oophorectomy group and there were some deaths from ovarian cancer from o.9% of women without ovaries. (4,5)
5. In other studies of the Mayo population, women with oophorectomies had higher risks of anxiety, depression, dementia or cognitive impairment, and Parkinsonism. (5) They had more mood changes and hot flashes too. This was not as significant if women took hormone therapy long term.
6. Unfortunately, women tend to not continue to take hormone therapy. Even though it may have been recommended that the women take hormones to treat the above problems, the data indicates that only 17% of women continue with to take estrogen 5 years after the initial treatment. (6) NHS studies concluded that women with a BSO before the age of 50 but who did not use subsequent estrogen therapy had a higher risk of mortality from all causes than those who did use estrogen by almost 40%. (5)
7. The fear of needing further surgery to remove ovaries is not well supported. The chance of needing a BSO after a hysterectomy is low. Only about 6.2% of women with ovarian conservations require this. The same risk in women who didn’t have a hysterectomy was 4.8%; thus not statistically different. (7)
8. Ovarian cancer does not always come from the ovary. Seventy percent of epithelial ovarian cancers are of the serous high-grade and clinically aggressive type. However, the ovary does not contain epithelial cells. (9) There is other evidence to show that what we have called ovarian cancer may be cancers coming from other pelvic organs that have epithelial cells, such as tubes. It may also come from the lining of the abdomen, called the peritoneum, not needing ovaries for its development.
9. Removal of just the tubes does not seem to cause ovarian problems. Some believe that doing a salpingectomy (removal of just the tubes) could compromise collateral circulation to the ovaries and predispose women to early ovarian failure. However, so far the literature does not confirm this fear and ovaries contained just as many follicles after as before removal of tubes. (10)
10. In those women desiring prophylaxis, removal of the tubes may be better than removal of the ovaries. This would result in maintaining ovarian function, but potentially decreasing the risk of the epithelial tumors though to come from the ovaries but which may actually be coming from the tubes. This can be considered prior to a hysterectomy if desired. (11)
In conclusion, women with an average risk of ovarian cancer should not be performed in women undergoing a hysterectomy. Doing so may increase their risks of developing other fatal medical conditions. If they have a high risk of ovarian cancer, such as BRCA positive or a strong family history of breast or ovarian cancer, this could be recommended. It may be better for patients to remove tubes and preserve ovaries for most women.
1. Hartge P, Whittemore AS, Itnyre J, McGowan L, Cramer D. Rates and risks of ovarian cancer in subgroups of white women in the United States. The Collaborative Ovarian Cancer Group. Obstet Gynecol. 1994;84(5):760–764.
2. Parker WH, Feskanich D, Broder MS, et al. Long-term mortality associated with oophorectomy compared with ovarian conservation in the Nurses’ Health Study. Obstet Gynecol. 2013; 121(4):709–716.
3. Parker W, Broder M, Chang E, et al. Ovarian conservation at the time of hysterectomy and long-term health outcomes in the Nurses’ Health Study. Obstet Gynecol. 2009;113(5):1027–1037.
4. Parker WH, Feskanich D, Broder MS, et al. Long-term mortality associated with oophorectomy compared with ovarian conservation in the Nurses’ Health Study. Obstet Gynecol. 2013;121(4):709–716.
5. Rocca WA, Grossardt BR, de Andrade M, Malkasian GD, Melton LJ III. Survival patterns after oophorectomy in premenopausal women: A population-based cohort study. Lancet Oncol. 2006; 7(10):821–828.
6. Sprague BL, Trentham-Dietz A, Cronin KA. A sustained decline in postmenopausal hormone use: Results from the national health and nutrition examination survey, 1999–2010. Obstet Gynecol. 2012;120(3):595–603.
7. Casiano ER, Trabuco EC, Bharucha AE, et al. Risk of oophorectomy after hysterectomy. Obstet Gynecol. 2013;121(5):1069–1074.
8. Pavlik EJ, Ueland FR, Miller RW, et al. Frequency and disposition of ovarian abnormalities followed with serial transvaginal ultrasonography. Obstet Gynecol. 2013;122(2 Pt 1):210–217.
9. Kurman RJ, Shih IM. The origin and pathogenesis of epithelial ovarian cancer: A proposed unifying theory. Am J Surg Pathol. 2010;34(3):433–443.
10. Rocca WA, Grossardt BR, de Andrade M, Malkasian GD, Melton LJ III. Survival patterns after oophorectomy in premenopausal women: A population-based cohort study. Lancet Oncol. 2006;7(10):821–828.
11. SGO Clinical Practice Statement: Salpingectomy for Ovarian Cancer Prevention. Society of Gynecologic Oncology. November 2013. https://www.sgo.org/clinical-practice/guidelines/sgo-clinical-practice-statement-salpingectomy-for-ovarian-cancer-prevention. Accessed February 10, 2014.
Still now majority of the patients seeking cosmetic surgery procedures are caucasian females but the proportion of patients, those who belongs to other racial and ethnic population (including both males and females) has been increasing in recent years. According to a study twenty-five percent of all cosmetic plastic surgery patients were different ethnic people including Asian, African or Hispanic. The increase in number (approximately)of racial and ethnic patients undergoing cosmetic surgery are as follows :- black patients 7.5 percent, Hispanics by 4.7 percent, Asians by 14.5 percent and Native Americans by 105.5 percent over last decades.
These rising demand of cosmetic surgery have been attributed to various factors such as ethnic patients are becoming increasingly aware of the benefits of cosmetic surgery due to more global appeal of the same, improved technology, scientific advances, reduced costs and in some cases erasing the stigma attached with cosmetic surgery.
Rhinoplasty is one of the top three surgical procedures performed in African Americans, Asian Americans and Hispanics. Others procedures are eyelid surgery, liposuction, breast reduction, botox and injectable fillers.
Ethnic patients, who desire cosmetic surgery have similar motivation like other patients, they also want to reduce sign of aging, look refreshed or want balance and symmetry on their face or body. According to many facial cosmetic surgeons, ethnic patients wants the result more ethnically congruent—refining features without losing ethnic identity.
It is very important to note that they want to maintain their ethnicity and do not want to lose important features, those exhibit their racial character. For instance although an Asian patient desires eyelid surgery for wider and fuller eye yet they want to maintain an almond shape, typical to their race. An African American patient interested in nose reshaping want to reduce the size of their nose but they do not want a high bridge nose that is more European looking. So applying a general ” standard of beauty ” in ethnic people may produce inconsistent results.
It is really crucial to understand their point of view and the specific need before performing the surgery. Another important thing is to note and understand the differences in skin textures, skin colour and internal supporting structures.
According to The American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) the most Common Cosmetic Plastic Surgery Procedures for ethnic groups are given below :
Hispanic Americans : The most commonly requested surgical cosmetic procedures by Hispanic Americans are nose reshaping, breast augmentation and liposuction where as the most requested minimally-invasive cosmetic procedures are Botox, injectable fillers, and chemical peels.
African American : The most common surgical procedures for this ethnic group are nose reshaping, breast reduction, and liposuction. The most commonly requested minimally-invasive procedures are same as Hispanic American.
Asian Americans: The most commonly requested surgical procedures are eyelid surgery, nose reshaping, and breast augmentation. The most commonly requested minimally-invasive procedures are same as above.
The main aim of an aesthetic consultant is to enhance the overall beauty of a person. According to Robert L True, M.D. , it is very important to know the patient’s real reason for aesthetic improvement and treat accordingly. The real aesthetic treatment requires multi dimensional approach, that includes safe treatments, establishing trust and producing positive outcomes, these will ensure loyalty and future treatments because the patients are not paying for a unit treatment rather they are paying for overall good results.
Most patients who come in for aesthetic surgeries are focused on a certain concern they have. The aesthetic consultant needs to understand these concerns and tailor a plan of action to correct the concerns. Most of the time, these concerns are actually from multiple issues of the patient’s face, and the consultant must then help the patient understand that to enhance natural beauty full- face restoration is far better option than focusing one area of the face.
Beauty is the combination of symmetry, balance and harmony. Keeping this in mind, before performing any aesthetic procedure , the patient’s features should be analyzed during the consultation exam, and then photographed for documentation. The many expressions of the face should be captured, showing different moods of the patients such as relaxed, animated, smiling, and spontaneous smiling images. These not only help to see the particular line or wrinkles of the patient’s face but also help to point out the positive features of the same. This is very useful to treat the the lines and wrinkles as well as to enhance those good features to restore overall natural beauty. The treatment is done accordingly with multiple procedure and aspects including a mosaic of different fillers (Voluma and Juvederm), neurotoxins (Botox), and laser therapies (CO2 laser resurfacing), different aspects of the aging face such as asymmetries, sagging skin, brow ptosis, dyschromias (i.e. pigmentations) and general deflation of the facial skin and tissues. So the treatment is done with proper and prior planning.
Treatment should not be done all at once instead it should be done with proper care and lots of patience. This treatment is comparable to restoration of an antique painting, which is done gradually in part by part and with caring fashion. Therefore, antiaging treatments should be employed in multiple sessions over time resulting in natural-looking, youthful face.
According to Dr. True, the most important thing is to instill trust among the patients by giving them time, understanding their need, their background, ethnicity, jobs and the real reason for desiring rejuvenation treatment, in this way they will feel connected with the aesthetic consultant and in turn the consultant can address their concerns, as a result the outcome of the aesthetic procedure will be excellent.
Leaky gut is a condition of the gastrointestinal tract that may increase inflammation in the body. Subsequently, this inflammation can cause many health problems. It is a condition that most doctors don’t discuss, yet affects millions. Thus, most people who have this condition are unaware of it, and continue to suffer from multiple problems that may be helped with its treatment and/or prevention.
What is leaky gut?
Let’s go down to the cells lining your small intestine. Through this lining, made of cells attached side by side, nutrients from the foods you eat are absorbed. The membranes of these cells contain microscopic pores so the nutrients can be transferred into your bloodstream. Once transferred, the nutrients can then be utilized by your body.
The pores are selective, that is they only allow certain things to enter the bloodstream while blocking other things. Thus, beneficial minerals and nutrients are allowed to pass while toxins and large undigested food particles are blocked. Each cell is attached to each other through tight junctions and these should be sufficiently tight enough to prevent material from the gut from passing between them.
There are several theories of leaky gut. One is that these tight junctions, held together with tight bonds containing glutamine, loosen up or are disrupted, resulting in toxins entering the area and the blood. Another theory is that the pores in your intestines widen, resulting in the same scenario.
When undigested food particles and toxins that are supposed to be blocked are allowed to make their way into the bloodstream, they result in an increase in the immune system function, which tries to rid your body of these toxins. If this process goes to excessive amounts, the excess immunity can result in damage to your other cells and organs in your body, which can result in medical conditions.
Immunity is good when in moderation, for it fights off foreign invaders into our body. However, if in excess, your own immune response can not only hit the invaders, but may also attack your healthy cells. Think of immunity as your body’s soldiers fighting off invaders. If a few invaders come in, these can be knocked off with rifles. However, if armies come in, your army fights them massively, say with grenades, that results in collateral damage to your health cells.
This damage to your normal cells can result in inflammatory conditions. These may include arthritis, cardiovascular disease, cancers, diabetes, Alzheimer’s disease, and multiple other degenerative diseases. Sometimes it may result in food allergies or autoimmune disorders.
How does leaky gut develop?
There are several different ways you can develop leaky gut. Chronic constipation may allow the toxins in your stool to irritate the lining of your intestines. This irritation may lead to inflammation which will cause the pores in the small intestine to expand or the tight junctions to loosen. If this process continues, toxins enter and inflammation into your blood occurs.
Other conditions of leaky gut include irritable bowel syndrome, Crohn’s disease, and colitis, which are inflammatory conditions of unknown cause. Here, your intestines become inflamed and very “leaky”, allowing toxins to invade your body in overwhelming numbers, resulting in your body working overtime to combat. This may result in severe fatigue, malaise, and poor health.
Leaky gut may also occur when an imbalance of the flora inside your gut develops. A perfect balance of the good and bad bacteria within our digestive system must exist for best health. When this balance shifts and there are more bad bacteria than good, irritation occur, which again, causes the pores and the junctions to open up with resulting inflammation formation.
How is leaky gut treated?
The best treatment for leaky gut starts with taking large amounts of glutamine. This amino acid tightens the junctions between the cells in the intestines. It also has the ability to heal soft tissue like the lining of your intestines. By improving the health and integrity of your gut, the inflammatory response may be prevented and/or treated.
Next, we add probiotics. Probiotics are essentially the good bacteria which help to restore the good balance of your gut flora. The good bacteria can thus overwhelm the bad bacteria, the ones that can produce the undesirable toxins within your gut, thus less toxins can enter through a leaky gut.
Another way to reduce the toxins within your gut is to give you antibodies which kill or neutralize them. Your intestines produce these antibodies every day, but this may not be enough to prevent leaky gut, thus, taking these antibodies, i.e. IgG, be beneficial.
The most obvious treatment is to eat the right foods. Not only will your gut be healthier, but so will the rest of your body. Roughage is good, so eat plenty of fiber to allow proper passage of the stool through your gut. Anti-inflammatory foods are also very helpful, such as certain fruits, like berries, to fight this inflammation.
There are many inflammation modulators that can help. For instance, a good fat, Omega-3 fatty acid, is known for its ability to combat inflammation. Thus, increase the amount of omega-3 in your diet by eating more fatty fish like salmon, or by taking an Omega supplements. Make sure these have high amounts of the omega 3 fatty acids, DHA and EPA, and not a lot of omega 6 fatty acids. We usually recommend you take 1 to 2 grams a day, but doses of 4 to 6 grams daily can also decrease high triglycerides in your blood and are safe to take.
At our office, we treat leaky gut using all the above modalities. Probiotics and omegas are recommended to not only treat this, but to improve your overall health. A product that contains high amounts of glutamine and IgG is GI protect, and is recommended if you have any signs of leaky gut.
In summary, leaky gut is widespread but not well treated and sometimes ignored by conventional medicine. Focus on healing the gut and preventing this problem through the steps listed above. By knowing what leaky gut is and how you can heal it, you have the tools you need to keep your gut healthy, which can improve your health.