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Table of Contents 

Toxic Shock Syndrome


 Symptoms Women Shouldn't Ignore 


Healthy Living: Necessary Nutrients 


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Robert J. Rubino,

M.D., F.A.C.O.G.
Audrey A. Romero, M.D., F.A.C.O.G.
Lisa Abeshaus,
M.D., F.A.C.O.G.
Jacqueline Saitta, M.D., F.A.C.O.G.

Allan D. Kessel,
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Diana Huang,
M.D., F.A.C.O.G.
Priya R. Patel,
M.D., F.A.C.O.G.,MPH
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M.D., F.A.C.O.G.
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Medical Fact

 "I didn't know that!"


 The biological sign for the female sex, a circle placed on top of a small cross, is also the symbol for the planet Venus. The symbol is believed to be a stylized representation of the Roman goddess Venus' hand mirror.


We hope you are enjoying the heart of the summer and taking in some of the warm, lazy days.

In this issue of our newsletter, we provide information on toxic shock syndrome and when it was first discovered. We also highlight some symptoms women should not ignore. In our Healthy Living section, we supply a list of necessary nutrients for women.  And, you'll find a new interesting "Medical Fact".  Reminder - we have a new user-friendly, interactive website! Please let us know your thoughts.
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As always, we will continue to provide topics that are current, informative and important to your good health.  

The Rubino OB/GYN Group

Toxic Shock SyndromeRH

It is common to open a box of tampons and see a warning insert for Toxic Shock Syndrome. But what is it really?


Toxic shock syndrome is a sudden, serious disease that involves fever, shock and problems with several body organs. It's caused by a toxin produced from an overgrowth of bacteria called Staphylococcus aureus, or staph, which is found in many women's bodies.


Staph is normally -- and harmlessly -- present in the vagina. How staph causes toxic shock syndrome is not understood. But two conditions are necessary: First, the bacteria need an environment in which they can grow rapidly and release poisons. Then the poisons must get into the bloodstream. 


The earliest cases of toxic shock syndrome involved women using tampons, especially super-absorbent, during their periods in the 1970s. However, today less than half of the cases are linked to tampon use. It has also been linked to the use of menstrual sponges, diaphragms and cervical caps. It can occur in men or women who have been exposed to staph bacteria when recovering from surgery.


Toxic shock syndrome causes a sharp drop in blood pressure that deprives organs of oxygen and can be life threatening. More than a third of all cases of toxic shock involve women under 19, and up to 30% of women who have had the disease will get it again. 


Risk factors include:

  • Recent childbirth
  • Infection with Staphylococcus aureus (S. aureus), commonly called a staph infection
  • Foreign bodies or packings (such as those used to stop nosebleeds) inside the body
  • Menstrual period
  • Recent surgery
  • Tampon use (particularly if you leave one in for a long time)
  • Wound infection after surgery

Some symptoms to look out for include:  

  • Confusion
  • Diarrhea
  • General ill-feeling
  • Headaches
  • High fever, sometimes accompanied by chills
  • Low blood pressure
  • Muscle aches
  • Nausea and vomiting
  • Organ failure (usually kidneys and liver)
  • Redness of eyes, mouth, throat
  • Seizures
  • Widespread red rash that looks like a sunburn -- skin peeling occurs 1 or 2 weeks after the rash, particularly on the palms of the hand or bottom of the feet.

No single test can diagnose toxic shock syndrome. Your doctor will look for some of the symptoms including fever, low blood pressure, rash and problems with the function of at least three organs. In some cases, blood cultures may be positive for growth of S. aureus.


Treatment includes the removal of materials, such as tampons, vaginal sponges, or nasal packing and the drainage of infection sites (such as a surgical wound).

The goal of treatment is to maintain important body functions. This may include:

  • Antibiotics for any infection (may be given through an IV)
  • Dialysis (if severe kidney problems are present)
  • Fluids through a vein (IV)
  • Medicines to control blood pressure
  • Intravenous gamma globulin in severe cases
  • Staying in the hospital intensive care unit (ICU) for monitoring

You can lower your risk for toxic shock syndrome by avoiding highly absorbent tampons, changing tampons frequently and only using tampons once in a while during menstruation.


If you experience any of the symptoms of toxic shock, contact medical help immediately.  

Symptoms Women Should Not Ignoretests

Have you ever had medical symptoms but wondered when you should take them seriously or follow up with your doctor?  There are certain specific medical symptoms that women should not ignore. They include:

  • Pain or discomfort in the center of the chest sometimes accompanied by pain in the upper body including arms, back, neck, jaw, or stomach; shortness of breath; a cold sweat; nausea; or lightheadedness. Women are more likely than men to have heart attack without having chest pain.
  • Sudden severe headache.
  • Sudden or developing problems with speech, sight, balance, walking, confusion, or coordination, as well as numbness or weakness in the face, arms, or legs. Call 911 if you have any of these symptoms which could be indicative of a stroke.
  • Bleeding or spotting between periods; itching, burning, bumps, blisters, or sores on the vagina or genital area.
  • Pain during sex.
  • Severe menstrual pain or severe pelvic pain.
  • Unusual vaginal discharge.
  • Lower back pain with bloating and/or feelings of fullness.
  • Difficult or painful urination.
  • Issues with your breasts: nipple discharge, breast tenderness or pain, changes in the skin covering the breast or nipples (ridges, dimpling, pitting, swelling, redness, or scaling), a lump or thickening in the tissue of the breast or underarm area, or tenderness in these areas.
  • Digestive or stomach problems: Bleeding from the rectum; blood or mucus in the stool or black stools; change in bowel habits; constipation, diarrhea, or both; constant heartburn; pain or feeling of fullness in stomach; bloating; vomiting blood.
  • Skin problems: A new mole or changes in the color, shape, or size of an existing mole; small lump on skin that is smooth, shiny, and waxy and sometimes reddish brown in color; painful, crusty, scaling, or oozing skin lesions that don't heal within 14 days.

If you experience any of the above symptoms, you should act on them immediately. If you have any questions, please make an appointment with one of our doctors. 

Healthy Living: Necessary Nutrients For Womengiving

During early childhood, nutrition recommendations for boys and girls are similar, but that begins to change with a clear separation by age 14.


Folate: The U.S. Department of Agriculture and the Department of Health and Human Services say many women are not consuming enough folate (a B vitamin) or calcium. Folate (or folic acid) helps support growth and development, prevents certain birth defects and anemia during pregnancy, and may reduce the risk of heart disease and some cancers. 

The recommended level of daily folate intake in women is 400 micrograms daily, unless you are pregnant (600 micrograms) or nursing (500 micrograms).


Sources: beans, lentils, spinach, asparagus, lettuce, avocado, broccoli, tropical fruits (mango), oranges and wheat bread.


Calcium is not only important to bone and teeth health but also overall health. Calcium keeps your circulatory system, muscles and nerves working normally. Insufficient calcium intake, beginning as a teenager, can increase your risk of osteoporosis (a painful bone-thinning disorder) later in life. Women aged 19-50 need 1,000 milligrams of calcium; after age 50, 1,200 milligrams. Pregnant or nursing women aged 18 and younger should get 1,300 milligrams.


Sources: dairy products (milk, yogurt, cheese) and calcium rich greens like kale, cabbage and broccoli.


Vitamin D not only helps the body use calcium, it also helps regulate the immune and neuromuscular systems and plays a major role in the life cycle of human cells. Vitamin D is produced by our bodies naturally when exposed to sunlight however, we all know the importance of protecting your skin from the sun.


Sources: sunlight (in moderation), fatty fish, fortified milk, orange juice and supplements.


Iron - women are at the highest risk for anemia - a blood disorder that is caused by low levels of iron. Lack of iron can cause high levels of fatigue. Women lose iron during their periods and need more of this mineral than men - and as much as three times more during pregnancy.


Sources: lean meats, seafood, nuts, beans, iron fortified cereals and breads.

Menopause and Beyond

Your body goes through a shift as menopause sets in. After the age of 50, your body is no longer growing and your activity level tends to drop.When that happens, and estrogen levels start to plummet, your body needs more of some nutrients and less of others, like iron.


Calcium and Vitamin D

Getting enough calcium and keeping active with weight-bearing exercise is critical for slowing down bone loss. Calcium intake should increase to 1,200 milligrams a day and 800 IUs of vitamin D.



Fiber helps lower the risk of all sorts of health conditions, including high cholesterol, diabetes, heart disease, and cancer. It also helps keep your colon working well. If you're over 50, you need at least 20 grams a day. You can get fiber from unrefined cereals (like bran), fresh fruit, whole grains, vegetables, and legumes. 


Vitamin B6

Vitamin B6 keeps your mind sharp. Try to get at least 1 milligram a day from brain foods like chickpeas, liver, fish, and chicken.


Taking care of your body now and feeding it proper nutrients will help you live a healthier, longer life. 

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