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101 Old Short Hills Rd
Atkins-Kent Building, Suite 101
W. Orange, NJ 07052
33 Overlook Rd.
Summit, NJ 07901
Bayonne, NJ 07002
1119 Raritan Road
Clark, NJ 07066
Robert J. Rubino,
Audrey A. Romero, M.D., F.A.C.O.G.
Jacqueline Saitta, M.D., F.A.C.O.G.
Allan D. Kessel,
Priya R. Patel,
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"I didn't know that!
Estrogen thickens the vaginal tissue and causes it to buckle slightly, creating many tiny folds called rugae. This provides more surface area for secretions and lubrication, and it also gives the vagina more stretch during intercourse and childbirth. Estrogen decreases in women who just had a baby, are breastfeeding or are going through menopause, causing the ridges to flatten out and the vaginal tissue to become thinner and drier.
As another year starts to close, we reflect on how grateful we are for our patients and how much we value the relationships we have developed through the years. We wish all of our families a Merry Christmas, Happy Hanukah and happy & healthy New Year.
In this issue of our newsletter, Dr. Kessel authors an article on vaginal discomfort and diagnosis. We are excited to introduce a new photo gallery in the waiting room and hallways of our main office in West Orange. In addition, we review insurance coverage with our practice and remind of Health Republic's closure. In our Healthy Living section, we have a guest author offering guidance on how to choose the best workout. Our walk-in flu clinics continue until supplies last. And, you'll find a new interesting "Medical Fact".
As always, we will continue to provide topics that are current, informative and important to your good health.
|Not All That Itches Is Yeast
Allan D. Kessel, MD, FACOG
Vulvar irritation is one of the most common reasons for women to make an appointment with their OB/GYN. In general, the causes for this condition are easily treated however, in some patients, symptoms can become recurrent or chronic and require a more prolonged course of medication to successfully manage or eliminate the issue.
Yeast infections occur in 17-39% of women with symptoms of vaginal infection. Symptoms include a thick white discharge, itching, burning, pain with sex and burning with urination. But the specific range and severity of symptoms varies greatly per patient. Up to two thirds of women who purchase products
without consulting a physician to treat a yeast infection actually have a
different condition. Women can be diagnosed definitively by microscopic visualization or culture.
External yeast infections are treated with either external vulvar creams or the oral antifungal agent fluconazole ("diflucan"). External creams such as Lotrisone or Mycolog combine an antifungal cream and a low-mid potency steroid cream to reduce inflammation. Depending on the case, the physician may also treat a coexisting internal vaginal infection.
Recurrent yeast infections, or more complicated yeast infections,
may be more difficult to eradicate. The precise treatment course needs to be optimized for an individual patient and regimens may include:
- Weekly diflucan pills for up to six months
- Weekly clotrimazole vaginaly suppositories
- Boric acid vaginal suppositories for resistant or atypical cases
- Daily over-the-counter probiotic acidophilus, which helps support the normal bacterial environment of the vagina
These conditions are not sexaully transmitted and treating one's partner has not been shown to be effective in helping patients.
Trichomoniasis can cause both vaginal discharge and vulvar itching. Patients may have a range of symptoms, from no symptoms, to vaginal discharge, vulvar inflammation and burning, itching, or bleeding after sex. This infection is
transmitted by sexual contact. Diagnosis is made by the physician with
direct visualization under the microscope, culture, or on a pap
smear. Treatment is with oral metronidazole or tindazole. As an important point, alcohol should never be consumed with medications, but particularly not with either oral or vaginal metronidazole.
Vulvar dermatitis is a common source of chronic vulvar itching. This evolves as a local allergic reaction to an allergen or irritant which is frequently unknown to the patient. It will appears as vulvar redness, swelling and thickening of the vulvar skin. Common allergens (from ACOG Practice Bulletin No. 93) include:
Treatment is best with a short course of steroid cream, such as desonide or triamcinolone, and identification of the inciting agent if possible. In some cases, consultation with a dermatologist may be recommended.
In postmenopausal women, but also in some premenopausal women, vulvar
atrophy causes irritating symptoms including discharge,
itching, burning, and pain with sex. The basis for this is reduced
estrogen support of the health and maintenance of the vagina and vulva. These
symptoms can mimic those of a yeast infection. Treatment consists of
water-based moisturizing solutions (ie. over the counter "Replens"), or estrogen creams. An oral medication known as Osphena has been recently introduced to support the vaginal tissue in postmenopausal women for this condition.
Three less common inflammatory conditions can lead to vulvar
itching: lichen sclerosis, lichen planus, and lichen simplex chronicus.
All are more chronic conditions, and are generally treated with higher dose
topical steroid creams.
Lichen sclerosis is a suspected autoimmune disease where the skin appears
"parchment-like". Patients may experience itching, burning,
lacerations and pain with sex. Lichen planus is very uncommon, and more frequently presents as red erosions on the vulva which can extend into the vagina. Lichen simplex chronicus is the end result as any kind of chronic inflammation of the vulva. It appears later in a woman's life, and presents as a scaling flat area on the vulva in its initial stages. All of these conditions require careful assessment by the gynecologist and vulvar biopsy to confirms the diagnosis, and also rule out and precancerous changes to the vulvar skin.
Precancerous conditions of the vulva (vulvar intraepithelial neoplasia) are rare, but may present with as discrete skin lesions that may be pink, red, brown or white. These lesions can cause moderate to severe external itching. If you see a
concerning area on your external genitalia, please make an appointment with
The symptoms of these conditions can often be subtle and very difficult for a patient to evaluate on their own. If you have vulvar itching or vaginal discharge, please make an appointment to see your Rubino OB/GYN physician for optimal identification, and management of the problem.
|New Photo Gallery in West Orange Office
The artwork you see on the walls of our main office in West Orange is a new gallery collection by Hartshorn Photography and are actual pieces created from family portrait sessions. We think it is a wonderful addition to our waiting room and exam room hallways.
The photographer, Mac Hartshorn, captures special moments and personality nuances that would otherwise be lost in the typical portrait photography setting. Mac's penchant for fun is infused into each photo session enabling his clients to feel instantly at ease in front of the camera.
This fine-art portrait studio, founded in 2002, is based in Hoboken. In-house archival printing and custom framing add the finishing touches to portraits are treasured for generations.
|Mac showed his talent with a portrait of Dr. Rubino's children.|
201 610 1199
Horizon introduces Omnia Health Plans for 2016
Horizon has introduced a new line of health exchange insurance products called Omnia. The Rubino OBGYN Group will be participating in the Horizon Omnia plans at the Tier 1 level.
If you have any questions regarding the Horizon Omnia plans please contact Horizon directly or visit www.Horizonblueomnia.com
Overall Insurance Coverage
For your convenience, we accept most insurance plans including the union locals, with the exception of Medicaid, any of the New Jersey Family Care Medical policies, Tricare, US Family, and Wellcare.
We accept all Oxford plans except Compass, Core, Core Essential and Garden State and all Aetna plans except Aexcel (but Aexcel Plus is accepted).
We participate in the Horizon Omnia plans at the Tier 1 level.
If you have any questions regarding the Horizon Omnia plans please contact Horizon directly or visit www.Horizonblueomnia.com.
It is always best to check with us prior to your visit if you are unsure regarding The Rubino OB/GYN Group's participation with your policy.
|Health Republic Of NY Insurance Closed
Reminder, Health Republic of New York insurance has closed as of 12/1/15.
Patients previously with Health Republic of New York insurance will need to provide a new health insurance, effective 12/1/15, with a participating insurance company. If insurance is not available, they may become a self-pay patient and pay associated costs out-of-pocket.
Please note this does not affect Health Republic of New Jersey customers.
Health Republic of New York offers only Health Exchange or "Obamacare" health insurance policies.
Patients who have Health Republic of New York policies can call our office and reach either billing or insurance questions for assistance.
|Walk-In Flu Clinics Continue
We are continuing our walk-in flu shots for all patients.
on the following days in the following offices.
Mondays 1:00 pm - 4:00 pm and
Thursdays 10:00 am - 2:00 pm
Fridays 11:00 am - 2:00 pm
Thursdays 11:00 am - 2:00 pm
Mondays 11:00 am - 2:00 pm
The clinics will run every week while supplies last.
|Healthy Living: Exhale - Taking Care Of You|
Guest author: Fred DeVito, EVP Movement Classes, Training & Core Fusion co-creator at exhale
One of the most talked about steps to living a healthy lifestyle is to add regular
workouts to your weekly routine. Often, this is easier with group fitness options as it builds a sense of camaraderie, accountability and a fun atmosphere. But with so many options out there...how do you choose the workout that's best for you?
Following are a list of three important things to look for when choosing a fitness class:
When it comes to exercise, there are three elements that keep the body looking (and feeling) young: muscle elasticity (your flexibility), bone density (weight bearing exercises) and muscle density (for higher metabolism). Focusing on these three elements will help your body feel more youthful. Classes that incorporate stretching, light hand weights and work at a barre are great options to cover all three in a one hour workout.
Pushing yourself beyond your limit may lead to injury. It's important to take a class at your fitness level to allow you to feel comfortable and safe in your environment, especially if you are a beginner. You can always progress to harder, more challenging classes as you build your fitness stamina. There are many classes that offer progressions so everyone can be at their own level as the class moves along. With consistency and patience, everyone can achieve a change in their body.
Any fitness class should leave you feeling fantastic when it ends. This feeling of euphoria carries over into your daily life. Self-love and self-care is very important in balancing out your mental and physical well-being. Taking care of yourself allows you to be a better spouse, parent, or business partner. A one-hour class that you "gift" yourself three times a week will give you a sense of pride that you are taking control of your life and making your health and well-being a priority.
Incorporating these ideas when choosing a fitness routine will help you select the one that is best for you.
"If it doesn't challenge you, it doesn't change you." ™ - Fred DeVito
Pay Your Bill Online
You can pay your Rubino OB/GYN Group bills online right from the homepage of our website. Simply click on the button at the top of the page that says "New! Pay Your Bill Online!".
Options include paying by credit card or echeck. It is an easy one-time registration to create a password.
For easy reference, the direct link is: Pay My Bill.
|Office Announcements |
Flu Shots Now Available
Please note the available walk-in flu clinics in each office location in the article above.
Pay Your Rubino OB/GYN Bills Online
Patients can pay their bills online at the following web site:
Options include paying by credit card or echeck.
The Rubino OB/GYN Group offers vitaMedMD™ in all 4 office locations. VitaMedMD offers patients high quality physician recommended products at an affordable price. Available products include Prenatal One, Menopause Relief and Iron 150.
Emmi Video TutorialsEmmi is a free, online video tutorial that makes complex medical information simple and easy to understand. Emmi provides clear and concise step-by-step information on common health topics and procedures right on our website. Click here to find out more.
"Important Announcements" on Our Website
You can find important new developments and time-sensitive announcements (such as office closings) right on the upper right hand portion of our home page.
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