In This Issue
Symptoms of Iron Deficiency
Anti-Depressants and Pregnancy
10 Ways to Reduce Your Risk of Getting a UTI
6 Surprising Health Problems Associated with Menopause
10 Questions to Ask Your Doctor - Stat!

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Symptoms of Iron Deficiency  iron

1. Extreme Fatigue and Exhaustion
People lacking enough iron in their blood often feel sluggish, weak, and unable to focus. Though fatigue can be the sign of numerous conditions, if it does not go away with adequate rest, consider having your iron levels checked.
2. Frequent Infections
Iron plays a key role in a healthy immune system, so lower levels of the mineral can make someone more susceptible to infections. When someone has an iron deficiency, the white blood cells aren't being produced as well, and they're not as strong because they're not getting enough oxygen, making that person more susceptible to infections.
3. Pale Skin
Hemoglobin gives skin its rosy color, so low levels cause the skin to become lighter. When red blood cells become low with iron, they become smaller and paler in the center so skin also becomes paler. This may be easier to detect in people with lighter complexions, but no matter what your skin tone, if the area inside your bottom eyelid is lighter than normal, this may be a sign of iron deficiency.
4. Swollen Tongue
Lack of oxygen can also cause muscles to enlarge and become painful. It happens to all the muscles really, but the tongue is the only one you can see. Cracks on the side of the mouth are also common among people with iron deficiency.
5. Restless Legs Syndrome
Some people who have iron deficiency develop restless legs syndrome, a disorder that causes you to have a strong urge to move your legs. The urge often comes with an unpleasant, crawling sensation in the legs that can make it hard to sleep.
6. Pica
People with iron deficiency may develop cravings for non-food substances, such as clay, dirt, or chalk, a condition known as pica.Scientists have yet to figure out why this happens to people when they do not get enough iron, but submitting to your cravings and eating these substances could be harmful. Clay, chalk, and dirt would actually interfere with absorption of iron.
7. Hair Loss
When hair follicles don't get enough oxygen, they go into a resting stage, and hair falls out and doesn't grow back until anemia is improved. It is normal to lose about 100 strands of hair per day. However, if you notice your hair loss is excessive and it is not growing back, this may be a sign of iron deficiency.

If you're experiencing these symptoms and think you may be iron deficient, speak to your doctor. He or she can help you find ways to include more iron-rich foods in your diet and determine whether you need to take iron supplements.

Anti-Depressants and Pregnancypregnancy   
pregnant woman in shadow
Co-authored By Dr. Arthur Castelbaum & Dr. Kara Nguyen
The use of anti-depressants by both men and women has skyrocketed over the last decade, and there have been many articles about the side effects of these drugs.  One area in particular that has received a lot of attention is the impact these drugs have on women of childbearing age.
Many women attempting pregnancy, or who are already pregnant take anti-depressants.  Past research has suggested a slightly higher incidence of birth defects when mothers take anti-depressants during pregnancy.  However, it is difficult to accurately assess the risk of birth defects and later cognitive deficits as timing of exposure and duration of use are variable. 
Research published recently in the British Journal of Clinical Pharmacology summarized 23 studies looking at the effect of Paxil use during pregnancy.  This study concludes that the risk of major congenital heart defects in the offspring of women using Paxil was increased by about 20%. 
In addition to congenital birth defects, there are studies that looked at later cognitive deficits in children who were exposed to anti-depressants in utero.  While there appears to be some association, there are many factors that complicate these studies, such as the existence of other medical conditions or other exposures such as tobacco smoking, so it is hard to draw any definitive conclusions.
For many patients, the benefits of remaining on anti-depressant medications during pregnancy outweigh the increased risk of congenital defects or later cognitive deficits.  This study is a reminder that all women taking anti-depressant medications should speak with their prescribing physicians before attempting to conceive. The American College of Obstetricians and Gynecologists recognize that the prevalence of anti-depressant use among reproductive aged women is significant and encourage gynecologists to engage in active discussions with their patients to help weigh these risks and benefits.  Whether or not to continue Paxil and other anti-depressants in pregnancy remains a highly individualized decision.

Dr. Castelbaum is currently seeing patients at the Yardley office of Lawrence OB/GYN. Please call 267-852-0780 or visit RMA Specialists to learn more about Dr. Castelbaum and RMA at Jefferson.

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March 2016  

Spring into Good Health!

Urinary tract infections (UTI) are one of the most common reasons that women seek medical attention. Once you experience a UTI, you'll do whatever it takes to prevent another. What can a woman do to prevent them? Here are some tips to help you maintain a healthy Urinary Tract for UTI protection. 

While hot flashes and night sweats are familiar menopause symptoms, many women swear their gyrating hormones cause a host of other unusual problems. So, are those strange sensations really a sign of menopause? Odd change-of-life conditions are creating lots of confusion. To help clear things up, check out these 6 Surprising Health Problems Associated with Menopause.

Lady doctor with stethoscope Maybe you keep forgetting, or maybe it never even occurred to you, but don't let another short and scattered doctor's appointment pass without asking important questions. Read these 10 Questions to Ask your Doctor - Stat! that you'll want to squeeze in.

Iron deficiency is the most common nutritional deficiency in the United States, and women are among those at greatest risk. Iron is critical for producing hemoglobin, a protein that helps red blood cells deliver oxygen throughout your body. So without it, everything suffers -- and can lead to anemia. Check out these symptoms of iron deficiency and, if you have them, see your doc and request a ferritin test, which measures your body's iron stores.

Pregnancy can be an emotional roller coaster for any woman, but if you have depression, anxiety or a mood disorder, those nine months can be especially tough. Although anti-depressant medications may have helped you before, they can be risky for both you and your baby. Drs. Castlebaum and Nguyen explain what the latest research shows about Anti-depressant Use During Pregnancy and what you should consider before taking your next dose.

With warm regards,
The Practitioners and Staff of Lawrence OB/GYN 
10 Ways to Reduce Your Risk of Getting a UTI uti
woman in pain Burning pain whenever you go to the bathroom, feeling like you need to pee all the time, pain in the lower back, nausea, vomiting, dizziness-these are just a few of the symptoms associated with a urinary tract infection. And although some women will always be more prone to UTIs (like diabetic women and those past menopause) there are steps you can take to avoid future infections, no matter your risk level.

Drink enough fluids
Doing so means you'll have to use the restroom more often and therefore flush out your bladder periodically. Fluid helps move things through the urinary tract, but it also dilutes the urine so bacteria can't grow. Doctors recommend 6 to 8 cups a day.

Empty your bladder after sex
Urinating after sex flushes out any bacteria that could have migrated to the bladder during intercourse. "But what if I don't have to go?" Chances are, you do. Most people have a relatively full bladder even when they can't feel it. Try peeing both before and after sex.

Don't hold it
Let us paint a picture for you: As urine sits in your bladder it starts to become kind of like mucky pond water-it just stays there and stagnates. And stagnate fluid is an ideal environment for an infection to develop. Try to use the bathroom at least once every 4 to 6 hours, and more often (about every 3 hours) if you're prone to UTIs.

Wipe from front to back
Bacteria that finds its way into your urethra comes from two places: your vagina and your rectum. And wiping back to front, especially after a bowel movement, is the main reason rectal bacteria get introduced into the vagina and urethra.

Don't Douche
You already know that douching is bad. But in case you're a little fuzzy on why, here's a refresher. Douching sends a stream of water, or water mixed with antiseptics like vinegar, into your vagina to wash out bad-smelling vaginal bacteria. But it also washes out good bacteria, disrupting the natural balance in your vagina and allowing more bad bacteria to grow.

Choose contraceptives wisely
If you're prone to UTIs you might want to avoid spermicides and diaphragms. Spermicides can not only introduce bacteria into your vagina but they also alter your vaginal pH, which can foster bacterial overgrowth, says Cooper. Diaphragms are less harmful, but can cause problems if they inhibit your ability to empty your bladder completely. Then you're back to that "murky pond water" situation.

Avoid baths
Stick to showers if you're super prone to getting UTIs. Many women take baths and have no problems, but others can't even look at a bathtub because the water may collect bacteria from your skin or any bath products that you use and introduce it to your vagina.

Wear breathable underwear
Tight fabric can create a moist area that breeds bacteria, so you should probably opt for cotton undies. If you often get UTIs and think your clothing has something to do with it, then try going for 100% cotton.

Eat probiotics
Fermented drinks like kombucha and probiotic-heavy yogurts like kefir might help more than your digestion. Preliminary studies say taking probiotic supplements or eating probiotic foods can help populate good vaginal bacteria.

Change out of sweaty workout clothes and wet swimsuits ASAP
Unless you get a UTI at the drop of a hat, sitting in a wet swimsuit for a few hours isn't going to do you harm. But if you do have frequent UTIs it won't hurt to quickly change into dry clothes, which will eliminate the risk of bacteria multiplying and migrating into your urethra.

Source: Prevention

6 Surprising Health Problems Associated with Menopause menopause
You've heard about the hot flashes and mood swings, but the end of your periods could also mean the beginning of some surprising health issues. While many women will sail through "the change" relatively unscathed, others may develop one or more of the following problems. Read on and learn how to protect yourself.

Pelvic Organ Prolapse 
When you're younger, your pelvic muscles do a pretty good job of contracting and keeping everything in place. But after menopause those muscles can weaken, causing the bladder, uterus, rectum, or vagina to droop downward. In severe cases, one or more of those organs can hang out of your body like a ball, which can rub on your clothes and cause bleeding, pain, and other discomfort. Women who have had a child via vaginal delivery are the most susceptible.

What you can do: Speak up. If you feel a bulge between your legs or have trouble emptying your bladder or bowels completely, see your doctor, stat. For the best care, seek out a urogynecologist who specializes in pelvic floor disorders. For a mild case, your doctor may simply recommend pelvic floor exercises like Kegels. More advanced cases may merit surgery or a pessary, a device that you wear internally to support your pelvic organs.

Liver Disease
When you're young and healthy, the liver tends to easily repair damage from things like alcohol, infections, or excess fat. However, sometimes the organ lays down scar tissue instead of healthy cells. Estrogen seems to interfere with this process, so when this hormone drops at menopause, scar tissue can start building up. As levels of this hormone decline, damage can ensue, further accelerating liver aging.
What you can do: The next time your doctor orders a routine blood screen, ask him or her to check the box for a liver enzyme test. Elevated levels are often the first sign that something's wrong in this critical organ. For many people, liver disease is fairly silent until it gets to more advanced stages.
If you were born between 1945 and 1965, you should also ask to be tested for hepatitis C, a virus that can wreak havoc on the liver.

Autoimmune Disorders 
Feeling tired, moody, or experiencing hot flashes? Those are all normal menopausal symptoms-but they could also be signs of an autoimmune disorder such as multiple sclerosis, lupus, or rheumatoid arthritis. It could be a new immune problem cropping up at menopause, or the change of life might very well cause a condition you already had to worsen.  

What you can do: Keep track of any symptoms you experience during menopause and discuss them with your doctor. If you already know you have an autoimmune issue, be sure to explain what you're going through to your rheumatologist and/or endocrinologist, in addition to your gynecologist. They can help you keep tabs on your disease and tweak your treatment as necessary.

Dry Eye
Estrogen isn't the only hormone that's going awry. Levels of testosterone-yes, women make it, too-also fall during menopause, and that can mess with your eyes. When testosterone declines, that oily layer can get thinner. As a result, more water evaporates from your eyes, leaving behind irritating salt.  
What you can do: Even people with perfect vision should get routine eye exams starting at age 40. If you haven't been seeing an eye doc, start now-and tell him or her if your eyes feel very dry. Using OTC lubricating eye drops is sometimes enough, but you might need an Rx or tear duct plugs to prevent moisture from draining too quickly.

Hearing Loss
Everyone's sense of hearing tends to decline with age, but women may experience problems more rapidly after menopause. That's because estrogen plays a role in your cochleas, the snail-shaped organs in your inner ears that convert vibrations into electrical signals your brain can process.
What you can do: Step one: limit your exposure to loud noises. Then focus on eating well and exercising. It may sound strange, but following an overall healthy lifestyle can help protect just about every part of your body-including your ears.

Sleep Apnea 
Sure, night sweats (which are hot flashes that occur while you're snoozing) can keep you awake, but that's not the only way menopause affects your slumber. There are a few things happening at menopause that make you more prone to sleep apnea. First, progesterone, a hormone that helps protect your respiratory system, declines. The skin in your neck also thins, which could impinge on your airway and obstruct nighttime breathing. Menopausal weight gain can obstruct your respiratory system as well.

What you can do: Seek out a sleep specialist if you have any symptoms of sleep apnea. Although snoring is the most famous sign (ask your partner), it's not the only one. Many women who suspect they have insomnia eventually find out that sleep apnea is the culprit. Excessive daytime sleepiness is another reason to head to the doctor's office. You may need continuous positive airway pressure (CPAP) or a dental appliance to keep your airways open while you sleep.

Source: Prevention

10 Questions to Ask Your Doctor - Stat!questions
Next time you have a physical, arm yourself with this article:

1. Am I getting the best cancer screening possible?
When it comes to breast cancer screening, mammograms are the best option for women who are at average risk and aged 50 to 69. But ultrasound and MRI testing may be a good adjunct to mammograms for women who are at a higher risk, such as those with a family history of the disease. Mammograms can detect tiny calcifications that may indicate early breast cancer, ultrasounds may offer more follow-up clarity for women with dense breasts, and MRIs may be useful for women at high risk.

If you do have a family history of breast cancer, testing for BRCA1 and/or BRCA2 genes can help your doctor develop a customized prevention plan for you. For cervical cancer testing, while Pap smears often first detect the disease, human papillomavirus (HPV) tests are increasingly used as an adjunct. The technology is still in limited distribution, however.

2. Am I clinically obese?
Most Americans are obese, with a body mass index (BMI) of 30 or higher. And even though obesity opens the door to type 2 diabetes, heart disease and cancer, only about 40 percent of those affected get advice from their doctor. Ask the doctor to measure your waist: 31 inches (80 centimetres) or higher could spell trouble. Then ask for his or her advice on treatment options because if you are clinically obese, even a five to 10 percent weight loss will benefit your health.

3. Could my back or joint pain indicate a chronic illness?
Ovarian and pancreatic cancers and even kidney stones can show symptoms through back pain. In a Tokyo Women's Medical University study, 30 percent of patients who had pancreatic cancer suffered from abdominal or back pain. And diseases such as lupus often reveal themselves through joint pain.

4. Should I worry about hypertension before I'm 50?
Yes, if you had a hypertensive pregnancy or have a family history of high blood pressure. We know that within 10 years of that pregnancy, women have an increased risk of significant hypertension, and their cardiac risk goes up 10 years earlier than the general population. What we do to our arteries in our 30s and 40s is critical: Eat a reasonable diet low in cholesterol, maintain a normal weight, and exercise.

5. Should I get a bone density screening even though I'm young?
If you are under 50 and have a family history of bone deterioration, ask your doctor if you should get screened. If you're over 50, you should be assessed, and if you have one or more major, or two or more minor, risk factors, a bone mineral density test is recommended. (Anyone over 65 should have this test.) Doing weight-bearing and resistance exercises three times a week reduces risk. And women over 50 should get 1,500 milligrams of calcium and at least 800 International Units (IU) of vitamin D daily. For those under 50, it's 1,000 milligrams of calcium and at least 400 IU of vitamin D daily.

6. Why won't this severe headache go away?
'Severe' means a headache with excruciating pain levels that you've never experienced before: Whether it's a single headache or a recurring pain, dial your doctor. And if it's accompanied by nausea, vomiting, seizures, or other neurological symptoms, get to an ER. It may only be a migraine, but it could also be a ruptured aneurysm'a potentially fatal bursting of a widened or bulging blood vessel in the brain. If it's caught in time, you can recover.

7. Why won't my flu symptoms go away?
The flu usually lasts three to four days, with fever, chills, dry cough, aches and pains. But if it continues past four days, you may have a secondary infection of pneumonia, mononucleosis, strep throat, a staph infection or even early-stage lung cancer. Especially if there's a chronic cough or if you're coughing up coloured sputum, you need to be seen.

8. Should sexually transmitted infections worry me?
If you have a new sexual partner, regardless of your age, there's a risk of STIs. HIV-positive cases have increased in the past five years for those over 30, due in part to more active sex lives among older adults and poor HIV awareness. Not using a condom during sex is a concern because your chances of developing an infection increase as you age. Post-menopausal women have thinner vaginal tissues and are more at risk of chafing, and those are risk factors for developing HIV. Chlamydia, gonorrhea and HPV are also on the rise. If you're post-menopausal and you get gonorrhea, you may not have the heavy discharge a younger woman does. So you can get sicker before you know you have an infection.

9. Why am I experiencing abdominal discomfort?
Feeling bloated, gassy or achy may indicate something more serious than a bad meal. Chronic discomfort can point to conditions such as appendicitis, ovarian cysts, diverticulitis and pelvic inflammatory disease. To be sure, your physician may, along with pressing on your abdomen, order an X-ray. If you're in severe pain, if it gets worse within 24 to 48 hours, if you have a fever or if your bowel patterns have changed over time, you should be seen.

10. Why do I have heartburn and shortness of breath?
The signs of heart trouble in women may be more subtle and long-lasting than the chest pain and arm numbness you've heard about for men. Women having heart attacks might feel short of breath or sick.Heartburn is the number one thing it's confused with. Chronic heartburn could also indicate GERD'gastroesophageal reflux disease, in which stomach acid comes up into your esophagus. If these symptoms arise suddenly, or persist, get a formal diagnosis.

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