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Polycystic Ovarian Syndrom (PCOS)

PCOS: Metabolic Disorder vs. Gynecological Disorder

By | Devani
Polycystic Ovarian Syndrom (PCOS)

It is likely that you or someone you know has Polycystic Ovarian Syndrome (PCOS), as it is becoming more and more prevalent among women of all ages. In fact, it is estimated that up to 20% of women (1 in 5 women) have this disorder. The sheer mention of PCOS comes hand in hand in the context of challenges that are highly distressing, such as becoming pregnant or having signs of excess male hormones (androgens), producing unwanted hair growth or acne, for instance.

Historically, PCOS was described as mostly a reproductive problem. The first mentions of this syndrome in current medical literature came from Stein and Leventhal, who described the classical triad of polycystic ovaries (or multiple cysts on the ovaries), hirsutism (signs of excess androgens) and oligo-amenorrhea (having too few or no menstrual cycles).

However, as we have made significant strides in understanding this disorder, we are understanding that PCOS is better described as an endocrine or metabolic disorder, and that PCOS is more of a harbinger of endocrine diseases like Type 2 Diabetes and metabolic syndrome, rather than the originating disease itself.

Some now consider insulin resistance as central to the origins of this condition. As a result of insulin resistance, insulin levels rise and sex hormone-binding globulin (SHBG) made by the liver decrease, resulting in an increase in bioavailable, active androgens. Insulin may also increase appetite, contributing to weight gain. This leads to a number of downstream effects, such as metabolic syndrome, nonalcoholic fatty liver disease and sleep apnea. Furthermore, PCOS sufferers are more likely to have depression and anxiety and experience miscarriages or other pregnancy complications.

Unfortunately, PCOS is to this day, highly underdiagnosed.

We are finding that PCOS can present itself clinically in a variety of ways. For instance, while phenotype A has the classical high androgen, low ovulation and polycystic morphology, other phenotypes may not include any one of these criteria. Thus, women with PCOS may endure a variety of symptoms, including, but not limited to:

  • infertility
  • irregular periods, including more frequent periods
  • long lapses between periods
  • acne
  • weight gain
  • unwanted hair on the upper lip, chin, neck, upper chest, abdomen, back, arms and thighs
  • hair loss on the temporal regions of the scalp
  • thinning of hair or hair loss
  • darkening of the skin around the armpits, groin or back of the neck

Further, testing results are highly variable. Testing may include a number of lab tests, such as testosterone levels, thyroid hormone levels, progesterone levels and an oral glucose challenge test; however, it is not necessary to have abnormal results of bloodwork or imaging, like ultrasounds.

That being said, all is not so grim in the world of PCOS. There are real, actionable things a woman can do, in regard to their health. As a physician who strongly believes in a holistic approach, I first encourage all PCOS patients to take their diet and lifestyle into account. Insulin resistance being central to this syndrome, it is important to work at this level.

We know that weight loss can be highly impactful. Shedding as little as 5% of the initial body weight can regulate menstrual cycles and ovulation and potentially even improve SHBG levels. Diet is critical to a holistic approach to PCOS, particularly eating a whole food, non-processed diet. Many foods can contribute to inflammation in the body, and inflammation certainly contributes to insulin resistance. It is important to eat a diet similar to a low-glycemic, Mediterranean diet that is high in fibrous vegetables, high-quality fats, legumes and whole grains. I also work with certain supplements, such as those from the inositol family or bitter melon, when extra help is needed. Lastly, we cannot talk about healthy living without talking about stress. Excess stress leads to increased cortisol levels, which also causes insulin resistance. I work with patients to find their anchor that they can do regularly as their daily exercise to stave off stress.

When all of these fail, we luckily have other options, such as hormonal methods and antiandrogen medications.

The bottom line is that there ARE solutions that work. Speak to your physician about your concerns, and together, find a plan that works best for you.

Vrinda Devani is a board-certified Obstetrician and Gynecologist practicing at Grace Clinic®. Learn more about Dr. Devani or call 806-744-7223 to book an appointment.

Learn more about Dr. Vrinda Devani

Living On Your Own - Grace Gertiatrics

Living On Your Own – Grace Geriatrics

By | Malhotra
Living On Your Own - Grace Gertiatrics

As of July 2017, 12% of the Lubbock county population was over the age of 65 years. This comes out to be almost 36,627 people. A large number of these older people reside in community living settings such as residential homes, assisted living facilities and nursing homes. However, many older people continue to live in their own homes, sometimes facing several challenges.

Challenges of Living at Home

The challenges older people face when living at home could be several. Difficulty in carrying out day to day activities like cleaning the house, transport issues when not driving, difficulty being able to obtain or prepare meals, trouble navigating stairs, struggle getting into tubs to take showers and requiring help getting dressed are some of their daily predicaments. Faced with these troubles, many finally relent against their wishes and give up their homes to go live in a community living place. Sometimes it is a choice made to avoid loneliness and boredom, when their friends and family are living far or pass away.

Transitioning to Community Living

This transition to a community living can be a welcome change for some, where they now enjoy their housekeeping, cooking, and transport needs being taken care of. However, some residents miss the spaciousness of their homes, their neighbours and friends, and the independence and privacy they had in their independent houses. Depression after such a move is a common problem that continues to ail some for years. Living in a community setting is like living in a world of its own. Not only does the outside world start to slowly forget them, but they too get more and more drawn into their new world and new friends, that sooner or later they forget their old lives.

If you are getting older, and some of the above seems inevitable, then there are some things you could do to continue living in your home as long as possible.
  • Enlist the help of your children and grandchildren in assisting you with your needs at home.
  • Seek help from home health agencies in the area, who can send help to your house on an hourly basis for assisting with housekeeping needs, showers, dressing etc
  • Exercise daily to keep yourself functional and fit for longer.
  • Participate regularly in social activities such as church, senior centres, hobby groups.
  • Volunteer or work part-time to increase socialization, and keep mentally active.
  • Use services such as Meals on Wheels if unable to prepare your own meals.
  • Modify your home to avoid stairs, have a walk-in-shower, grab bars, and raised toilet seats.

If leaving your home does become necessary, remember that the transition may be hard, but with time, patience, and preparation you will soon be happy and contented in your new world.

Keya Malhotra is an Internal Medicine and Geriatric physician practicing at Grace Clinic®. Learn more about Dr. Malhotra or call 806-744-7223 to book an appointment.

Learn more about Dr. Keya Malhotra

Healthy Weight Week

By | General Information

Healthy Weight Week is going on now! It’s a time to celebrate healthy, diet-free living habits that last a lifetime. These habits are what produce weight loss, weight maintenance and good health. Methods like starvation diets, diet pills and low-calorie diets are often tried as a quick fix to a long-term problem, and usually, don’t work. Healthy weight differs from one person to another depending on several factors such as height, bone density, body type and body composition. We each have different body types and compositions that require a different approach for healthy weight loss. The following are activities and ideas to better your health.

Stop dieting. Diets are not individualized. Every single person has unique energy and nutrient needs, based on a number of factors – height, weight, activity level, hormonal health and stress levels. All of these factors contribute to how much and what you should be eating.

Be active. Physical activity is good for your body and your mind, as well as adding years to your life and life to your years. An active lifestyle has many benefits. Regular physical activity not only improves the quality of your daily life but also increases your lifespan by reducing the risk of chronic illness.

Relax. Take time for yourself to relax and relieve the stress in your life. Stress can lead to health problems that make maintaining a healthy weight and lifestyle more difficult.

Eat well. Everything that you eat and drink matters and all five food groups should be incorporated into your daily meals. The right combination of these foods can help you be healthier now and in the future.

By incorporating these ideas and activities into your daily routine you have a better chance of getting healthy and staying healthy. Celebrate Healthy Weight Week by making a promise to yourself that you will make healthy choices that are realistic for your body type in 2018.

Great News for Dog Owners

By | Beals

Dog Ownership Linked to Lower Mortality Rate

In this register-based nationwide prospective study including 3+ million individuals, dog ownership was associated with a lower risk of incident cardiovascular disease (CVD) in single-person households and with lower cardiovascular and all-cause mortality in the general population. Ownership of hunting dog breeds was associated with a decreased risk of CVD, and ownership of all purebred breeds was associated with a lower risk of all-cause mortality. Although further investigation in the Twin Cohort did not show any association between dog ownership and CVD and mortality likely due to the smaller sample size, additional adjustment for detailed lifestyle and socioeconomic factors only marginally altered these estimates (The Finnish Twin Cohort was first established in 1974 to investigate genetic and environmental risk factors for chronic disorders).

In conclusion, in a nationwide population-based study with 12 years of follow-up, we show that dog ownership is associated with a lower risk of cardiovascular disease in single households and with a reduced risk of cardiovascular and all-cause death in the general population.

Celebrate your furry friend with a walk. You both will be happier you did.

Fall Sport Injuries

By | Beals

It is November and no matter where you look there is a sporting event around every corner, whether it is local, state, or national. Many of us will be participating in one or more of these sports. Why is *insert your favorite sport here* America’s favorite pastime? The endorphins have us all hooked. Competition feeds your adrenals to excrete hormones culminating in the increase in testosterone. Yes, men and women can benefit from active and passive participation and all ages apply. There is an increase in socialization and community surrounding these events. These areas lead to the same thing: youth or cellular regeneration. The more cortisol and testosterone rejuvenate, the more it heals and repairs your body!

Whether you are competing against other teams or just competing with yourself, sports have been known to cause injuries. What can you do to help yourself? Train, train, train. Elite athletes are always working to keep their body in shape, and they should. It is their full-time job. Weekend warriors still need to train. The good news is even other types of physical activity will benefit your game. The stronger your body is in both types of muscle tissue, the more resilient you will be if and when you get injured.

No one wants to be hurt. Just like planning for success, you can plan for your injury. How do you do this? If you consider a problem and have a plan to manage that problem, your outcomes will be better. It has been proven in multiple disciplines, especially when it comes to sports and physical activities.

The most common injuries are soft tissue trauma: skin, muscle, fat, lymphatics and tendons can all be torn. They can also be repaired. A simple petrolatum product or bandage on your skin will heal in days. If you bleed, you quite possibly need stitches. Your body can repair torn muscles as well. Muscle training keeps the tissue engaged to handle that rapid repair. Tendons are tougher to heal because of the lack the same blood supply that the first to have. Injury involving this is classified as the first stage: a stretch with microscopic tears but overall intact. You will experience swelling and tenderness, but there is no limitation. The second a more extensive injury involving an incomplete tear of the ligament and you can have moderate pain, swelling tenderness and bruising. A grade 3 sprain involves a complete tear of the ligament. Severe pain, swelling, tenderness and bruising can all occur because of the torn ligament. However, this time there is instability of the joint with loss of function. These unfortunate individuals cannot even bear weight.

You may not be able to control the situation that caused the injury, but you can condition yourself. It has been shown in all types of literature that muscle and bone strength training limit the severity of the injury.

Consistent muscle training, both white and red muscle fibers, limit the trauma and restore functioning faster.

Regardless of the type of injury, it is frustrating. You have to stop what you are doing. Your hormones decline and the emotions change. The process… seeing the physician… wearing a splint, or worse, having to have surgery. This puts limitations on your lifestyle. Loss of patience with yourself or others while your body repairs itself. This time is important. Complete restoration of this tissue is important. It may not be the first injury that is a problem. If you have a second or third injury, it can be life-altering. Moral of the story: Don’t rush back too soon. Take time and heal right the first time. Then, you can come back strong.

What you can do is supplement. Remember the trifecta: Vitamin C, Green Tea and Vitamin E are the key ingredients to tissue repair while mitigating the inflammation in the skin. For the rest: Co Q10 every other day, Vitamin C daily, Glucosamine daily or twice a day will all help other areas. Don’t forget the fats. Steric acid and linoleic acid are found in butter, olive oil, flax oil and canola oil.

Please see me if you have any more questions.