Obstetrics & Gynecology in Augusta, GA

Adult onset acne

“Hey doc, my face looks like a war zone.  I wouldn’t mind having the complexion of a sixteen year old if I could have the body of one also, but this is ridiculous for a grown woman!”  Gladys was a victim of adult onset acne, and she was not pleased.  She is not alone.  Some experts estimate that up to 50 % of women over 30 suffer from some type of acne or acne like complexion disorders.

     It is not known what triggers adult onset acne. The development of hormonal irregularities in the menstrual cycle may be a factor, or ovarian cysts may cause hormonal abnormalities that increase androgen productivity, resulting in acne breakouts.  The classic situation is one in which a woman experiences irregular cycles, setting up an over production of estrogens and testosterone.  These hormones stimulate oil production in the skin glands which in turn become inflamed and irritated. Sometimes these sebaceous glands continue producing a higher amount of sebum well into adulthood and thus acne infection continues even at that age. Androgens have also been associated with acne flare-up in women before menstrual cycles or sometimes during pregnancy.   Whatever the cause, it is not wanted or welcomed.

     Most acne treatments require prolonged care, from months to years. These treatments include topical creams and gels and/or oral medicines.  Once improvement is achieved, a maintenance dose is usually necessary. Women who develop adult acne typically have the problem for years, frequently through menopause.  The suspected hormonal disruptions that trigger adult onset acne are often treated by attempting to regulate the hormonal imbalance. The modalities used most in hormonal acne treatment are oral contraceptives and antiandrogens. (medicines that counteract the effect of too much testosterone in a woman’s system).

     There are several simple things to do to minimize adult onset acne.  Washing with soap and water once or twice daily is a good way to keep debris and oils from the day accumulating on the skin surface. Salicylic acid and benzoyl peroxide are both common over-the-counter treatments for acne. Benzoyl peroxide exfoliates the skin and the anti-bacterial agents in it clear the excess debris from the skin to help prevent infections.      

     Retinoids are a class of molecules in the vitamin A family. The retinoids are potent against acne because they stabilize abnormal growth and death of cells in the sebaceous follicle. These abnormal growth cycles are believed to play a key role in the formation of blackheads, whiteheads, and other acne. The danger in retinoids is that they cannot be used by pregnant women or women who might be getting pregnant because of the high rate of serious birth defects in unborn children.

     Topical and oral antibiotics are used together with other agents. Topically, antibiotics neutralize the skin-based bacteria and, when used with other agents, help deplete the excess sebum or oil secreted by the sebaceous glands, allowing acne spots to heal without infection.

     Oral contraceptives prescribed for women are based on their ability to regulate hormones.  A birth control pill stimulates the production of a protein that binds testosterone, thus reducing the androgen’s ability to affect oil glands.

     Occasionally, adult onset acne can be confused with a condition known as rosacea.  Although it is not exactly acne, its red-faced, acne like appearance can cause many physical, psychological and social problems if left untreated. In a recent survey by the National Rosacea Society, nearly 70% of rosacea patients said that this skin disorder lowered their self esteem, and 41% of patients said that they avoided social contact or functions because of their skin disease.

     The cause of rosacea in unknown and there is no cure, but with available medical help this skin disorder can be controlled and minimized. Its typical symptoms are redness on the cheeks, nose, chin or forehead, small visible blood vessels on the face, bumps or pimples on the face, and watery or irritated eyes.

    Whatever the cause, whatever the result, if adult onset acne is cramping your style, see your doctor because there is help.

Too Pooped to Play

“I’m sick and tired of being sick and tired!” 

“I just have no energy.”

     One of the most common problems of the 21st century woman is fatigue.  I am not exaggerating by stating that well over 40% of women I see in my office complain at some stage of their life of excessive tiredness.  Lack of energy is not a local phenomenon either (in spite of the claims of one woman who was sure that SRS had something to do with her low energy level.  Of course this was the same gal who had been nabbed by aliens and forced to watch reruns of “Geraldo”).  National statistics are equally as impressive.  One study even went as far to claim that 30.3 % of adolescents experienced excessive fatigue (PEDIATRICS Vol. 119 No. 3 March 2007, pp. e603-e609) 

   The classification of fatigue runs the gamut from a transient mild tiredness to a debilitating lack of energy.  One of the inherent problems in studying a condition such as this is the subjectivity of the diagnosis.  Those who suffer with chronic fatigue are often perceived as malingerers and pa
tronizingly dismissed.  There is still reluctance on the part of many medical practitioners to legitimize chronic fatigue syndrome, the most extreme form of tiredness, as a genuine entity; however, this appears to be an area where the science is finally catching up with the clinical observation.  As with any medical problem that is poorly understood, the treatment of excessive fatigue is varied, sometimes unconventional, and often unsuccessful.  It is important to distinguish chronic fatigue syndrome from “garden variety” tiredness as they differ in numbers of symptoms and degree of disability.  For many sufferers it comes down to how much the lack of energy interferes with normal day to day activities.  The Center for Disease Control in Atlanta has set down certain criteria for physicians and researchers to use in making the diagnosis of chronic fatigue syndrome.  A CFS diagnosis should be considered in patients who present with six months or more of unexplained fatigue accompanied by other characteristic symptoms. These symptoms include:

  • cognitive dysfunction, including impaired memory or concentration
  • exhaustion and increased symptoms for more than 24 hours following physical or mental exercise
  • non-refreshing sleep
  • joint pain (without redness or swelling)
  • persistent muscle pain
  • headaches of a new type or severity
  • tender lymph nodes
  • sore throat

  You can see from these symptoms that there is tremendous overlap with other common problems.  We all may experience some of these problems some of the time. The key is the persistence and intensity of the problem and, importantly, no other medical or emotional troubles that serve as a cause.

   There is hope!  Since becoming a more universally defined syndrome, additional research has been done on ways to thwart this bothersome illness.  Many of these treatments and suggestions also apply to the woman who has only mild symptoms.  So whether you are unable to get out of the bed or just collapse at the end of a busy day, these pointers may be worthwhile pursuing.

     First and foremost, get a good checkup by your doctor.  Many medical conditions such as hypothyroidism, menopausegyn, Lupus, depression, anemia, and sleep apnea have fatigue as a primary symptom.  If you check out well with your doc, consider the following:

1.  Check your sleep habits.  We are a culture of sleep deprivation.  It makes logical sense that if we don’t sleep restfully we will be tired the next day.  I am amazed at the number of folks that forget this simple connection.  Improve your sleep and your energy will rebound.

2.  Force yourself to get off the couch.  Multiple studies show the positive effect of exercise on energy level.  You may be saying, “I would exercise if I wasn’t so darn tired!” It is tough, but forcing yourself to do something, even a good walk, will, over time, improve your energy level.

3.  Garbage in equals energy gone.  We are what we eat, and this applies to energy level.  In fact, energy derives from the body’s ability to metabolize food.  If we put molasses in our car’s gas tank, it won’t go far.  If we put junk in our gas tank, we won’t go far!

4. Reduce stress.  Stress magnifies everything!  The more stress, the more your lack of energy.  It’s as if the body tries to shut down to save itself from the stress. The more you can minimize stress, the more energy you will have.

  I realize this is a very superficial treatment of very complex solutions, but maybe it can stimulate you to investigate these approaches on your own. 

Menopause or Mental Pause?

     Aileen blew into my office like a Summer storm.  “Help me, I’m a poster child for Hormones from Hell!”  After catching my breath, I assured her that there were many ways of dealing with the ravages of hot flashes, dry skin, mood changes and forgetfulness.  I started by reinforcing that menopause is not a disease. Inaccurately and unfortunately there is a pervasive sense that menopause is the “ultimate and inevitable bad experience” for aging women.  I jokingly explained that women were not designed to self-destruct at fifty!   

     Menopause is a normal, natural transition, and it is vital for women to view it with a positive perspective.  That simple understanding is the cornerstone in building a plan to thwart the symptoms of “the change.”  But it is equally important to realize that not everyone has a problem with menopause.

      As a physician, my experience treating menopausal women is that there are some universal similarities in women’s experiences, but because of every person’s unique physiology and life journey, this time in a woman’s life is very individualized.

      I am a “recovering traditionalist”.  I was trained in the old school approach to menopause (which means drugs, and if that didn’t work, more drugs). In almost thirty years of practice I have found that many women are not satisfied with their options and many discover that their “treatments” are worse than their symptoms.  Especially in this age of “estrogen panic” where the media (and many physicians) has touted misleading and confusing advice on hormones, many women are looking towards alternative treatments for their symptoms. One woman put it well.  She said, “Physicians have a duty to give a woman the best care they can provide, especially their options.  However each person is ultimately responsible for his or her own health.  We, the patients, need help, guidance, and a listening ear.” Those were powerful and challenging words.

   The general dissatisfaction among women is amplified by the observation that only 17% of eligible women in the US are taking some type of hormone replacement and up to 80% of women who start on hormones stop them after two years!  The needs of women are not being met!  This problem with compliance is due to poor communication and fear.  After all, treatment of symptoms is not limited to simply taking a drug.  Successfully navigating the potentially turbulent waters of menopause requires a more comprehensive approach.

Herbs, complimentary teachings, diet, and exercise all should be discussed along with hormones.  The main caveat surrounding these modalities is that they must be held to the same standard and scrutiny that safeguards traditional hormone replacement.

The major problem in meshing the traditional and complimentary approaches to health is a mistaken perception of mutual exclusivity.  These treatments can coexist and be complimentary.

  I am saying that choice and personal responsibility are keys to unlock a joyous menopause.

      This is an opportunity to live with passion and fulfill your life mission. This is a time to take stock of the past and choose your path for the future. The choice is yours. It is a choice that is difficult if not impossible to make wisely without sound information and guidance

Men and Women are different

Men and women are different.  I realize this may not be a ground breaking revelation but aside from certain anatomical variations, the differences are not always noticeable. 


Women certainly have a different hormonal milieu than men, and some of the internal variations can be directly attributed to such; however, laying everything at the feet of the hormonal hooligans is both simplistic and unfounded.  In other words, men and women are not solely their hormones, but a complex interaction of gender specific, unique physiology.  Let’s look at some examples.

Women are at a greater risk of developing problems from alcohol use than men.  This applies to simple health risks as well as severe consequences.  The National Institutes of Health state that, based on current research, female alcoholics have death rates 50 to 100 percent higher than those of male alcoholics, including deaths from suicides, alcohol-related accidents, heart disease and stroke, and liver cirrhosis.  Even though there are more male alcoholics than female, the women fare worse overall.  This is related to how alcohol is metabolized in the female system.  Women are more likely to develop liver damage from excessive alcohol consumption even when compared to similar intake for males.  In addition, having more than 2 drinks a day can increase the risk for breast cancer for a woman.  Why do these differences exist?  In general women have less body water than men of similar body weight, so that women achieve higher concentrations of alcohol in the blood after drinking equivalent amounts of alcohol.  In addition, women have smaller quantities of the enzyme dehydrogenase that breaks down alcohol in the stomach. A woman will absorb about 30% more alcohol into her bloodstream than a man of the same weight who has consumed an equal amount.  There is a push by many organizations, especially on college campuses to educate women as to these differences.  The consequences later in life can be substantial.

For years medical research on heart disease and risk factors was done exclusively on men.  The vast majority of major work done in the earlier decades purposely excluded women for reasons ranging from potential pregnancy to volunteer recruitment.  What resulted is a plethora of data that is extremely useful, but biased.  Only with the advent of multiple studies including women have researchers realized that heart disease risk factors, occurrence, and prognosis are different for men and women.  Heart disease has taken a back seat to breast cancer, for example, largely due to media attention and breast cancer awareness programs; however, heart disease is the leading cause of death in women over 50.  A woman is more than ten times as likely to die of cardiovascular disease as she is to die of breast cancer. This is partly due to the fact that the survival rate for breast cancer is quite high, whereas over 40% of women do not survive their first heart attack.   Women’s hearts are anatomically different from men, and they also function differently.  A woman’s heart on average is smaller than a man’s, and it also tends to have smaller blood vessels supplying it.  Researchers from Columbia University and New York Presbyterian Hospital believe that women also have a different rhythmicity to the pacemaker of their hearts, which causes them to beat faster. These same researchers believe that it may take a woman’s heart longer to relax after each beat. Some surgeons also hypothesize that the fact that women have a 50 % greater chance of dying during heart surgery than men could be related to some fundamental difference in the way women’s hearts work.   These differences have led to a bias in how physicians viewed heart symptoms in women.  Several studies indicated that if a woman and a man presented to an emergency room with identical symptoms, the man would be more likely to be evaluated for heart problems than the woman.  Luckily with the new data, this trend is reversing and early disease is being suspected and detected in women, hopefully reducing both death and disability.

Most would agree that men and women think differently.  This may have a physiologic basis as research indicates that men’s and women’s brains are structurally different.  There are variations in grey and white matter, which leads to differences in things such as verbal abilities and connectivity between the two sides of the brain.  These anatomical peculiarities can lead to a number of behavioral differences once thought to be social or environmental.

It’s important to understand there is no advantage or disadvantage with these variations, it’s just that being aware of the differences may help in promoting each individual’s health.

Brain Food

     “I’m not kidding; it’s Miracle-Gro for the brain!”  The statement reminded me of some ridiculous infomercial infecting late night TV.  In this case however, it was generated from the mouth of a world class neurobiologist, so I took notice.  He was speaking of a substance called Brain Derived Neurotrophic Factor (BDNF).  What immediately intrigued me was he claimed that BDNF was the link between exercise and improved brain function.  For years I had read articles in both the medical and running journals touting the psychological benefits of fitness, yet here was proof that fit folks were happier folks.  Dr.John Ratey, a clinical professor of psychiatry at Harvard, outlined in his amazing book “Spark: The Revolutionary New Science of Exercise and the Brain” how exercise increased the production of BDNF which in turn stimulated nerve cells to grow and connect in the Hippocampus, a tiny area in the brain responsible for a number of high level functions. This growth of new cells actually translated into better memory and quicker learning.  He went on to claim that certain other chemicals were released by exercising muscles that improved functioning in the amygdala, the emotional center of the brain.  The implications of this and other research are monumental. 

     Twenty-five years ago when I was in medical school we were taught that we were born with a set number of neurons (brain cells) and there were no more to be made…period.  I remember joking in college about taking another late night excursion to the disco (yes, I am that old!) to “kill some brain cells” with Singapore Slings and Jack and Coke.  We didn’t fret about the wholesale slaughter of brain cells as we all knew from biology class that we only used 20% of our brain anyway.  In our way of thinking, that gave us a pretty good cushion!  It was the unlucky folks born with fewer brain cells, and we all knew a few of those, who had the most to fear.  We were wrong on all accounts.  Now research is proving that new brain cells can be created, and formed in areas that have a major effect on cognition and emotions.  Don’t take this as permission to guiltlessly get plastered; I don’t need to tell you of the disastrous effects of that, but it does open the door for medical miracles.  The study of such alphabet soup as BDNF, IGF-1, and VGEF and other neuropeptides has given hope to developing successful treatments for senile dementia, Alzheimer’s and Parkinsonism.  Medicine is not there yet, but we can conclude that getting fit by exercising regularly can reduce the incidence of these diseases as well as certain cancers and diabetes. 

     The great news is that you don’t have to train for a marathon to reap the benefits of fitness. The studies indicate that a brisk walk for 45 minutes three to four times a week can elicit these life enhancing outcomes.


One of the most exciting applications of this knowledge is illustrated by the Naperville school district.  A middle class suburb south of Chicago, Naperville has been the focus of a real-life experiment documenting the benefits of fitness in kids.  It is no surprise that kids who are active are more physically fit than their sedentary counterparts, but what has been found in Naperville is that these fit kids are also smarter!  Over the past seventeen years the school district, consisting of 11 elementary schools, five junior high schools and two high schools, has made physical education an integral part of the school day (unlike the national average where only 6% of high schools have a daily PE program).  Their gym class is not your typical dodge ball, basketball, softball curriculum (the average student in the typical hour long PE class spends 16 minutes actively moving).  It is a program that promotes and measures fitness, not competition, and grades based on effort, not ability.  They regularly run or ride bikes using donated treadmills and stationary bikes measuring effort by heart rate monitors. And they do it at a lower cost per student than comparable school systems!  The results have been amazing.  In 2002, 97% of entering freshmen were at a healthy body mass index (BMI) as compared to the national average of 65% and most striking was the impact that fitness had in the classroom.  In that same year 96% of the eighth graders took the Trends in International Math and Science Test, an instrument designed to compare student’s knowledge level in different countries around the world.  On the science part of the test the Naperville students scored the highest…in the world!  Through a strict and comprehensive analysis it was shown that regular physical activity and fitness level correlated with the academic success of the Naperville students!

     The message is clear.  For adults and kids alike, regular aerobic exercise is not only good for the body, but it is great for the mind.             

Ovarian Cancer

For women, ovarian cancer is a frightening malady because of its insidious nature.  It’s been called a silent killer because once symptoms appear, the disease is often widespread.   The key to overcoming this fear is understanding the reality of the disease and dispelling myths.

The American Cancer Society states, “Ovarian cancer ranks fifth in cancer deaths among women, accounting for more deaths than any other cancer of the female reproductive system. A woman’s risk of getting ovarian cancer during her lifetime is about 1 in 75. Her lifetime chance of dying from ovarian cancer is about 1 in 100.”  Juxtapose this with the most common cancer in women, breast cancer, where a woman’s lifetime risk is 1 out of 8.  Even when you consider total cancer deaths, ovarian ranks low compared to breast, lung, and colorectal.  So indeed ovarian cancer is a fierce adversary, but realistically there is a much lower incidence of this type of cancer than many others.

One reason ovarian cancer is so feared is its delayed presentation of symptoms.  Unlike many illnesses which telegraph their appearance early with notable symptoms, ovarian cancer often doesn’t produce noticeable problems until relatively late in its development.  And when it does, the symptoms are nebulous and rarely initially recognizable as ovarian in nature.  For example, a common symptom of ovarian cancer is abdominal bloating.  Unfortunately, this same symptom can be associated with everything from bad sushi to irritable bowel syndrome.  Common symptoms associated with ovarian cancer include:


Upset stomach.

Back pain.

Pain during sex.


Menstrual changes.

Abdominal swelling with weight loss

As you can see, virtually all women will experience at least one of these symptoms intermittently. The distinguishing factor often is a persistence or continual worsening of symptoms. 

Unlike the Pap smear for cervical cancer, there are no good screening tests for ovarian cancer.  There is some evidence that a combination of various blood tests and a pelvic ultrasound may suggest an early ovarian cancer, yet these have not yet been shown to be useful enough in a low risk population to be promoted as a screen for everyone.  Certainly these tests (and others like a CT scan) can help steer the diagnosis in someone with unexplained symptoms, but we are still woefully lacking in a universal screening test for ovarian cancer. 

There are some folks who are at a higher risk for this disease and therefore warrant closer monitoring.  Risk factors for ovarian cancer include a family history, menstruating at an early age (before 12), having not given birth to any children, a first child after 30, menopause after 50, and having never taken oral contraceptives (taking birth control pills actually reduces the risk of ovarian cancer).  Of special interest is the genetic relationship between various female cancers like breast and ovarian.  About 10 to 15 percent of women diagnosed with ovarian cancer have a hereditary tendency to develop the disease. The most significant risk factor for ovarian cancer is an inherited genetic mutation in one of two genes: breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2). These genes are responsible for about 5 to 10 percent of all ovarian cancers.  Eastern European women and women of Ashkenazi Jewish descent are at a higher risk of carrying BRCA1 and BRCA2 mutations. Since these genes are linked to both breast and ovarian cancer, women who have had breast cancer have an increased risk of ovarian cancer.  These can be detected with a blood test and many insurances will cover this in high risk women.  There is an ethical debate regarding someone who tests positive for these mutations.  Do you prophylactically remove the ovaries as a preventative tool?  There are no clear cut answers at this stage as not everyone who has these mutations will develop cancer.  The utility in this knowledge allows the individual to make a rational decision based on a variety of factors.

Treatment of ovarian cancer is often a combination of surgery and chemotherapy.  Much of the treatment depends on the extent of the disease noted during the surgical removal of the cancerous tissue.  This cancer tends to spread both by local growth in the pelvis and through the bloodstream and lymphatics, so it can metastasize or  reoccur in distant parts of the body.  There have been advances in treatment, especially in chemotherapeutic agents, and one of the most exciting ares of research is in various immunological techniques.  These approaches literally label the cancer cells with tags that allow a chemotherapeutic agent to selectively attack the bad cells while leaving the good cells alone.  Many women are successfully propelled into remission with these and other techniques, so there is expanding hope as research develops.

Ovarian cancer is a serious and scary disease, but it is not the death sentence it once was.   

Teens…When to see a gynecologist

I am convinced most women view visiting their gynecologist somewhat like having a root canal…with no clothes on!  This is a completely rational reaction as no “normal” woman relishes the necessary but unappreciated ritual.  You arrive on time and two hours later Nurse Ratchet puts you in a room cold enough to hang meat and then tells you to disrobe and put on a napkin.  By the time the doctor arrives you are so cold your skin has changed to an eerie shade of light blue: you look like a Smurf in a togo.  The doc asks you to scoot down…then scoot down some more and well, you know the rest.  Actually the whole thing takes only a few minutes and is not as bad as, say, an
IRS audit, but I am a male so what do I know!  I understand it is different on your side of the speculum.

So given this exam is something you relish passing on to your beloved daughters, much as you would Malaria or Scabies, when should a young woman be exposed to this sisterhood right of passage?  The American College of Obstetricians and Gynecologists  recommends a young woman’s first visit to the gynecologist be between the ages of 13-15.  Before you and she run screaming from the room, let me reassure you that those guidelines are rarely followed and, in my opinion, somewhat misguided.  I understand that Ivory Tower practitioners denote this visit as a “preventive” ,but I don’t know many 13 year olds who are comfortable talking herpes and contraception.  The College clarifies that no exam is needed at this impressionable age, but that then raises the question of its true necessity.  Unfortunately there are those folks who need a thorough and graphic discussion of various reproductive health topics at this age, as 14% of 15- year olds and 75% of 19- year olds admit to having at least one episode of intercourse. 

I know if I had told my daughters at thirteen they were headed to the gynecologist, they would have booked a slow boat to Australia.  Now, to be certain, anytime a young woman is having issues with her period, needs contraception, or specifically has questions about her health she should have unlimited access to a compassionate, non intimidating physician, but for most that will come a bit later.  The same national organization recommends starting Pap smears and exams at 21, and I think this is more realistic.  I certainly am not naive enough to assume women under the age of 21 are not having reproductive or gynecological issues, witness the unplanned pregnancy rate in this country, yet if a young woman is not sexually active, has no period issues, and has no specific gynecological concerns, I think 21 is a reasonable time to initiate gyn visits.

Much of the anxiety in both mothers and daughters regarding gynecological health revolves around knowing what is normal and what is not.  There are definitely genetic predispositions that would make mom’s and daughter’s experiences somewhat similar, but that is not necessarily the case.  For example, the median age for the onset of menses is 12.4.  That means there will be plenty of young women who start cycles at 11 and also some who don’t start until 14.  In general, a girl needs to be evaluated if she has not begun developing breast buds by age 13 or hasn’t started her cycle by age 15.  The average time between cycles for young women is 32 days, but that can vary wildly, especially in the first few years of menstruation.  A flow lasting longer than seven days or requiring more than 3-6 pads or tampons a day is considered excessive.  You can see this is somewhat subjective, so each woman’s situation should be individually assessed and analyzed.

There a number of common scenarios that change both the cycle amount and regularity, especially during the teen years.  Two frequent influences are stress and weight change.  Worrying about midterms, making cheerleading, or the soccer playoffs  can wreak havoc on cycle regularity.  Any change in weight (usually by at least 5-10 lbs) can also affect regularity and amount.  Vigorous exercise (take note you cross country runners, gymnasts, and swimmers) can cause what is known as exercise induced amenorrhea, or lack of cycles.  Many a pregnancy test has anxiously been checked by those whose unending athleticism led to missing a period.  The good news is that most of these irregularities resolve with stabilization in weight or a reduction in stress.  A more rare but serious cause of irregular cycles is eating disorders like anorexia and bulimia.

The goal of an effective young women’s health program is to provide education, advice, counseling, and compassionate care.  The age at which you begin your interaction with the system is largely dependent on your individual needs and health history.   

Vitamins and Women’s Health

Americans have the most expensive urine in the world!   Let me explain.

We are massive consumers of vitamins in this country, and unfortunately, much of the good stuff is eliminated from our body before it has any beneficial effect.  That is not to say that vitamin supplements are a waste, in fact, we strongly recommend that patients use certain vitamins and minerals.  Yet in a billion-dollar industry like the vitamin market, you must be a discerning consumer.  If you are going to take vitamins (and many of you should), you must first know your individual needs, and second, choose an appropriate dosage and quality.

    In general, most women in the country conform to the SAD diet (Standard American Diet), which leaves them short on some essential nutrients.  Vitamin supplements are used to either meet basic nutritional needs or to treat a particular problem such as anemia or hot flashes.  For most folks, the best way to make your body happy on a day-to-day basis is to eat balanced whole foods; but if you don’t (let’s be real here!), a basic multivitamin that contains Vitamins C, E, A, D, and the B series is essential.  Many will also contain important minerals for women including iron, calcium, magnesium, boron and potassium.   In spite of the many advertising claims otherwise, there is very little real difference among quality multivitamins.  We suggest doing your homework (a good place to start is www.ConsumerLab.com ) and get comfortable with a particular brand and then stick with it.  Your pharmacist or health food store may also be a great source of information.  Don’t walk into a discount warehouse or a grocery store and buy the first bottle you see. 

     Two vitally important caveats go with any vitamin or supplement.  First you must take an appropriate dose, and second, you must take the supplement for an appropriate time frame.  Herein lie many of the problems with vitamin use.  Dosage is important! That sounds simple, but consider what would happen if you took a tenth of an aspirin for a headache.  Probably nothing!  And it would be absurd to then conclude that aspirin doesn’t help headaches.  However, that is what happens all the time with vitamins and herbs.  The scientific studies that show beneficial effects of supplements are always performed with specific dosages, and it is essential to know what amounts are proven to be effective.  There are many reference books that list evidence based dosages from various studies. 

     Don’t forget that most vitamins and supplements don’t work overnight.  Many may take up to four to six weeks of continual use to achieve any benefits.  Some, like the antioxidants, need to be used on a regular basis to exert their action.    

    Certain individual vitamins have been shown to help specific problems.  Below is a list of common problems and their vitamin remedies that have at least one good study to compliment their use:

Hot Flashes, Breast tenderness,                             Vitamin E (d-alpha-tocopherol) 800IU /day



Antioxidant, immune enhancement                       Vitamin C (1-3 grams a day)

PMS                                                                                Vitamin B6 (50mg twice a day)

Anemia                                                                           Vitamin B12 (100 micrograms a day)

Vision                                                                              Vitamin A (2,500 IU a day)

Cold sores                                                                       Zinc  50 mg/ day

Bone health                                                                    Calcium 500-600 mg /day

                                                                                          Magnesium 200-400mg/day

                                                                                          Boron  3-5 mg / day

     As with all vitamins and supplements, always tell your doctor what you are taking, as there can be interaction between these substances and prescription medicines.

A Merry Heart Does Good Like a Medicine

         Norman Cousins, while struggling with a severe neuromuscular disease, said, “Laughter is like internal jogging. Ten minutes of genuine belly laughter had an anesthetic effect and would give me at least two hours of pain-free sleep.” Those of you who regularly scan Reader’s Digest remember a column titled, “Laughter is the best medicine”.  Indeed it is, and sometimes we forget that.  So here is my prescription for surviving everyday stress…laugh three times a day!  Some of the most effective laughter is that which we do at ourselves.  The less serious we take ourselves, the less burdensome everyday stresses and strains.  For example, I recently attended a local high school football game and quickly lapsed into a flashback when the bands took the field for the halftime entertainment.  No, I wasn’t in the band in high school.  The idea of walking backwards in circles while reading music was a bit overwhelming, but my mother was convinced that I had the potential to be the next John Philip Souza.  She felt that one way to navigate the treacherous waters of a new high school was to join their celebrated band.  I had just been uprooted from a comfortable middle school existence in Memphis to the mountains of East Tennessee , replete with orange painted outhouses, to begin my high school years.  I was the size of a Hobbit, and about as good-looking, so my social integration options were vastly limited.  I certainly was not a candidate for football (a religion in Knoxville) although; in retrospect, I would have made a wonderful tackling dummy.  Track was not an option as I had the speed of an anemic sloth.  Basket ball…well let’s just say dribbling at the level of other’s knees didn’t fare well for a stellar career.  So maybe the band was a way that I could find my niche in an otherwise niche-less existence.  At least my mother thought so.  So the first day a school she set up an appointment with the band director to discuss my future musical career.  Unfortunately, she made me come along.  Once we arrived in the hallowed sanctuary known as the “band room” , Mr.Jenkins, the band teacher, granted us an audience.

     “Now exactly what instrument does your boy play?”, he asked condescendingly.  I felt this was a rather appropriate question and a reasonable place to start the discussion until it dawned on me that I didn’t play an instrument.  I suspected that my mother also knew this as she had not seen or heard me with anything other than a kazoo since kindergarten, but she was not fazed by the inquiry.

     “He doesn’t…yet”, she confidently replied.  This obviously was not the response Mr. Jenkins was expecting as he stared at her with a look that said, “Well what in the name of Beethoven are you doing here then?”  Mom, ever the perceptive sort, picked up on his incredulity and explained that before we invested in lessons or instruments, she wanted to get his impression as to which instrument I was best suited to play.  At this point I was busily plotting both my escape and my plan for putting mom on medication.  I had read of studies that looked at a person’s likelihood of being a criminal based on their physical traits, you know, beady eyes, big forehead etc, but I had yet to see any research correlating a person’s physical appearance and their ability to master a band instrument.  I felt myself slowly sinking into “Music Man” hell.  Mr. Jenkins composed himself, obviously trying to pacify the crazy woman sitting before him, and shot a glance at my face, as if to say, “Is she serious?” I cocked my head, subtly conveying the dual message that yes, she is serious and she may be armed, so do what she asks.  He then proceeded to survey my mouth, fingers, eyes and anything else he could possibly think of that would indicate the ideal instrument for me.  It was like being scrutinized for lice after being accused of infecting the whole school. 

     After what seemed like hours, he stopped, grunted, and said “trumpet…yes, trumpet”.  A huge grin crossed mom’s face as this seemed to validate her quest.  All I could think of was Dizzy Gillespie, that huge, old guy who puffed out his cheeks to the size of a steroid laced chipmunk whenever he played his horn.  I didn’t want to walk around school with the cheeks of a bloated rodent, so I instantly expressed my apprehension.  Of course, my protest fell on deaf ears as mom was already negotiating horn rentals and lesson fees. 

     How was I supposed to get the girls playing something you have to clear spit out of every few minutes?  Neil Diamond never wooed a woman with his classic marching tunes!  As I walked out of the room, visions of chapped lips and elastic cheeks dancing in my head, I realized that maybe I needed to find a better way to fit in.  I wonder if girls dig science projects?

Dr.Ron Eaker

Eat For Life!

     The one question we are asked in the office most often, other than how to improve libido, is how to eat healthy.  Since 45 million people in this country are overweight, it is no wonder that this is on everyone’s mind. Simple is better, so here are some simple guidelines for eating healthy.

     Rule number one: Eat balanced meals.  What your mother always taught you is true.  There is no one super food, in spite of what the algae lovers claim, and there is likewise no naturally evil food (well, maybe Spam qualifies as evil).  We were created to survive on a variety of nutrients and no one food can provide everything you need, so mix it up to guarantee proper health.  Balance proteins, carbohydrates, and fats by selecting a wide variety of foods.  Spice up your life! Get crazy and try foods that are different from burgers, bacon, and barbecue!  Travel the world by making one night a week “ethnic night” and sample various foreign cuisine.  There are three sub rules in this category: eat whole foods whenever possible, mainly plants, and prepare them in as close to the natural state as you can.  In other words don’t fry, fritter, and fracture your food!  And one final caveat, don’t overdo it.  One given in proper weight management is watching total calorie intake.  How much you eat is just as important as the mix.

     Rule number two: Eat low fat meals.  This is not to demonize fat but to remind you that too much of some stuff is just not healthy.  In spite of the cacophony of nutritional advice out there, there is not a reliable expert around who tells you to eat more lard.  Some fat is necessary but we should all limit saturated and trans fats.  These include margarine, salad dressings, processed cakes, chips,cookies, and gobs of other nasties.  Become a label reader.  It’s right there in black and white.  If the serving size contains more than 5 grams of saturated fat, put the item down and run away screaming.  Total fat in your diet shouldn’t exceed 25% of total calories.  There are a number of fat counters available in Apps and online so it is relatively easy to calculate how much of the grease is sliding down your gullet.  Don’t forget there are some good fats.  For example, the omega 3 fatty acids found in abundance in some plants (flaxseed) and cold water fish (tuna, halibut) are critical in assuring good health and are essential for their anti-inflammatory actions.

     Rule number three: Eat low sugar. The average person will consume 160   pounds of sugar a year!  Most sodas will contain 40g of sugar in each can!  Sugar, or glucose in fancy doctor talk, is necessary for energy, yet most of us eat enough sugar to power a high school soccer team.  The low carb craze of recent vintage did make us aware of the evils of consuming to much sugar (carbohydrates=sugar); and the data supports that a low carb lifestyle is healthy.  Keep in mind that your need for sugar and energy is directly proportional to your activity level.  Marathoners need more carbohydrates than chess masters. 

     Rule number four: Eat more fiber.  This rule may be a bit of a surprise because it doesn’t get the airplay that the other rules seem to enjoy; however, fiber, both soluble and insoluble, is a key component of a healthy diet.  These are things that aren’t actually metabolized in the system put serve a variety of vital functions such as binding excess cholesterol, promoting bowel health, and regulating hormone levels.  The American Heart Association has stated that consuming 28 grams of fiber a day can reduce your risk of heart disease, the number one killer of both men and women.  Fiber is abundant in fruits and vegetables, grains, nuts, legumes, and tree bark. (Just seeing if you were paying attention).  Choosing foods high in fiber not only fulfills the need for roughage, but these foods also tend to be low in calories and filling.