September 16th, 2010

The success of fertility procedures has allowed couples, both young and older, to experience the miracle of life when nature otherwise would not allow for it. The availability of these procedures now also secondarily helps us plan our families, in balancing it with careers, household, and other social pressures. However, is there an ethical and biologic limit in terms of how far we should go? Currently, it is a personal and medical decision to be made depending on the state, the doctor, and the circumstances of the individual(s) in question.

Our modern lifestyles are causing us to be out of sync with our biological lifecycles. Despite our emphasis on pro-youth, anti-aging prevention and medical treatments, our bodies still keep track of chronologic time. As women especially spend more time in education, careers, and social development (there has been a fourfold increase since the 1970s in the number of women after age 30 having their first child), our years of prime fertility often slip behind the wayside. When we are emotionally, socially, and economically ready to start families, it can be a shock when our bodies fail to cooperate.

Female fertility is at its peak around the ages of 19-24 years. After the age of 30, our fecundity drops, especially dramatic after age 35, with a concomitant rise in the rate of miscarriages and chromosomal abnormalities. Though infertility issues are half the time caused by male factors, it is the female that is the biologic bottleneck since we are capable of conceiving only 12 times a year for about 30+ years of our lives. Thus, only about 400 of our original one million eggs that we have at birth are ever potentially “usable” due to human female ovulatory cycles. The quantity and quality of those eggs also diminishes greatly after age 30, with about 1,000 eggs lost per month.

At any given time, 11million of 90 million US couples are trying to conceive, with a success rate of 20% per month. It will take the average fertile couple 5-6 months to conceive before success. 1 out of ten couples will experience infertility as defined as failure to conceive after 12 months of active efforts.

Doctors often start diagnostic testing if the female is over 30 years old, if there is an abnormal medical, reproductive gynecological history such as repeated miscarriages, or if the male undergoes testing and has a low sperm count.

Infertility treatment options currently include medications and medications in conjunction with variations of the following procedures (Assisted Reproductive Technology). The most common are:
• Glucophage to boost ovulation if insulin-resistance is a suspected factor
• Clomiphene therapy to stimulate mature egg production
• Gonadotropin therapy (often follicle- +/- leutenizing stimulating hormone; or gonadotropin releasing hormone) to stimulate increased numbers of eggs produced per cycle
• Human Chorionic Gonadotropin to stimulate release of eggs from follicles
• intrauterine insemination (IUI, aka artificial insemination) where washed sperm is injected into the uterus around the time of ovulation
• In-Vitro Fertilization (IVF) – harvesting the egg and inseminating it in a petri-dish and placing the zygote back in the uterus

The frustrations of infertility treatment aside from cost (often in the tens of thousands of dollars), is that these tests can take many precious months of time, and there can be a significant failure rate. They are also not without their side effects including the probability of multiple births or enlarged ovaries.

Talk to your Ob-Gyn or Urologist if you are concerned about what is the right treatment course. Aside from medical intervention, both the male and female should avoid tobacco, excess alcohol, and perhaps excess caffeine, as well as maintain a normal weight by good nutrition and moderate exercise…and the hardest advice of all to follow: Avoid Stress.
Roopal Bhatt, MD, is a practicing Dermatologist in the Four Points Area. To reach her about questions on this topic or others, please email her at contact@fourpointsdermatology.com or visit her website at www.fourpointsdermatology.com.

September 16th, 2010

We all wish for a good life with happiness, but when our health, or that of a friend or family member, is compromised, it consumes us. Perhaps the most dreaded threat is the big “C.” For 2008, it is predicted that there will be over 1.44 million people diagnosed with cancer and more than 560,000 cancer deaths. Unfortunately, everyone is vulnerable.

Cancer occurs when one of our normal cells has a DNA mutation that causes a rapid and uncontrolled division. This malfunctioning cell population, no longer recognizing “self,” competes with our normal tissue for blood supply and nutrients. These cancer cells may then invade other parts of our body, or metastasize, causing organ failure and possible death if left untreated.

Because of senescence, or biological aging, our cells lose the ability to maintain cellular repair and immune surveillance. That can be one reason why certain cancers are almost expected once a certain age is reached, such as prostate cancer in older men.

While cannot control genetics and aging, we can control our environmental and lifestyle choices, which is sometimes more than half the battle. Specifically, tobacco, alcohol, dietary, occupational, and physical activities and even our reproductive and beauty habits affect our cancer risk. There are things we can do in our everyday lives that are easy and still allow us some fun!

The first step starts with your doctor. There are cancer screening guidelines according to age, past medical and family history, and perhaps even past chemical or viral exposure that your general practitioner can address. For example, women should get a pap smear by age 21 or earlier and a screening mammogram by age 40 or earlier if strong risk factors. Both genders should get a screening colonoscopy by age 50 or earlier. Lung, prostate, skin, and ovarian cancer screenings are discretionary at this time. We do know, however, that cancer screenings can prevent up to 35% of cancer deaths.

Simple daily lifestyle changes:

1. A healthy diet is important. So far, there has been mainly indirect evidence for healthy diets decreasing cancer risk, but the point is that it can’t hurt. “Power foods” loaded with antioxidants, fiber, and vitamins include fruits, veggies, green tea, whole-grains, fish with omega-3-fatty acids, yogurt, nuts, soy, etc.

2. Stop smoking. First- and second-hand smoking increases our risk of virtually every cancer. Smoking also negatively affects every major organ system in our body.

3. Limit alcohol consumption. Modest alcohol intake, especially red wine, can be heart-healthy. But excess alcohol consumption can increase risk of breast, oral, esophageal, and perhaps liver cancer.

4. Exercising 30 minutes a day, at least 5 days a week is recommended with the approval of your physician.

5. There is a new HPV vaccine for females age 9-26 years which may prevent cervical cancer. Most importantly, preventing transmission of this STD is essential.

6. Get the right amount of sun exposure. Unless you are getting adequate Vitamin D through diet, 5-30 minutes of natural sunlight twice a week (more if you are darker skinned or elderly), should provide the amount you need. Vitamin D as a hormone may protect against breast, colon, prostate, ovarian, and ironically, even some skin cancers! But excess UV exposure can increase our risk for skin cancers including the dreaded melanoma.

7. Women should do monthly breast self-exams and men testicular self-exams. Both genders, especially with a previous history of skin cancer, should do monthly skin self-checks.

8. Wear your sunscreen and reapply often. It can prevent squamous cell carcinoma of the skin and hopefully, melanoma, without greatly affecting Vitamin D synthesis.

9. Brush and floss at least daily and see your dentist regularly. One recent study suggests gum disease may be associated with up to 14% higher cancer rate.

For more information on this topic, go to: www.cancer.gov and www.cdc.gov

Roopal Bhatt, MD is a Dermatologist starting her practice in the Four Points Area. To reach her for questions on this topic or others, please e-mail her at contact@fourpointsdermatology.com.

September 16th, 2010

This article is in tribute to October as breast cancer awareness month and is dedicated to the 182,000 women and 2000 men newly diagnosed with breast cancer and to the 40,000 who will die from it just this year.

We are all aware of the statistics – 1 of every 8 women will get breast cancer – a number that guarantees that we all know of or have been victims. Breast cancer is the second leading cause of cancer death in women.

Fortunately, 8 of every 10 breast lumps are benign. Breast cancer in women under age 30 is very rare, with 75% of cases occurring in women over 50 years old. The 5-year overall survival rate for localized disease has risen to 98% due to better public awareness, early detection through screening, and improved treatment options.

Risk factors for breast cancer include:
• having a mother, sister, or daughter who had breast cancer before age 50
• having a male relative at any age with breast cancer
• if onset of menstruation occured before age 12 and/or menopause occurs after age 55
• never having children or having delivered a baby after age 30
• having a certain ethnic background such as Ashkenazi Jewish ancestry
• having a close relative with a known BRCA 1 or BRCA 2 gene mutation (see below)

Some preventative measures include maintaining a healthy weight, exercising, limiting alcohol intake, and stopping smoking. Aside from the clinical breast exam performed by the doctor every one to three years and monthly breast self-exams, there are also mammograms (standard X-ray or digital), ultrasounds, and MRIs that can provide early detection. Women should start getting annual or biennial screening mammograms by age 40 or earlier if strong risk factors exist.

If a breast or armpit lump detected, with or without overlying skin dimpling, clear or bloody nipple discharge and scale, or skin contour and color changes, see your doctor immediately for evaluation. Your physician may recommend a diagnostic imaging test with a biopsy. Treatment options include surgery, radiation, hormone- and chemotherapy according to the stage of the disease. Some women with very high risk for developing breast cancer opt for prophylactic removal of both breasts and/or ovaries before any possible tumor arises.

Five to 10% of all breast cancers are hereditary. The BRCA 1 & 2 genes (BReast CAncer) are ordinarily tumor suppressor genes meant to fight off cancer development, particularly for breast but also for ovarian, prostate, colon, and other tissues. If a woman tests positive for a mutated BRCA1 or 2 gene, her risk for developing breast cancer rises to 80%.

Some high-risk women (and men) can request getting tested for the BRCA 1 and BRCA 2 mutations. While those with a negative test feel relief, those with positive results showing the abnormal gene(s) may find themselves in an emotional, medical, and ethical Pandora’s Box. On one hand, they can get screening and subsequent early intervention if tumor is detected, but if the screening tests are negative, there is anxiety from the anticipation of possible future cancer. In addition, there may be genetic discrimination from employers and insurance companies that arise from having a positive result documented in the medical record. Thus, many people may confidentially seek to pay for the test out-of-pocket despite the potential high cost of this test.

Those interested in getting tested should first talk to their physicians and a genetics specialist, and then also research their insurance policies and state privacy and anti-discrimination laws. In Texas, the Genetic Information Non-discrimination Act of 2007 forbids employment and enrollment discrimination by employers and health insurances based on genetic testing.
For more information, go to: www.cancer.gov

For more information to find facilities offering free and low-cost mammograms if un- or under-insured, contact:
-the CDC at 1-800-CDC-INFO or via www.cdc.gov
-the American Cancer Society at 1-800-ACS-2345
-the Susan G. Komen Breast Cancer Foundation helpline at 1-877-GO-KOMEN

Roopal Bhatt, MD is a Dermatologist starting practice in the Four Points area. For questions or more information, please contact her at contact@fourpointsdermatology.com.

September 16th, 2010

Will we ever be able prevent heart disease, cancer, Alzheimer’s, and external aging with just pills, creams, and shots? Theories of disease and aging involve concepts of free radical interactions in body biochemistry. While most people have heard of “free radicals,” what exactly are they, what do they do, and why are antioxidants are so important to fight these scavengers?
Free radicals are molecules that are atomically unstable and thus highly reactive due to lack of a complete electron subset in their outer orbit. They take an electron from a more vulnerable molecule thus rendering that latter substance unstable (oxidation reaction). Antioxidants, on the other hand, have the capability to donate an electron to help stabilize molecules (aka reduction). Luckily, we do have repair enzymes in our bodies to inhibit overzealous free radical interactions and promote effects of antioxidants.

Free radicals often involve the oxygen molecule, thereby forming reactive oxygen species, which oxidize and damage cell components such as DNA, lipids, and proteins. Free radicals can be in the form of air pollution, excess sunlight, alcohol, smoking, and even internal stress (from a rise in our adrenalin levels). In our bodies, there are complex cascades where both free radicals and antioxidants are necessary for maintaining health. It is imbalances that can cause disease.

For instance, theories of carcinogenesis conceptualize that free radicals prevent proper DNA repair mechanisms, thereby perpetuating DNA mutations, leading to a cascade that causes uncontrolled cell growth. Likewise, internal markers of aging, such as atherosclerosis, also involve oxidative stress on lipids, specifically low-density lipoproteins or LDLs, that cause plaques and ultimately blockage on artery walls. This blockage causes to heart disease and stroke. And lastly, external markers of aging such as skin wrinkling also involve free radical-induced collagen breakdown through excess sun exposure and smoking.

Antioxidants such as vitamin A,C,E, and polyphenols (often from green tea), as well as lutein, lycopene, and selenium, are some of the body’s major antioxidants. While we have natural antioxidants and enzyme repair systems in our bodies, we also obtain much of our antioxidants from our diet, specifically diets rich in plant matter such as fruits and vegetables and legumes. Internal consumption and even topical placement through creams if they are able to penetrate deep enough into the skin, can slow down damage to our cells.

Foods with the highest antioxidant properties judged by the ORAC scale (aka, Oxygen Radical Absorbance Capacity) include: beans, berries (acai seems to be the berry of the moment), apples, green tea, dark chocolate/cocoa, red wine, certain nut and seeds, and green, leafy vegetables. Diets rich in these foods promote good health – not just through their high antioxidant levels, but also through their high fiber, relatively low-calorie, and nutrient-rich properties.

While the role of free radicals is not the only factor in disease and aging, it is part of the story, just as antioxidants may be part of the anti-aging and good-health panacea that we are all seeking.

September 13th, 2010

Health Effects of Alcohol

The holiday season wouldn’t be the holidays without the five “f’s” – food, family, friends, fun, and fermentation. Some cultures view alcohol as an essential part of social and culinary life, and others shun it. Regardless of viewpoint, medical research has shown us some mild potential benefits of alcohol consumption and the many dangers of overconsumption.

Perhaps the “healthiest” alcoholic beverage to consume is red wine or a dark beer. The depth of color of alcohol is partly determined by the flavonoids and polyphenols in the beverage. These chemicals, and specifically another chemical called resveratrol, are anti-inflammatory and are anti-oxidants, so they can improve overall cardiovascular health.

Moderate alcohol intake for those who already drink, ie 1-2 drinks per day on average for men and 1 drink a day for women, also can modestly increase ”good” high-density lipoproteins (HDLs), lower blood pressure, and provide anti-clotting properties to the blood. A “drink” is defined as about one 12 oz. beer, 4 oz. of wine, 1.5 oz. of 80-proof spirits, or 1 oz. of 100-proof spirits. The American Heart Association does not recommend starting alcohol intake for these mild benefits, and instead recommends a combination of daily exercise and a healthy diet, sometimes in addition to lipid-lowering medication, to increase HDLs and decrease the “bad” low-density lipoproteins (LDLs). Some even speculate that eating red grapes or drinking red grape juice may provide the same benefit.

On the flip side, science has proven that too much alcohol can increase triglycerides, another component of blood lipids, and increase risk of stroke, cardiac arrhythmias, high blood pressure, heart failure, certain cancers, liver disease, fetal alcohol syndrome, obesity and diabetes, suicide risk, and accidents; and the list goes on.

How can such a simple molecule, two carbon, one oxygen, and five hydrogen atoms, cause such potential havoc in our bodies? First, the ethanol gets absorbed from our gastrointestinal system to our bloodstream, and then gets metabolized mainly by our liver and less so by our kidneys where the toxic byproducts taken up preferentially by tissue with high water contents. Also, because of the simple chemical structure, it is able to pass through the Blood-Brain Barrier. So our brain gets a double whammy, which is why the immediate alcohol effects include social “relaxation” and loss of inhibition and then memory and judgment impairment. But no body system is left unaffected, causing adverse effects to our brain, liver, heart, muscles, kidneys, stomach, lungs, bones, endocrine, reproductive, and immune system with long-term excessive alcohol consumption.

If and when consuming alcohol over the holidays, it is extremely important to drink on a full stomach, drink in limited amounts, and to drink slowly. Blood alcohol concentration (BAC) is affected by gender, weight, and body fat of the individual. A rule of thumb is that one drink, as defined above, can increase the BAC by 0.02 to 0.05%. It can take 1.5 to 3 hours for the BAC to go back down to zero. In all states in the US, a BAC equal to or above 0.08% constitutes intoxication. In certain individuals in certain circumstances, as little as one to one and a half drinks can cause the BAC to go up to 0.08%.

Lastly, to also be safe, avoid alcohol with sedating antihistamines like Benadryl, narcotic pain medications like codeine and vicodin, anti-anxiety medications and antidepressants, sleep and anti-seizure
and cough medications, certain antibiotics, muscle relaxants, and even herbal oral medications such as St. Johns Wart, Kava Kava, chamomile, lavender, and valerian. Speak to your doctor for advice.
Enjoy in moderation, be safe, and Happy New Year!!!

Roopal Bhatt, MD, is a dermatologist opening her practice in the Four Points Area. For questions or more information, email her at contact@fourpointsdermatology.com or go to www.fourpointsdermatology.com.