Study shows US women get too many Pap tests

Study shows US women get too many Pap tests
A new study from America's Centers for Disease Control and Prevention (CDC) reveals that many American women are getting too many unnecessary Pap tests, the screening for cervical cancer.

A study published August 18 in the American Journal of Obstetrics and Gynecology found that many doctors are recommending annual Pap tests, even though guidelines in both the US and UK suggest that women over 30 years old and at average risk for cervical cancer wait at least three years between negative tests.

Researchers noted that over-screening adds up to extra costs, more hassle for women (arranging child care and/or taking time off work for doctor's appointments), and an increased risk of unnecessary treatment for false-positive test results, with no benefit to women in detecting more cancers.

Mark H. Einstein, MD, a gynecologic oncologist in New York City told WebMD News that "there is quite a bit of over-screening in women in the US, which ultimately leads to over-management and over-treatment."

Also the researchers stated that about 51 percent of doctors in their study ordered a recommended co-test for the human papilloma virus (HPV), which is a common cause of cervical cancer, in addition to a Pap test.

"If only half are using the co-test, there is a lack of understanding about the guidelines," says study researcher Katherine Roland, a behavioral scientist at the CDC in a statement. "Women should discuss with their provider whether they are eligible for extended intervals between testing or not based on the type of test that is ordered and their results."

The new findings appear in the American Journal of Obstetrics & Gynecology

Pharmacist Reveals 5 Trade Secrets You Don't Get 'Over-The-Counter'

Pharmacist Reveals 5 Trade Secrets You Don't Get 'Over-The-Counter'

By Alan Okpechi

Behind the glass at your national chain pharmacy exists a world of long periods of boredom punctuated by extremely busy periods of stress, angry and illogical patients in Xanax withdrawal, and screaming babies with fevers. The typicalpharmacist has grown accustomed to a mostly sedentary life of sitting in chairs and occasionally helping patients with problems of the insurance variety.

While we may think our job is to make time go by as quickly as possible, there are constantly issues that go unresolved and leave patients without medication. Placing too much trust in your local pharmacy can also be dangerous for your health and, though rare, errors are made that can compromise your health.

There are, however, simple steps that patients can take to ensure everything is done correctly every time you fill a prescription. Whether it's the pharmacy's fault or not, there are also ways to resolve insurance denials with little effort.

1. Do not trust the expiration date on your prescription bottle.

Unless you are given the exact bottle delivered to us by the manufacturer, you may as well be guessing as to when your medication actually expires. While expired medication may not be worrisome, the effectiveness of your medication decreases with each passing day that the tablet or capsule is expired. With hundreds of bottles of medication being delivered to pharmacies every week, it is easy to overlook the expiration date of medication.

Safety is our first priority for patients, but some things do slip through the cracks. If you have a condition which requires a precise medication and strength, ask the pharmacist to show you the bottle from which the medication originated. Self-verifying the expiration date only takes a few seconds, and gives you the confirmation that you need to trust the effectiveness of your prescription.

2. Do not pay full price for an insurance denial.

If an expensive medication is denied by your health insurance company, ask your pharmacist to perform aprior authorization while you wait. Waiting in the pharmacy is crucial for this process to be successful. A prior authorization is simply a form that is sent to your insurance company and doctor's office that can force your insurance company to pay for your medication. This process usually takes up to 10 days depending on the pharmacy. However, I have personally pushed this process to be completed in under 10 minutes. Make sure that your doctor or his/her staff is prepared to answer the call from your insurance company. Once your doctor or staff says the magic words, "medically necessary," you are on your way to paying your regular co-pay for your medication.

The alternative is waiting 10 days for a rejection from your insurance company for a prior authorization that may or may not have been done in a correct and timely manner. Some pharmacist may try to brush off this request, but the fact is we are legally required to assist you in getting your medication. Anything else can be considered unprofessional, irresponsible, and possibly grounds for malpractice. Do not get pushed around by anyone when it comes to your health.

3. All generics are not created equal.

Insurance companies push generics due to their low cost, but every person reacts differently to medication. There are some medications for conditions like epilepsy and thyroid issues that, for some patients, work differently than their brand-named counterparts. Even the same generic medication made by different manufactures can have a different effect on the same person. While the chemical structure of the medication may be the same, the way it is synthesized and concentrated differs from company to company.

Small differences between medications can make all the difference for a patient. If one generic does not work for you, ask for a different malefactor. If no generics work, you always have the option (under federal law) to substitute for the brand name version. Many patients experience a change in their health when a generic becomes available for their medication, but are unaware that they do not have to take the generic medication.

4. Ask for a loaner when needed.

If you for some reason run out of medication (that is a non-controlled medication such as Xanax or Hydrocodone) your pharmacist has the option to give you up to a three-day loaner supply to hold you over until your doctor is contacted for a refill. This loaner supply also goes for when you are out of town and forgot to pack your medication -- if you do have a refill somewhere in the United States -- though you may have to pay for the three-day supply in this circumstance. Many pharmacist do not extend the offer because they fear taking a loss for the pharmacy, but simply asking is often all a patient needs to do.

5. Take advantage of transfer gift cards!

We will give you a gift card for a transfer in almost any situation. If you are in a large national chain pharmacy, at least. When gift cards were popular for transfer prescriptions in 2005, there were many restrictions placed as to how they were to be given out. These restrictions no longer exist since we have been notified not to argue with customers in this situation. Instead of a pharmacy district manager personally replying to complaints on transfer gift cards, most pharmacies simply give them out. There may be nice pharmacy staff who will give you a gift card automatically, but most hope you don't ask. Ask for the card: Issuing $30 gift cards brings returns to the pharmacy that exceed their cost. The pharmacy makes a fortune from insurance companies, you shouldn't feel guilty or timid for taking advantage of a program created for the patient.

Asthma, preterm birth and preeclampsia

Asthma, preterm birth and preeclampsia
By Crocker Stephenson

An extensive review of pregnancies over the course of more than three decades shows that women with poorly managed asthma are at an increased risk of having a low-birth weight baby, a premature baby and other pregnancy complications, such as preeclampsia.

The new study was recently published in the British Journal of Obstetrics and Gynecology.

Christina Chambers, a professor of pediatrics at the University of California, San Diego was part of the team of seven researchers who reviewed data involving more than 1 million women between 1975 and 2009.

“The findings are significant and call for women with asthma to be more closely monitored during pregnancy,” Chambers said.

“It would be advisable for women on regular medications for asthma or having frequent symptoms to be monitored at least monthly during the course of their pregnancies,” she said.

The study found that the infants of women with asthma were likely to weigh an average of 0.2 lbs. less at birth compared to babies of mothers without asthma. Mothers with poorly controlled asthma were also at a 25% increased risk of preterm birth and 50% increased risk of developing preeclampsia, a condition in which high blood pressure develops during pregnancy.

Click here to read more about the study.

Menopause Treatment Not Effective

Soy Supplements Don't Ease Bone Loss, Menopausal Symptoms

Women taking high-dose soy isoflavone pills for 2 years even had more hot flashes.

By Kathleen Doheny, HealthDay News

Soy supplements, sometimes promoted as a healthier alternative to estrogen for maintaining bone and relieving menopausal symptoms, don't appear to do so, according to a new study.

"Our study shows that contrary to popular belief, soy isoflavone supplements do not prevent bone loss or alleviate menopausal symptoms," said lead author Dr. Silvina Levis, professor of medicine and director of the Osteoporosis Center at the University of Miami Miller School of Medicine.

In fact, a greater percent of women taking the supplements hadhot flashes after the study than those taking the placebo.

The study, funded by the U.S. National Institutes of Health, is published Aug.8 in the Archives of Internal Medicine. The researchers reported no conflicts of interest.

Levis and her colleagues evaluated 248 women between the ages of 45 to 60, all of whom were menopausal. At the study start, they had bone density levels considered healthy.

In a study in which neither the participants nor the researchers knew which women were getting what, the team randomly assigned 126 volunteers to the placebo group and 122 to the soy group. The latter group took 200 milligrams of soy isoflavones a day for two years.

After two years, the researchers measured the hip and spine — standard areas to screen for bone loss — to determine whether the soy had made a difference in bone density. It had not.

They also looked at the women's reports of menopausal symptoms. At the beginning, 176 of the women reported one or more symptoms such as hot flashes, night sweats, insomnia, loss of libido or vaginal dryness.

The two groups showed no differences in any of the symptoms at the end of the study, except hot flashes: Those taking soy isoflavone supplements actually had more. Of those taking soy supplements, more than 48 percent had hot flashes, compared to about 32 percent of those on placebo.

More women taking soy isoflavone tablets reported constipation, too, although the differences were not significant from a statistical point of view.

The researchers did find that spinal bone loss was smaller in a subgroup of women taking the soy isoflavone tablets: women whose vitamin D levels were less than 20 nanograms per milliliter.

Interest in soy supplements increased after the Women's Health Initiative study, halted in 2002, found increased risk of strokes and heart attacks in women who took combination hormone therapy using estrogen and progesterone. Soy has been promoted as an alternative to estrogen, providing comparable benefits of bone preservation and symptom relief without the risks.

Levis said that if a patient were to ask her now about taking soy for menopausal symptoms or bone health, "I would not suggest they start for hot flash [relief] or bone loss prevention."

Dr. Deborah Grady, professor of medicine and epidemiology at the University of California San Francisco, co-wrote a commentary to accompany the study. In an interview, she said that, "I personally would say we have spent enough time and effort on this. And to do more trials on soy doesn't seem to be an efficient way to spend money if we want to come up with better treatments for menopausal women."

Many studies have looked at soy, she said. Every time one has had negative results, it seems, people say perhaps the dose was wrong or perhaps the study was not long enough, she noted.

But the results of the new study are definitive, Grady said. "This one is important because it was funded by the NIH, was long-term and they gave a huge dose of soy."

The bottom line: "Paying money to buy soy supplements doesn't make sense," she said.

Costs vary, but soy isoflavone supplements are widely sold on the internet. A month's supply can be bought for about $7.

Grady points out that the study was on soy supplements only; in addition, the study found the soy supplements to be benign. "It probably is not going to hurt anyone to eat soy in their diets," she said.

In her commentary, Grady also noted that the search for a safe alternative to hormone replacement therapy continues, with some menopausal women finding their symptoms are relieved by the class of antidepressants known as SSRIs. Other researchers have recommended yoga and other relaxation techniques as complementary therapies.

"Perhaps effort should be directed away from the hope of a one-size-fits all therapy for menopausal symptoms toward using existing treatments to target the symptoms that disturb patients most," Grady and her co-author concluded in the journal.

Learn more in the Everyday Health Menopause Center.

Bladder inflammation may be cause of sex difficulties

Bladder inflammation may be cause of sex difficulties

The China Post--A urogynecology group identified two potential physiological hindrances against smooth sexual intercourse and named potential solutions, yesterday, in Taipei.

The Foundation for Women's Health and Urogynecology of Taiwan (FWHUT) announced yesterday that interstitial cystitis (IC), a kind of inflammation of the bladder, has long been the culprit of pain during sexual intercourse for women; an epidemiological research has indicated that about 52 to 67 out of every 100,000 Taiwanese women in Taiwan suffer from IC.

According to FWHUT, IC involves complex syndromes that result from autoimmunal, endocrinal, and neuronal dysfunctions, which often leads to inflammation in the bladder independent of foreign pathogens.


Common warning signs of the disease include bladder pain that can only be relieved after urination, frequent urination and enuresis that interrupt one's daily functions and interferes with one's sleep, with no infection or germs detected in one's urine.

In addition to causing patients physical pain, the chronic disease often sacrifices patients' sex lives; while their day jobs are disrupted by having to frequently use the bathroom, the quality of their sexual intercourses is also reduced - patients not only have to endure additional pain, but also fear that they would fail at holding back the urge to urinate.

Many disrupted marital lives result from the disease, the FWHUT noted.

Recent research has shown that hyaluronic acid infusions could relieve the discomfort resulting from bladder inflammation by protecting the endometrial of the bladder, the FWHUT said, while how much it alleviates the discomfort during sexual intercourse is still being investigated.

Other research on "the ideal sex life," taken from polling of 3,282 people from ten Asian countries, indicated that the hardness of erection, in addition to being the indication of men's cardiovascular health, also reflects men's self-confidence and dignity.

This research indicated that many males who face erection-related problems care about the process of sexual intercourse as a means only of reaching orgasm themselves; in other words, they focus on their own rather than on mutual feelings. About 30 per cent of this category of men feel uncomfortable discussing sex-related issues with their partners.

Jiaan Ban-pin (???), head of the Taiwanese Association of Andrology, pointed out that sexual intercourse is an important means of interaction between the two genders; without enough communication, one could neglect a partner's feelings, which would lead to chronic sexual dysfunction. Asking for help from professionals could be a good solution, Jiaan added.

Osteopenia: Know Your Fracture Risk

Osteopenia, an early stage of bone loss, isn't as serious as osteoporosis, but it can still cause your bones to break. Are you at risk?

By Diana Rodriguez

Medically reviewed by Lindsey Marcellin, MD, MPH

Do you know your T-score? This magic little number is calculated from bone density tests such as dual absorption absorptiometry (DEXA) — and it can tell you a lot about yourbone health. If your score shows low bone density (but not yet low enough to be osteoporosis), you could have osteopenia.

But to get a full picture of your bone health, you and your doctor need to take several additional factors into account.

Bone Density Tests: Your T-Score

Your T-score is a number on a scale that measures bone density. The ideal score is 0, which means that your bones are as dense as those of a healthy young adult. Negative numbers indicate less-dense bone. The lower the number, the more severe the bone loss; for example, -3 is worse than -2.

A T-score between +1 and -1 is considered normal. Osteoporosis is defined as a T-score lower than -2.5, which indicates substantial bone loss and significant risk of fractures. A T-score between -1 and -2.5 indicates less-severe bone loss, a condition called osteopenia.

However, even with a T-score in the osteopenia range, you can still be at risk of fracturing a bone. In fact, more than 50 percent of fractures due to weakened bones occur in women with T-scores in this range.

Assessing Other Fracture Risk Factors

Your T-score is only one piece of the puzzle. Determining your fracture risk requires also looking at your current health, medical history, and other factors. Your risk of breaking a bone is higher if you:

• Are 65 years old or older
• Have a thin, small frame
• Smoke tobacco
• Experienced early menopause
• Have a family history of osteoporosis
• Have used steroids for a long time or used certain anti-seizure medications
• Are undergoing treatment for prostate cancer or breast cancer
• Have an overactive thyroid or are taking high doses of thyroid hormone for an underactive thyroid
• Are female — men also experience bone loss as they age but are less likely to develop osteoporosis or experience fractures
• Don’t get enough calcium and vitamin D
• Consume more than three alcoholic drinks per day
• Have a disease that can cause bone loss, such as rheumatoid arthritis or anorexia nervosa

Evaluating Your Risk

One way to calculate your fracture risk based on the above factors is to use the WHO Fracture Risk Assessment Tool, or FRAX, according to Nelson Watts, MD, a nationally recognized bone health and osteoporosis expert and the director of the Osteoporosis and Bone Health Program at the University of Cincinnati in Ohio.

Available for free online, the FRAX calculator, which was developed by the World Health Organization (WHO), uses a range of criteria to determine your likelihood of having a fracture in the next 10 years. FRAX is an effective assessment of risk because it incorporates so many factors, says Dr. Watts.

Guidelines from the National Osteoporosis Foundation encourage the use of FRAX for patients with T-scores between -1 and -2.5, says Watts. For people with scores in this range, the foundation recommends osteoporosis medication for those who also have a FRAX 10-year probability of a hip fracture of 3 percent or higher or a FRAX 10-year probability of a major osteoporosis-related fracture of 20 percent or higher.

Having a bone density test to learn your T-score is important for those concerned about bone health and fracture risk. But remember that your T-score alone doesn't give you a complete appraisal of your risk of breaking a bone. For a more realistic assessment, take a look at the bigger picture.

Common vein problem raises clot risk on the Pill

Common vein problem raises clot risk on the Pill

Women who use the standard form of birth control pill may have a much higher than average risk of dangerous blood clots if they also have a vein malformation seen in a quarter of the population, California researchers say.

Up to 25 percent of the healthy population has a narrowing, known as stenosis, in the left common iliac vein (one of two major veins deep in the pelvis that return blood from the lower body to the heart), according to Dr. Lawrence Hofmann and his colleagues at Stanford University School of Medicine.

In their study, published in the American Journal of Obstetrics and Gynecology, having a "left common iliac vein stenosis" and taking so-called combined oral contraceptives - the kind containing both the hormones estrogen and progestin - multiplied a woman's risk of deep vein thrombosis nearly 18 times compared to women with neither risk factor.

Sometimes known as "economy class syndrome," a deep vein thrombosis is a blood clot - often formed in veins of the lower legs -- which is potentially dangerous because it can travel to the heart and lungs and cause serious harm.

Some 12 million women in the U.S. use the "combined" form of birth control pill, which is already known to increase a woman's risk of blood clots.

In general, the researchers note, among every 10,000 young women who are not taking oral contraceptives, about 1 to 3 will have a deep vein thrombosis every year. For young women who've been taking the Pill for a year, that risk goes up six-fold.

In the study, Hofmann's group looked at 35 women with deep vein thrombosis and 35 women without the condition for comparison. They found that left-side common iliac vein stenosis raised a woman's clot risk 3.5 times. Combined oral contraceptives raised clot risk nearly 5 times. And the combination of the two raised the risk 17.7 times.

For the study, the Stanford group used CT or MRI scans to evaluate women with deep vein thrombosis. They compared them to an equal number of women of the same age who came to the emergency room with abdominal pain.

In total, 37 percent of the women with deep vein thrombosis and 11 percent of the control subjects used the combined type of birth control pills. Among thrombosis cases, 63 percent also had other clot risk factors, such as pregnancy or a clot-prone condition called thrombophilia, compared to 23 percent of the controls.

Among women with deep vein thrombosis and left common iliac vein stenosis, the degree of narrowing of the vein was, on average, 70 percent, compared to 56 percent blockage in controls.

For the women in general, every one percent increase in iliac vein stenosis above 70 percent boosted the risk of thrombosis by five percent. But for women using the Pill, every one percent increase in stenosis raised the risk of thrombosis about 500 percent.

Given the risks, the authors caution doctors that, "If a young woman using combined oral contraceptives develops left-sided deep vein thrombosis in the absence of other risk factors, the possibility of common iliac vein stenosis should be considered."

SOURCE: bit.ly/oxHUeK American Journal of Obstetrics and Gynecology, online July 11, 2011.

Endoscopic Instrumentation Linked to Insulation Failures

Endoscopic Instrumentation Linked to Insulation Failures
Robotic and laparoscopic endoscopic instrumentations -- particularly robotic -- are associated with high incidence and prevalence of insulation failure after 10 procedures, according to a study published in the August issue of the American Journal of Obstetrics & Gynecology.

TUESDAY, Aug. 2 (HealthDay News) -- Robotic and laparoscopic endoscopic instrumentations -- particularly robotic -- are associated with high incidence and prevalence of insulation failure (IF) after 10 procedures, according to a study published in the August issue of theAmerican Journal of Obstetrics & Gynecology.

Mercedes Espada, M.D., from the Hospital Quirón Madrid in Spain, and colleagues investigated the incidence, prevalence, and location of IF in laparoscopic and robotic instruments. A total of 78 robotic and 298 laparoscopic instruments were tested at 20 W and 2.64 kV in phase A, and 60 robotic and 308 laparoscopic instruments were tested at 20 W/1 kV and 20 W/4.2 kV, respectively, in phase B.

The investigators found that the robotic group had a significantly higher prevalence (32 versus 13 percent) and incidence (80 versus 36 percent) of IF after 10 uses in phase A compared to the laparoscopy group. In phase B, 81.7 percent of robotic, and 19.5 percent of laparoscopic instruments demonstrated IF.

"There is a high incidence and prevalence of IF in robotic and laparoscopic electrosurgical instruments, even when tested according to manufacturer specifications of voltage," the authors write.

FDA warns of counterfeit 'morning-after' pill

The Food and Drug Administration says the emergency "morning after" birth control pill Evital could be counterfeit and may not be safe or prevent pregnancy. The agency is asking women not to use the medication.

Evital is not approved for use in the United States.  But the FDA says, while it doesn't have evidence of "pattern targeting" of a specific ethnic group, the drug may have been distributed in Hispanic communities under the label "Evital Anticonceptivo de emergencia, 1.5mg, 1 tablet by Fluter Domull."

"Evital was discovered through routine imports entry review and we are currently working to find out more about this apparently illegal U.S. distribution of what FDA suspects is a counterfeit product," said FDA spokeswoman Shelly Burgess.

The FDA is asking consumers to contact their doctor if they've taken the pills and had any side effects. It also is asking anyone with information about the pills to contact their Center for Drug Evaluation and Research/Ingredient Adulteration (CDER). Any information gathered will be used to get Evital off the market.

Emergency contraception can be used to prevent pregnancy up to five days after unprotected sex. Common brands are Plan B One-Step, Next Choice and ella. The drug can cost from $10 to $70 depending on the brand.

FDA-approved emergency birth control is available with a prescription and over-the-counter if you are at least 17 years old.

Labiaplasty complications may result from cookie-cutter approach

Labiaplasty complications may result from cookie-cutter approach

-In consultation, surgeon must determine whether patient's anatomic goal is achievable
-Be cautious regarding aggressiveness of reduction
-Careful technique critical for avoiding complications when performing linear resection

ATLANTA — Success in labiaplasty requires understanding of the patient's motivations and outcome goals along with good surgical technique. While these principles seem obvious, the frequency of women presenting for revision labiaplasty suggests they are too often being overlooked, says John R. Miklos, M.D.

"Avoiding complications in any surgery involves choosing the right procedure and performing it correctly. However, the first step depends on obtaining a good history to determine the patient's indication for seeking surgery and postoperative expectations, and then one must have proper training and skills," says Dr. Miklos, a private practitioner in Atlanta with fellowship training in urogynecology and laparoscopic reconstructive vaginal surgery. "Considering the number of women I see who are devastated by the results of their labiaplasty, not all surgeons are following these basic rules."

PATIENT MOTIVATIONS 

Almost universally, women seeking labial reduction surgery present with protrusion of the labia minora beyond the edge of the labia majora, Dr. Miklos says. Results of a study undertaken by Dr. Miklos and his partner, Robert D. Moore, D.O., to identify patient expectations determined that 98 percent of more than 500 women having labiaplasty wanted the labia minora to be at or below the level of the labia majora. It may be surprising to some surgeons, however, that findings from a previous study (Miklos JR, Moore RD. J Sex Med. 2008;5(6):1492-1495) showed that for two-thirds of women, relief of pain, discomfort or irritation was at least part of the underlying reason why labiaplasty was being pursued, Dr. Miklos says.

"Only about one one-third of women wanted labiaplasty solely for cosmesis. For the majority, there was a functional quality of life issue involved," he says.

With the patient's anatomic goal in mind, surgeons must first determine whether it is achievable and inform the patient of their determination. In some women, the labia majora are so flat because of changes in weight and/or age-related fat atrophy that it is not possible to get the labia minora below the level of the labia majora, Dr. Miklos says.

"However, lowering of the labia minora will still relieve discomfort because the tissue will be less pedunculated. Therefore, the outcome may be acceptable to women seeking surgery for functional reasons," he says.

Dr. Miklos says it is important to be cautious about the aggressiveness of the reduction performed, taking into account whether the patient wants or is willing to have the tissue completely removed.

"One recurring problem among women who come to me for postlabiaplasty revision is a desire to have the labia minora rebuilt because the tissue was totally amputated by their previous surgeon," Dr. Miklos says.

COLORING COUNTS 

Another misconception about labiaplasty surgery that leads to patient dissatisfaction is the idea that the procedure should maintain the current skin color of the labia edges. Rather, Dr. Miklos's research also shows that 98 percent of women don't want what is "natural" for their age but rather desire restoration of the pinker skin color present when they were younger.

"It is widely written throughout the literature that labiaplasty should maintain the natural skin color and border, and for that reason, the procedure is usually performed with a V-wedge resection," Dr. Miklos says. "However, to meet the expectations of the majority of patients, a linear-contouring resection should be done instead. Even then, depending on the anatomy, it is sometimes not possible to provide the desired skin color, and patients need to be told that preoperatively."

Careful technique is also critical for avoiding complications when performing a linear resection. Cutting the labia while pulling the tissue with excessive tension is one mistake that results in over-shortening to the point of near complete amputation, Dr. Miklos says.

"Though all cosmetic surgeries have their potential financial incentive, the ultimate physician reward is an elated patient with an improved quality of life. Therefore, I would caution surgeons to be slow to adapt new surgical procedures and techniques and to address patients' cosmetic labia requests with the same intensity and concern as he/she would for themselves or a family member," he says.