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Mona Lisa Touch

The Mona Lisa Touch is a new FDA-approved procedure for the treatment of vaginal dryness, vaginal atrophy,

non yeast related itching or burning, poor vaginal lubrication, pain with intercourse and urge incontinence.  It

consists of three in-office treatments of less than 5 minutes each, with no pain, no side effects and no anesthesia.

The results are long lasting with only one refresher treatment a year needed.  There are 5 Mona Lisa Touch lasers

in Knoxville, TN.  This therapy option is not covered by any insurance.   The other four practices are charging $500.00-700.00 per treatment.

That means $1500.00-$2100.00 for the three treatments.  I have decided to make it much more affordable(which has

angered the other practices and the laser company!)  I am charging only $200.00 per treatment so only $600.00 for

all 3 treatments!  This is to make it available to more women.  One of my patients who is a breast cancer survivor came in

and had such extreme vaginal dryness that she bled if she tried to have intercourse.  She could not use estrogen and she

couldn’t afford $1500.00.  This is when I decided to make it affordable!!!


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Destination Desserts Treats That Travel To The Ones You Love

Destination Desserts is now PUBLISHED!!!  You can purchase it now on Amazon and at

www.westbowpress.com.  Also several college bookstores are stocking it including

Hampden-Sydney College Bookstore!


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Menopause Through The Eyes of a Gynecologist- Hormone Replacement Therapy

 

Almost everyday I am asked by a patient who has recently entered Menopause and feels bad “what can I take to feel better?”  The first question we have to answer

is what are your symptoms?  25% of women enter Menopause with no symptoms.  Of the 75% who do have symptoms most have a mixed bag including Hot Flushes, Vaginal Dryness,

Decreased Sex Drive, Irritability, and Not Sleeping Well.  You can either piecemeal all of these symptoms and end up taking 5 medications or start Hormone Replacement.  I experienced

all of these so I started on a very low dose estrogen patch- minivelle .0375.  I know you are probably thinking her Mom had breast cancer and she is taking estrogen?  I came to this decision

after careful review of the literature and a strong desire to feel like myself again.  The Women’s Health Initiative Postmenopausal Hormone Therapy Trials was started in 1991 and involved 161,808

healthy postmenopausal women.  The trials wanted to test the effects of HRT, diet, calcium supplements and vitamin D supplements on heart disease, bone fractures, breast cancer and colorectal cancer.

The HRT trial had two arms.  One involved Estrogen Plus a Progesterone in women with a uterus.  Progesterone has been shown to prevent endometrial cancer in women taking Estrogen with a uterus.

The second arm involved women taking only Estrogen without a uterus. The arms cannot be compared directly because the women in the estrogen-alone(no uterus) arm had a higher risk of cardiovascular

disease ( more women had hypertension, diabetes and obesity in the Estrogen only arm).   But the results were significant.  Compared with Placebo, Estrogen plus Progesterone resulted in 1. increased risk

of breast cancer 2. increased risk of heart attack 3. increased risk of Stroke 4. increased risk of blood clots 5. reduced risk of colorectal cancer 6. reduced bone fractures 7. and increased risk of dementia in

older women.  Now you know why I am so afraid of non FDA approved Bio-Identical Hormones that are so unregulated as to strength!  For the Estrogen alone arm the findings were different.  1. No difference

or slight decrease in breast cancer 2. no difference in heart attack 3. increased risk of stroke 4. increased risk of blood clots5. no difference in colorectal cancer 6. reduced bone fractures 7. and increased risk

of dementia in older women.  With these results in mind the recommendation is that we use the lowest dose for the shortest length of time. It’s a good thing that most symptoms of menopause except for

vaginal dryness usually improve on their own by age 60. Whether you take HRT and what you take is between you and your own doctor but this is what is available and the pro’s and con’s of the various treatments in my opinion.

 

When you have a Uterus –      Estrogen plus progesterone oral –  examples are prempro (premarin and provera), generic estradiol and northindrone, Con’s – Prempro is what was used in the WHI study, but the risks have been

found in most combination oral estrogen-progesterone treatments.  Oral estrogen passes through the liver increasing your Sex Hormone Binding Globulin which in turn does not help your sex drive

and also increases your clotting factors. Oral progesterone might be the more significant player in breast cancer because the increase in breast cancer was not seen in the estrogen only arm of the

WHI study. Pro’s- you just take one pill a day and it helps hot flushes, vaginal dryness, irritability and decreases your chances of bone loss and colon cancer.

 

Estrogen plus progesterone Patch- examples are Climarapro(which is generic and once a week) and Combi-patch( which is not generic and 2x per week)  Con’s- Hard to keep on.  They are big patches

and some women react to the adhesive.  Progesterone patches and creams have a low absorption rate so I see a lot of break through bleeding on these. Pro’s- there is no pass

through the liver so they help your sex drive and have less effect on your clotting factors.

 

Estrogen patch, gel or mist and an oral progesterone-  examples of Estrogen options- Minivelle, Climara, generic Estrogen Patch, Estrogel, Elestrin (gel) and Evamist with options of oral progesterone- provera,

aygestin and prometrium (all progesterones are available in generics)   Con’s-  This can be more expensive because it involves 2 prescriptions.  Oral progesterone might be the more significant player in breast cancer

because the increase in breast cancer was not seen in the estrogen only arm of the study.  Some patients feel that they get a happy spike after applying their gel or mist and then it goes down as the day goes on.

Estrogen Pellet with Progesterone Cream- Con’s- NOT FDA APPROVED, expensive,  progesterone cream has not been shown to protect the uterus as well as oral progesterone but we also don’t know what dose of estrogen in a Pellet you are receiving which makes counteracting endometrial growth with progesterone cream or pill difficult.  Pro’s  perceived as “natural”; no pass through the liver; relieves symptoms continuously for several months

 

Estrogen Only (No Uterus)

Pill- Premarin and generic Estradiol.  Con’s- passes through the liver so in some it doesn’t help your sex life and increases clotting.  Although some have painful intercourse from vaginal dryness so this would help in those women.  Pro’s-  It helps hot flashes, Irritability, inability to sleep and vaginal dryness and you only take a pill a day.

Patch-  Minivelle, Vivelle Dot generic, Climara and generic Climara    Con’s- keeping them on-  I do fine with the Minivelle but the generics are BIG and hard to keep on;  some patients are sensitive to the adhesive;  black ring when you replace it that you have to scrub off.   As long as a discount coupon is available for Minivelle then there is no significant difference in cost.  Climara non generic can be expensive.  Pro’s- no pass through the liver and steady release of Estrogen over days.

Gel or Mist-  Elestrin, Estrogel, and Evamist    Con’s no generics and can be pricey;  some patients are very sensitive to it; some patients are sensitive to how it wears off over a day.  Pro’s  no pass through the liver, no sticky residue like patch, no sensitivity to adhesive like patch.

Pellets- Con’s NOT FDA APPROVED;  unknown amount of hormone; expensive and insurance doesn’t cover; no control over manufacturing with possible mold contamination; and must be surgically placed. Pro’s no pass through the liver, relieves symptoms continuously for several months.

 

 

 


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Menopause Through The Eyes of a Gynecologist- Vaginal Dryness

In 2010 there were 46 million women between the ages of 50-80 years old.  Approximately 40 % of these women are having problems with vaginal dryness, burning, “post menopausal slime” and/or painful intercourse.  We have multiple treatment options for this condition if you do not have any risk factors for breast cancer.  However, if you are a breast cancer survivor or have a strong family history of breast cancer your options are extremely limited.  I have advised these women for years to use vegetable oil daily.  For a few this has been helpful but for most it has not been successful.  I understand that Dr. Oz in one show recommended Olive Oil.  I personally can tell you that Olive Oil is to thick and sticky!  The FDA has recently cleared a new treatment modality for these patients called the Mona Lisa Touch.  This is a vaginal CO2 laser that is an in-office procedure, requires no anesthesia, takes less that 5 minutes to perform and is highly successful.  It requires 3 treatments spaced 6 weeks apart. I’m sure everyone will say “Sign Me Up!”  The downside is that it is not covered by insurance so the out of pocket cost is about $1800.00 for the 3 sessions.  Visit www.VaginalHealth.com

If your only symptom of Menopause is vaginal dryness and you have no contraindications to Estrogen then there are several options.  In the cream category there is Estrace Cream ( remember this is Bio-Identical) and Premarin Cream.  I have had more patients react to Estrace  Cream because they are allergic to the perfume in it.  Both are covered by insurance but still a little pricey.  Both have prescription cards to make them less expensive.  Premarin has a study out that it can be used twice a week in patients with a uterus and not have any effect on the uterine lining. Premarin is obtained from pregnant horse urine.   Most patients feel these are messy.  Vagifem is a pellet (Bio-Identical) of estrogen that is placed in the vagina with an applicator 2 times a week.  It does not increase the uterine lining so you don’t have to take a progesterone with it.  Most insurances cover these at a second or third tier rate.  Some doctors will prescribe you oral estrogen tablets to place in the vagina.  This is an off label use and whether this increases your chance of uterine cancer has not been studied.  Another option that I use a lot is the E-string.  This is a thin plastic ring of Estrogen that you place in the Vagina and it stays for 3 months.  Some women take it out for intercourse although you don’t have to and it is third tier on most insurance.  It does not increase the Uterine lining.  The new one on the block is Osphena.  This is a once a day oral pill that selectively treats the vagina with estrogen.  It does not have an estrogen effect on your uterus or breasts.  You cannot use it if you have had breast cancer and most insurance covers it at the highest rate.

Most Menopausal Women have more symptoms than just vaginal dryness so I will address these treatment options in future posts.


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Getting a Patent First Step

The first decision to make when you want to obtain a patent for a new invention is to select a “good attorney.” These advertisements on TV about just making a call if you have a new invention are a little misleading.  They make it seem that you make a call and everything is taken care of quickly.  The average time your patent will sit in the Patent Office before even being looked at is about 2- 2 1/2 years. For my first ” invention” I called a Patent Attorney in town and he did a Patent Search and told me that there was already a Patent on what I wanted to “Invent.”   My second attempt at getting a Patent was for  a Fetal Scalp pH Probe.  This is a means of checking the well being of a baby while Mom is in labor by scratching the baby’s head and getting a drop of blood to test a pH on.   I chose a large Patent Attorney group in town. They changed Attorneys on me 3 times and not one of the 3 really understood my invention.  The biggest mistake these attorneys made was not doing a thorough Patent Search.  This is the most important step because you will spend a lot of money arguing with the Patent Office when a Patent for your invention may already exist!  Just because your invention has never been produced does not mean it does not have a Patent already.  My first Patent Search was for a Bumper Sticker you could text to.  A Patent for this already exists but has never been produced in large quantities because the LCD screen to make this would cost over $ 2000.00.  A huge pet peeve of mine is that you do not have to prove your invention works to get a patent.  There are millions of Patents out there that have never been produced on a large scale because the prototypes have not worked or are too expensive to manufacture.  Because of this you will spend a lot of money arguing with the Patent Office about prior Patents that they will say are too similar to your Patent Application even though the prior Patent does not work and was never manufactured.  This is what happened with the Fetal Scalp pH Probe Patent Application.  I finally gave up after years of fighting and thousands of dollars even though the prior Patent was never produced because the prototype didn’t work.  You are probably thinking at this point that you don’t even want to try.  But I learned each time I hit a road block what not to do the next try.  For my present Patent Application the Menstrual Shield, I obtained a wonderful Patent Attorney that is in Solo Practice in Knoxville, TN.  Mr. Michael McKee.  He did several extensive Patent Searches before he even agreed to take my case.  The Menstrual Shield is a tampon device.  We currently have several components allowed and are working on getting everything allowed.  This is how it works with a Patent.  After about 2 years you get a notice that your Patent Pending has been published.  That means that the Patent Office is going to start work on it.  Then you get a notice that they are allowing maybe one or two components of your Patent.  So then you start bantering back and forth with legal jargon trying to prove that your design is different than the previous patents they are comparing it to.


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Menopause through the eyes of a gynecologist- Bio- identical Hormones

Many women assume that the word “natural” means safer or better.  But there is no control over the use of the word “natural” unlike “organic” and many things felt to be “natural” are not only unsafe but can cause harm.

I have to address this almost every day when a patient comes in demanding “Bio- identical Hormones” from some compounding pharmacy in another state.  Usually they are ready to spend hundreds of dollars because these are “safer and better” than any prescription I would give them.  The truth is that there are many prescription hormones that are bio-identical but have been thoroughly studied to get through the FDA.  Examples of FDA approved Bio-identical estrogens are Estrace Cream, Climara, Vivelle and Minivelle patches, Estrogel gel and Vagifem tablets.  With these medications I know exactly how much you are getting and they are produced in a regulated fashion so I don’t have to worry about mold.  The added bonus is that most insurance covers these with minimal out of pocket expense.  When you buy compounded hormones you do not have any consistency in the dose you are getting and open yourself to possible infections.  You will also pay the compounding pharmacy, gynecologist or any Doctor who wants to set up shop a lot of money.  Doctors who sell hormones to you out of their offices are making a lot of money doing this.  That’s why I have encountered a Pulmonologist (a Lung doctor) and several Family Practice doctors whose practices consist only of Bio-identical Hormones.   I have had patients receive Estrogen Pellets from these physicians who developed serious complications.  One patient received Estrogen Pellets that were tainted with mold and she developed a 4 cm lump on her right hip where the Pellet was placed that had to be surgically removed.  Another Patient who received these Pellets had a stroke.  They had not taken a thorough history and followed up on the cause of her 3 miscarriages.  It turns out she had 2 clotting disorders that were exacerbated by the high dose estrogen in the Pellet.  Another patient received Pellets and the doctor did not put her on progesterone to protect her uterus.  It’s been known for years that unopposed estrogen increases your risk of Uterine Cancer.  In my view Compounded Hormones are expensive and unsafe especially when they are being prescribed by a non-gynecologist.

You may ask how did we get to the point in the US  that so many vitamins, supplements and compounded medicines have no proof of  safety or efficacy?  Our wonderful Congress did this backed by the Millions of dollars the Vitamin Companies spent to remove the FDA oversight from their products.  Dr. Paul Offit wrote a very well researched book “Do You Believe in Magic?” where he outlines exactly how this happened. ” On May 11, 1994, the Dietary Supplement and Education Act became law. The act defined a supplement as “a product intended to supplement the diet that bears or contains one or more of the following ingredients: a vitamin, a mineral, an herb or other botanical, or an amino acid.”  “The law permits manufacturers to define a product as a ‘dietary supplement’ merely by saying so, no matter how artificially it was derived.”  They are doing this without any proof that their “supplements” do what they are supposed to do and without any oversight by the FDA.  I heard a story last month on NPR about a fact checking group who bought 3 bottles of supplements from GNC, Walmart and Target and tested them for content by a very reparable lab.  The lab did not find any of the stated product in any of the pills.  Even more outlandish was the fact that all three stores refused to remove these products from their shelves!  Why should they?  They are making a lot of money on these products and they are not breaking any laws.


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Kids Getting Married and Pregnant

bride_emptynest_2

I think being married for 28 years, being a gynecologist for 26 years and owning a 108 acre Event Facility- Castleton Farms gives me a different perspective on my own kids getting married and pregnant. I’ve already experienced several times getting to know my son’s girlfriend or my daughter’s boyfriend only to have them break it off and then start dating someone else.    I have seen so many of my patients experience troubled marriages and pregnancies that I hope by sharing some of these lessons learned and some of the weddings we have orchestrated at Castleton Farms will help others maneuver successfully through these waters.  www.Castletonfarms.com


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Getting a Patent

I think we all hear about a new invention from time to time and think “I should have thought of that!” I have been coming up with things for years and have maneuvered through several unsuccessful patents and then finally a Success! The Menstrual Shield. I know there are hundreds of books written about obtaining a patent, but these seem to make it sound easy and it is not! When you finally obtain a patent then the truly hard part starts and that is bringing your patent to market. Why do you think all these people bring their dreams to Shark Tank? I want to share my trials and tribulations of obtaining a patent and bringing it to market.  This will be discussed in future posts!


next page

Mona Lisa Touch

The Mona Lisa Touch is a new FDA-approved procedure for the treatment of vaginal...
article post

Destination Desserts Treats That Travel To The Ones You Love

Destination Desserts is now PUBLISHED!!!  You can purchase it now on Amazon and at...
article post

Menopause Through The Eyes of a Gynecologist- Hormone Replacement Therapy

  Almost everyday I am asked by a patient who has recently entered Menopause and...
article post

Menopause Through The Eyes of a Gynecologist- Vaginal Dryness

In 2010 there were 46 million women between the ages of 50-80 years old.  Approximately...
article post

Getting a Patent First Step

The first decision to make when you want to obtain a patent for a new invention is to...
article post

Menopause through the eyes of a gynecologist- Bio- identical Hormones

Many women assume that the word “natural” means safer or better.  But there...
article post

Kids Getting Married and Pregnant

I think being married for 28 years, being a gynecologist for 26 years and owning a 108...
article post

Getting a Patent

I think we all hear about a new invention from time to time and think “I should have...
article post