| Dr. Rachel Yankama – VoiceAmerica: A Doctor’s Guide to Robotic Surgery Are robots in surgery just a fad? Or, will it revolutionize medicine and general surgical practice? Robots are being used to make surgery that was previously done through large incisions now possible with much smaller incisions. In gynecology, laparoscopic surgery actually set the stage for expanding the utilization of smaller incisions. Sterilizations, removal of ovarian cysts, ectopic pregnancy, removal of small fibroids were the initial uses and for diagnosis of chronic pelvic pain with treatment of endometriosis. Since then uses have expanded to include the general surgeon’s realm of appendectomy, gallbladder removal, and bariatric surgery. More recently, gynecologists have expanded the use of laparoscopy to include hysterectomy as well, and gynecological oncologists are using laparoscopy to do lymph node dissections for cancer surgery for uterine, cervical and ovarian cancer. Of course the benefit of having surgery (if you have to have surgery) through smaller incisions is that there is significantly less blood loss, hospital stays are shorter, there are fewer infections, and postoperative pain is significantly less. Plus, most people are back to work a lot earlier as well. So how does the robot fit in with all of these advances? For one thing, the robot is connected to the laparoscope and provides a 3-D picture for the surgeon as compared to 2-D on the traditional laparoscopy. Secondly the surgeon controls the robot “arms” and “hands” to move the equipment in the direction desired. With traditional laparoscopy the movements of the equipment in the body are the opposite of what the surgeon’s hands are doing outside the body. Thirdly, there is a certain amount of magnification which makes it easier to cauterize blood vessels to prevent excess bleeding. And finally, the robot makes suturing so much easier to perform in comparison to traditional laparoscopic suturing. For hysterectomies, this is known as the DaVinci Hysterectomy.
So overall there are a lot of benefits to the person having robotic surgery. Smaller incisions, faster recuperation, less pain medication after surgery so therefore less trouble with constipation from the pain medication, also there is less blood loss, and shorter hospital stays resulting in lower chance of getting an infection. However, with the good side there are also potentially some complications which are part of the fact that it is a laparoscopic procedure, and that includes a potential injury to the bowel, bladder, or to a major blood vessel. In addition, specifically for laparoscopic hysterectomy there are reports of the vagina not healing well after surgery and breaking down at a later date. This may require emergency surgery to fix. This does NOT happen very frequently. Hormone balance can be achieved naturally, and how you can find out if your hormones are out of balance. If hormones are in balance, it adds to the sense of well being and to a person’s health. To start with, there needs to be a basic discussion about the hormones that are produced by the ovary, adrenals and peripheral tissue and their basic function. Then we’ll review how the hormones get out of balance and then how to re-balance them. The basic building blocks for all the steroid hormones is cholesterol, and most hormones in the blood are bound by protein carriers—albumin and SHBG. Hormones are cleared out of the system by converting them to either weaker or inactive forms, or by conjugation to water- soluble forms that are then eliminated through the urine or the bile. The ovary produces estrogens, progesterone, and androgens. The process is moderately complex, and in reviewing biochemical processes cholesterol is converted to several steps to either progesterone or 17-hydroxy- pregnenolone. Progesterone is then converted to 17-hydroxyprogesterone and then to androstenedione. 17-hydroxyprenenolone requires an additional step, but can also be converted to androstenedione. Androstenedione is then converted either to testosterone or to estrone, and both of these can be made into estradiol. Estriol is not made by the ovary, but instead is made by peripheral metabolism of estrone (a weak estrogen), and estradiol (a potent estrogen). Estrone is also made by the fat cells. Progesterone is made predominantly by the ovary, (and a small amount from the adrenal gland) in the amount of 20 to 30 mg/day after ovulation (about 2-3 mg/day before ovulation). In the post-menopausal woman, estrogen levels will decline to about 1/3 of the follicular phase level. Progesterone levels will become practically non-detectable, and testosterone levels will decline to about ½ of follicular phase levels. So, what are the effects of these hormones and what symptoms may indicate that they are out of balance? Estrogen is what stimulates a girl to go through puberty, develop breasts, and the female curves around the hips. Estrogen also signals the ovary to develop a follicle which will be primed for ovulation, and it also causes build up or proliferation of the endometrial lining cells. During the menstrual cycle, the first half is estrogen dominant. Once ovulation occurs, then progesterone is made from the corpus luteum. On the average, about 20 mg of progesterone is made daily and its main effects are to thicken the endometrium, make it secretory and prepare it for implantation of a fertilized egg. It increases the amount of nutrients and oxygen that are present in the endometrial lining. It also increases libido. So during the second half of the cycle progesterone is dominant. Estrogens and progesterone are meant to balance each other, and work together for optimal health. Now, if fertilization and implantation do not occur, then after about 14 days, the corpus luteum regressed and progesterone levels fall, estrogen levels are low as well and the period then starts. Every month this process occurs over again. What are the symptoms of hormone imbalance? I’m sure you’ve heard people complaining of : - PMS,
- Mood swings,
- Hot flashes,
- Low sex drive,
- Acne,
- Bloating,
- Weight gain,
- Migraines,
- Fatigue,
- Insomnia,
- Breast tenderness,
- Infertility,
- Fluid retention, or
- Thinning hair.
Any three of these together can indicate that a person has too much estrogen compared to the amount of progesterone, and in the words of Dr. John Lee, “Estrogen Dominant”. Polycystic ovarian syndrome is an example of estrogen dominance. What causes the hormones to get “out of balance”? - Improper Diet,
- excess calories,
- liver dysfunction,
- too many sugars and refined starches,
- Environmental toxins,
- pesticides, insecticides, plastics,
- hormones fed to cows, chicken, pigs to speed up growth or milk production,
- mineral oil and petrochemicals,
- many skin care products,
- microwaving food in plastic containers,
- increased exposure to toxins, including chlorine bleach, cleaning solutions, fertilizers,
- air and water pollution,
- petroleum by-products that are in chemicals from building materials and carpeting,
- exposure to toxins as an embryo,
- Prescription exposure in hormonal forms of birth control, especially synthetic estrogens and progestins,
- conventional hormone replacement therapy, and
- antidepressants and other medications that affect liver function and P450 enzyme systems, so the liver does not metabolize the estrogen and levels increase,
Stress is another factor that can contribute to hormone imbalance. Daily living in the USA leads to physical and emotional stress. This constant “fight or flight” response releases too much adrenaline, which then leads in time to FATIGUE, so what do people do next? They resort to stimulants, such as (caffeine, sugar , alcohol, chocolate). And when the adrenal glands become exhausted, the body uses up progesterone to make more adrenal hormones. When the adrenal glands are fatigued, the whole body does not work as well, nutrients aren’t absorbed as well, and by using up the progesterone, this also leads to estrogen dominance. It is a known fact that infertility increases considerably starting @ age 35, and according to Dr. John Lee, studies show that by age 34, 50% of women in the USA have little or no progesterone. Women low in natural progesterone are @ a higher risk for developing breast cancer. There are many studies which confirm that excess estrogen increases cancer risk, not only uterine cancer, but also breast cancer (women that are overweight , and thus making more estrogen are at 10 X increased risk for uterine cancer than their normal weight friends). All people that are overweight have a higher risk for bowel cancer, so you wonder if there is some role that estrogen is playing there as well. Studies have shown that the effect of natural progesterone on the breast is to decrease proliferation of the cells. Potential benefits of using natural progesterone include: - natural diuretic effect,
- natural antidepressant effect,
- normalizes blood clotting cascade,
- increases bone density,
- clears estrogen receptors, and
- helps use fat for energy.
In large doses, it can contribute to drowsiness, and can slow the bowel down. (This is why pregnant women want to take naps and have trouble with constipation). The oral form of natural progesterone (Prometrium) has this effect of causing drowsiness and so needs to be taken before bedtime. For some women who are having sleep issues, this does help a lot. The oral doses start at 100 mgs up to an average of 400 mg. There is more trouble absorbing progesterone from the gastrointestinal tract and so larger doses are needed in order to obtain the same benefit as with topical forms. About 80% is intercepted by the liver and passed out of the body, unused. The vaginal form of progesterone (Crinone) is absorbed well from the vaginal mucosa; however, the suppository form in a waxy vehicle is not absorbed as well. Topical forms of natural progesterone are absorbed very nicely. In fact studies from Europe confirm that topical absorption is so much better for all hormones. Balancing Hormones Naturally: 1) Start with diet changes: decrease the amount of starch, sugar, alcohol, caffeine, and processed and refined foods. 25% of the average diet (in the USA) is sugar which leads to at least 25% less nutrients to help protect your health; 2) Increase the amount of clean water. Each person should drink the amount of water to equal at least ½ their body weight (in oz). 3) Increase the intake of whole grains, fruits and vegetables. Fruits and vegetables that are high in these following phytonutrients, and have been shown to help prevent heart disease and cancer and can help to balance hormones as well: - carotenoids (beta-carotene, lycopene, lutein, zeaxanthins) such as carrots, tomatoes, leafy dark green vegetables, kale, apricots, chlorella and watermelon);
- diallyl disulfides, (such as onions, garlic, leeks, and chives);
- flavonoids (such as in tea, citrus fruits);
- indoles (such as in broccoli, cauliflower, kale, cabbage, brussels sprouts);
- isoflavones (such as in soybeans, particularly tofu and soy milk;
- phenolics (particularly ellagic acid and ferulic acid), found in berries, citrus fruits, apples, whole grains, and nuts;
- polyphenols (found in green tea, grapes and red wine);
- saponins (found in beans and other legumes); and
- terpenes (particularly perillyl alcohol, limonene, and carnosol) which are found in cherries, citrus fruits, and rosemary. It is also important to include plenty of folate (at least 400 mcg) and B6 (2 mg).
4) Increase the amount of fiber—the recommended daily amount is 25-30 grams, the average person gets about 10 grams daily. Fiber is a cleanser and helps to rid the body of excess sugar, toxins, and circulating estrogens. It also helps with weight management. People tend to loose weight on high fiber diets, and studies have shown that diets low in fiber have a higher rate of breast and bowel cancer. 5.5 servings of vegetables a day reduce rectal cancer risk by 28%, 3.5 servings of fruit reduce risk by 27% , and adding 3 servings of whole grains reduces risk by 31%. 5) Add natural progesterone as it will help to restore natural hormone balance. The body will make the estrogen it needs from the progesterone. Many women have used natural progesterone to reduce the symptoms of PMS, (particularly when it is used on days 12- 26 of the cycle), and menopause (used daily) as a natural alternative to synthetic hormone replacement therapy. There is very good absorption through the skin (as with topical estradiol) of natural progesterone. Plus there has been a lot of press about bio-identical hormone replacement therapy, particularly since Oprah had physicians talk about it on her show. This is a topical form of hormone replacement therapy that involves a combination of estriol (80%), estradiol (10%), estrone (10%), natural progesterone, and testosterone, with or without DHEA. The pharmacist compounds this for the person. It can also be made into a troche which is dissolved under the tongue. Dosages are then adjusted up or down as needed. There are temporary and permanent methods available to men and women. Of the temporary methods there are hormonal and non-hormonal methods available. The non-hormonal methods include: condoms, diaphragms, sponges, withdrawal methods, cervical caps, non-hormonal IUDs, and rhythm methods. Hormonal methods that are reversible (temporary) include: birth control pills, plan B, birth control patches, the birth control ring, hormonal IUD, implants, and shots. Permanent methods include sterilization for men (vasectomy), and women, including laparoscopic sterilization and hysteroscopic sterilization. Of course, the permanent methods are more effective (for preventing pregnancy) than the temporary methods. The decision to proceed with a permanent method should only be made if a person is absolutely sure that no more children are desired. The biggest problem after a permanent procedure is regret that it was done. And attempts to reverse the procedure are never as effective in the long run as not ever having it done. So you’ll want to be sure that you are done, done, done. Of the temporary methods there is a variation in ease of use with the non-hormonal methods probably the easiest with the least amount of side effects. However, efficacy in preventing pregnancy ranges from about 40% for the withdrawal methods to 75-80% with the barrier methods (such as condoms, diaphragms and cervical caps), to around 98 % with the Copper T IUD. The hormonal methods range between 97 to 99% efficacious, of course depending upon consistent and reliable usage. a person’s body weight may have an effect on efficacy of certain hormonal methods such as the pill or the patch; and antibiotics may reduce the reliability of the pill. To listen to a program on contraceptive options please click on the following link: Dr. Rachel Yankama – VoiceAmerica: Contraceptive Options Food intolerances/sensitivities can be the source of a myriad of health issues ranging from gastrointestinal, to joint problems, sinus issues, and emotional problems, and lack of energy. Food intolerances usually develop after years of exposure to particular antigen. What happens is that the gastrointestinal tract allows partially digested food particles (proteins, carbohydrates, fats) to be absorbed into the blood stream and the body recognizes these substances as foreign, and starts to react to the foreign substances over time. Where the person experiences the problem varies from person to person . Some feel it in the sinuses, some get chronic headaches, some get abdominal pain and bloating, others may get joint pain and muscle aches. By identifying the food that is causing the problem, one can then start to feel better, although it does take a few months to clear these reactions from the system. Most will feel significantly better within about 3 months, which in the long run wiill reduce the cost of seeing the doctor regularly and will reduce the number of sick days taken off work, and also reduce grocery bills by eliminating the foods that cause problems. Plus there would be less need for medications to handle the symptoms that are now improved. For example, fewer medications for sinus problems, headaches, acid reflux, fibromyalgia, arthritis, asthma, etc would be needed. Dr. Rachel Yankama – VoiceAmerica: Interview with Mr. Zavik, CEO of ImmunoLabs Hi there, I hope that you will find this site helpful to your overall health. We’ll cover a wide variety of topics including: - Pregnancy
- Nutrition
- Exercise
- Cancer Prevention
- Food Intolerance
- Robotics in Surgery
- Eliminating Toxins
- and more!
If you apply the information that you gain from this site, this will enhance your life so that you feel the best that you can feel–energized, and healthy. I can’t stress the importance of prenatal care enough! Obtaining prenatal care is the single most factor to contribute to lowering the infant mortality rate. Healthy moms means healthy babies, and healthy babies means less stress on the parents and decreased health care costs. As an aid to your prenatal care you can read a very helpful guide for pregnant women: A Doctor’s Guide to Pregnancy, by Dr. Rachel Donaldson. You can get it at www.dimensions-of-wellness.com, or at www.amazon.com, www.barnesandnoble.com, or www.borders.com. Healthy living includes vitamins, (which ones are best, or do you only want mediocre, or are there some which are not helpful at all?) antioxidants, and eliminating smoking. Plus we’ll review factors that help to reduce miscarriage, and explain why prenatal care is so important.
| A Doctor’s Guide to Pregnancy!VoiceAmerica Program!I am hosting an hour program each week for 13 weeks beginning on January 6th, 2010 on VoiceAmerica.com. This will start at 3:00pm (PST), and 6:00 pm (EST). We’ll cover lots of topics and you’ll be sure to learn ways to improve your health and your life. Be sure to tune in… |
