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See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Every day in my office I hear horror stories about how my female patients are dismissed by the doctors they trusted to help them resolve their problems such as: · Hot Flashes and night sweats · Loss of libido · Rapid weight gain · Brain Fog · Insomnia · Arthritis associated with lack of hormones · Anxiety/Depression starting in their late 30s · New irritability · New Migraine headaches · Lack of motivation · Fatigue There doctors dismissed them, telling them they were just getting old, or they were “babies” because they can’t stand a few hot flashes, the doctor changed the subject, or my most unfavorite response to a plea for help, “It is just in your head”. Many other demeaning responses have been recorded, but I am appalled at these responses. For a patient it takes so much strength to ask these questions, and patients are literally at the doctor’s mercy. In case you didn’t get it, the doctor who says these things is covering up for his/her own ignorance. These are methods used by a person in charge who is challenged to answer a question he or she doesn’t have an answer for. In general, these doctors are men and women, however women have been trained by men and they taught women to do what they had been doing for years. These “medical” responses are used to belittle the patient to hide their own lack of knowledge. If you are dismissed in this way you should not put up with it. You can just never schedule with that doctor or practice again or you can find a new doctor who will hear your distress and treat you or tell you they don’t know how to help and refer you to someone who does. You shouldn’t put up with dismissive doctors. Another dismissive phrase used by many doctors since the inaccurate WHI study is you’re your doctor tells you that he doesn’t BELIEVE in hormone replacement. You should respond that hormone replacement is not a religion, it is a medically necessary treatment for menopause! Board certified OBGYNs and Family Doctors should be trained in this treatment. We women have not only been dismissed by doctors, but also by the Colleges (eg. American College of Obstetrics and Gynecology) that tell doctors how to practice. In my OBGYN training I was taught that most of women’s complaints were because they were depressed so they told us to put women on anti-depressants that just make them numb, but that did not treat our symptoms. Misogyny is alive and well in the practice of medicine, even in the group of doctors who are supposed to dedicate their lives to the health of women, Obstetricians/Gynecologists. Discrimination CAN be taught, and I believe medical training still teaches these male oriented beliefs to new doctors who are almost 50% women. Medical schools allow women to become doctors because we are qualified, and they can’t discriminate anymore. When I was trained and for a few decades after I became a doctor, you would think I was a second-class citizen. I was left out of resident training run by the residents (almost all men). Those older male doctors treated me like and. Interloper and some even told me I was not supposed to be a doctor because of my sex. …I was never treated as if I was an equal from the minute, I started medical training and women now practicing over the age of 50-something were all trail blazers and were told all women were hysterical and complainers. I never accepted this view but now know that women complain because we are not believed and not treated with a treatment that really relieves our symptoms. After my hysterectomy 2002 I was in private practice with like-minded women in Balanced Care for Women, and they tried to help me but admitted they didn’t have the knowledge. I had terrible symptoms that I now know was from lack of testosterone. The endocrinologists and primary doctors I sought help from belittled me and treated me like I was making the symptoms up!...

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog That is a strong statement, however I am confident in saying that belly fat can put you at risk for Alzheimer’s disease, because it is a fact supported by medical research. These studies reveal that obesity, especially abdominal obesity (Beer belly, Gut, “Dunlap’s disease”…..), increases the onset and rate of Alzheimer’s dementia! Another reason to change your lifestyle to benefit your longevity. Abdominal obesity can come from fat accumulation right underneath your skin (the fat you can pinch between 2 fingers) OR the fat that grows inside your abdomen like an apron draped over the intestines. It is called “visceral fat”, and this type of fat is what places you in the crosshairs for several diseases of aging including Alzheimer’s Disease, heart disease, stroke, diabetes, and rapid aging. A large belly is more common in men, but it is still a risk for women if they develop an apple shaped body. Below is a picture of visceral fat, and a diagram of what it looks like in an artist’s sketch of a normal weight person. When the yellow fat doubles and triples in thickness the abdomen pushes out to look like a “beer belly”. Visceral fat extends from your stomach over the transverse colon and your small intestines like an apron. This fat pad thickens with alcohol abuse (beer belly), high carbohydrate diet, overeating, junk food, under exercise and creates a large pad of fat that secretes inflammatory cells. The resulting inflammation is the vehicle that damages your brain leading to Alzheimer’s disease and damages your arteries leading to heart disease and stroke. In my office we use INBODY machines that measure your Visceral fat, BMI, and percent body fat. Normal visceral fat is below #10 on our machine, BMI less than or equal to 25, and fat % for men < 19% and for women < 26%. The Research: A recent study correlated the size of patient’s belly (visceral belly fat), and obesity with the amount of amyloid plaque (the cause of Alzheimer’s disease) in their brain. This was measured by MRI in the study subjects’ brains. The age of the patients studied was between 40-60. The study found that the amount of visceral fat (fat inside your abdomen) is directly correlated with the amount of amyloid plaque and inflammation in the brain! That causes Alzheimer’s Disease. If that doesn’t motivate you to lose your belly fat, then you are making a choice to eventually suffer from Alzheimer’s disease, a heart attack, a stroke or arthritis. If you are thinking that you will just wait for “something to happen”, then not making a decision to change your lifestyle is making a decision to take on illness in the future. We have new medications to help you lose that belly fat and they really work. You should ask your doctor to help you and if they don’t understand the importance of arriving at ideal weight then look for a different doctor who will help you. Even with medication you will have to put in the work and self-control to turn down unhealthy foods when others are being unhealthy. You will also have to add daily exercise to your schedule if you really want to avoid Alzheimer’s Disease, heart attack, stroke and early death. The possible meds and habits that can help you lose your “belly”: · Limit calories and or carbohydrates · Increase daily exercise · Diet pills (amphetamines that older patients usually can’t take) · Xenical (Orlistat)-Side effect is fatty diarrhea · Qsymia (topiramate/Phentermine) can increase BP · Contrave for craving (naltrexone/bupropion) can decrease sex-drive · Semelanotide (Imcivree-new), darkens the skin, expensive · Metformin ER an oral, effective medication to treat insulin resistance, and promote weight-loss · Victoza and Saxenda injections are diabetic treatments, that can cause GI reflux, however they work well for patients who have Type II Diabetes who need to lose weight. Even though many patients lost...

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog At Bio Balance Health I order blood tests to evaluate my future patients before I even have my first appointment with them. I use them to find a baseline for an individual patient, and to see if hormones will help them with their symptoms. Blood tests work well for establishing a diagnosis but are not the only factor in determining an ideal dose of hormone that works for that patient. Symptoms and medical history supply most of the information for determining dosage as well as help me find other medical problems to treat at the same visit. Many diseases in the early stages are not treated by primary care doctors because they are overwhelmed with their number of patients and the short-time they are allowed to see them. Our goal is to prevent disease that have been missed or treat conditions at an early stage before they become severe. Blood tests establish and confirm both hormone deficiencies and provide a baseline level before treatment and the optimal level for each individual patient. That blood level may or may not be within the range that is expected for a treatment success (written on the lab report). You are an individual and it is my job to find the ideal blood level of hormones for you. Why would the blood level not tell the whole story? Your body is genetically programed to both PRODUCE hormones from your endocrine glands and ACCEPT those same hormones in each cell. Every person is an individual and each person makes hormones based on their genetic map and environment. Everyone is programed genetically to accept hormones into their cells in an individual manner. This is the key to understanding the differences between patients’ responses to an equivalent dose of hormones, either excreted from their own glands or absorbed through their chosen delivery system (oral, vaginal, transdermal or subdermal pellets) after their glands have aged and don’t produce enough hormone, like estradiol and testosterone. I was in Cambridge in 2014 for the release of my first book, The Secret Female Hormone, when I visited a medical bookstore. I discovered a large red book that weighed no less than 10 lbs was titled Testosterone. I looked through this book and found that there was information that I had not discovered in my research of the American medical journals and books, so I bought it and read some of it on the long flight home to St. Louis, MO. I found that this book had answers to questions I had uncovered in my then,13 years of hormone medical practice. My biggest question at that time was why 2 people of the same sex having the equivalent blood level of free testosterone often feel completely different. For example, I was trained that if a man had a blood level of free testosterone that was above 129 pg/ml and under 350 pg/ml (using Quest Diagnostics lab), then he should feel normal, like he did when he was in his thirties (barring any other illnesses interfering). However, I observed that some men felt great at 110 pg/ml while others at 130 continued to have the symptoms of low T. This puzzled me, but at that time I had no answer. Then I read the first chapter of Testosterone. The answer is found in the individual differences in the receptors on each cell for that hormone, the receiving end of the hormone physiology. It informed me that receptor sites are genetically created differently in each individual and that one-size-does-not-fit-all! You can bathe a person’s cells with what is considered an adequate blood concentration of testosterone for most people, let’s say men since that was the subject of the first chapter, of the book Testsosterone, but some men would receive and use only a small portion of the circulating hormone. Their cells were “resistant”, therefore they required a higher concentration of hormone, to activate their cells. This very important fact in endocrinology has been ignored until recently when we...

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog When I tell my patients that they need a high protein diet, all they can think of is meat…but protein sources are found in many parts of our diet and eating a variety of protein sources is the key to health, we should find out what we should eat and why? Protein contains amino acids that are the major building blocks to make our muscles, skin, connective tissue, tendons, ligaments and bones. It also supplies the components of our skin, hair and nails, and carries with it calcium (the major component of bones and connective tissue). Protein is found in cheese, milk, all milk products, whey for protein shakes, pea protein, fish, all seafood, chicken, lamb, eggs, Quinoa and beans for building muscle. Pieces of proteins make up every fluid the body makes, including hormones, enzymes, peptide communicators, the immune globulins, semen, breast milk, and vaginal discharge….is it any wonder that I tell my patients to increase protein in their diets! Despite the need for amino acids and short chains of amino acids called peptides, we also need a variety of foods, all colors at every meal to provide the other building blocks of our body. For example, fat is a very necessary food for every person, at every meal. When I was pregnant, I wanted to feed my baby everything she needed to build a healthy beautiful brain, so I ate Braun Schweiger every day (made from liver) for lunch with a salad. The Braun Schweiger provided Rachel, my daughter, with the building blocks for an amazing brain. Our brains are almost all fat. That is the type of tissue that nerves are made of, but nerves also need B12 to work properly and B12 is primarily from animal products. It is relatively easy to include fat in our diets, but it is truly difficult to get enough protein to build muscle on a vegan diet. My vegan patients must be experts in obtaining protein from their diet and must be aware of the components in all the food they eat to get the proper nutrition. Carbohydrates are made for “action”. Carbohydrates are required for exercise, walking and brains also burn carbohydrates when you are doing “brain work”. Carbohydrates are stored as fat if we eat them but don’t exercise! Think before you eat carbohydrates about your next 12 hours and whether you are going to exercise to burn the carbohydrates in your diet. So How Much Protein Do We Need? Growing teenagers, people who lift weights and try to gain muscle, pregnant women (need a minimum of 100 grams a day) and patients like mine on testosterone need more protein in their diet than the average sedentary, adult. To quantitate the number of grams of protein you need to sustain your body with a high percentage of muscle, a person needs more than ½ their weight in grams of protein. For example, a 125 lb. woman with average to high muscle mass will need more than 62.5 grams of protein a day. A person with higher muscle mass will need more than that. For athletes, weight lifters, patients trying to lose weight and sustain their current muscle mass, they need to eat the equivalent number of grams of protein to their weight, every day. To do this a person will have to know how many grams are in each serving of their current foods and if they aren’t eating enough, they should add high protein, low carb protein shakes times before or after they work out or exercise. A typical protein shake will have 15 to 20 grams per serving and less than 5-10 grams of carbohydrate. An average size hamburger has about 20 grams of protein. Add beans, peas, cheese, yogurt, butter, ricotta cheese, milk, eggs, custard, chicken, fish fillets, shrimp, and protein bars. Be careful not to overeat carbohydrate with your protein which can cause you to gain fat, while you make muscle. Why do we need more protein on the days we work out, especially with weights? Weight training is a great muscle builder, in fact it is the best form of exercise...

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog There are almost as many different human metabolic variations as there are people in the world. Our genetics make us all unique in ways that vary the way we can lose weight or even gain weight. On the other hand, we all had to descend from humans who survived famine, lack of water and lack of nutrition sources, so in one way we are all the same…we have genes that helped us survive times that required of us the ability to maintain our weight even without eating! The people who genetically were unable to gain fat and keep it to hold them over during famine just didn’t make it to an age they could procreate. The rest of us whose ancestors survived, have given the majority of us the genes to maintain body fat. Unfortunately, we have been blindly unaware of what man’s evolution and progress has led us to physically, and most of us are over-fat, and have trouble losing it! The very genes that allowed us to survive the beginning of man’s existence, are the same ones that make it hard to become slender. In addition, in our current societies in the western world, food is plentiful and inexpensive. Our genes have not changed, but our environment has, and we are becoming sick because of our obesity…how do we survive this “new world”? You may hear a lot about insulin resistance, and I talk about it a lot on my Healthcasts, but it is insulin resistance that has allowed us to survive and has also led us to obesity today. The humans who were insulin resistant who also held on to their fat in times of starvation are also the humans who have become obese in the face of plenty. We can’t change our genes, but we can turn some of the obesity genes off through lifestyle and sometimes with the help of medication. Despite our basic sameness, we are also each individual, and genetically programed so that some of us lose weight if we restrict calories, others lose weight only if they exercise; Some of us don’t lose weight with exercise; some people don’t lose weight with carbohydrate restriction or fat restriction, and some do. This is the ugly truth that lies behind the millions of books on diet, none of which work for more than a small number of us, and because it is a diet we can’t maintain it...what we need is to determine is the best weight loss program for each of us, by using trial and error, or by using genetic testing that tells us what our best pathway to a normal weight looks like. To begin we must take baby steps and learn about food and what the words mean that we use when referring to food. Because there are many people who may have several hurdles to jump before they can live at their healthy weight, we need to all speak the same language of weight loss. So let’s start with a bit of education about food. WHAT IS A SIMPLE SUGAR? A simple sugar is a nutrient meant to give you energy for physical activity. Eating a small amount of a simple or a complex sugar before exercise is a good idea. However, if you sit most of your day, working with your brain instead of your body, simple sugars can increase your fat storage because you aren’t physically working. This is true whether restricting sugar is your genetic method of weight loss or not. Too many simple sugars make you hungry and cause everyone to overeat.….causing weight gain and fat gain. So what are simple sugars? Examples of simple sugars: · Sugar, white, cane and brown · Molasses · Regular Soda · Agave · Honey · Syrup-maple or any · Rice, white and brown · Cereals-all · Oatmeal · Donuts · White potatoes · Bread · Pancakes/waffles · Noodles · All Grains: wheat, oats, rice, corn and anything made from them including flour · Sweet tea · All Cakes, brownies, candy, chips, and many energy bars · All bagged snacks like pretzels, chips, cookies, and fruit with sugar added · Pies and most desserts, except fresh or frozen fruit. · Dried Fruit (has...

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog This subject is for men who have had a high PSA and who have been advised that they need a prostate biopsy to determine if they have cancer. Many men go into the doctor for the biopsy necessary for diagnosis without expecting the “blind biopsy” procedure that is done through the rectum and is extremely painful when the doctor blindly takes pieces of the prostate…over and over again. Blindly, means he is randomly picking a place to biopsy without a real target….with the urologist biopsying everywhere in the prostate 10 or more times. Finding a small cancer with this random or “blind” biopsy method is a less than effective way to find a small area of prostate cancer. Men who have had this procedure done rarely agree to a second round, under any circumstances and I agree with them. I always do a PSA test before I treat a man with testosterone so I often am faced with the question of what advice I should give him in this situation before I feel it is safe to give him testosterone. Of course, if he has prostate cancer, even a high PSA, I will not give a man testosterone until his urologist says he is safe to receive it. Until recently there was no radiologic way to screen a for prostate cancer. Now urologists use Ultrasound or MRIs to find an abnormality in the prostate that they can biopsy. This makes the procedure both more accurate and less painful. The way this procedure was done in the past, and is still done throughout the US, always caused me to wonder why urologists hadn’t figured out a way to do it in a way that accurately biopsied a high risk area of the prostate, with one or two biopsies. Now Urologists use rectal ultrasound or MRI, like Gynecologists use vaginal ultrasounds to find and drain or biopsy ovarian masses, or to harvest eggs in IVF. The urologists have even borrowed the idea to use numbing medicine as well to make it comfortable. In the last 2 years I have found a few Urologists who have embraced the new, accurate biopsy procedure that used the MRI to find high risk areas and ultrasound to locate suspicious areas for biopsy, then used the same radiologic method to locate and treat discrete focal areas of abnormality with cryotherapy (freezing) or focused ultrasound. Finally in August of 2023, a research article titled, “Focal Therapy for Localized Prostate Cancer in Older Men”, was published in the Journal of Urology. This article describes a much more accurate method of treating prostate cancer that resulted in the diagnosis and treatment of low grade prostate cancer without recurrence and without complications, allowing men to have a conservative treatment for low grade prostate cancer, following a less painful and invasive diagnostic procedure. Compassion has finally come to diagnosis and treatment of prostate cancer. We applaud the authors. August 22, 2023 Focal Therapy for Localized Prostate Cancer in Older Men Allan S. Brett, MD, reviewing Habashy D et al. J Urol 2023 Jul Lomas DJ and Frendl DM. J Urol 2023 Jul In an observational study, focal therapy was compared with radical treatment. At some centers, focal ablative therapy (generally with high-intensity focused ultrasound or cryotherapy) is a treatment option for selected patients with localized prostate cancer. This option could be attractive for some older patients with comorbidities who might be candidates for radical prostatectomy or radiotherapy (according to tumor grade) but who wish to avoid complications from radical intervention. Using data from national registries, U.K. researchers compared 262 patients (age, ≥70; median age, 74) who underwent focal ablative therapy with 262 propensity-score–matched patients who underwent radical treatment (mostly radiotherapy with androgen-deprivation therapy). At baseline, nearly all patients had intermediate- or high-risk disease. Estimated 5-year failure-free survival (the composite primary outcome, which...

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Are you menopausal and have any of the following symptoms? · Hot Flashes · Night Sweats · Dry Vagina · Painful intercourse · Dry skin · Lack of sex drive · Lack of motivation · Fatigue · Depression and or anxiety · Change in body composition, with fat collection in the abdomen · Loss of Muscle Mass and strength · Irritability · Inability to remember names and places · Decreased ability to problem solve · Insomnia · Arthritis · Body pain These are all symptoms we currently are aware of associated with menopause and low testosterone. These symptoms can be treated and reversed with bioidentical estradiol and testosterone pellets. Menopause should be treated like an illness that is universal but more severe in some women compared with others. If your symptoms affect your lifestyle, relationships and work then you should see a doctor who treats hormone deficiency and accept treatment! However, if you allow yourself to be manipulated by a male-dominated medical system that teaches all doctors to believe that menopause is normal as women age and don’t seek out hormone replacement, then you just may be setting yourself up for years of symptoms that are treated with handfuls of medications, but never get you back to normal. Just think about this for a minute: Men develop erectile dysfunction and experience muscle loss as they age, but medicine doesn’t consider ED or Sarcopenia a natural aging process for men, they advocate and endorse treatment with testosterone, ED medications, injections for ED and therapy for ED, and in most cases pay for it! If the male mentality would include women we would all be treated with estrogen and testosterone when we got to age 50 (or menopause). It is not just about the symptoms that E-T replacement can cure, but the diseases that you can avoid by taking estrogen and testosterone after menopause. These avoidable diseases of aging include: · Osteoporosis leading to broken bones and spinal stenosis. · Heart disease and stroke · Diabetes · Alzheimer’s Dx and dementia · Obesity · Low muscle mass and inability to walk or move independently. · Autoimmune diseases · Loss of blood flow to Lower extremity, resulting in amputations and inhibiting walking and running · Severe arthritis · Gout · Worsening depression and anxiety · Frailty which is what causes most older people to be placed in a nursing home. Just think it is not fate that gives you these conditions. It is genetics plus lifestyle plus whether you replace your sex hormones or not! This decision is in your control. If you really want a life free of debilitating disease and symptoms that are require constant medical care, then you must buck the system (that was designed to keep us from maintaining our mind and body) and look for a doctor to replace your testosterone and estradiol in a non-oral delivery system and maintain it for life. By stopping ERT or Testosterone like the ACOG doctors tell you to, you will start the symptoms all over again. My job is to offer you the right type of help to reverse the effects of menopause…both symptoms and diseases. Your job is to decide whether you want to get help and become healthy by taking nonoral estrogen and testosterone for the rest of your life. Think of menopause as a disease and you will be more prepared to fight for your right to be treated by the medical system.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Even though all women eventually stop having periods and stop making estrogen, testosterone, and progesterone we all have symptoms of menopause, even if you don’t recognize them as symptoms relating to loss of estrogen, testosterone, and progesterone after menopause. However, every woman experiences menopause differently. Some of us are devastated in every way by the multitude of symptoms that loss of our sex-hormones can create, on the other hand some women merely endure painful intercourse, hot flashes, headaches, and fatigue…or are told by their doctors that their symptoms are “getting older” and they have to live with it! Aren’t your symptoms enough for you to demand treatment? What I See: Every day in the office and even in my private life I run into women who complain about their symptoms of hormone loss. When I offer a solution for their symptoms of menopause and low T, I am often shot down by my patient’s “fear” of hormones. For example, I was at a 70 birthday party recently and a flood of women came up to me and told me how young and heathy I looked. When they asked me what I do to achieve that, and I explain that I have taken hormone pellets with T and E2 since I was 47 and they can get the same results, they immediately say, “I’m not doing that! I don’t want breast cancer! Or “that will cause heart disease or gain weight! “. The media and their doctors who are not up to date in their reading of research have frightened them away from treatment for their symptoms! The doctors should read more and not depend on 40-year-old information (med school and residency). They just told me I was doing something right, but then the fear that society has instilled in them shuts the door on a chance to be healthy, mobile and at ideal weight forever. The opposition to us is strong and this is really brainwashing women away from taking care of themselves! The recent (last 10-15 years) research has revealed that medicine has been wrong about much of the advice that we give patients based on flawed research and the need for the media to scare women into dangerous action (not taking hormones). These groups are literally making women suffer, take too many medications, and literally to be ill during the second half of their lives! The power of the press causes women to comply. Here are the “facts” doctors were taught over the last 4 decades: that are lies! Genetics hold your future. Diet—Exercise“Hormones”Testosterone is a MALE hormone Do you see that we are manipulated into following false truths because our doctors are too busy to keep up and fear sells newspapers, magazines, and other news agencies. This is how we are discouraged from treatment by our gynecologists, our friends and society. Women are continually barraged with misleading information that makes us think that menopause is no big deal and we just have to live with it and get old gracefully, like our mothers did! However, our mothers did get estrogen and other treatments for menopause! Medicine has been completely revamped in the last 50 years, so we should be healthier, happier and have a better quality of life, yet we are prevented from achieving that through instilling fear in women. While we are dissuaded from treating the symptoms of menopause that take away our productivity and quality of life, we are put in an untenable position. We are discriminated against because we are menopausal. The most recent example of this mission to cripple women’s success was on national TV when Former Governor Nikki Hayley, the 52 yr. old female Senator who is running for president, was described as inadequate because she was “past her Prime”, by a male politician who is in a party that touts the ability of an 81 year old man in that position to act as president of the US. This is one example of millions of examples as to how we are denied treatment to give us powerful and productive lives while we...

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Often in medicine, doctors discover a new use for an old treatment or a treatment that is approved for one use and serendipitously doctors find a new use for a drug or medical device. I have used a specific type of IUD in menopausal women on estradiol to prevent postmenopausal bleeding. The Mirena or Kyla IUD produces progesterone into the uterus to suppress the effects of estrogen on the endometrium, preventing post-menopausal bleeding and growth of fibroids. In the May 2023 Journal of OBG Management the experts have discovered that these special IUDs can be used for more than just birth control. They don’t contain any estrogen, but they deliver the progesterone (progestin) where it is needed to the lining of the uterus for 8 years! The cost of one IUD/8 years vs that of daily progesterone reveals a great cost savings by using a Mirena or Lyetta or Kyla (for uteruses that have not been pregnant) and a time savings for patients who are having difficulty with post-menopausal bleeding while on estradiol pellets, or any form of estrogen after menopause. The way these IUDs work is that the soft plastic material of the IUD has a packet of progestin attached to it that slowly dissolves over 8 years. In general, I don’t advise the use of Progestins orally as it increases risk of breast cancer and heart disease ONLY when it is taken orally. The small dose that circulates locally in the uterus is only beneficial and is not circulated throughout the bloodstream. The Mirena (I will use “Mirena” to represent all IUDs of the same genre because it was the first one FDA approved) is placed in the uterus in the GYN office, and a short string is left to stick out of the cervix to be palpable by the patient or the doctor to show that the IUD has not exited the uterus (which is rare in women not having periods, menopause). Generally the patient is given a week of progesterone to cause her to evacuate the remaining lining of the uterus before the IUD is placed. This will decrease the spotting and bleeding after the procedure. If it is a difficult insertion of the IUD, the GYN will often do a post insertion Ultrasound of the uterus to make sure the IUD is in place. There are a few menopausal women who cannot have an IUD after menopause. Those patients who have had an ablation of the lining of the uterus usually has scarring of the uterine lining so that an IUD would not be inserted easily or at all. A patient with a uterine septum is not a cancidate for an IUD. Patients who have had a perforation of the uterus in the past are not a candidate for this treatment either. Patients with fibroids on the inside of the uterine cavity are not a candidate either, because the IUD may rub against the fibroid and cause it to bleed. However if you have a uterus and are on estradiol or oral estrogen and take progesterone or progestin with it to protect your uterus, and have trouble remembering the progestin or progesterone dose every night or you continue to bleed even on progesterone/progestin, then a Mirena would be a good solution for you! There is a novel treatment for those women who we have been unable to give estrogen to because of uterine bleeding, and the Mirena IUD or one of its sisters is the answer!

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog My medical practice at BioBalance® Health brings me many interesting issues that my patients have had to struggle with, before they finally come to me for T Pellets. The latest complaint that men bring to me on their first visit is their reticence to try T pellets because they already tried T cream, or T gel or T patches and they did not get the results that they expected and needed, so they believe T Pellets won’t help them either. Another problem the other forms of T can pose for men is that they try non-pellet forms of T and tell me that they felt a little bit better and they tell me that is all they thought they would get from any form of T replacement….they settle for feeling slightly better instead of feeling Completely Well! Compared to FDA approved Testosterone Creams, Gels, and Patches, Testosterone Pellets at BioBalance Health are superior in every way! When deciding on a treatment or even when buying an important item for your home you should do your homework! I am going to tell you today why men should switch to long-acting Bio-identical testosterone pellets instead of the other forms. Deciding between various forms of Testosterone #1 Effectiveness of each form of Testosterone When making a decision about which treatment to employ, you should look at whether the treatment will completely treat my symptoms, or just some of them/ and what are the side effects (what is the downside)? Below is a comparison from my book for men, “Got Testosterone?” that compares T pellets to other forms. Note that Creams/Gels/patches are all “Transdermal”, or delivered through the skin: The reasons for why the quality of the treatment is different for trans-dermals and pellets is because the up to 80% of testosterone converts into estrogen as it is absorbed by the skin. Men don’t need or tolerate estrogens like women do, in fact estrogen binds up testosterone so it can’t be used by the body. So, gels, creams and patches give a man a small amount of T, but soon it inactivates the testosterone, and doctors think the dose is too low, so they raise the dose. The same thing happens over again and finally both doctor and patient give up and generalize the treatment failure and assume the man cannot take Testosterone (in any form). Pellet testosterone dissolves under the skin in a layer of fat and goes directly into the bloodstream where it goes to work and attached to Testosterone receptor sights. A small amount is converted into estrogen, but it is not enough to inactivate the testosterone from the pellet, so the effectiveness of Pellet Testosterone is quite different from transdermal forms of testosterone, and is greatly superior. #2 Side Effects/Risks The flipside of whether a medical treatment of any kind is right for you, is the risks of the treatment and the likelihood of side effects. Knowing the effectiveness of a treatment and the risks, helps you decide whether it will work for you. Knowing these two most important factors help a patient make a decision on which treatment he wants to try. There are risks that may not apply to you, however you should look to the side effects or risks that apply to you, to make your decision. In the table the highest risk is noted with three Xs, and the lowest risk is one X. The side effects of T in Pellets are much lower than other forms of Testosterone. You must review whether these are risks for you individually or not. For example, if you are still of childbearing age or you still want more children than the lowest risk of infertility is offered by T Pellets, however there is still a risk. For those men who don’t have hemochromatosis then this risk is not a risk at all. This really means that risks must be individualized for each man just like dosage. #3 Ease of Complying with Dosage and #4 Cost Whether you can actually continue treatment for a long period of time is pivotal to determine...

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Your Consultations with Dr. Sullivan or Dr. Maupin last one hour! No other medical practices schedule an hour for consultations with each patient. You will see a doctor and have time to discuss your issues!!! Drs Maupin and Sullivan spend hours preparing for your first appointment. They know what medical problems you have, your medications and allergies, and based on your medial history they determine your treatment plan. This plan includes your pellet dose, treatment of other conditions or diseases that are out of control, a diet and eating plan, exercise advice, individualized supplement advice, and prescriptions for medications. Your health will benefit from the expert advice given by Dr. Sullivan and Dr Maupin and their team of Nurse Practitioners and Registered Nurses. BioBalance® Testosterone Pellets are the most effective, lowest risk Testosterone Replacement: We exclusively use Testosterone and Estradiol Pellets made from Non-Micronized Bio-identical Testosterone powder, from two compounding pharmacies who have been our providers for two decades. BioBalance® Health has the most experience in providing Testosterone and Estradiol Pellets in the Midwest We have been practicing anti-aging medicine and treating patients with bioidentical testosterone pellets longer than any other practice in the Midwest, over 20 years! BioBalance® Health doctors and NPs provide such a unique and successful level of care that patients fly from all over the world to see them. We are innovators and we have learned how to trouble shoot side effects and treat them before they happen. We have such a unique treatment method that we have doctors who request training with us, and patients who spread the word of our success to their doctors and their friends. BioBalance® Health Has the Highest Success Rate of any other provider of T and E2 pellets. We not only offer quality and service to the practice of Anti-Aging Medicine/ Functional Medicine, we also have the highest success rate of any other BI hormone practice anywhere. We encounter the fewest side effects and complaints of any other hormone practice, and we are 95% effective at resolving the symptoms of hormone deficiency. We Treat Much More than Just Your Sex Hormone Deficiency! When replacing hormones and treating the symptoms of hormone deficiency is not enough, we treat our patients for other hormone deficiencies and diseases of aging: hypothyroidism, and Pre-diseases like pre-diabetes, obesity, fatty liver disease, and nutritional deficiencies. Our doctors and NPs often diagnose illnesses that your primary hasn’t found yet! We apply cutting edge medical and nutritional treatments to keep you healthy as you age. Our goal for you is much more than giving you testosterone, it is lasting health. We combat the sickness and symptoms of aging with a foundation of bioidentical hormones (testosterone and estradiol pellets) plus nutrition, weight loss, exercise advice, esthetic procedures and genetic evaluations to determine your health risks and to diagnose cancer early. We add new novel and effective ways to help our patients live healthier, longer, and more productive lives like the Gallery test for 99 types of cancer that finds cancer before traditional tests can (this test is for those patients who chose to have it and it is an additional fee). You are Not Just a Number! We are not a practice built on volume. We learn your history and know who you are when you see us. We make sure we keep your health history in mind when we make decisions for your treatment! Our staff is family to the doctors and to each other. When you enter our office, you will feel special and cared for! Our results are remarkable! BioBalance Health receives most of our referrals from existing patients and doctors. Our Patients tell us that they have never had such a complete evaluation of their symptoms and that no other...

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog BioBalance® Health uses other forms of measurement to determine body composition, and to diagnose healthy weight, versus overweight and obesity. BMI is a calculation of healthy weight, overweight, and obesity using just two parameters: Height and Weight. The US government endorses and uses this measurement in many ways to manage citizens, categorize them and even pay their salaries. The AMA has been using this as a measurement of body health for decades. As of July 2023, the AMA is rejecting this measurement of health and illness. Calculate your BMI Go to https://www.calculator.net/bmi-calculator.html and you can calculate your own BMI. Below is a chart that many types of companies and people use as a reliable measurement to use for many purposes. Below is the NIH explanation of BMI. You can find your BMI and corollate it with how lean your body is. The Body Mass Index (BMI) Calculator can be used to calculate BMI value and corresponding weight status while taking age into consideration. Use the “Metric Units” tab for the International System of Units or the “Other Units” tab to convert units into either US or metric units. Note that the calculator also computes the Ponderal Index in addition to BMI, both of which are discussed below in detail. BMI introduction BMI is a measurement of a person’s leanness or corpulence based on their height and weight and is intended to quantify tissue mass. It is widely used as a general indicator of whether a person has a healthy body weight for their height. Specifically, the value obtained from the calculation of BMI is used to categorize whether a person is underweight, normal weight, overweight, or obese depending on what range the value falls between. These ranges of BMI vary based on factors such as region and age and are sometimes further divided into subcategories such as severely underweight or very severely obese. Being overweight or underweight can have significant health effects, so while BMI is an imperfect measure of healthy body weight, it is a useful indicator of whether any additional testing or action is required. Refer to the table below to see the different categories based on BMI that are used by the calculator. Nurses have understood the fallacy of using BMI to judge whether a patient is overweight or not for decades, but the AMA and medical specialty societies have defended its use for as long as I have been in medical practice. However, BMI is a crude way to evaluate patients for obesity and we use a more accurate measure, a true body composition from an InBody® machine to determine exactly how much fat, muscle, and water our patients are made of and if they need to lose fat for their health. This true measurement of body composition gives us an accurate measurement of your percent body fat, weight of your muscle and your visceral fat (belly fat) measurement. You may say, “so what?”, but I’ll give you a few examples of how BMI is an INACCURATE measurement to follow for healthcare and for insurance, and other agencies that require employees to be a certain weight for their height. In my practice I take care of two men whose height is exactly the same, 5-10 (70 inches), both weigh 200 lbs., and they both have a BMI of 28.69 which is considered overweight (normal is < 25). However, the two men are very different in their body compositions and therefore their health risks: Man number one has very little muscle and 30% body fat and is overweight and therefore is at risk for diseases that accompany obesity, high blood pressure, diabetes and heart disease. Man number two has a very muscular build with heavy bones and has a body fat of 19% and looks lean and is healthy and is not at risk for hypertension, heart disease and diabetes. The BMI makes them the same, and therefore their doctors and employers consider them the same for insurance, treatment of their illnesses and categorization in...

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Every physician and every overweight patient have struggled with achieving effective weight loss that was effective for most people, until now! Almost simultaneously 6 weight loss drugs hit the market approved by the FDA for different uses. The only drug approved for just weight loss is called Wegovy, a once-a-week injection that causes loss of appetite as well as a feeling of fullness when only a fraction of volume of an American meal is eaten. It also works by limiting the hormone glucagon that dumps stored blood sugar into the blood when blood sugar levels get low, and it decreases the craving that many overweight patients complain of. The majority of overweight people have been eating a high carbohydrate diet filled with sugared soda, bread, pasta, cereals, candy, cake, cookies, chips, crackers etc. This is the average American diet, and it is killing us! Years of eating this diet has made us fat and insulin resistant, as well as malnourished. Humans need food for fuel, and we have made it into entertainment! We need a varied diet of proteins, fats, and carbs. Our genetics dictates how much of each group we need; however, the one size fits all mentality of the FDA and the US government has led citizens to believe that cereal and bread is the basis for diet because America grows grain and sells it to our citizens…it is a diet based on GNP not our metabolism. Simply said this has left most children and adults obese and fatigued because they are not getting the right nutrition from their food intake. Now we have to work backward, and the insurers of this country will not pay for the drugs we need to reverse the process. The drugs above are all variations of the generic name Semaglutide. The only drug that is different is Mounjaro or Tirzepide. It is more effective for treatment of diabetes and obesity, however Ozempic and the only oral version, Rybelsus, are also effective for both Diabetes and weight loss. We generally prescribe Wegovy for weight loss without diabetes, and we can try to get it approved by insurance for weight loss. However, this is generally not approved. The requirements for insurance to pay for these drugs for weight loss includes: Even with these requirements fulfilled they usually don’t pay for it! The price is $ 1,500 for one month! Three months is around $4,500. This is prohibitive for everyone. To solve this access problem, Dr Sullivan has contacted several compounding pharmacies who will make the drug for weekly self-injection at a much lower price! The price is $540 for 3 months compared to $4,500. We have been recommending this avenue when we cannot get the drug paid for. The only difference is that patients must draw up the small amount of semaglutide in an insulin syringe and inject themselves with a needle instead of a “pen”. This is the way we have been accessing this medication for our patients and we have seen unbelievable results! People who could never lose weight are losing and very obese patients who did not have the staying power to continue dieting to get appreciable weight loss are now approaching ideal weight. The only people who cannot take this medication are those with a history of a specific type of thyroid cancer or a disease of the endocrine system called MEN II. You know it if you have one of these rare problems. Others love to eat so much that limiting their intake is a problem for them. Special Cases: Those people who genetically are “never full”, or “always hungry”, this is the drug for them to make them feel full for the first time in their life….. Obesity from never feeling full or always hungry is genetic. Dr. Maupin: “I never understood those kids and adults who had to eat 24-seven or who could eat 2-3 plates of dinner. .I just had never walked in their shoes until I was pregnant…At that time in my life being 118 lbs and 5-3 when I got pregnant I never could catch up by eating...

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog Most women believe that the only reason to start taking estradiol when menopause begins is to decrease hot flashes and night sweats. But Estradiol replacement is so much more effective and versatile than just stopping hot flashes! When it comes to the replacement of testosterone for women, most still believe that T is just for men! If a woman has been reading for the last ten years, she may have picked up the fact that T brings back a sex drive and energy to women over 40, but most of the important benefits of Estradiol and Testosterone replacement are hidden from the majority of women. Journalists just aren’t interested in us after we are no longer young and fertile, unless of course we are involved with a scandal! The importance of replacing the hormones that are deficient after age 40, and the unpublished benefits that you can receive with E2, and T are the subject of this Blog. After the age of 40, after our childbearing years, we experience a multitude of symptoms and changes that when asked, OBGYN doctors shrug their shoulders and tell their patients that these terrible, quality of life “downers” are “just aging” and therefore the don’t address them and won’t treat them! It seems medicine discriminates against women in mid-life by ignoring their pleas for help dealing with many symptoms of aging. These common problems are listed below, and I will address each of them in regard to hormonal solutions for these problems. By the way, the replacement of the hormones estradiol and testosterone will treat all of these problems! Stress urinary incontinenceIrritable BladderRecurrent Bladder infectionsInterstitial CystitisVulvodyniaAnemiaPainful intercourse from a dry vulva and vaginaOsteo-ArthritisHormonal Migraines — As you can see many of the complaints that perimenopausal bring to their doctors can be treated with a single hormone complication! Instead, they are told that these terrible symptoms are just a normal part of aging and that they should just “suck it up”! I believe that if the American College of OBGYN and the FDA would listen to women over 40 more, and “bless” the use of hormone replacement therapy in all forms, but especially Testosterone and Estradiol Pellets we would create a generation of women who were still productive, happy and without multiple doctors’ visits! How can the powers that are making the rules be so discriminatory against women! We are more than half of the public….we need help in this area of medicine.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog A month or so ago I had a woman come to me for hormone replacement and one of the symptoms that bothered her the most was Lichen sclerosis on her vulva, the area around her vagina. The symptoms are itching, burning, intolerance to putting creams and gels on the area, pain on intercourse, and the skin is fragile and breaks open and bleeds with intercourse. My patient did not come to me to treat this problem, because she had been told by many other doctors that it was not going to get better. Lichen sclerosis (LS) is an autoimmune disease that affects the vulva and vagina. I know from reading the research and my 20 years of experience that our treatment with T pellets has decreased the symptoms and sometimes reversed many different autoimmune diseases, however I had not had a patient with lichen sclerosis before so I told her that I was hopeful that her lichen sclerosis would resolve with Testosterone and estradiol pellets. After 3.5 months when she returned to the office she was grinning and said that she no longer had the LS…her gynecologist said it was a coincidence, because she had not been trained with the use of testosterone for treatment of post-menopausal symptoms, and autoimmune disease. I had another surprise when I treated a patient who had become agoraphobic when her doctor had told her she couldn’t have any more post-menopausal hormones, even though she had had her ovaries removed 10 years before and before her hormones she had multiple severe symptoms of estradiol and testosterone deficiency. The ERT had resolved her problems but now they all came back more severely…she became depressed and anxious and afraid of leaving her house. Her son is an Internal Medicine doctor and he called to ask for my help with his mother. He had tried everything he knew of medically and nothing worked. Agoraphobia is thought to be a psychiatric condition, but in this patient’s case it was merely a chemical reaction caused by a lack of estradiol and testosterone. After 4 months of E+T pellets she was planning a trip to New Zealand and her agoraphobia was just a memory! I had no idea that that condition could be due to menopause and lack of E2 and T. In the end it was clear that hormonal deprivation can cause agoraphobia and replacement can treat it! I have prescribed T and E2 pellets to treat a different group of diseases, autoimmune diseases, like Lupus, Rheumatoid arthritis, Sarcoidosis, and Grave’s disease of the thyroid. The testosterone pellets are very effective at modulating the immune system and normalizing it, which decreases the severity and symptoms of these diseases. Even though I know that every person with an autoimmune disease that I have treated with T pellets, has gotten much better the specialists who take care of them won’t admit that it was testosterone pellets that improved their patient’s quality of life. There is plenty of research on the use of testosterone for autoimmune diseases, but it is not in the journals that Rheumatologists read. The research is in the Journal of Metabolism and Endocrinology. Worse yet, These doctors have learned that “hormones” worsen autoimmune diseases, however the information they are quoting really only refers to oral estrogen replacement and not non-oral testosterone. This scares their patients from even seeking help for their hormone symptoms, and prevents them from improving their autoimmune diseases with a safer treatment, T and E pellets. Here are some examples of my patients who have had autoimmune (AI) diseases and have come to me for E and T pellet replacement. Women with autoimmune diseases improve drastically with testosterone pellets! Not only do their symptoms of low testosterone and menopause resolve, but their symptoms of their autoimmune diseases improve! The old belief that hormones make AI diseases worse springs from the fact that oral estrogen (Premarin) that turns into...

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog There was once a Saturday night live skit that featured one of their actors, Eddie Murphy, teaching how to spell and say Py-ro-man-ia..and every time I see the word sarcopenia, I think of that skit…mostly because it is a word only researchers and doctors use to describe a condition where a person has lost a lot of skeletal muscle, leaving her or him without enough muscle to move around normally. Sarcopenia is considered a side effect of aging….but it is really a condition of low testosterone level in the blood, that occurs with aging and results in disability. For people over 70, this is what happens, you lose your muscles if you don’t take testosterone replacement, and don’t exercise and eat enough protein. At any age your muscle is stimulated to grow by your resistance training, daily exercise, and it must be supplied with the building blocks of muscle which is protein from animal products in your diet. However, you can exercise daily and eat the right amount of animal protein and you will still become sarcopenic if you don’t replace your testosterone to a level that is clinically needed as you age. Muscle is only made in people who have enough testosterone. I am hoping that the next generation of women and men who are 70-year-old now will not be bent over, using walkers, and wheelchairs, and unable to get out of a chair as they age. With long-acting testosterone pellets, in combination with daily exercise, active daily life and sufficient animal protein to make muscle I am working toward a world where humans aren’t put on the shelf because they can’t physically take care of themselves. But muscle mass does more for you as you age than just get you from here to there without assistance. Your muscle mass also is the primary organ in your body that burns 80% of your calories and turns them into energy. The muscle cell itself is like a generator. It takes in blood sugar and burns it to make energy for your cell. The trick here is to maintain enough muscle mass to make enough energy and burn your calories! This takes the three elements above: 1) Young healthy free testosterone blood levels, 2) a diet including a large amount of the proteins needed by your body to make muscle which are found in animal proteins, and 3) exercise! Every day, many times a day you must be active to keep your body healthy and muscled. What happens when free testosterone does not stimulate your muscles to make more muscle? Here is how it works when you are young and have sufficient testosterone and when you replace your deficient testosterone. Every time you move or exercise you use your muscles. Your muscles make heat and energy for you and for your cells. Testosterone sends blood flow to your muscles to stimulate your muscle cells to take in blood sugar and make energy and heat. Testosterone does something more; it directs the muscles to regenerate after they are broken down the 24 hours after exercise and are discarded. The day after exercise, your use your dietary protein to rebuild your muscles. Without the stimulation of Testosterone to rebuild your muscle mass, your muscles break down as usual, but are not built up again! This leads to a never-ending loss of muscle, leading you to lose muscle mass, bone mass, and your best burner of calories! The endpoint is a person who is 75, looks frail, can’t walk fast, who has poor balance and falls and breaks bones. Older people who don’t take testosterone also replace their muscle mass with fat, so their weight may go down (loss of muscle with fat replacement causes the waistline measurement to go up and clothing size to go up, but weight may in fact go down from the lack of testosterone stimulating muscle growth. All of this is well known to doctors yet it is hard to explain in a 15-minute office visit. Now let’s talk about what is new to our knowledge of muscle tissue and the diseases of...

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog. At BioBalance Health we use the information from a vaginal probe ultrasound, combined with information from your medical history questionnaire, and an extensive fasting blood panel to determine whether an individual woman is a candidate for estradiol and testosterone bioidentical pellets. We also review the collated information to determine if we need more tests before we see a new patient. The ultrasound of the pelvis gives us a visual picture of the ovaries and uterus of a woman. It is necessary to know if a patient is menopausal yet to interpret a new patient’s ultrasound. We obtain that information from your blood lab and medical history from the patient questionnaire. All three pieces of information are essential to our treatment plan. What can we discover from the vaginal ultrasound? We are ruling out (making sure a woman doesn’t have these pelvic problems): Several of these conditions preclude the use of estradiol in any form, some require a visit to your gynecologist for treatment before we add estradiol to your hormones and some of these conditions increase the risk of side effects. 1. Endometrial Cancer 2. Endometrial hyperplasia 3. Endometrial polyps 4. Fibroids 5. Ovarian cancer 6. Ovarian cysts 7. PCO **We use the vaginal ultrasound to determine the risk of bleeding on HRT. ***For the first 3 uterine pathologies listed above we look at the measurement of the Endometrial Thickness (ET), or finding an endometrial polyp necessitates a visit to her GYN for evaluation, and most probably an endometrial biopsy or D&C. This pathologic test will rule in or out Endometrial cancer, endometrial hyperplasia. The other diagnoses are determined by looking at the uterine size, contour, whether there are uterine fibroids, and looking at the ovaries for cysts or masses and the presence or absence of fluid in the cul-de-sac (area behind the uterus). Why would we order a Vaginal Probe US for our hormone pellet patients after the first visit, while they are taking estradiol? 1. Uterine bleeding is nonresponsive to treatment 2. Uterine size is getting larger (patient complains of pain or pressure) 3. High risk patients with recurrent uterine bleeding 4. To follow the growth of fibroids 5. To check the ovaries in patients who have a Family History of ovarian cancer (generally we have the patient’s GYN follow this). 6. To follow a benign looking cyst seen on the first US for growth.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog At Biobalance® Health we often find cysts or masses on the ovaries of women who are menopausal quite by accident. We order an ultrasound before we treat a menopausal woman with estradiol to see if there is a thickened lining that might cause bleeding under the influence of estrogen replacement, or to make sure there is no uterine cancer before we treat a new patient. We also incidentally find ovarian masses or cysts when we are investigating pelvic pain or postmenopausal bleeding on our patients who are already on estrogen replacement. In general, since BioBalance’s female patients have their own GYN we don’t do pelvic exams in the office, therefore we don’t find a mass by palpating (feeling) the pelvic structures, however ovarian cysts and masses can be found by ultrasound as well as by physical exam. We generally find ours by vaginal ultrasound. Why do we get ovarian cysts? Before menopause we make an egg every month (if we are not on birth control) that grows within a fluid filled sack. This egg will grow to about 18 mm, or 1.8 cm before it ruptures and releases the egg. That is the miracle of ovulation. It is normal to see one or two of these small cysts on the ovaries of ovulating, fertile women. These small sacks are not cysts because of their size. Ovarian cysts are fluid filled sacks attached to the ovary that are over 2.5 cm. They often occur secondary to a trapped egg that won’t ovulate for some reason, and the cyst will remain until the next period. If the cyst doesn’t dissolve before the next cycle, it can grow larger with the surges of hormones and it can prevent future ovulation, or it can cause pain from the stretching of the outer covering of the ovary. If a cyst is less than 2.5 mg. we don’t re-ultrasound in cycling women. If it is larger or continues to cause pain, we follow up an ultrasound in 6 weeks to see if it is growing. If it is growing but is still clear, depending on the size and the pain involved, we might do a laparoscopy to remove the cyst from the ovary. If it is growing and looks unusual in shape or density, we order 2 blood tumor markers for ovarian cancer. If those are negative, we follow up with another ultrasound in 3 more months. In some patients, multiple ovarian cysts are the norm. Those patients with polycystic ovaries create multiple cysts each month and rarely ovulate. It helps to use the drug Metformin ER to improve ovulation in PCO patients (and the rupture of cysts). Some patients require laparoscopy to punch holes in all the cysts especially if she is trying to get pregnant. What does a postmenopausal ovarian mass or cyst mean indicate? Now for postmenopausal patient’s ovarian cysts and masses are much more worrisome but much rarer. Because the ovary is not metabolically active, and therefore not ovulating the menopausal ovary should look small without cystic structures, however there are some exceptions! The menopausal ovary that has a fluid filled cyst 2.5 cm or less can have been there since the patient stopped ovulating and it never deflated, or ovulated. This type of cyst doesn’t grow and is not malignant. Ovarian cysts in postmenopausal women that are fluid filled and larger than 2.5 cm, or solid, or partially fluid filled and partially solid are suspicious for malignancy. In this case your doctor may order an MRI, a CT scan of the pelvis, and order cancer tumor markers. In most cases these masses are benign, or early in a malignancy and can be treated with surgery. Sometimes we find a suspicious mass that needs confirmatory ultrasound or MRI by a GYN Oncologist, tumor markers, and surgery would be scheduled to take the uterus tubes and ovaries and sometimes the omentum and lymph nodes. When will a patient know that her mass if not malignant and if she needs surgery? The surgeon may do a frozen section in the operating room to see if more than the ovary itself must be...

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog. I learned about electrolytes in medical school as the substances Sodium, Chloride, Potassium, Calcium, Magnesium, and Phosphate we check on a metabolic panel. However, electrolytes are much more than values on a blood test. These minerals are some of the most vital substances needed to keep us alive. Electrolytes can get out of balance in normal daily life and put us at risk of illness and death if we do not replenish them orally along with rehydration with water. Our kidneys and hormones manage electrolyte concentrations as our intake of these substances in our food and drinks replenish electrolytes that are lost in urine, sweat, and bowel movements. We are not conscious of the bodily mechanisms that manage our water balance, urination, keep our blood pressure normal and supply our brain with these vital nutrients to maintain consciousness, and we become symptomatic only when we are severely deprived of them. In my medical training, I also learned about how illnesses, and medications affect the amount of each electrolyte in our body however what I didn’t learn was how important it is for healthy people who exercise in the heat to replace their electrolytes. You don’t have to be an NFL football player or play in the NBA to require electrolytes when you exercise. With inadequate electrolytes you can become weak, and confused, lose muscle strength, faint or completely lose consciousness when you are working or playing games in the heat, even if you are drinking water! To make my point I’ll relay a personal experience that you may have experienced as well, while playing a game outside in the heat. I don’t play much golf, but I do play in charity golf tournaments. They are generally timed at the height of the summer heat, and they take almost twice as long as a usual round of golf. This scenario sets all the players up for dehydration and a deficiency of electrolytes. For several years in a row, I noticed that I was well hydrated for about 3 hours by drinking 3 or more bottles of water while I played the first 9 holes. By the 10th hole I was becoming physically weak and mentally slow. I felt I should be ok because I was drinking water and staying hydrated. However, I felt like I was playing golf in Jell-O. I continued to drink water because I thought I was dry, and that is what I thought was wrong with me. Not so…instead of feeling refreshed by drinking endless water, I got worse. Two years in a row I didn’t finish the 18 holes. What had I done wrong? I started using my diagnostic brain to figure out what I was missing. Was I sick or was there something wrong with my metabolism? While I was watching a pre-season football, I noticed the Gatorade that the players were guzzling. I had never tried Gatorade because of the amount of sugar in that drink. I pulled up the contents of Gatorade and found that not only did it rehydrate the hot and sweaty players with water and sugar, but it contained all the electrolytes that players lose when they sweat and exercise in the heat! Bingo! I bet that was what I needed to finish the golf tournament….electrolytes! It turns out that I had been half right by continuing to drink water, however the more water you drink while you are exercising the more your electrolytes are diluted! It is not a reason to hold off drinking water, because dehydration can damage your kidneys and you can get heat stroke, however adding electrolytes is vital to surviving exercise in the heat. The following year I armed myself with many bottles of water and plenty of electrolytes in the form of NUUN. To every third bottle of water, I added NUUN electrolytes tablet…voila! I could play 18 holes in hot weather and sweat for 5 hours without fainting, or losing muscle strength, and quitting! So how do you know when you are getting dehydrated and low on electrolytes? You pay attention to your symptoms! Like everything else,...

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog. BioBalance Health® pellets are very safe and not painful to have inserted. They are also the easiest form of hormone replacement a woman can have because the dose is adapted every 4 months and our patients only have to think about their hormones three times a year. BioBalance Pellet therapy is associated with fewer side effects than any other hormone replacement, and we have a 95% success rate for resolving the symptoms of menopause and testosterone loss. Women’s lives are drastically impaired at menopause. BioBalance, and T pellets improve their quality of life to the level of quality they had before they were 40. Dosage and pellet side effects are specific to the individual and it may take us a few pellet insertions and blood tests to get the ideal result. Finding your perfect fit is like having a custom suit made: hormone balance requires patience and several fittings, before we determine your maintenance dose, which will direct your dose of E/T for follow up pellet insertions. We give a handout to each patient when she checks out after her first pellet insertion. We ask patients to follow the instructions given to them verbally and in writing in our office. Risks of pellet insertion procedure, risk of taking estradiol and risk of taking testosterone are rare, but patients are given this handout, so they know what to expect. These same risks are on their consent that they read and sign before they even come to the office the first time. Here are the most important instructions for immediate care of the insertion site: · Take the pressure dressing off in 3 HOURS · Take the steri-strip off in 3 DAYS · Don’t traumatize your incisional area · If you are allergic to tape please tell us · For three days don’t submerge in water—hot tubs, bathtubs, the lake, a stream, or the ocean. · For three days don’t exercise · Don’t take oral or IV steroids if it is not life-threatening Please tell us if you are on steroids or take blood thinners so we can alter our treatment plan. The risks of the pellet insertion procedure include: · Infection · Bleeding, · Bruising · Allergic reactions · Swelling · Pain · Reaction to the lidocaine with epinephrine :shakiness and anxiety, lasts a short period of time, and is not permanent. Tell us if you have this side effect, and we will use lidocaine without epinephrine the next insertion. · Keloid scarring As is usual for medicine , individual patients have a higher risk based on their medical history. Patients who are at higher risk for complications secondary to the pellet insertion procedure in patients who are: · Diabetic · Have an autoimmune disease · Take steroids · Have a clotting/bleeding disorder · Keloid former · If you have many allergies · If you have orthopedic implants that require antibiotics at the dentist, then you should tell us so we can give you antibiotics. Risks of taking testosterone pellets with BioBalance Health® in the first few weeks or months and are transient. These side effects usually resolve on their own without treatment. The transient risks of testosterone treatment include: · Over the top sex drive=Hypersexuality · Vaginal itching from increased blood flow—it is not an infection · Facial hair and acne (Prevented with Spironolactone preventive treatment) · Weight gain from muscle mass and sometimes from conversion of testosterone into estrone which is a genetic risk. · Increased muscle mass that is confused with weight gain. · Lowered voice is only a problem when you are a singer. Generally, those who think they have a lowered voice really have reflux and it has nothing to do with testosterone pellets. · Clitoral enlargement—this is a reaction to a new testosterone exposure, and generally will go away in the following few months. · Thinning of hair at the temples and crown (Prevented with...