In the past , osteoporosis received relatively little attention among medical professionals because there was so little that could be done to treat this condition. It has always been known how serious osteoporosis is (hip fractures, need for nursing home care etc.) but there was not much that could be done to change the progression of the disease process.

Over recent years there have been substantial advancements in the treatment of osteoporosis. There are now medications that have been proven to be effective at actually increasing bone mass. Furthermore, there has been substantial progress in the evaluation and monitoring of the condition.

In the past, women's health care providers could only give their patients the following recommendations to manage/prevent osteoporosis:

-  Vitamin D and calcium supplements

-  sun exposure and exercise

- hormone replacement supplements, if appropriate, based on your medical history

Now , with the development of bone-building medications and the advanced technology to monitor bone density, the management of osteoporosis is approached very differently as the focus is no longer on prevention, but instead, on treatment.

Like so many other medical illnesses, there are no signs or symptoms of this disease until it is manifested by clinical problems resulting from its long term effects (spontaneous fractures etc.) . As a result , compliance with treatment programs for osteoporosis are poor, as there is no perceived benefit to the patient until it is too late to make a significant difference in their prognosis.

Be proactive when it comes to learning about osteoporosis. Talk to your doctor about bone health. If you have a family history of osteoporosis it is even more important that you address this topic at an early age.

Years ago, it didn't seem to matter whether this problem was addressed as there was so little that could be done. I hope I am helping women (and men) realize that this is definitely not the case today.

I simply want to raise awareness about osteoporosis. There are extensive resources available on the management of osteoporosis. Check out the many government-sponsored health organizations for more information.

This is the type of information I enjoy sharing with my readers. Advice that is intended to be practical and very applicable, to help you with the little things that can make a big difference.

When scheduling an OB/GYN office visit, it is helpful to first have an understanding of how a women's health medical practice is managed on a daily basis.

In OB/GYN, there are many unpredictable factors that can impact how efficiently a practice will function from day to day. Unexpected events can disrupt even the most well thought out office schedule. Miscarriages, surgical emergencies and patients in labor are unpredictable events.

Granted there are always coverage arrangements in place to meet practice demands, but even with this being the case, there will always be occasions when the medical staff will be over-extended. When this happens, it is our hope, as providers, that patients will be understanding .

I am very sensitive to the total amount of time which can be lost by a prenatal patient during the course of her prenatal and postpartum care. Frequent visits can result in a significant amount of lost time from their daily schedules, including travel time, etc.

Providers dread running late for patients and even worse having to reschedule a patient, as this is not good for the relationship. Furthermore, it can often feel like a double standard to the patient ,if the provider cannot see her. Patients wait for doctors ... why shouldn't doctors wait for patients?

The recommendations I am going to list below are extremely simple and intended to help minimize some of the inconveniences and frustrations associated with scheduling office visits:

1.) Book as many appointments at one time as is possible/allowed so that you can get the times that you want. The intervals between appointments will be determined by the gestational age of your pregnancy.

2.) Schedule to be seen at the start of a provider's office session. This will reduce the possibility of problems occurring that can set your provider behind. If you are scheduling an afternoon appointment, try to get a time immediately after lunch (at the start of the afternoon session). Most providers, who are running behind, will tend to use their lunch time as a buffer to catch up if their morning session runs late. Needless to say, this might mean giving up their allotted time for lunch but that is simply how schedules are kept on time in this setting.

3.) Whenever possible, phone ahead to determine whether your provider is running on time. Most practices are glad to hear from you before you arrive so they can address a potential delay in the office schedule. When I am behind and am asked what to do about a patient who is inquiring , I much rather hear that the patient is on the phone and not sitting in the waiting room. I feel I have more flexibility, perhaps I can see the patient for the last appointment of the day or during a canceled appointment time that might have been called in earlier that day.

4.) Schedule your office visits (if there are choices) on days when there are more than one provider in the office. As a result of surgical schedules, providers being on-call or just coming off call (at the hospital) there can be days with limited office coverage. This is no fault of anyone, it is simply part of the logistics of maintaining an office practice. If there is only one provider in the office ("your provider") it can take just one urgent problem/emergency to disrupt a schedule for the rest of the day as there is no one else in the office to help catch up.

I hope these suggestions are helpful to you and also will help you have a better understanding of why there may be a wait for routine office visits.

I am often asked about the treatment and prevention of varicose veins during pregnancy. It is important to realize that the development or exacerbation of varicose veins during pregnancy is largely (not solely) related to one's underlying predisposition to this condition.

Varicose veins in the legs are only one manifestation of pregnancy-related vascular changes. Hemorrhoids , prominent vascular changes on the abdomen (around the navel) and vulvar varicosities are other noticeable changes in the venous vascular system during pregnancy.

I will list a few simple suggestions (you may have heard before) that can have an impact on the severity of varicose veins. These suggestions are worth considering as they are fundamentally sound and have a scientific basis for why they can be helpful (certainly not harmful).

The best example I can think of, to help explain how/why varicose veins form, is when you have your blood drawn:

When one applies a tournicate to your arm to draw blood, notice that is it not as tight as a blood pressure cuff since it is only intended to obstruct venous blood return. The pressure from a tournicate is enough to block the veins so they become distended. This also makes the veins easier to "see" so you can draw blood... see what I am trying to say !!!. A blood pressure cuff, on the other hand, gets much tighter because it has to inflate to the point of obstructing the arterial system as well.

Here are some simple suggestions:

1.) Do not cross your legs when sitting (something you may have been told many times before) especially for prolonged periods of time. This contributes to impaired blood return from the legs and whether it will contribute to an exacerbation of varicose veins or not, I can assure you it does nothing good for the blood flow in your legs.

2.) During prolonged trips in your car or by plane , make an effort to frequently stand and exercise your legs as this facilitates blood flow and prevents pooling of blood in the lower extremities which can also contribute to the development of blood clots. The airline industry recognizes this risk and you may have noticed that they do make suggestions to prevent problems such as this on long flights.

3.) Elevate your legs whenever possible to counteract the forces of gravity that contribute to the pooling of blood in the lower extremities. As I will discuss in future articles , this also contributes to the swelling (edema) in your legs/ankles.

4.) Lastly , consider compression stockings to help keep the appropriate pressure on superficial veins. This will also help reduce swelling from fluid retention while you are ambulating during the day. It is absolutely essential that you discuss the use of stockings (Jobst, Teds etc.) with your provider and use stockings that are appropriate for your clinical circumstances and fit properly. In severe cases of varicose veins , there are stockings produced by medical supply companies which are actually measured and ordered by your provider. Do not to use ankle or thigh-high stockings that have constrictive bands or that are tight at the top as they will act like a tournicate (see above) and can make matters worse. Use full length stockings whenever possible and check them out first with your health care provider.

Women (after their pregnancy) and men who have severe/symptomatic varicose veins may consider treatment for varicose veins at some point in their lives (stripping veins, sclerosing , laser etc.) . If you pursue a treatment for varicose veins, be sure to do your research and consult with specialists who regularly treat varicose veins.

This article is only intended to help women understand why varicose veins develop and some simple measures one can take to help prevent their progression. I cannot possibly comment on the management of complications resulting from varicose veins as this can only be addressed with you by your provider who can evaluate your clinical findings and knows your medical history.

Clearly, if you ever notice any redness, tenderness, warmth or swelling associated with varicose veins, you should immediately bring these concerns to the attention of your provider as these symptoms can be related to a more serious condition called thrombophlebitis, where there is inflammation of the veins which can lead to other problems (blood clotting etc.) Again, the diagnosis of such a condition can only be carried out by your personal health care provider. Should my comments help bring a problem such as this to your attention then I am grateful they have served this very useful purpose.

Adenomyosis is not uncommon and can cause severe cramping and heavy menstrual  bleeding  or it can be assymptomatic . We know this  to be true because it is often noted  as an incidental pathology finding  after a hysterectomy has been performed for other conditions.

The condition is best understood if one has a basic understanding of the uterine anatomy. How the uterine musculature relates anatomically to the endometrial lining. The endometrial lining or menstrual lining, is shed each month resulting in menses due to cyclic hormonal changes, while the uterine musculature remains intact.

The development  of  adenomyosis  on pathology evaluation shows the well-defined anatomic separation between the endometrial lining and myometrium (uterine muscle) is maintained; however, there are crypts of endometrial tissue that grow into the myometrial wall.

The amount of adenomyosis likely is what determines the severity of the symptoms (ie. cramping and bleeding). On pelvic exam the condition can cause a softness to the uterus as a result of the displacement of the firmer uterine muscle with endometrial tissue. This is a physical finding that is not diagnostic but consistent with adenomyosis .

It used to be that adenomyosis was a diagnosis of exclusion and it still is in some cases. Now , with the evolution of high level studies ( MRI etc.) and  findings described  on  hysterosopic evaluation, the condition can be defined more often preoperatively.

The definitive finding is seeing the pathologic changes when cross-sectional views are taken of the uterine specimen showing crypts of endometrial tissue growing into the wall of the uterus .

Adenomyosis is managed individually, based on symptoms, one may go through hormonal trials or endometrial ablation (when fertility is not a concern).

I hope this information helps one to understand adenomyosis. It is not a life-threatening condition and thus management can be based on the entire clinical picture.

If fertility is not a factor, endometrial ablation using various techniques (resection etc.) may not be effective. Personally, I have taken this step initially if one wishes to try and manage conservatively. If ablation is not successful then either repeat ablation or hysterectomy is the option to consider. You may ultimately have to weigh the risk of repetitive operative procedures, including anesthesia etc. versus definitive treatment by hysterectomy.

Ablation can actually result in more cramping as there can be scarring over crypts of endometrial tissue. There is also a very small risk of harboring an underlying endometrial cancer. Thus screening of endometrial tissues should be done during the course of one's preoperative evaluation.

I hope this information is helpful and again I must state that it is intended to be educational and cannot be interpreted as suggesting a cure, treatment or preventive measure as it is crucial to know the entire medical history of a patient to make decisions about management.

Frequently I have encountered patients who are understandably concerned about when or where they were exposed to the HPV virus (or other STD's) and are anxiously desiring answers. I have spent many hours counseling patients on this subject and what is most disturbing to me is that I will often find patients wanting answers to "their" concerns only so they can call their partners who are awaiting an explanation.

I see women burdened with the task of trying to find a plausible explanation for an abnormal finding on a routine exam or a "symptom" that brought them to their health care provider. It is tragic to see this, since in many cases the problem should no more be a concern of hers than her partner's.

Women are often times more involved with the health care system starting at an early age ......menstrual problems , birth control issues, pregnancy and most notably: routine screening procedures (ie. pap smears , STD testing). This can inherently make women appear to be the origin of problems in a relationship, when in fact, they are simply the first one to bring a medical problem in a relationship to the attention of a health care provider..... an abnormal test result (pap smear) or the clinical manifestation of a medical condition (pelvic infection).

When I am asked about the various "mutually-at-risk conditions" between partners ( herpes, HPV, chlamydia etc.), I explain to the patient what the condition is , as best I can, and give supporting literature to share with her partner. When there is any indication that the findings are affecting her relationship or being construed as her fault I will encourage an appointment along with her partner to address any disagreements or "misunderstandings" in the relationship that might have come about as a result of this finding.

There are patients who are truly shocked and devastated about their diagnosis and clearly are lacking the emotional support they need once they leave the office. It is stressful in itself to find out about any medical condition and when this is compounded by the fact that one is being unfairly accused of being the source of the problem it is even more difficult to deal with.

It is imperative for anyone dealing with this situation to get the answers that best explain her personal set of circumstances. This effort is well worth the time and leads to a far better mutual understanding in the relationship.

Lastly, one should not overlook a very important clinical matter relating to any new findings of this sort. It is important that the patient's partner be evaluated and treated when indicated. I have seen patients treated on more than one occasion for the same problem because the partner would not get evaluated/ treated. This should never happen and should prompt the patient to address any concerns in the relationship that might contribute to this problem.

This article is a general statement about the "burden of proof" often placed on women when dealing with STD's . I will deal with more specifics in the near future.

When searching for a health care provider to manage your pregnancy you want someone who is well-qualified, has clinical experience and has a good reputation among those who you trust the most. With this being said, there are still some additional (personal) factors that one should consider when selecting a provider for prenatal care. The prenatal care experience lasts close to one year (including postpartum follow-up) so you want to be sure the relationship you have with your provider is well-suited.

Very simply, you should make sure you share the same philosophy about a few fundamental issues relating to prenatal care . You do not want to be in conflict with your provider as you approach your delivery date. Often times there can be more than one management option and what is decided upon is largely based on one's personal preferences and a mutual understanding of the risks and benefits of a particular clinical approach.

The options available to you might be defined by the services offered within a particular clinical setting (hospital, birthing center etc.). Be sure your provider's decisions regarding your care are not determined by what services are available when the services you want might be available at another health care facility.

If a provider is busy and has a loyal patient following, you should feel confident that your treatment will be based on what you desire.

There are two main topics most often at the center of any discussion surrounding the choice of a prenatal care provider. It is crucial to address these topics right up front to secure a good relationship. You do not want to ever feel you were misunderstood or deceived about what your expectations were at the time of your delivery (assuming there were no unusual circumstances).

The topics I am referring to are: preparing for "natural"  childbirth and pain management options.

Whether you choose a midwife or an obstetrician as your primary provider the same holds true. In either case, providers can still vary tremendously regarding these topics. It is simply about being on the same page with your prenatal care provider at the start.

The definition of what natural childbirth is and what adequate pain management is, can differ depending on who you talk to and what resources you read. It is very easy to put these topics aside at first as there is so much excitement about the pregnancy and the fact that your delivery seems so far off in the future. My suggestion is to initially discuss these subjects thoroughly and do not gloss over them.

I think pain control in labor is a crucial topic you should discuss with your provider from the start. I can think of nothing more upsetting to a patient than to not be in control of her options for pain control particularly if she is not aware of what the options are.

This article is certainly not the place to define natural childbirth or discuss pain management during labor. I simply want to bring this important topic to your attention.

The last question to consider when choosing a provider has to do with who is anticipated to be there for your delivery. As a result of the tremendous overhead (medical practice expenses) and lifestyle issues for practitioners, it is virtually impossible, in this day and age, to be assured that you will have your provider at your delivery. As a result , it is important for you to be aware of your provider's arrangement for on-call coverage. Cross-covering with other providers at the same health care facility is not unusual and may be necessary depending on the size of the medical group you are seeing for your care. It is simply about having this discussion with your provider at the start. Discussing these issues is what maintains a trusting relationship with your provider.

The timing of events surrounding labor and delivery is not always foreseeable and there is not a perfect solution every time. What is important and acceptable to most patients is that a reasonable effort is made to fulfill one's expectations.

When searching for a health care provider to manage your pregnancy you want someone who is well-qualified, has clinical experience and has a good reputation among those who you trust the most. With this being said, there are still some additional (personal) factors that one should consider when selecting a provider for prenatal care. The prenatal care experience lasts close to one year (including postpartum follow-up) so you want to be sure the relationship you have with your provider is well-suited.

Very simply, you should make sure you share the same philosophy about a few fundamental issues relating to prenatal care . You do not want to be in conflict with your provider as you approach your delivery date. Often times there can be more than one management option and what is decided upon is largely based on one's personal preferences and a mutual understanding of the risks and benefits of a particular clinical approach.

The options available to you might be defined by the services offered within a particular clinical setting (hospital, birthing center etc.). Be sure your provider's decisions regarding your care are not determined by what services are available when the services you want might be available at another health care facility.

If a provider is busy and has a loyal patient following, you should feel confident that your treatment will be based on what you desire.

There are two main topics most often at the center of any discussion surrounding the choice of a prenatal care provider. It is crucial to address these topics right up front to secure a good relationship. You do not want to ever feel you were misunderstood or deceived about what your expectations were at the time of your delivery (assuming there were no unusual circumstances).

The topics I am referring to are: "natural" childbirth and pain management options.

Whether you choose a midwife or an obstetrician as your primary provider the same holds true. In either case, providers can still vary tremendously regarding these topics. It is simply about being on the same page with your prenatal care provider at the start.

The definition of what natural childbirth is and what adequate pain management is, can differ depending on who you talk to and what resources you read. It is very easy to put these topics aside at first as there is so much excitement about the pregnancy and the fact that your delivery seems so far off in the future. My suggestion is to initially discuss these subjects thoroughly and do not gloss over them.

I think pain control in labor is a crucial topic you should discuss with your provider from the start. I can think of nothing more upsetting to a patient than to not be in control of her options for pain control particularly if she is not aware of what the options are.

This article is certainly not the place to define natural childbirth or discuss pain management during labor. I simply want to bring this important topic to your attention.

The last question to consider when choosing a provider has to do with who is anticipated to be there for your delivery. As a result of the tremendous overhead (medical practice expenses) and lifestyle issues for practitioners, it is virtually impossible, in this day and age, to be assured that you will have your provider at your delivery. As a result , it is important for you to be aware of your provider's arrangement for on-call coverage. Cross-covering with other providers at the same health care facility is not unusual and may be necessary depending on the size of the medical group you are seeing for your care. It is simply about having this discussion with your provider at the start. Discussing these issues is what maintains a trusting relationship with your provider.

The timing of events surrounding labor and delivery is not always foreseeable and there is not a perfect solution every time. What is important and acceptable to most patients is that a reasonable effort is made to fulfill one's expectations.