Women's Health: Live Question and Answer Session
Tuesday, October 14

From infertility to preventing osteoporosis. Do you have questions about women's health topics?

We will do our best to answer all questions about this topic submitted in advance and during the live chat session. We look forward to continuing to be your resources for healthcare information, motivation and empowerment.

Q: Jennifer of Kenosha - Is it safe to have a colposcopy performed if the woman is 4-5 weeks pregnant? Are there any risks to the baby?
A: Moderators - Very safe to have colposcopy during pregnancy, but a biopsy should be performed with great caution and only if necessary because of the risk of bleeding. If there is little chance of a serious lesion, a biopsy might be delayed, but follow up colposcopies during the rest of the pregnancy might be appropriate.

Paul Burstein MD


Q: Lynn of Gurnee - I have been always been very thirsty since I was a baby according to my parents. I am 38 now. At times, I feel a great deal of anxiety and confusion if I go for a couple of hours without drinking water. My doctors have ruled out diabetes, but I do have hypothyroidism. I have very low blood pressure (88/67). In previous blood tests, it shows that I am low in vasopressin. Any ideas on how I can help my thirst? i drink water or other liquids and am always thirsty afterwards. I drink 6–8 16 oz bottles of water a day, plus other liquids. No soda, no caffeine, some herbal tea and pure juice. No preservatives in anything I eat if at all possible. I try to eat as much organic product as I can. No milk products, no sugar, no white flour and no wheat. I hope you can help me. Thanks.
A: Moderators - Your problem is more complex than can be answered in a few lines. A thorough work-up by an Internal Medicine expert will irule our any serious endocrine problem and, if none is found, reassure you that your fluid intake is not excessive.

Gerald Vitamvas, M.D.
Ob/Gyn
Advanced Healthcare


Q: JAIMIE of SAUKVILLE - When will you be addressing the issue of ovarian cancer---symptoms, diagnosis, importance of referral to gyn. oncologist, etc.
A: Moderators - Columbia St. Mary's has a series on women's health issues. Check the Lifestyle section of the Sunday Journal Sentinel for future topics. It is a great question and we are planning a discussion of ovarian cancer.

Paul Burstein MD


Q: Kathlyn of Milwaukee - Please explain what a complex ovarian cyst is and how this differs from a simple ovarian cyst. Once diagnosed with a complex ovarian cyst, through ultrasound, what do you recommend as the next course of action? Also can ovarian cysts have any bearing on ability to get pregnant? Thank you!
A: Moderators - Ovarian problems should be evaluated by your family/internal medicine physician via a physical exam and/or ultrasound. Ovarian cysts are very often without symptoms; women often have no idea they have them and are found incident to other test. Ovarian cancer is quite rare and is frequently without symptoms early on. I would definitely involve an gyn. oncologist if there is a cancer diagnosis. I would check the American Cancer society or National Institute of Health Web sites for more information about cancers. As far as ovarian cysts and pregnancy there should be no contraindication or difficulty in getting pregnant ( unless the ovarian cysts are related to a diagnosis of PCOS). I would refer you to your primary care provider or doctor with further questions.


Q: Mary of Eagle - The Dr. said that I have Fibromyalgia. I don't have a lot of joint pain like I have read about but my biggest problem is with my walking. After walking for a short time my legs feel so heavy and have to sit down. Sitting down for a short time is helpful. Legs have been very achy at the end of the day and after walking for awhile. I do have joint pain in my knees. Could this be something other than Fibromyalgia? I have been to a neurologist and had an MRI (had 3 of them) and an EMG. My primary Physician had numerous blood tests done with no answers. There is Heart Disease in my family (Father). I had a stress test about 3 years ago. There are other health problems that the Dr. blames on Fibromaygia but Walking is my biggest problem right now. Thank you
A: Moderators - I would ask your doctor how he or she diagnosed the Fibromyalgia. Secondly I would ask what the treatment will be. After a while on treatment you can evaluate the effectiveness.


Q: Jennifer of Kenosha - How long should a woman wait after being on antibiotics, before trying to conceive?
A: Moderators - It is advisable to wait a few weeks to allow medications to clear your system before "trying"; however there are some antibiotics that are quite safe during pregnancy so it depends on which med one are taking.

- Marcia Sullivan, MSN, APNP


Q: Darlene of Grafton - What is the upper limit for calcium intake? I am in my 50's, past menopause. I take two 600 mg. tabs of calcium per day (one also contains 81 mg. aspirin), and usually have 2 glasses of skim milk per day, and 2 snack size containers of yogurt (no-fat). My orange juice is calcium added type. Is this too much calcium? Thank you. I am of slim build.
A: Moderators - the recommended amount of calcium is 1200mg daily for a woman your age. I think you are fine with what you are doing.


Q: Janet of Elkhorn - Is there any correlation between the menstrual cycle and a lowered immune system? It seems I always get colds and like-viruses just before I get my period.
A: Moderators - Some studies suggest a very subtle change in certain immune system factors related to the menstrual cycle. These are probably not enough to cause you the problem you have noticed. Make sure at those times that your diet is well balanced and that you are getting some extra sleep. Regular exercise dramatically improves immune function.

Gerald Vitamvas, M.D.
Ob/Gyn
Advanced Healthcare


Q: Cecilia of Whitewater - What can I do to reduce the symptoms of PMS? For at least 10 days each month I am irritable, depressed, constantly hungry, tired, bloated... I feel like a psycho, and it only seems to be getting worse as I get older (I am currently 32, never had children, and have not been particularly sexually active for some time). Is there anything I can do to ward-off the symptoms?
A: Moderators - There are lots of things to consider. Typically PMS is found in the 10 to 14 days prior to your period and these symptom, many of which you have described, go away quickly after the onset of menstruation. Exercise helps. Calcium seems to help. Paradoxically, carbohydrates seems to help. For more severe cases, Sarafem, Zoloft, Prozac, and Paxil CR have been approved recently for treatment of PMS. Hope that helps


Q: Kris of Mequon - I am a 5' 5'' woman, 31 years old. I have recently lost a significant amount of weight and am trying to determine the appropriate 5 pound weight range to live in. I asked my doctor what I should weigh, and he told me the average woman of my height is 111 pounds! I don't believe him (obviously). I currently weigh 140 and think 111 would be darn near anorexic. Was he right, or should I shoot for a different range?
A: Moderators - Your BMI is 23.3 and the adviseable range to be in is below 26 which is about 150 or so. Your weight is really fine and my opinion is that 111 would be to thin. Check out BMI tables on a search engine of your choice.

-Marcia Sullivan, MSN, APNP


Q: Jill of south milwaukee - I'm 26 years old and just got a hysterectomy two weeks ago and I started spotting today is that normal?? Another question I have is do I need to be concerned about osteoporosis even though my ovaries were left and my uterus was just removed??Please respond asap. Thank you. Jill
A: Moderators - Hi Jill, Spotting after ahysterectomy is common but needs to be watched. If it is bright red and doesn't resolve you need to call your Dr. You should avoid strenuous activity, tub baths abd intercours. In regards to osteoparosis, once you go into menopaus, you are at the same risk as you would be with a uterus. Your OBGYN can advise you on how to know if you are menopausal.


Q: Gina of Waukesha - I am 1week late with my menstral cycle. Yesterday I very briefly spotted and I have no signs of getting my period. Is this a sign of being pregnant, and is it too soon to take a test because I have been under an enormous amount of stress also. This has never happened to me before.
A: Moderators - Hi Gina, You can take a pregnancy test, and should. Women can spot, and be pregnant. Stress can cause changes in your cycles, so that is a possibility too. Make sure you pick a reliable brand of pregnancy test, and call your MD. Good question.


Q: Linda of Kenosha - I have had a bone density test that revealed osteoporsis. I have had a complete hysterectomy 12 years ago, I am small framed and light weight, I also receive monthly i.v. treatments of steroids for multiple sclerosis. I take premarin daily and have been perscribed fosomax. My question is will the foxomax really do anything since I am on the steroids? Or am I fighting an uphill battle? Thank you.
A: Moderators - Fosamax is approved to steroid induced osteoporosis and sounds like an appropriate choice. I hope you are a non-smoker. You needs adequate calcium, 1200 to 1500 mg/day depending on age, and vitamin d.


Q: Colleen of Waukesha - I am a laid off single mom without insurance. I wanted to know where can I get a free mamogram??? I am way overdue.
A: Moderators - Call the City of Milwaukee Health Department. They can provide the information that you need. Get one. It is very important.

Sandy Harris RN, Director of Patient Services at Columbia St. Mary's.


Q: Mary of Fond du Lac - I am a 49 year old breast cancer survivor of 4 years. My cancer was strongly estrogen positive. I am now trying to lose some weight and have checked into higher protein programs (nothing as extreme as Atkins) There are many high protein drinks and supplements that are composed of soy protein. Are these safe for me? If so in what amount?
A: Moderators - High doses of soy protein can provide estrogen. It is unclear if this is a risk for women with estrogen positive breast cancers. I would not assume it to be safe. Modest intake of soy is a good idea. It is high quality protein and would not contain fat or cholesterol.

-Paul Burstein MD


Q: Rosalie Chart of Waterford - What type of medication would you suggest for improving bone density? I am taking Evista at the moment ,60mg. once a day and 2400mg of calcium with vitamin D. I've heard that Foxsamax is the best but because I have GERD I'm not supposed to take that drug. It was first thought that I had Barrett's esophagus. I'm now waiting for my bone density results,which I will get on Friday. If this test is worse my Dr. is thinking about putting me on some sort of nasal spray with the Evista.
A: Moderators - Your doctor is probably thinking of using Calcitonin. Evista helps osteoporosis but is not as good as the bisphosphates or estrogen. It sounds like your doctor is carefully evaluating what is best in your individual circumstance.

Gerald L. Vitamvas, MD, FACOG Advanced Healthcare


Q: Katie of Brookfield - I was dianosed with Osteoporosis quite a few years ago but stopped taking Calcium because it is so confusing. One DR says take this one, one says no, take this one, all because of the way it is absorbed into the body. Some of the DR's say I may as well be taking nothing because it is not absorbed at all. Can someone there tell me which one is the one, and how many a day, a woman of 60, with high blood pressure, (on pills) and a very sensitive stomach should be taking??? Thank you for your time. Katie
A: Moderators - A woman your age needs 1200mg of Calcium daily. This should be elemental calcium preferably with Vit D. There are many products to chooce from. You can also check with your pharmacist. Be sure to eat foods high in calcium such as milk,yogurt,veges, etc.


Q: Linda of Greenfield - I have fibrocystic breast disease - Occasionally I have cysts that develope before or during my period. Several days after my period has stopped, they disappear. However, this month, (currently am menstruating) one cyst is especially painful. What would relieve the pain? Hot or cold compresses?
A: Moderators - While cold compresses and Tylenol may relieve such discomfort, persistant breast cysts often need to be aspirated (this means having a doctor remove the fluid with a needle). This sounds drastic, but usually immediately relieves pain and the cyst will normally not return.

Gerald L. Vitamvas, MD, FACOG Advanced Healthcare


Q: Linda of Milwaukee - I'm 55 and trying to stay healthy, although I can't quit smoking I've tried to maintain my health by walking on the treadmill every other day for at least three miles. Am I hurting myself by putting added stress on my heart by smoking or am I improving my health by better heart circulation?
A: Moderators - Exercise is the best thing we can do for our health. Smoking is unfortunately the worst. Keep trying until you quit. It is a process of trying many times so don't give up!! It will cause health problems sooner or later as it is linked to many illnesses. It is well worth the effort to keep trying. Good luck and keep exercising.

Sandy Harris RN, Director Patient Services Columbia St. Mary's


Q: Debi of Delafield - Have researchers/doctors found more information regarding the disease of eating disorders? I have suffered from bulemorexia for over 16 years and I am no further in a form of treatment than I was 16 years ago. The insurance companies still do not recognize this disease, which further complicates the ED. Thank you! Debi
A: Moderators - Eating disorders are a complex problem of physical and psychological origin. There are programs within the community which can be effective for this problem, and can be controlled and cured. Such treatment would be covered on most insurance plans to my knowlege, so I'm not sure why you have the impression that insurance companies "do not recognize" the disease.

Gerald L. Vitamvas, MD, FACOG Advanced Healthcare


Q: Linda of Milwaukee - I'm 55 and am still smoking. Although I try to stay healthy. Question? Am I helping yself or hurting myself by walking three miles every other day on the treadmill. Is walking an added stress on my heart muscles or is it beneficial for the circulation benefits? Yes, I know idealistically quit smoking but after 35 years it seems like a lifelong battle that I haven't overcome.
A: Moderators - ALL of us should strive to get at least a half hour of exercise daily, or at least most days. Smoking is a major risk factor for many serious diseases and it sounds like you are interested in quitting. It is one of the best decisions you could make. I would strongly urge you to quit. I would consider some of the nicotine replacement products available without prescription, and would suggest you contact your physician for a prescription for a drug called Zyban. This is very effective in motivated patients. Good luck, keep trying, and hopefully you can quit and do yourself a big favor.

Paul Burstein


Q: Geri of Kenosha - What can be done for chronic yeast infections? Diflucan in conjunction with anti-fungal creams offer relief, but the problem comes back within a few months. I am not diabetic, nor do I have HIV, but I believe my problem is systemic. Acidophilus capsules worked for awhile, but again the problem is back. Is Nystatin something that would completely cure the problem? How is it taken and does it require a prescription? What type of physician/specialist should be seen for this type of problem? HELP! Thanks!
A: Moderators - Chronic yeast infections frustrate patients and doctors alike. Sometimes, the patient self-diagnoses "yeast infection" when that is not the problem. Vulvar skin disorders are commonly mistaken for yeast infections. A thorough gynecologic evaluation can make sure that this is really yeast. If it is, sometimes long-term treatment with an antifungal, oral Nystatin (a prescription medication), or acidification of the vagina with Boric Acid suppositories (also by prescription) can solve the problem. Don't give up!

Gerald L. Vitamvas, MD, FACOG Advanced Healthcare


Q: Jodi of Greendale - I am about 4-5 weeks pregnant and have been spotting for 8 days starting 4 days after my missed period. Lower back pain accompanied it very strongly in the beginning but then has subsided. I do have some other cramping in my lower abdomen on both sides but this could be due to constipation and gas. What could be going on? I at first thought it might be an ectopic because of the pain on one side, but when the constipation subsided the pain went away and actually moved to the other side. I have also had really bad morning sickness at 2 or 3 am that subsides within a couple hours and doesn't come back during the day. What could be going on? Could constipation cause enough irritation for spotting to occur? I see the doctor next week. Is that too long to wait?
A: Moderators - Pain and spotting can be symptoms of ectopic pregnancy. I would call your physician.

Paul Burstein MD


Q: Cindy of Milwaukee - I had ductal carcinoma in situ a year ago. I had radiation and now am on Tamoxifen. I've been bothered by back pain only at night. I do have a new mattress. Is muscle pain a side effect of Tamoxifen? Or am I just getting old? I'm 57 and physically active. Thank you. Cindy
A: Moderators - Back and muscle pain are not side effects of Tamoxifen to my knowlege, although any medication can cause unusual side effects in individual people. Like all of us in our 50's, you may have some arthritis in your back, and the new mattress may be aggrivating it. Make sure that you are stretching your back as part of your exercise program.

Gerald L. Vitamvas, MD, FACOG Advanced Healthcare


Q: Mary of Eagle - I read your answer to my previous question. My Dr. did so many blood test and came to the conclusion of the Fibromyalgia. He put me on anti-Depressants (two different kinds at two different times) neither did anything for me just made me more tired. My question is..would you have any suggestion on what kind of specialist I should see? I really need help with the walking. My legs really ache at the end of the day and at the end of walking for awhile. Maybe you have some idea what would cause this walking problem. The only medical history problem in my family is Heart Disease. Thank you
A: Moderators - Fibromyalgia is a challanging condition to treat. A Rheumatologist is an expert in this disorder and can help you achieve your maximum functionality.

Gerald L. Vitamvas, MD, FACOG Advanced Healthcare


Q: Barb of Brown Deer - I would like to know what you feel the safest and best approach is regarding hormone therapy. Many years ago, I was prescribed estrogen, then they decided it could cause cancer. Some time ago, I was given a hormone cream to use, but I'd like to know what the latest thoughts are on the issue as of today. My age is 60.
A: Moderators - It used to be thought that the benefits of HRT were so great that every menopausal woman should use it. Currently, the decision to use HRT is an individual one between the patient and her physician. HRT has not been shown to cause cancer but it may increase the speed of growth of breast cancers which are already present. HRT is actually very safe therapy and can really benefit women who have estrogen deficiency symptoms- primarily hot flushes, night sweats, and vaginal dryness. You should consult with a Gynecologist who is willing to spend the time with you to inform you and help you make the right decistion for your individual health issues.

Gerald L. Vitamvas, MD, FACOG Advanced Healthcare


Q: Kris of Waupun - After my second child my breasts became very sensitive and I can't even let my husband touch them. It's been 2 years, any suggestions?
A: Moderators - Many women have fibrocystic breast changes which can cause pain in the breasts. Elimination of caffeine and the addition of Vitamin E (400 IU daily) can help. There is also a medication called Danazol that can dramatically reduce breast pain. Please see a physician to make sure nothing else is going on.

Gerald L. Vitamvas, MD, FACOG Advanced Healthcare


Q: Jennifer of Kenosha - I have had aching cramps in my addomen for the past few months and at times the pain shoots down my leg. I did have an MRI to check for tumors or cysts and everything came back negative. I am hoping to try to conceive soon, and I want to be sure that I am in the best of health before doing so. Do you have any idea what may be causing these pains?
A: Moderators - I can't diagnose your pain without collecting a careful history and doing a careful exam. Abdominal pain can be caused by intestinal problems, gynecologic disorders, urinary system problems and problems with muscles of the abdomen, pelvis and leg movers. Many of those problems will not show up on an MRI. The kind of discomfort you describe is not likely to prevent you from conceiving, but I agree it would be good for you to be comfortable that the problem has been appropriately addressed before starting a pregnancy, as many physical symptoms may occur during normal pregnancies.

Gerald L. Vitamvas, MD, FACOG Advanced Healthcare


Q: lisa of racine - on sept. 24th i had just my uterus removed and that following tues. if you pressed on my stomach it soundded like a water bed and you could see movement from one side to the other. i went in to the doctors office and he removed a little bit of fluid and some air. then this past wednes.(oct.8th) he removed 90cc of a pinkish/red fliud. told me to wrap my self up in ace bandages....and if this happened again he would have to go back in. on fri.oct.10th, i called his office and told them that it was happening again. i was told to put a towel around my stomach and then put the ace bandages around that and we would do surgery on mon oct.13th. i had the surgery on mon. stayed in over night and i am home today oct.14th. i was sent home bandaged up with a drain tube. i have an appointment on thursday with him. he is trying to tell me that because i have excesss skin around my stomach from losing weight that this is why this happened. we have asked around and it doesn't make sense to anyone we talk too. have you ever heard of this??? we haven't really gotten any of our questions answered. (he is always on the go) could you tell us if this is common or not?? thank you for your time lisa
A: Moderators - Sounds like you developed a seroma (a collection of serum-which is the fluid part of blood) in the tissue beneath the skin. This is quite common after abdominal operations, and is more common in people who are overweight. The fluid sometimes will drain itself through the incision, sometimes the incision needs to be opened to drain it and sometimes it is reabsorbed by the body. This is a recognised, common minor complication of this kind of operation. It does not cause any long term bad effects.

Gerald L. Vitamvas, MD, FACOG Advanced Healthcare