CareConnection
Innovative Healthcare in Your Backyard.
Volume 1
Keep It Clean! In The Community My Story. My Life. Struggling with Fertility. Nothing is Taboo Testosterone Therapy and Heart Attcks
A WellHealth Quality Care Publication
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Issue 5
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WELCOME TO THE PRACTICE, DR. QUEZADA! Dr. Yarini Quezada is board certified in Female Pelvic Medicine and Reconstructive Surgery. Dr. Quezada is a well-known national expert in the field of urogynecology. She is currently seeing patients at our WellHealth Women’s Specialty Care Spring Valley, Southern Hills, and Mountainview locations. Currently seeing patients regarding medical issues such as: • Pelvic Pain • Mesh Erosions • Fistula Repairs • Interstitial Cystitis • Voiding Difficulties] • Pelvic Organ Prolapse • Non-Surgical Treatments • Urinary and Fecal Incontinence • Vaginal Reconstruction Surgery
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Tips, stories, and guides for a
Healthier You In this issue:
06. KEEP IT CLEAN!
Your work desk may be hoarding bacteria and germs.
09. NOTHING IS TABOO.
You wondered, we asked! OB/GYN questions from everyday people.
11. MY STORY. MY LIFE. STRUGGLING WITH FERTILITY. Infertility affects nearly 1.5 million married women.
13. TESTOSTERONE THERAPY AND HEART ATTACKS New studies may be the key to saving lives.
Credits MEDICAL EDITOR
K. Warren Volker, MD, PhD
MANAGING EDITOR Meghan Bailey
COPY EDITOR
CONTRIBUTING WRITERS Jasmine Pedroso, MD Chelsea Corarito Kimberly Doan Milton Wong, MD FACE
Kristina Pool
ART & DESIGN Chelsea Corarito
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Letter from the Medical Editor
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“Moving faster than the speed of light.” This old saying seems to be more accurate with each passing year. Time appears to stand still as a child, but as you get older, everything from family to healthcare constantly moves faster and faster.
relationship with their Primary Care Doctor. Primary Care Doctors are the cornerstone to every patient’s health. Fostering a relationship with one is crucial to ensure an easily treatable condition doesn’t turn into a long-term health problem.
This year in the Las Vegas Valley, we will see new hospital locations breaking ground, a new Clark County Medical Society building, the finishing touches on the new UNLV School of Medicine, enhancements to our current medical schools, and, of course, the grand opening of Ikea.
I want to challenge you as you read through this issue to write down your questions and schedule a time to meet with a Primary Care Doctor. Talk with them about your concerns, let them know what conditions you feel that you may have, and begin the journey to a better, healthier life. These days, your health may be moving faster than the speed of light.
With all these new healthcare access points, patients are going to have additional medical facilities in which to receive their care. However, this won’t replace the importance of a patient’s
Let’s live healthy and happily, K. Warren Volker, MD, PhD CEO of WellHealth Quality Care
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Letter from the Editor Why are we so embarrassed to ask questions about our health? Is it the stigma associated with revealing our personal problems that makes people uncomfortable? Do we think that no one else in the world will be able to relate to us? I can safely say that the doctor you are staring at during your appointment has heard it all, and they are the last person who will judge you. Their passion is to make your health whole again, no matter the struggle you may be experiencing.
No matter what your job or career is, where you live, or what you do with your free time, we all have one thing in common: our health. Let’s not be afraid to talk to our friends and family about our health. Put down Dr. Google, start connecting with your doctor, and find support within your inner circle. You may be surprised to find that you are, in fact, not alone.
This issue of CareConnection is going to push you out of your comfort zone. We are talking about “taboo” topics, such as endometriosis, infertility, periods, and menopause. We asked our readers to submit their questions regarding women’s health and we received questions about the same issues over and over again.
Meghan Bailey Managing Editor
No longer embarrassed,
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Looking to keep your desk bacteria-free? Here are a few easy tips you can follow to keep germs at bay: •Wipe down your desk and all of the items on it once a week with an antibacterial wipe. This will keep germs from building up on places like your phone and keyboard. •If you have room on your desk or in your cubicle, get an air-cleaning plant to help with the air quality in your office. The Peace Lily, English Ivy, Bamboo, and Gerbera Daisies are all great choices for air quality control. •Don’t eat food at your desk. It may seem like the multitasking will help you get ahead, but food encourages bacterial growth. And if you get sick, you’ll be even less productive! •When a winter cold finally hits you, do the whole office a favor and stay home. Even if you think you’re being a model employee by toughing it out, you’re just making it more likely everyone else will get sick as well. •Wash your hands throughout the day, and keep hand sanitizer at your desk. That way you can share the antibacterial gel with anyone else who may benefit. Sources: http://entm.ag/1tQYPjV http://bit.ly/1QglZgm http://on.wsj.com/1SjeVgU
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Dr. Paul Tomasic
treatment for endocrine system ailments. We are accepting new patients who have been diagnosed, may be showing symptoms, or experiencing:
support, and the tools to help patients manage their health condition.
- Diabetes - Osteoporosis - Thyroid Disorders - Calcium Disorders - Pituitary and Adrenal Evaluations - and more
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WellHealthEndocrinology.com | 702-255-3547
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Nothing is Taboo:
Your questions about your gynecological health. You know the questions you’ve always wanted to ask your OB/GYN during your annual appointment but haven’t mustered the courage to say out loud? Don’t worry, we asked one of our WellHealth Women’s Specialty Care OB/GYNs, Dr. Jasmine Pedroso, so you won’t have to ask! CareConnection: If your period starts later in life (16, 17 years old), will your fertility be impacted? Jasmine Pedroso: That depends on a few factors. If your period started later in life due to extreme exercise and low body fat, that may not affect your fertility. If your period started later in life due to Polycystic Ovarian Syndrome (a condition which causes you to ovulate less frequently), then the answer would be yes. CC: Should there be bad odor coming from my vagina? JP: The vagina normally has special kinds of bacteria that help to control pH balance or acidity. Bad odor is usually due to an imbalance in that bacteria leading to an infection called Bacterial Vaginosis, which is not sexually
transmitted. Loosefitting breathable underwear, good hygiene, and a healthy diet can help keep this balance healthy. CC: Is it normal to leak urine? JP: Leakage of urine is a common problem women can face throughout their lifetimes. Women may leak urine due to severe bladder irritation from a urinary tract infection. Women may also leak urine on their way to the restroom if they have a sudden urge to go but cannot make it on time, a condition known as urge incontinence. Women may also leak urine when coughing, laughing, sneezing, or exercising, a symptom of weakness in the support structures of the pelvis, known as stress urinary incontinence. If you are experiencing
any of these issues, talk to your doctor about ways to manage and treat your symptoms. CC: How can I talk to a new sexual partner to make sure that they have been tested for STDs? JP: When discussing STD screening, it is important to be specific about which STDs have been screened for and how recently they have been screened. Ask directly: When were you last screened for STDs and which ones? Would you mind getting tested again? You should mention HIV, HEP B, HEP C, HPV, Herpes, Gonorrhea, Trichomoniasis, and Chlamydia. If it is still difficult to discuss, talk about and/or show your partner your recent test results - this may help encourage them to get tested themselves.
CC: Is there anything I can do to improve vaginal dryness during sex? JP: Dryness during sex may be due to lack of blood flow and circulation in the area. Water or silicone-based lubricants are sold at most drug stores and are helpful for immediate lubrication. Vaginal moisturizers, such as Vitamin E oil, KY liquibeads, and vaginal estrogen creams, are often prescribed for postmenopausal vaginal dryness when the above methods have failed; however, very high doses of hormones can be harmful in some patients. If you are currently experiencing any of these symptoms, or other conditions that are affecting your quality of life, make an appointment to talk with your preferred provider. Many of these symptoms can be managed or alleviated entirely! 9 9
When you need us, we’ll be here. Las Vegas’ Premier Primary Care Doctors • Arthritis • Diabetes • Heart Disease • High Cholesterol • Preventative Medicine • Wellness Exams • Pre-Operative Surgical Exams
Accepting New Patients
(702) 225-3547
wellhealthprimarycare.com
9260 W. Sunset Road, Suite 207 Las Vegas, NV 89148
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My Story. My Life. Struggling with Fertility.
A study by the Center for Disease Control suggests that more than 18% of women in the United States will have trouble conceiving or carrying a baby to term. These difficulties often go undiscussed or are hidden in fear of shame.
Unexplained Infertility “At first, my husband and I were told nothing: just ‘unexplained infertility’.” As far as Britney knew, she didn’t have a family history of infertility. Her OB/Gyn told her to try and conceive for a year before making an appointment with a reproductive endocrinologist. That was four years ago. And after multiple visits to specialists, they’ve continuously been told that nothing is wrong with either of their reproductive systems. “It’s disheartening to hear this. I would much rather know there was a problem so we could work with our doctors to fix it.” Britney and her husband have tried two unsuccessful medicated intrauterine inseminations (IUIs). While her doctor has recommended treatments for in vitro fertilization (IVF), Britney and her
Medically Risky After nine months of actively trying to conceive, Lacy visited her OB/Gyn. “I didn’t have a period for the nine months I tried to conceive, but I had milk and colostrum discharge.” Lacy was diagnosed with Prolactinoma, a small growth on the pituitary gland that elevates cortisol and prolactin. When she met with specialists they advised her that she could become pregnant with this diagnosis, but it is risky, and she would have to take multiple medications that have many side effects.
“One of the hardest parts of adopting a baby is knowing that in order to become a mother, another person had to lose their child.” “I chose to adopt through fostering.” Lacy is an elementary school teacher, and the cost of IVF wasn’t something that she would be able to financially do. “I began my journey to adopt through fostering in May of
2014, and after finishing my classes, I received the call in October that changed my life forever.” Lacy’s case worker placed a three-weekold baby girl in her care. This baby girl stole Lacy’s heart, and they both knew that it was meant to be. “The journey to adopt my baby girl was long and very emotional.” Lacy had to wait until her daughter’s parents were able to take care of the child again or they lost their parental rights before she would be able to adopt her. “Almost one year to the day she was placed in my arms, I raised my right arm and promised to take care of her for the rest of my life.” Lacy became a mom, something she had dreamed about for years. “One of the hardest things for women who struggle with infertility is hearing people ask when they are going to have their first child, or find Mr. Right if they are not married. For me, Mr. Right wasn’t there, but being a mom was. Any path to having a child is emotionally difficult, but when you can look in your child’s eyes and say ‘Hi, I’m your mom.’ It makes it all worth it.”
husband have to wait in order to be able to cover the hefty financial cost of IVF.
“For anyone else going through this, you are not alone! Let’s go get coffee and talk about how much this sucks.” “I want to be a voice for infertility because it is not shameful, it’s a struggle.” Britney has become an advocate for infertility, making sure that people understand that others struggling to conceive are not jealous or upset that a friend or family member is expecting. “I want to jump for joy with friends and family. A new baby is very exciting and I know I’ll have my jump-for-joy moment one day too.”
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In The Community Q: What is The Public Education Foundation and how does it help the local community? A: The Public Education Foundation is an independent, nonprofit organization whose Board of Directors includes a broad-based group of business and community leaders. For the past 24 years, The Public Education Foundation has worked to bring about
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transformational change in teaching, learning and education leadership. We work collaboratively with other nonprofits, businesses, the Clark County School District, and state and local government. Q: Who benefits from the services that the Foundation provides? A: Students and their families, teachers, principals, and Clark County School
District leadership benefit from our many initiatives. The Foundation’s programs and initiatives, fueled by generous donors, are helping our public education students realize their goals and are better preparing them to succeed in a global economy. If you would like to help the Public Education Foundation, please contact us at (702) 799-1042 or visit us at thepef.org.
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Testosterone Therapy and Heart Attacks Milton Wong, MD FACE
As the average age in our country rises over time, so does the complaint of loss of libido, or sex drive, and erectile dysfunction (ED). While men do suffer a gradual decline in testosterone levels, they do not experience the acute drop in the sex hormone as women do in their 50s. Rather, men have a more gradual decline in testosterone as they age, and so men fathering children well past the age of 50 is not uncommon. Due to the gradual rise in the human life span, there is a call for therapy to address the decline in testosterone. This increasing demand has resulted in the availability of multiple forms of therapy and multiple brands of topical testosterone gels. In recent years, multiple small studies suggest a correlation between the use of testosterone therapy and nonfatal heart attacks. A recent study supported
by the Intramural Research Program of the National Cancer Institute suggests there may be a link between the onset of use of testosterone therapy and the risk of nonfatal heart attack in men. Involving 55,593 men, the study found the risk of having a heart attack more than doubled in the first three months following the start of therapy in men ages 65 or older. The risk of heart attack was also elevated in men younger than 65 if they also had a pre-existing history of heart disease. The data also suggests that the risk of heart attack could decline if older men stopped testosterone therapy after the first 90 days. The mechanism for the observed increased risk is not precisely known, but it is speculated that physiologic changes while on testosterone therapy, such as an increase in red blood cells, a thicker blood viscosity, or a drop in HDL
cholesterol may be involved. It should also be noted that while the study was large and included both older and younger men, it was an observational study. It did not involve a blinded-crossover trial, which is a more rigorous approach. Such a study needs further corroboration with additional studies for a stronger confirmation of its validity. It should also be noted that using the class of drugs known as phosphodiesterase inhibitors, known more commonly as Viagra and Levitra, did not show the increased risk of heart attack. For now, testosterone therapy remains a valid therapy for hypogonadal men. However, more research is needed on the risk of heart attacks and the use of testosterone. A candid discussion between physicians and patients regarding the risks and benefits remains essential before starting therapy. 13
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Tips To Get Moving
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Just because you’re at your desk all day, doesn’t mean you have to sit still! Use these moves to keep active during the work day without even leaving your desk! Exercise 1: Get On Up! Sitting all day is the culprit of weight gain, bad posture, and poor health. The easiest fix? Get up and walk around once an hour! How It Works: Set a timer on your phone or watch to go off every hour. That will remind you to get up and move around, even if it is just for a few minutes! Exercise 2: Raise Them Up Looking for a mostly inconspicuous move to do at your desk? Raising and lowering your legs is harder than it seems! How It Works: Raise one or both legs for 5-10 seconds, then lower without letting them touch the ground. Do this 15 times to keep your leg muscles in shape!
Exercise 3: Lifted Leg Cross Does your cubicle give you enough privacy for slightly more involved maneuvers? This one will help you work your arms and keep your legs flexible. How It Works: While sitting with your legs crossed in your chair, use your arms to lift your body so it hovers above the chair seat. Hold this for 10-20 seconds. Slowly lower yourself on to the chair. Do this two to three times. Exercise 4: Shoulder Roll Hold This move will keep your shoulders back and your posture proper, even if you’re hunched over a computer most of the day. How It Works: Push your shoulders back until you feel your shoulder blades nearly touch. Hold for 5-10 seconds. Repeat 15-20 times. Exercise 5: Swivel Those Hips Do you have a desk
chair that spins? Why not relive the youthful fun of spinning in an office chair while engaging your core at the same time? How It Works: Lift your feet off the ground. Place your hands lightly on your desk. Using only your hips and obliques, twist left and right in chair. Swish back and forth 15 times until you feel the burn! Exercise 6: Toe Raises Your job may not provide you with a treadmill desk, but we’ve got an exercise that will still work your calves. How It Works: When you are waiting for the printer or sitting at the desk, put both feet on the ground and slowly raise yourself on to your toes, then lower. The slower, the better! Repeat 12-15 times. Want more of a challenge? Try one leg at a time!
Always speak with your doctor before starting a new exercise routine.
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Dedicated Doctors: JASMINE PEDROSO, MD is a fellowship trained minimally-invasive surgeon and OB/ GYN provider with an interest in providing quality care to women of all backgrounds. After working for multiple nonprofit organizations in the San Francisco Bay Area, she attended the Harvard School of Public Health where she served as Harvard University Presidential Scholar and received her Masters Degree in Public Health with a focus on Society, Human Development and Health with a concentration in Women, Gender and Health. After working internationally on HIV/AIDS issues with Physicians for Human Rights in Uganda, and several Women’s Rights Organizations in the Philippines, Dr. Pedoso knew she needed to be a doctor. As a first-generation Filipino-American with extensive experience serving urban communities, Dr. Pedroso is especially passionate about increasing access to minimally-invasive surgery for the underserved, both nationally and internationally. Dr. Pedroso will undoubtedly continue to teach and serve, as best she can, the millions of women who still needlessly suffer around the world.
MILTON WONG, MD FACE, a native of Hawaii, earned his B.A. in 1982 and
M.D. in 1986, both from the University of Hawaii. He is the founder of Desert Endocrinology, one of the largest endocrine practices in Nevada, and has helped to set the standard of endocrine care in this community. Dr. Wong is a pioneer in the field of osteoporosis therapy, having been the first to implement DEXA scanning to the Las Vegas valley. Additionally, he has served as the Director of the Nevada Diabetes Center at Valley Hospital. He is a principal investigator for a number of clinical research protocols investigating new endocrine therapies. He has served on both state and national levels of the Board of Directors of American Association of Clinical Endocrinologists (AACE), the nationally-recognized organization for endocrinologists and their patients. Dr. Wong, his wife and two sons have lived in southern Nevada since 1991.
JAY HSU, MD practiced for six years in Wichita, Kansas before relocating to join his family
in Las Vegas. With his skills in cardiology, he also brings an emphasis on preventative care and less-invasive treatment therapies. He is originally from Nebraska, and completed his medical training in California at UC Irvine’s medical school, fulfilling his residency requirements and cardiology fellowship at UCLA Kaiser Permanente Los Angeles. Dr. Hsu had the honor of being Chief Resident in Internal Medicine and Chief Fellow for his Cardiology program, during his medical training. Afterwards, he returned to the Midwest to work at the largest multi-specialty practice in Kansas. While there, he served as the Chairperson of Internal Medicine at St. Teresa Hospital’s Medical Executive Committee. Outside of treating patients, he has additionally taught a Mayo Clinic-derived Communications course for physicians, underscoring his commitment to patient engagement and patient-doctor cooperation in health promotion.
CHRISTINE OKPALA, MD grew up in a small city in northern Nigeria. The huge
deficiencies in the health system sparked the fire that led to her decision to become a physician. She completed her medical degree from St. George’s School of Medicine and her residency completed at the University of Iowa. She is affiliated with American Medical Association, American Association of Gynecologic Laparoscopists, and the American Congress of Obstetricians and Gynecologists. She goes above and beyond to ensure that she is doing what is best for her patients, utilizing all available resources to provide the best evidence-based care. Dr. Okpala feels privileged that women trust her with the most intimate details about themselves and she does not take this for granted. She enjoys working with patients from diverse backgrounds. In her spare time, she loves to travel, eat out, watch movies and spend time with her family.
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YOU ONLY FAIL WHEN YOU STOP TRYING. 19
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The Public Education Foundation
Young Minds Matter ThePEF.org
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