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Happy 2019!  As we run, walk, or maybe even crawl into the New Year, we often begin with a desire, if not a definitive plan to make lifestyle improvements.  Once and for all, we’re going to tackle that cluttered home, lose those extra pounds, or find the career where we’ll truly find fulfillment.  Despite our good intentions, we may quickly find ourselves overwhelmed and frustrated as we set lofty and often unrealistic goals.  Without a thorough assessment of our needs, wants, and resources, we can often fail to achieve our intended lifestyle improvements.  The New Year offers an excellent opportunity for a fresh start and a reexamination of our goals and choices.  As we begin 2019, I encourage you to look at your life with a critical eye and decide what you need to, want to, and are willing to try to work to improve.  Here are 19 suggestions for 2019 that can help.  Through these, you can improve your chances of lifestyle balance, goal achievement and of living the life you want and deserve.

1) Spend some time alone.  Get to know yourself without the influence of others.  You might find you like your own company.

2) Learn and practice Mindfulness.  Work on being in the present rather than allowing yourself to dwell in the past or anticipate the future.

3) Set boundaries with others, be they family, friends or coworkers.  Do not accept disrespect.

4) Allow others to help you.  They’ll feel good and you may get some much needed relief.

5) Get up and move!  Take the stairs, go for a brisk walk, do some jumping jacks, practice yoga, ride your bike.  Find a way to move your body.  Simply moving briskly 20 minutes each day can help decrease anxiety, depression and relieve stress.

6) Don’t be so hard on yourself if you don’t accomplish everything you planned each day.  No one does.  Work on small, realistic, attainable daily goals.  Small achievements reinforce us, leading us to want to strive for more.

7) Help someone else.  You’ll feel good and they may get some much needed relief.

8) Surround yourself with supportive and loving people.  Make good choices about with whom you choose to share your world.

9) Work on clearing away physical clutter.  You’ll be amazed at how this can lead to increased productivity and decreased anxiety.

10) Decide what changes will make you the happiest in the coming year.  Prioritize those.

11) Give yourself a time out.  When you feel overwhelmed, take 10 minutes alone to regroup.  Close your eyes and breathe.

12) Stop comparing your life, body, career, children, house, relationship, etc., to others.  You are a unique individual and deserve to be treated as such.

13) Look for opportunities to enhance parts of your life you never considered.  Read more.  Learn an instrument.  Take a break from social media.  Volunteer.

14) Share your intentions to improve your life with someone.  You’re more likely to achieve goals when you tell someone else.

15) Take risks but don’t be careless.

16) Let go of regret and grudges.  These simply expend energy unnecessarily and increase stress.

17) Have high expectations of others, both personally and professionally.

18) Be honest about your present circumstances.  If you’re feeling anxious and depressed, seek help.

19) Finally, as the great Maya Angelou said, “My mission in life is not merely to survive, but to thrive; and to do so with some passion, some compassion, some humor and some style.”  Let’s all seek to do the same in the New Year.

Best wishes for a wonderful 2019!



We all know that winter time can be joyful and cozy. However, this time of year can also be accompanied by frequent illnesses, extra stress, and overindulgences. To protect yourself this holiday season, we recommend the following:

1)  Wash your hands!!! Yes, it seems obvious, but it’s all too easy to forget. This simple action, when done right, can protect you against many respiratory and diarrheal infections. Wet your hands under running water, lather up with soap, and scrub your hands (including the backs, under nails, and between your fingers) for at least 20 seconds, or for the length of time that it takes you to hum/sing the “Happy Birthday” song twice. Wash your hands before and after you handle food, before eating, before and after you care for a sick individual, after using the bathroom or changing a diaper, after blowing your nose/coughing/sneezing, after touching garbage, and after handling pets/pet food/pet waste. If you are interested in the science behind handwashing, please check out the CDC’s website here: https://www.cdc.gov/handwashing/show-me-the-science-handwashing.html

2)  Get your flu shot. The science behind the flu shot is robust. Getting your yearly vaccination can help avoid flu-related hospitalizations, illnesses, and transmitting the flu to others who are unable to obtain the vaccine (infants under 6 months or those with severe, life-threatening reactions to the flu vaccine).

3)  Aim for a regular sleep schedule, and if possible for 7-8 hours of sleep every night.

4)  Stay well hydrated- ideally (unless you have other significant medical conditions such as heart failure) aiming for about 6-8 glasses of water a day.

5)  Make sure you are aiming for those 4-5 fruits and vegetables a day, even during special occasions. If you overindulge, don’t beat yourself up, but aim for healthier, well balanced meal options in general.

6)  Be cautious with alcohol intake. We recommend no more than 7 drinks per week in women, and specifically no more than 2-3 drinks per day.

7)  Avoid contact with individuals that are sick to the best of your ability, and as above- make sure you wash your hands frequently to avoid spreading germs.

8)  Take time out for yourself to decompress; this may mean yoga, meditation, therapy, reading a good book, watching your favorite TV show, exercising, etc. Self-care and mindfulness is important.



‘Tis the season for lots of cookies, cakes, creamy drinks, hearty meals and overall indulgence!  This is the time of year when you are faced with more temptation than ever. Let’s take a few moments to think about how you can maintain your health while still enjoying the season:

1. Remember that balance is everything! 
Follow the 80/20 rule. This means that 80% of the time you will eat as healthily as usual and 20% of the time you will let yourself enjoy a treat without guilt. Here is some math: There are 40 days and 120 meals between Thanksgiving and New Years. If you follow the 80/20 rule you can have a treat at 24 of those meals. Choose wisely and consider tracking on your calendar. You may find that you can’t resist indulging at one event but you have no problem at another. Skip the donuts and leftover pies at work and save your 24 for a dinner or a party!

2. “Indulge” with these healthy but tasty treats:
A) Dip your vegetables in something creamy…. Make a savory dip with plain Greek yogurt!  For a thicker consistency, strain the yogurt overnight over a cheesecloth to remove liquid, then mix the thickened yogurt with your favorite savory seasoning and top with fresh chives or scallions. (Tip: you can use Greek yogurt as a substitute for many recipes that call for cream or sour cream).

B) Fill your house with the warm smell of baked apples and cinnamon: Slice apples in half or in to bite sized pieces. Coat with a small amount of coconut oil and cinnamon to taste. Optional: Sprinkle with almond slivers. Bake in the oven at 350F 20-30 minutes.

C) Try making “cookie dough” balls with chickpeas! Blend together chickpeas, nut butter and a small amount of honey. Your goal is a cookie dough consistency. Toss in some chocolate chips and roll the “dough” in to bite sized balls. You can eat this raw or you can bake it to get the melted chocolate effect!

3. Ask yourself, is this making me healthy? Is it making me happy?
If the answer is neither, why are you eating it? When was the last time somebody offered you a cookie and you took one bite and thought “this isn’t very good” but kept eating it anyway? This season challenge yourself to put the not-so-tasty cookie down! Save your 24 for something worthwhile!

4. Choose this not that:
A) Choose an apple crumble instead of an apple pie
B) Choose grilled, braised or roasted instead of stuffed, smothered, or rich
C) Instead of randomly grazing at a party, choose one item you can’t resist and then fill the rest of your plate with protein and produce



A game-changing new treatment is giving women back control of their bodies as well as their sexual desire.

What would say if we told you there was a shot which you could get directly into your clitoris, which would increase your sexual desire, give you mind-blowing orgasms and even treat urinal incontinence… and all of this could be achieved on your lunch break with zero downtime? You’d probably believe us more readily if we told you we’d commuted to work this morning on a purple unicorn. But the truth is that this procedure, known as the O-Shot, does exist and is about to become mainstream. In fact, you may have already heard of it in another guise – the vampire facial (made famous by Kim Kardashian, if you happened to catch that particular episode of Kim and Kourtney Take Miami). The vampire facial is the brainchild of Dr Charles Runels, who saw that PRP (Plasma Rich Platelets) medical technology was revolutionising medicine by helping to heal musculoskeletal injuries, and that it could also be applied to the the face to encourage skin rejuvenation.

As part of the treatment, a blood sample is taken from the patient and using a centrifuge, platelet rich plasma (PRP) is isolated. This PRP’s is full of growth factors, which are injected into the affected area to activate stem cells the stem cells there. In 2010, it struck Dr Runels that this technology could be used not only in facials, but in another unlikely way. “One day a patient of mine was undergoing a facial, and asked if this procedure could, in theory, be used on her vagina. And of course I said that it could, so the idea for the O-Shot was born from this.”

Little Understanding

Patients come to Dr Runels seeking the O shot for a myriad of reasons, from female sexual disorder (difficulty getting aroused) and female orgasmic disorder (difficulty climaxing) both of which statistics* say that one in 20 women suffer from, to hypoactive sexual desire disorder (low desire), which around 10 per cent of women suffer from. There are also physical reasons such as urinal incontinence and dyspareunia (pain during sex), both of which can be caused by child birth, menopause, or just as part of the natural ageing process. Sadly research shows that only 14 per cent of women ever talk to their doctor about sex, even though approximately 48 per cent of women are concerned about their sexual function. “Part of the reason that doctors and patients don’t really get into discussions about these kinds of disorders is that there isn’t really a proven solution, other than hormone therapies, or psychotherapy, which may not be what the woman even needs,” says Dr Runels. “Whereas on the other hand men have drugs available to them such as Viagra.” Another problem which women have revealed to him is that they don’t get much sympathy from their partner or friends, in a similar way to if she were suffering from a psychological disorder. “If a woman has pneumonia or breaks her arm, sympathy is given in abundance, but a woman with depression or severe anxiety, can be slower to share her problems and friends can be even slower to understand,” says Dr Runels. “It’s the same with a sexual disorder.”

Feeling Good

Loss of sexual function can cause a downward spiral for women.“When a women has a positive sexual experience, she is more likely to initiate sex,” says Dr Runels. “If a woman has a negative experience – difficulty with arousal or pain – it’s more difficult for her to get aroused the next time. Her responses become less powerful, so it’s a vicious downward spiral. However after the shot, she has a positive experience, so there’s a positive spiral upwards. The effect is twofold – physical and psychological – because in addition to the tissue becoming healthier, she is also more open to future encounters.” The first O-Shot goes into the patient’s clitoris, and for those of you who didn’t get the anatomy class in school it’s worth noting that most of the clitoris is inside a woman’s body, the part that is visible is actually only the tip. When the O-Shot is injected the whole clitoris can be stimulated rather than just the tip because the nerves become more responsive. This is also how it helps with urinal incontinence because the same nerves help to control the urge to urinate, so women are better able to feel and control the musculature there. The second shot goes into the skene’s glands in the vagina, which is similar to the prostate gland in a man. After the O-Shot some women even become ejaculatory for the first time in their lives when they orgasm.

Sexual energy is a very big part of the creative process – it energises us whether that’s in the bedroom or the boardroom.

Release the Energy

According to Dr Runels, the majority of his patients have tried all the conventional methods of improving the quality of their sex lives, from sex therapy and sex aids to self-help books, and he acknowledges that while getting to know your body better is always a good thing, there is little point if your body is not working effectively because of hormonal changes or after a procedure like an episiotomy. “I compare this to being told to read a book on how to drive a car when your engine has broken down,” says Dr Runels. “I had a patient in her twenties who delivered a large baby, and had to have an episiotomy. She hadn’t been able to have sex with her husband since because she was in so much pain, and it was really affecting their once very loving, attentive relationship.” The fact that Dr Runels can offer women an option means women begin to feel they are taking back control of their bodies and their sex lives, and this is hugely transformative. “I can see that they feel like they are getting their spark back. The ancient Chinese believed that we could transmute sexual energy into genius and creativity, and without it people become like a castrated animal. I am a big believer that sexual energy is a very big part of the creative process, and it energises us whether that’s in the bedroom or the boardroom. Even women who do not have a partner and do not want a partner, but may just want to have sexual experiences alone benefit from this resurgence in sexual energy.”

Coming Soon

On this side of the Atlantic, currently Dr Sherif Elwakil, is the only doctor offering the treatment in Europe at his cosmetic clinics in Harley Street and Baker Street, London (Royalskinclinic.com). “I have patients who come specifically for this treatment from all over Europe and I expected it to be successful, but I had no idea it would be this successful. So far I’ve had four patients come to me from Ireland, who have even come to me in the morning and flown home that evening.” But why is this treatment not available more widely if it’s going to revolutionise how we treat sexual disorders for women? “I think old-school medical practitioners in Europe are slow to get on board with new treatments like this from the States. But the feedback is so good that more and more people will begin asking for it. I think women’s sexuality has been underestimated for too long. I have actually trained with Charles Runels in the US in how to teach other doctors how to administer this treatment and I’m going to start holding training sessions around Europe from January, so I expect next year that this treatment will really take off.”

What to Expect

There will be a nurse present with the doctor throughout the procedure, which takes about 35 to 40 minutes in all and will set you back £1,000. First the doctor or nurse applies a numbing cream to the vagina and the arm. Blood is drawn from the arm in the same was as with any blood test. While the PRP is being prepared, which takes about ten minutes, the doctor can talk to you and answer any last minute questions you might have. Then, using a very thin needle, the PRP is injected the clitoris and into the upper vagina into an area most important for the sexual response. Because these areas have been numbed with the anesthetic cream, you feel little or no pain and the actual injections themselves takes no more than five minutes. “The best this about this treatment is that you’re using the growth factors you have in your own body to stimulate vaginal and clitoral rejuvenation, so it’s a completely natural treatment, with no downtime afterwards,” says Dr Elwakil. “Some of my patients have even had sexual intercourse the same day after treatment.”

It Doesn’t End There

When it comes to PRP medical technology both Dr Runels and Dr Elwakil emphasise that we are only seeing the tip of the iceberg as regards its potential. “Stem cell research is in its infancy, which is why a lot of the money I make from the O-Shot I put back into research for its other potential uses,” says Dr Runels. “Imagine a keychain which holds the key to every room in the body – bone, hair, collagen – this keychain is the PRP and science hasn’t unlocked this stem cell technology fully yet. There are many doors still to be opened.” Another condition which has responded well to treatment with PRP has been lichen sclerosus, which is a long-term skin condition which can affect the genital and anal areas. “I am currently talking to the Lichen Sclerosus and Vulval Health, Association here in the UK,” says Dr Elwakil. “I have personally injected five patients with lichen sclerosus who have reported that it has improved the condition. I have also had patients come to me, who haven’t lost sexual function and don’t suffer from



Hormonal contraceptives offer women of all age’s protection against unintended pregnancies through suppression of ovulation, thinning of the uterine endometrium, and/or inhibition of sperm motility and decreased sperm dispersion through the cervical canal and into the ovum. Many reliable, effective, and safe contraceptives are available for women, including long-acting reversible contraception (LARC) for women who are not candidates for estrogen-containing birth control or who prefer continuous protection for extended intervals.

Hormonal IUCs release progestin, a synthetic version of the hormone progesterone. The levonorgestrel impregnated IUC releases progestin into the uterine cavity, thickening cervical mucous, and causing thinning of the lining of the endometrium. There are four approved devices in the U.S., to include the Mirena, Kyleena, Skyla and Liletta. These are small, plastic, T-shaped contraceptives, that are placed inside the uterus and prevent pregnancy more than 99% of the time. The progestin IUCs start working about seven days after insertion and may be left in place, depending on the type, from three to seven years. All are inserted by a trained healthcare professional and can easily be removed at any time. At RWWC, we currently have both the Liletta and the Kyleena.

Liletta slowly releases 52 mg of a progestin hormone called levonorgestrel. This is the same kind of hormone that is often used in birth control pills. Only a small amount of levonorgestrel enters your bloodstream. Neither the Liletta nor the Kyleena contain estrogen. Approved for use in the U.S. in 2015, it measures 32 mm x 32 mm. Kyleena, approved in 2016, contains 19.5 mg of levonorgestrel and measures 28 mm x 30 mm. It works the same way as the other progestin containing IUCs, slowly releasing levonorgestrel over time. Both are effective against unintended pregnancies for up to five years.

The Copper-T 380A IUD (intrauterine device) was introduced into the United States in the late 1980’s. It is a small, (36mm vertically x 32mm horizontally) plastic “T” shaped contraceptive placed in the uterus by a trained health care professional. The approved duration for use of the Copper IUC is twelve years. Otherwise known by the brand name Paragard, this IUC is the only nonhormonal IUC approved for use in the U.S. Paragard does not contain hormones, instead using the copper that surrounds it to halt sperm from getting to the egg as well as possibly creating an immune response within the reproductive tract that interferes with fertility before an egg reaches the uterus. IUCs prevent fertilization but are not abortifacients, which had been a common myth. The Paragard IUC works as soon as it is placed inside the uterus and can be used for emergency contraception if inserted within five days after unprotected intercourse. The Paragard is easily removed whenever you want and is safe to use while breastfeeding. Common side effects after placement include heavier periods and cramping for several months, both alleviated with over the counter non-steroidal anti-inflammatories (NSAIDs) like ibuprofen. We do offer the Paragard IUC at RWWC.

Hormonal contraception also offers many health benefits besides prevention of an unintended pregnancy. The hormonal intrauterine contraceptive (IUC) may reduce the risk of some cancers, including cancer of the endometrium (the lining of the uterus), cervical, ovarian, and even colon cancer. Many women benefit from menstrual regulation and decreased cramping, while others have a lighter period-or no period at all. Both the hormonal and non-hormonal IUCs are over 99 percent effective, cost-effective, long-lasting, and decrease the possibility of user error that comes with taking a pill every day or using condoms.

There are a few risks involved with the IUCs, as well as contraindications, that should be discussed with your healthcare provider prior to insertion. Please schedule a consult beforehand, if you have not already discussed the appropriateness of IUCs at your annual gynecologic visit. Problems can be managed, and most women are happy with their choice. Continuation rates for intrauterine contraceptives are generally higher vs. other forms of contraception for women.­

We also offer Nexplanon. The Nexplanon is considered a contraceptive implant – it is a very small rod inserted under the skin of a woman’s upper arm to provide birth control. It’s invisible and prevents pregnancy for up to 4 years.



If you don’t have endometriosis, you’ve probably heard of it – it affects about one in ten women of reproductive age. Although the condition’s two main symptoms are pelvic pain and infertility, both are treatable, and women with endometriosis often go on to have healthy pregnancies.

If you are having pelvic pain or trouble getting pregnant then you should schedule an appointment with your practitioner and we can refer you, if necessary, to a specialist.

What is endometriosis?

Endometriosis is a condition where cells from the endometrial lining implant and grow outside of the uterus (including on the ovaries, the pelvic cavity and the fallopian tubes), causing inflammation and scar tissue that can lead to pelvic pain and infertility.

What are the causes of endometriosis?

There are several potential causes, including:

  • Retrograde menstruation: During menstruation, while most of the blood and tissue flows out of the vagina, a small amount of blood and tissue travels up backwards through the uterus and fallopian tubes and into the pelvic cavity. In most women, the immune system gets rid of that blood and tissue. By contrast, the immune system of women with endometriosis is unable to fully eliminate the backflow. Therefore, tissue from the uterine cavity is able to stick to and invade areas outside of the uterus. This is the most common cause of endometriosis.
  • Blood or lymphatic system spread: endometrial cells can spread to other parts of the body (the pelvic cavity in particular) through blood.
  • Coelomic Metaplasia: in this case, cells in other parts of the body unrelated to the uterus turn into endometrial cells.

What are the symptoms?

Pelvic masses, pelvic pain and infertility are the main symptoms of endometriosis. All of them can be treated, but not necessarily at the same time. In some cases, women with endometriosis have no symptoms at all and are diagnosed only after they seek a reproductive endocrinologist’s help in getting pregnant.

How is the condition diagnosed?

While checking for symptoms and performing a physical exam is an important first step, the only real way to diagnose endometriosis is through a biopsy obtained during surgery. There is no blood test for endometriosis.

How is endometriosis treated?

When treating endometriosis, it is important to first identify whether a patient is mainly concerned with addressing her pain or treating infertility. It is not always possible to simultaneously relieve a patient’s pain and also help her to become pregnant. If a woman is not looking to conceive and just wants to alleviate her pain, over the counter pain killers like Advil or Motrin, as well as hormonal treatments like birth control pills or the Mirena IUD, can help.

Patients whose main concern is pregnancy will likely require treatment with fertility medications and either artificial insemination or in vitro fertilization (IVF). IVF is the most effective treatment for infertility in patients with endometriosis because it bypasses pelvic scar tissue and enables the sperm and egg to meet in a controlled environment. However, even in IVF, women with endometriosis have slightly lower pregnancy rates than other individuals with infertility.

So I can get pregnant if I have endometriosis?

Yes, you read that right! You might need a little help through IVF, but you can get pregnant.



Even though I am a city girl at heart, I have to admit there are some good things about living in the country.  I grew up in the suburbs (my parents hated the city) and once I went to college in the city, I never left.  The biggest thing I miss is sitting outside in the summer, staring up at the sky and listening to the sounds of nature.  But this isn’t about me – so I would like to present the pros and cons of city vs suburban living.

City life provides more options for anything you need at a moment’s notice. This can be a great thing, unless you have a hard time making decisions.  The city offers multiple choices for essential things like different health systems as well as less important things that only seem essential like coffee shops.  Sometimes finding alternative foods when you have food allergies/sensitivities may be more cumbersome in the country – while it is easier to find local produce in the country. However you may be lucky enough to have access to an open market in the city where you can get locally grown products.

The landscape of where you live does not discriminate on the types of sicknesses you can catch. Believe it or not, you can still get Lyme disease in a city.  On the other hand, if you need medication or help from a neighbor, these things are more accessible in the city.  Frequently there are fewer choices for medical specialists in the country and patients may need to travel further to get better care.  Equally you can spend a lot of time in a car travelling from one point of the city to another or from one town to the next.  Pick your poison.

Typically the city offers more resources in every category – whether you are considering a psychotherapist, yoga studio or the best French bakery.  Often times the hours are more flexible/longer in a city which makes it more accommodating for working people.  But sometimes, because people are more likely to know each other better in the country, people may be more likely to be to help out.  Have you ever tried stopping someone in the city to ask for help or ask a question?

One big advantage to living in the country would be larger living spaces and more green space.  This allows for kids, adults, pets and dogs to roam around.  Generally the trend is that you get more bang for your buck when it comes to housing.  The space that the country provides creates a lot of possibilities for your property, like a pool! Who doesn’t love that in the summer?

There are more employment options in the city, but often times the employer is more likely to be larger in size which has its own set of pros and cons.  On the flip side, sometimes in a smaller entity, it may be easier to communicate and achieve your task.  You can get lost in a large group, but smaller employment groups may be stifling.

The city comes with a lot of action. Entertainment, culture and groundbreaking events are more likely to occur in the city.  For someone that does not like crowds, traffic or noise, the city may not be for them.  Violence tends to be more prominent in cities. Some upkeep is questionable –  having tripped and fractured my elbow three years ago, I would always be aware of uneven payments when walking around on any side walk, especially in Philadelphia.

With more cars, buses and trucks come more pollution.  When it is windy/cold the city may be a few degrees warmer and less likely to have roads covered in snow.  Smaller city streets make it harder to clear away snow when there is a large accumulation.  Parking can be a challenge in the city.  City dwellers do tend to walk a lot in comparison to people living in the county, but at times whether it is for work or a consequence of where someone is living, people in the country may need to walk more to get somewhere on their property or to get to work if they do not own a car.

It is difficult deciding where to live when you are just taking yourself into consideration and the variables grow exponentially when making the right decision for a spouse or family.  There are a lot of things to consider when choosing where to call home. Some are lucky enough to live close to the comforts of a city with the positive attributes of residing in the country.  The best option is what fits best for the individual or family.



It’s summer, the weather is (mostly) beautiful, but you’re too tired or stressed out to enjoy it. Sound familiar? Fatigue that is unremitting, mood swings or depressed/anxious mood, changes in appetite, and feelings of detachment can all be signs that you are working too hard, and on the pathway to burnout. Other symptoms can include memory and concentration impairment, dizziness, frequent illnesses (or an illness that persists), palpitations, headaches, chest pain, gastrointestinal distress, labile/angry mood, and lack of productivity/motivation. If you have the above symptoms, it is important to get checked out by your medical provider, but you may also need to reconsider whether or not you are overburdened by demands of work and home.
Why does this matter? Long term stress and burnout (which is now recognized as a medical condition) can put you at risk of increased health problems, such as obesity or malnutrition, anxiety, depression, heart disease, chronic insomnia, and digestive problems, to name a few! Burnout is not just due to working too hard or too many hours. It can happen when the demands of your job/day overwhelm your body’s capacity to handle stress.

Why does this happen? When your body initially encounters a stressful event, your senses send signals to a part of your brain called the amygdala, which plays a role in processing of memory, emotions, and decision making. A condition called “amygdala hijack” can occur in times of increased stress, where your amygdala is constantly activated rather than calmed by your prefrontal cortex, causing a cascade of biochemical triggers that lead to the release of stress hormones cortisol and adrenaline (fight or flight response). Instead of your body regulating its response to stress, it learns to exist in a hyper stressful state, putting your overall health at risk. In studies, individuals who identified as burned out were noted to have enlarged amygdalae, demonstrating that chronic stress leaves a mark on your brain and can restructure how you cognitively function.

Can this be reversed? Early evidence suggests yes, but the best treatment is always prevention. Make sure you try to take time out for yourself whenever possible- whether it is healthy habits such as yoga, cardiovascular exercise, meditation, and eating fresh fruits/vegetables. If you cannot reduce your work hours, mitigating your stress at work and concentrating on the parts of your job that bring you pleasure (or looking for a new job) can be helpful. Speaking to a therapist, or to a career coach can also be ways you take time out for yourself and recharge. Aiming for a regular routine or sleep pattern nightly can be helpful, and exercise/meditation/decreased caffeine intake can support this as well.

We look forward to supporting you on your journey to health, and encourage you to talk to your provider more at your next visit about ways to reduce burnout.


21/Aug/2018

When it comes to female infertility, one of the most common causes is polycystic ovary syndrome (PCOS), which can prevent women from ovulating. The good news is that there are ways to spur ovulation in women with PCOS, and achieve a healthy pregnancy and baby.

Dr. Jackie Gutmann, a reproductive endocrinologist at Reproductive Medicine Associates of Philadelphia and Central Pennsylvania, see patients with PCOS and helps them start their families. She answered some of our questions about PCOS.

What is PCOS?
Reproductive hormones are abnormally regulated in women with PCOS. In a perfect world, the hypothalamus, pituitary gland and ovaries all work together each month to grow follicles, stimulate one of them and release one egg from that stimulated follicle. In women with PCOS, several follicles are stimulated but none mature enough to ovulate, so there is no release of an egg and no chance to get pregnant.

Why do some women get PCOS and others don’t?
We know genetics play a large role in who develops PCOS – first degree relatives of women with PCOS (mothers and sisters) have up to a 30-50 percent chance of developing the condition. There are also others theories about the cause of PCOS, such as the effect of the in-utero environment on the risk of developing PCOS later in life.

What are the symptoms of PCOS?

  • Irregular periods or a loss of menstruation entirely
  • Acne and abnormal hair growth (on the face, chest, or abdomen)
  • Obesity, difficulty losing or maintaining weight, and type 2 diabetes
  • Infertility
  • Anxiety, depression and eating disorders

How is PCOS diagnosed?

Because irregular cycles are a common symptom of PCOS, a doctor will ask about a woman’s menstrual cycle history and look for symptoms like acne, hair growth or difficulty losing weight. During a physical exam, the woman’s vital signs, including height, weight and a calculation of Body Mass Index (BMI) are important to determine. A transvaginal ultrasound will help doctors see whether the patient has ovarian features of PCOS. Then, the doctor will take blood tests to examine her levels of FSH, LH, estrogen, testosterone, AMH and to screen for insulin resistance.

How is PCOS treated in women who want to conceive?

The first line of treatment for women with PCOS is lifestyle modification. Modest weight loss and increase in lean muscle mass can have huge impacts on the abnormal hormone regulation seen in women with PCOS. For many women trying to conceive, medications are needed. The goal of treatment is to correct ovulation. A woman may be prescribed Clomid, an ovulation inducing medication that indirectly promotes the production of FSH and the growth and release of a mature egg. Another medication commonly used to induce ovulation in women with PCOS is Letrozole. After ovulation is induced with Clomid or Letrozole, the doctor may recommend timed intercourse or intrauterine insemination (IUI). In vitro fertilization (IVF) is another excellent treatment for women with PCOS and has superior success rates.


26/Jul/2018

Breastfeeding has many benefits to both mother and child, benefits that have been well studied and consistently shown for decades. Babies who are breastfed have lower rates of respiratory illnesses, gastrointestinal and ear infections, as well as lower rates of allergies, SIDS, diabetes and many other illnesses that can impact their life-long health. Breastfeeding mothers also experience health benefits, from decreased postpartum bleeding and depression to long term decreases in diabetes and breast cancer.

While infant formula has been improved over the years and offers an alternative for women who are unable or choose not to breastfeed, even in the best circumstances it has disadvantages. Formula is expensive and can cost families several thousand dollars a year in direct costs. Increased illnesses in formula fed babies also result in higher healthcare costs and loss of wages for parents who have to miss work to take care of their child. By increasing breastfeeding to optimal rates in the US, up to $13 billion a year could be saved on these indirect costs, according to analyses by the U.S. Department of Agriculture, Food Assistance and Nutrition Research. As a result of the importance of health and economic benefits, the American Academy of Pediatrics urges that breastfeeding be viewed as “a public health issue and not only a lifestyle choice”.

The impact of formula feeding on poor and developing countries can be even more profound than what is seen in the United States. Many women in these countries are malnourished and falsely believe they would be unable to produce milk with adequate nutrition for their children. Aggressive marketing by the formula industry, a multi-billion dollar industry, often focuses on poor areas and promotes this and other inaccurate information about the benefits of formula. This misinformation can be particularly dangerous as many of these women do not have access to clean water to mix with the formula, resulting in higher rates of water-borne illnesses in these areas. Due to the high cost, many women end up diluting the formula to extend its use, which also results in higher rates of illness and even death. A 2016 series in The Lancet journal estimated that worldwide 800,000 formula-fed infants a year could be saved by breastfeeding, mostly due to reducing rates of diarrhea, respiratory infections and malnutrition from formula dilution.

In 1981, the World Health Organization voted 118 to 1 adopt a non-binding resolution promoting the dissemination of accurate information on breastfeeding worldwide, as well as restrictions on inaccurate formula advertising and direct marketing and kickbacks to health providers. 130 countries have adopted the ban on the promotion of formula, and in countries where these laws are enforced, such as Brazil, the rates of breastfeeding are typically higher than those that do not. During the World Health Assembly (WHA) each year, this resolution has been reaffirmed and in 2016, the United States, under Obama, supported strengthening the resolution. Despite these efforts, in the past year alone, more than 800 violations of these practices have been noted by formula companies around the world. Funding for formula industry lobbyists has also remained high, with one company, Abbott Pharmaceuticals (makers of Similac and other formulas), spending more than $790,000 on lobbying efforts, including contributions to President Trump’s inauguration ceremonies. In the most recent WHA, our president sided with the formula industry in trying to oppose the existing regulations that would limit the negative effects of inaccurate formula advertising and direct marketing to healthcare providers. The US administration went as far as threatening the US contribution to funding for WHO to oppose this resolution.

Whether or not to breastfeed is a decision that each woman needs to make for herself and her family. Providing accurate information on options, as well as support for the challenges that new mothers will experience is the best way to optimize the health of future generations.


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