Multiples, the journey begins….

Avolonne Kimble, MDAs a, wife, parent of twin girls AND twin boys and a pediatrician, my perspective of pregnancy, life as a working mother and plans for the future may be a little skewed. I see everything in two’s. Being pregnant and having a baby is a joy and it can also be scary. Being told that you’re having more than one can be even scarier, especially if you have just a little bit of knowledge.

Multiples occur in 3% of all pregnancies with twins being the most common. When carrying two babies the risk of maternal complications rise and prematurity is more prevalent. Higher order multiples occur in much smaller numbers and with even more possibility of complicated pregnancies, risk of prematurity and less chance of survival. In my case, as a pediatrician working full time, co-owner in private practice, considering pregnancy is a very serious one and then to be told that you were having multiples brings in a very different element.

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Colonoscopy Facts

What is colonoscopy? Do I have to get one? How often? Why do I need one? What is the goal of that test?

These are questions that one asks as they visit their physician for their annual exam. A colonoscopy is a test that where the physician looks with a magnifying camera at the inner lining of a person’s large intestine. Sample biopsies may be done at the time of the test. The colonoscopy test is typically performed for colon and rectal cancer screening, but the physician may order it for other reasons as well, which include: blood in the stool, abnormal test results from another colon test, family history of colon cancer, anemia unexplained otherwise. The stated are some indications for colonoscopy, but it is not an inclusive list.

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August is National Immunization Awareness Month

Selwyn Rogers, Chief Medical OfficerIt was a typical Tuesday in my former job as chair of surgery at Temple University in Philadelphia, but that morning I felt sluggish. Although I wasn’t feeling well, I knew I had three surgical operations to perform that morning followed by an afternoon full of meetings.

I trudged out of my apartment and started the 15-minute drive to work.

A few miles into my commute, a feeling of illness suddenly enveloped me. I had to pull over and call my chief resident to cancel the morning’s surgeries.

I turned the car around and headed back home to bed. The next three days were a blur of sore throat and fever; it was the first time I’d had the flu, and I swore that I would never endure that experience again.
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You’re more like your mother than you know

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

While the benefits of breast feeding have been well-documented, scientists were surprised to learn of another one: breast milk contains a mother’s stem cells that become a part of different organs of the baby’s body.

Breast feeding protects infants against infections early in life and reduces their risk of juvenile diabetes, heart disease and cancer as children. It also helps mothers lose weight after giving birth and lowers their risk of osteoporosis and uterine and ovarian cancer.

In addition, seven years ago scientists discovered the presence of mammary stem cells in breast milk. The mammary gland is unique in its ability to go through different stages in anticipation of producing milk, then a period of milk secretion followed by a return to the non-lactating state. All of this can occur as many times as necessary. This massive restructuring of the breast suggested the presence of stem cells. Continue reading

Cigars are no better than cigarettes

Drs. Norbert Herzog & David Niesel

Drs. Norbert Herzog & David Niesel

Medical Discovery News

A common argument made by those who smoke cigars is that they are safer than cigarettes. However, several studies argue that this is not true.

Cigar smoking has increased dramatically in the U.S. Between 2000 and 2011, small cigar sales rose 65 percent and large cigar sales increased 233 percent. Americans smoked more than 13 million cigars in 2010, twice the number from 2000. About 13.4 million people age 12 or older smoke cigars. A cigar culture has arisen, with cigar bars or clubs, shops with walk-in humidors and magazines for those who consider themselves cigar connoisseurs. Their use among sports figures and celebrities has made it seem fashionable or sophisticated, a symbol of status or success.

The tobacco in cigars is cured and fermented to enhance the flavor, but this process also increases the amounts of harmful ingredients. Cigars come in three basic sizes, but the classic cigars are the large ones that contain more than half an ounce of tobacco, and some contain as much as an entire pack of cigarettes.

Just like cigarettes, cigars contain nicotine and can be very addictive. Most people who smoke cigars do not inhale, and therefore the nicotine is absorbed more slowly. However, cigar smoke dissolves more easily in saliva than cigarette smoke, enhancing the amount of nicotine absorbed. Smokers absorb one to two milligrams of nicotine out of the eight total milligrams in cigarettes. The large cigars contain anywhere from 100 to over 400 milligrams of nicotine, and the amount a person absorbs varies greatly depending on how long the cigar is smoked, how many puffs are taken, and how much smoke is inhaled. Second- and third-hand cigar smoke is dangerous, just like it is with cigarettes.

In one study, scientists measured the levels of two biomarkers for tobacco as well as arsenic and lead in over 25,000 cigar smokers. Cigar smokers had higher levels of these carcinogens than nonsmokers and equal levels to cigarette smokers. Overall, the study found that cigars are not safer than cigarettes. Cigar smokers are less likely to develop lung cancer than cigarette smokers, but they are at higher risks of developing other cancers.

Those who inhale while smoking cigars are more likely to develop laryngeal cancer, lung cancer, bladder cancer, pancreatic cancer and cancers of the tongue, mouth or throat than nonsmokers. Even those who don’t inhale the smoke directly still inhale the secondhand smoke and are at an increased risk of lung cancer. Cigar smokers are four to 10 times more likely to die from cancers of the mouth, larynx and esophagus than nonsmokers.

Cigar smoking also increases the risk of other diseases including emphysema, chronic bronchitis, heart attacks, gum disease and erectile dysfunction. One long-term study determined that cigar or pipe smoking costs people 10 years on average — they spent an extra five years in bad health and died five years earlier.

So before you take up cigars in an attempt to look cool, ask yourself if your image is more important than your health.

Professors Norbert Herzog and David Niesel are biomedical scientists at the University of Texas Medical Branch. Learn more at

Discussing sexuality for seniors

Dr. Tristi Muir

Dr. Tristi Muir

Despite the media and entertainment industries’ constant emphasis and exploitation of sexuality in the youth culture to sell products, services, films, and so forth, the mention of sexuality in aging persons remains a somewhat awkward and infrequently discussed topic.

There may be a number of reasons for this. Maybe good judgment, a more proper sense of decorum, and a natural modesty develop as we age — in some people at least. Maturity also brings with it a sense of perspective of deeper values in life that the raging hormones of youth do not have time for nor even fathom.

Dr. Victor Sierpina

Dr. Victor Sierpina

A recent research study of more than 1,700 seniors in the Netherlands, average age of 71, found that an active love life in older people was associated with improved cognitive function. Those who rated sexuality as “important” or “very important” had higher cognitive and memory scores than those who did not think sexuality was an important component of their lives. Perhaps the group more active sexually had better blood flow to their two most important sex organs- the brain and genitals. Cause and effect were not established by this study though it was an intriguing finding.

Physical capacity for sex changes as we age. Frequency of sexual relations diminishes with age for both men and women, though the desire for it may remain. Most doctors have a number of older patients who are alone due to the death, illness, or separation from an intimate partner but still wish for the intimacy, the touching, and the climactic events of sexuality if it were available to them. Continue reading

No-calorie soft drinks, weight and your gut bacteria

Dr. Victor Sierpina

Dr. Victor Sierpina

Do you know anyone who drinks a lot of diet sodas and just cannot seem to lose weight? It has been known for some time that these artificial, no-calorie sweeteners not only do not encourage weight loss but may actually promote weight gain and even diabetes by continuously stimulating our desire to taste sweetness. When they were invented by the food industry, these new-to-nature molecules promised to offer a positive option to sugar. They seemed to be a healthier alternative that promised to change our habits and health risks from drinking the high fructose, sugary soft drinks that have defined American billboard culture since the 1950s. However, there are issues.

Sweet foods, it turns out, activate a set of digestive processes, enzymes and hormones like insulin that promote weight gain and diabetes. No-calorie sweet drinks do the same. This is very different from the gut and endocrine response to more bitter or alkaline foods such as vegetables, grains, legumes and other plant-based foods. So despite no calories, these sweeteners have not been so helpful in weight loss as a substitute for the sugary soft drinks. They also are not helpful to diabetics for these same reasons. There is now another reason to suspect that there are other problems with these beverages. It turns out that no-calorie soft drinks change the profile of bacteria in our gut, part of the so-called microbiome. These bacteria, which may in aggregate weigh three to six pounds, constitute one of the largest “organs” in the body. They actually contain about 150 times as much DNA as our human genome. The key issue for our diet is that they are essential to the process of healthy digestion. Many foods, especially plant materials, cannot be adequately metabolized and absorbed without a healthy gut bacterial population. When artificial sweeteners alter this profile, our ability to utilize our food effectively is impaired. We still feel hungry. Continue reading

Find your inner peace

Dr. Victor Sierpina

Dr. Victor Sierpina

Chinese philosopher Lao Tsu once said, “Stillness and tranquillity set things in order in the Universe.”

The Danish sage Søren Kierkegaard likewise encouraged us to times of quietude: “Far from idleness being the root of all evil, it is rather the only true good.”

This is a remarkable attitude in our very busy, constantly moving world where activity, productivity and busyness are equated with our value as a human being. Is this really true?

Perhaps the things we busy ourselves with are not all that important, taking too much time and effort while accomplishing little or nothing in service of others or in helping us achieve our major life goals.

In my daily medical practice, I often encounter people who are busy, very busy. They attest to being too busy to exercise, to shop for and cook healthy meals at home, to attend to important relationships — and too busy, for sure, to center their minds by relaxation or meditation. In other words … too busy. Continue reading

Rainforest is a reservoir for new medicines

Dr. Tristi Muir

Dr. Tristi Muir

Our Bodies, Our Lives

On a recent trip to Brazil, I immersed myself in an exploration of the richly diverse Amazonian rain forest. I was awed to learn that so many of the plants that filled this paradise have been used throughout human history to make medicines, poisons, hallucinogens, rubber, building materials and so much more.

While it makes sense that native people use the plants to support their lives, it is astonishing to learn that approximately 70 percent of the new drugs introduced in our country in the past 25 years are derived from nature. Despite the expanding sophistication of bioengineering, Mother Nature retains the crown as the world’s greatest drug engineer.

The indigenous healers in the Northwest Amazon have used more than1,300 species of plants for medicinal purposes. Today, pharmacologists and ethnobotanists work with native shamans to identify potential drugs for further development. Continue reading

Always tired? Here are 5 things to check

Dr. Victor Sierpina

Dr. Victor Sierpina

“Doc, I just feel tired all the time.”

This is the kind of vague complaint, along with dizziness, that challenges every physician. Such patients often show up on a Friday afternoon or mention the fatigue at the end of a visit for other matters. The issue is so common, yet complex, that up to 40 percent of those suffering from chronic fatigue may never receive a specific diagnosis.

Our medical students are trained to make sure a fatigue complaint isn’t caused by anemia or low thyroid. While these certainly can be a factor, it is rare to find the answer to chronic fatigue with a simple blood test.

Many medical conditions can cause fatigue. Loss of organ reserve in vital organs such as the heart, lungs, liver, adrenal glands, and kidney can all lead to fatigue. Chronic infections, cancer, chronic pain, poorly controlled diabetes, obesity, and sleep apnea make up a partial list of well over a hundred identifiable medical causes for fatigue. Continue reading