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Marla Ahlgrimm | Hot Flashes – What You Should Know

January 15, 2013 By Leave a Comment
Marla Ahlgrimm

Marla Ahlgrimm

Women in perimenopause should eat well and get enough sleep, says pharmacist Marla Ahlgrimm, but there are several other ways to head off hot flashes before you feel the heat. Here, Marla Ahlgrimm, the pharmacist who taught the world about PMS in the 1970s, answers questions about hot flashes, flushes, and fending them off.

Q. What is a hot flash?

Marla Ahlgrimm, R.Ph.: It’s a temporary feeling of heat all over the body. It may be accompanied by sweating and facial flushing.

Q. How long do they last?

Marla Ahlgrimm, R.Ph.: Some women have hot flashes from before menopause that last forever. However, some women may never experience them.

Q. What causes hot flashes?

Marla Ahlgrimm, R.Ph.: Doctors do not completely understand what causes them but many speculate that it has something to do with hormonal changes and their effects on the hypothalamus.

Q. Do hot flashes happen during the day or at night?

Marla Ahlgrimm, R.Ph.: Both, in fact, some women report only experiencing hot flashes at night while others have them spontaneously around the clock.

Q. What causes flushing?

Marla Ahlgrimm, R.Ph.: Blood vessels in the skin dilating to help the body cool.

Q. How can I avoid hot flashes altogether?

Marla Ahlgrimm, R.Ph.: There is no guaranteed way to prevent hot flashes.

Q. Can stress trigger a hot flash?

Marla Ahlgrimm, R.Ph.: It definitely can; many women report having more frequent occurrences during times of elevated stress.

Q. Can I still drink coffee, tea, and other hot beverages while fighting hot flashes?

Marla Ahlgrimm, R.Ph.: Yes, but be aware that the heat from the liquid could be a trigger. As well, caffeine and other stimulants, including alcohol, may aggravate your symptoms.

Q. How should I dress to reduce the warmth of a hot flash?

Marla Ahlgrimm, R.Ph.: Layers are a must for women experiencing frequent flashes and cotton is highly recommended.

Q. What about night sweats? How can I combat these when they often interrupt my sleep?

Marla Ahlgrimm, R.Ph.: Use a lighter blanket and remove any mattress covers or feather tops from your bed and run a fan to keep cool air circulating throughout the night.

Q. Is exercise causing my hot flashes?

Marla Ahlgrimm, R.Ph.: Not likely as keeping active is known to help lower the severity of hot flashes in most women.

Q. What about hormone replacement therapy?

Marla Ahlgrimm, R.Ph.: A short-term course of HRT may help reduce or eliminate hot flashes and many other symptoms of menopause. Consult with your physician for more information.

Q. Do the foods I eat affect my tendency to experience hot flashes?

Marla Ahlgrimm, R.Ph.: Yes, they can, and certain foods, such as Indian, Tai, and Mexican cuisine, should be consumed in moderation during peak flash times.

Q. I’ve heard that there are botanical treatments for hot flashes and other menopause symptoms. Is that true?

Marla Ahlgrimm, R.Ph.: There are a number of plant based supplements including Evening Primrose Oil, black cohosh, and Dong quai but these should only be considered after medical consultation.

Q. Is estrogen still used in HRT therapy?

Marla Ahlgrimm, R.Ph.:  Yes, natural estrogen is still the most common hormone therapy for severe or disruptive hot flashes.

Q. What about hydration; do I need to drink more water during menopause/perimenopause?

Marla Ahlgrimm, R.Ph.: Yes, it can be helpful since the body needs water to regulate.

Q. Should I alter my outdoor activities during this time?

Marla Ahlgrimm, R.Ph.: You should avoid strenuous activities if you have been having hot flashes. As well, you should limit your time in the sun and shy away from the hot tub and sauna.

Q. What’s the best way to reduce the effect of hot flashes on my daily life?

Marla Ahlgrimm, R.Ph.: Stay as healthy as possible. If you eat the right foods, get ample sleep, and exercise regularly, your hot flashes should be less intense. Plus, you’ll feel better overall.

 

For more information about Marla Ahlgrimm including links to published works and current blog entries, visit her personal website at marlaahlgrimm.com. Marla Ahlgrimm is a registered pharmacist and member of the Pharmacy Society of Wisconsin, the Langer Society of the Arts, and the UW School of Pharmacy Board of Visitors.  A renowned public speaker, Marla Ahlgrimm has been a featured presenter at TEMPO, the Women’s Sexual Health Physician Symposium, and the Washington Business Group of Health, among others. In addition to her civic and professional associations, Marla Ahlgrimm is the author of The HRT Solution – Optimizing Your Hormone Potential and Self-Help for Premenstrual Syndrome. 

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Low T, or Low Testosterone, can Affect a Man in Many Ways, Says Paul Perito MD

February 20, 2012 By 10 Comments
Paul Perito MD

Paul Perito MD

Florida-based urologist Paul Perito MD says there are two predominant forms of testosterone replacement. He recently sat down with Interviewing Experts for a quick conversation about this common condition.

Interviewing Experts: We appreciate your time today, doctor. What is testosterone?

Paul Perito MD: Testosterone is the male hormone that is responsible for muscle mass, facial hair, and bone density.

Interviewing Experts: Is testosterone stable throughout a man’s lifetime?

Paul Perito MD: After the age of 40, some men will begin to experience diminished testosterone levels.

Interviewing Experts: What are the side effects of low testosterone?

Paul Perito MD: It can result in other medical conditions such as high cholesterol, poor cardiac health, and a lack of vitality.

Interviewing Experts: What symptoms do men experience as a result of low testosterone?

Paul Perito MD: Patients will describe not remembering things, they will describe having decreased libido and not wanting to engage in sexual activity with their partners.

Interviewing Experts: That has to really affect a man emotionally.

Paul Perito MD: One study indicates an increased risk of depression in men with low testosterone levels.

Interviewing Experts: Testosterone can be replaced, correct?

Paul Perito MD: Yes it can.

Interviewing Experts: Can you tell us how?

Paul Perito MD: Most of the testosterone replacements that you’ll see right now are either injectables, creams or long acting pellets.

Interviewing Experts: What are the benefits of testosterone therapy?

Paul Perito MD: Studies suggest that testosterone can improve cardiac health and reduce the threat of diabetes.

Interviewing Experts: Those are physical side effects; are there any neurological side effects?

Paul Perito MD: They’ve shown the man’s ability to think is improved dramatically once they restore their natural testosterone levels.

Interviewing Experts: When should a patient speak with their doctor?

Paul Perito MD: When it becomes a problem in their life or relationship.

Interviewing Experts: Is testosterone replacement right for everyone?

Paul Perito MD: Not necessarily, patients should speak with their doctor to find out if testosterone replacement is right for them.

Interviewing Experts: Very interesting, we hope that all of our readers will take this into consideration if they suspect they have low testosterone levels.

Urological surgeon Paul Perito MD has devoted his entire professional career to treating men suffering from Erectile Dysfunction. He is the founder and namesake of Miami’s Perito Urology, where he conceived and initiated the world’s first minimally invasive approach to penile implantation. Paul Perito MD has performed over 3000 of these procedures on men across the globe, and his patients enjoy a shorter recovery time and less scarring than traditional implantation methods. Since 1995, Paul Perito MD and Perito Urology have become synonymous with effective erectile dysfunction treatment and world-class service unparalleled anywhere in the nation. He is a graduate of the University of Maryland Medical School as well as a frequent contributor to text published by medical journals nationwide.

The information contained in this article is provided by Paul Perito MD for educational purposes only. It is not intended to treat or diagnose any condition.

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Dr. Paul Edward Perito MD: What to Know Before You Start a Urology Residency

February 9, 2012 By 10 Comments
Dr. Paul Edward Perito MD

Dr. Paul Edward Perito MD

Before creating his revolutionary penile implant procedure, Dr. Paul Edward Perito MD served residencies in Australia and Florida. During college, Dr. Paul Edward Perito MD also participated in an exchange program that allowed him to work in Africa for a time. Currently, Dr. Perito trains 2 to 8 urologists a month in the Minimally Invasive Penile Implant, an implant procedure he patented over 6 years ago.  Today, Dr. Paul Edward Perito MD explains the various choices for young students interested in pursuing a career in urology.

Q: Dr. Paul Edward Perito MD, as founder of Perito Urology, what advice do you have for students struggling to decide which residency program to choose?

Dr. Paul Edward Perito MD: Today’s students are lucky in that they can do online research on various residency programs before making a choice. The first thing a student should do is evaluate the curriculum of the residency program he or she is considering. Will you get the training you’ll need to continue into a career in urology? The more variety, the better. You’ll need to be exposed to several fields of urology to be able to diagnose and treat a wide variety of conditions over the course of your career.

Q: How many different fields of urology are there, Dr. Paul Edward Perito MD?

Dr. Paul Edward Perito MD: That’s a good question. There are urologists who specialize in pediatrics, oncology (cancer), renal transplants, and infertility in male patients, urinary tract stones, female urological conditions, urinary incontinence and impotence.

Q: Aside from the clinical materials, Dr. Paul Edward Perito MD, what else should students consider when interviewing for a residency?

Dr. Paul Edward Perito MD: The nature of the residency is important, of course. Will the residents be able to attend conferences and workshops to further their knowledge? Will the residents be active in publishing?

Q: Exposure to different subspecialties is important in a residency…

Dr. Paul Edward Perito MD: Absolutely. In fact, students considering a residency should research the background of the involved faculty. Are these experienced professionals in various areas of urology? And will the faculty be large enough in number to be able to give each student the case-load and case variation necessary to be considered properly trained?  Very few programs in the United States lack in this area.

Q: Dr. Paul Edward Perito MD, what should a student look for in the hospital or learning institution where he or she decides to complete a residency?

Dr. Paul Edward Perito MD: Research is important. Is the facility attempting to find new ways to implement old methodologies? A faculty that is always eager to learn and push the boundaries provides a great example for students. Does the facility have updated equipment? A student will need to make sure he or she is getting experience that will translate to today’s world of medicine.

Q: How many interviews should a student attempt before settling on a choice for a residency?

Dr. Paul Edward Perito MD: That’s an individual choice, but it’s important that each student find a facility that shares his or her goals and temperament. That right fit can be hard to find, but it’s well worth going on as many interviews as possible to find that perfect fit.

 

Dr. Paul Edward Perito MD is the founder of Perito Urology and the Chairman of Urology at Coral Gables Hospital in Florida. To contact Dr. Paul Edward Perito MD, go online to www.peritourology.com

The information contained in this article is provided by Dr. Paul Edward Perito MD for educational purposes only. It is not intended to treat or diagnose any condition.

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Erectile Dysfunction Expert Dr. Paul E. Perito Says That Erectile Dysfunction Treatments Are Discrete and Customizable to the Patient

January 30, 2012 By 10 Comments
Dr. Paul E. Perito

Dr. Paul E. Perito

In a recent interview with Interviewing Experts Blog, Dr. Paul E. Perito spoke candidly about the embarrassing side effects of erectile dysfunction and how penile implants can help.

Interviewing Experts: What type of procedure do you use when you perform a penile implant?

Dr. Paul E. Perito: The implant procedure that I have created is slightly different from ones done in the past. It’s an approach through the area just above the penis called the infrapubic area. And we call it the minimally invasive penile prosthesis, because in 10 min. the entire device can be put inside the body.

Interviewing Experts: So you can’t see anything?

Dr. Paul E. Perito: The entire implant is hidden inside the penis and scrotum. There are the cylinders that fill with saline. The pump goes inside of the scrotum. There’s a third part that I never describe because it’s inconsequential to patient, but that’s the reservoir that allows fluid to go out to the cylinders.

Interviewing Experts: So what does the implant do?

Dr. Paul E. Perito: It re-creates exactly what the patient used to have. Before, when he wanted to have sex, blood would fill the cylinders of the penis, called the corpora cavernosa. In this case saline fills the cylinders. When you want to have sex you pump the pump that is in the scrotum and it fills the cylinders.

Interviewing Experts: So it looks like a natural erection?

Dr. Paul E. Perito: These implants are the most physiologic replication of an erection. When you are done, there is a deflate mechanism and you squeeze and it allows all the fluid to go back into the reservoir.

Interviewing Experts: What does impotence do to the body; specifically to the penis?

Dr. Paul E. Perito: The one thing that you need to know is that the longer you remain impotent without treating yourself, the shorter the penis becomes. And there’s been excellent papers written where we render a guy impotent in a single day with a radical prostatectomy. You take his prostate out and he is rendered impotent in one day and then we follow his penis length in a process called the penile stretch test. A patient can lose anywhere from .5 to 5 cm every 14 months, that is one of the most reliable papers that I’ve seen.

Interviewing Experts: That is a significant loss in length.

Dr. Paul E. Perito: Yes it is. When I take patient measurements at the initial penile stretch test and I will tell them, “this is what you’ve got.”  Then I’ll push their penis up against the pubic bone and I will tell them, “If you wait another year, this is where you will be.”

Interviewing Experts: Is there way to stop the diminishing effects of erectile dysfunction?

Dr. Paul E. Perito: Truly you need to initiate some form of therapy if you are concerned about penile length as soon as erectile dysfunction occurs.

Interviewing Experts: Now are the implants one-size-fits-all?

Dr. Paul E. Perito: No they are not. They can vary considerably in size.

Interviewing Experts: So once you measure the length that is how you decide what size of implant to use?

Dr. Paul E. Perito: Intra-operatively, we measure the length with a device called a Furlow. And with every guy you give them back exactly what they have at that moment.

Interviewing Experts: Will all men retain the same length?

Dr. Paul E. Perito: I just wrote a paper that showed that 75% of men will have the same length postoperatively as they did prior to the procedure. So there is a predictive index that we can utilize.

Interviewing Experts: And this is sometimes covered by insurance?

Dr. Paul E. Perito: Medicare pays for penile implant because the penis is a functioning organ. Studies have shown that ongoing intimacy does indeed lead to a longer, healthier life.  Medicare pays for it, private insurance pays for it, and some HMOs pay for it. Often times it depends upon the cause of the impotence.

Interviewing Experts: Very informative, thank you very much.

Dr. Paul E. Perito: You are welcome.

***

Dr. Paul E. Perito graduated the University Of Maryland School Of Medicine in 1988. His Coral Gables, Florida, urology center, Perito Urology, draws patients from around the globe for its innovative and updated Erectile Dysfunction treatments. Having successfully performed over 3,000 penile implants since 2005, Dr. Paul E. Perito is considered a leader in the field. His signature minimally invasive technique, The Perito Approach, has been taught to surgeons worldwide through travel and at Coral Gables Hospital, where he is Director of Urology. Dr. Paul E Perito is has participated in countless medical studies in his quest to simplify the penile implant process and make the procedure safer for his patients.

The information contained in this article is provided by Dr. Paul E. Perito for educational purposes only. It is not intended to treat or diagnose any condition.

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Interview with Dr. Paul Perito: The Efficacy of Minimally Invasive Penile Implantation

January 12, 2012 By 10 Comments
Dr. Paul Perito

Dr. Paul Perito

Interviewing-Experts Blog recently had the opportunity to speak with renowned Erectile Dysfunction expert, Dr. Paul Perito, about the importance of utilizing a minimally invasive technique when performing a penile implant.

Interviewing-Experts: Good morning, Dr. Paul Perito. Thank you for speaking with us today about such an important topic.

Dr. Paul Perito: Certainly. Men’s health is a subject often ignored. I appreciate the opportunity.

Interviewing-Experts: So, please tell us a little about what makes your technique different from previous procedures.

Dr. Paul Perito: There are several key differences. I do not use a Foley catheter since I do not drain the bladder. I limit my dilatation, ensure that the reservoir is behind the transversalis fascia, use an artificial erection at the beginning of the procedure, and finally, there’s the use of a drain. My approach is infra-pubic, and as minimally invasive as possible. I think there are nuances that make it better than prior procedure techniques.

Interviewing-Experts: What kind of results have you seen from these differences?

Dr. Paul Perito: Our results have been good. Our infection rate was only .91% in the last 1,000 procedures.

Interviewing-Experts: That sounds very promising.

Dr. Paul Perito: Aside from that, there were only 2 distal urethra injuries, which were repaired primarily at the time of the procedure and two scrotal hematomas that were evacuated.

Interviewing-Experts: What do you consider the greatest measure of success for this procedure?

Dr. Paul Perito: How quickly my patients have gotten back to normal sexual function.

Interviewing-Experts: That’s certainly important.

Dr. Paul Perito: Yes, it is. 82% of patients were back to normal function within four weeks; the rest by six weeks.

Interviewing-Experts: Very interesting.

Dr. Paul Perito: These results tell me that the procedure is efficacious, expedient and safe.

Interviewing-Experts: How do you know what size to make the penis with the implant? Is there a way to gauge a patient’s natural penis size?

Dr. Paul Perito: Yes, there is. First, it’s important to know that when you render a man impotent, say with a radical prostatectomy, over the course of the next 14 months he’ll lose anywhere from .5 to 5 cm in length.  I use a penile stretch test to educate patients on what they can realistically expect postoperatively.

Interviewing-Experts: How did you conclude that the stretch test was the best predictive index for length?

Dr. Paul Perito: What I did was took 53 patients and measured their artificial erections, their penile stretch test and finally what they had at the end of the procedure. And, not surprisingly to me, the best predictive Index was the penile stretch test. So now when a patient comes into office and they want a penile implant, I’ll do the penile stretch test and tell them that 72% of the time, this is what they are going to have postoperatively, and if they don’t like that, they should probably not get a penile implant.

Interviewing-Experts: Sound advice, indeed.

Dr. Paul Perito: Additionally, since my procedure does not use a Scott retractor, the cost is reduced. My penile pack costs $72 to the hospital, and these days cutting cost is essential.

Interviewing-Experts: Absolutely. Well, Dr. Perito, we look forward to hearing more about this procedure in the future, and again thank you for taking the time out of your surgery and training schedule to speak with us today.

Dr. Paul Perito: You’re welcome.

 

***

Dr. Paul Perito is a 1988 graduate of the University Of Maryland School Of Medicine. His practice, Perito Urology, is considered one of the foremost Erectile Dysfunction treatments centers in the world. Since 2005, Dr. Paul Perito has successfully performed more than 3,000 penile implants, establishing him as a leader in the field. He has streamlined the procedure, making it not only more efficient, but safer, by the development and actualization of a minimally invasive approach. Aside from contributing extensively to medical publication libraries, Dr. Paul Perito heads the training center at Perito Urology where his technique is taught to an audience of surgeons from across the globe.

The information contained in this article is provided by Dr. Paul Perito for educational purposes only. It is not intended to treat or diagnose any condition.

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Pharmacist Marla Ahlgrimm Answers Your Questions

January 2, 2012 By 8 Comments
Marla Ahlgrimm

Marla Ahlgrimm

A pioneer in the field of hormone therapy (HT), Marla Ahlgrimm has helped more than 300,000 women manage their symptoms of premenstrual syndrome (PMS), perimenopause, and menopause. Marla Ahlgrimm, founder and CEO of Women’s Health America, receives many questions from women and will answer several of the most common ones.

Q: What is a natural or bioidentical hormone?

Marla Ahlgrimm: When choosing between hormonal medications, a woman and her doctor must select between hormones that are natural or bioidentical and those that are synthetic. A natural or bioidentical hormone is identical – has the same chemical structure – to those hormones naturally produced by a woman. These may include estradiol, estrone, estriol, progesterone, and testosterone. In contrast, synthetic hormones are similar to, but not identical chemically to those produced naturally by a woman. These include oral contraceptives, Provera, Premarin, and Estratest to name a few. A woman doesn’t naturally produce the hormones found in oral contraceptives for example, explains women’s health expert, Marla Ahlgrimm.

“A ‘natural’ hormone does not mean that it is an unregulated, organic product purchased in a health food store either,” Marla Ahlgrimm, co-founder of Madison Pharmacy Associates in Madison, Wisconsin, says. “In fact, ‘natural’ prescription hormones are manufactured by FDA approved pharmaceutical companies.”

Slight chemical differences between natural and synthetic hormones can have substantially different effects in a woman’s body. Pharmacist Marla Ahlgrimm tells her patients, “it‘s more important than ever to understand the differences before beginning hormone therapy”.

Q: What Does Micronized Progesterone Mean?

Marla Ahlgrimm: Progesterone is the hormone of pregnancy and the word means “for gestation.” Progesterone is produced cyclically, 2 weeks out of every month. If pregnancy doesn’t occur, the progesterone level falls and menstruation begins. Micronized describes the size of the particles of progesterone found in pharmaceutical progesterone capsules or tablets. Pharmaceutical companies micronize progesterone particles for better oral absorption. Pharmacists use micronized progesterone powder to formulate customized progesterone dosages for women.

Q: How is Hormone Therapy administered?

Marla Ahlgrimm: Hormones can be administered in a variety of ways. Depending on the hormone, options include transdermal skin patches like Climara or Vivelle for estradiol, transdermal creams, vaginal tablets or creams, oral capsules and sustained release progesterone tablets. Each route of administration is specifically selected by a woman and her physician, according to Marla Ahlgrimm, a licensed pharmacist.

Q: What types of natural estrogen are there?

Marla Ahlgrimm: Estrogen is a general term referring to a category of hormones which include estradiol, estrone, and estriol.   Marla Ahlgrimm has found that many women are surprised to learn there are natural estradiol preparations commercially manufactured and readily available. Brand names include Estrace tablets, Climara, Vivelle patches and Estraderm cream. When hormone therapy is needed, your doctor will likely prescribe a specific hormone or combination that works best for your particular situation, Marla Ahlgrimm, founder of Women’s Health America, concludes.

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