Category: Women’s Health Testing

by Marcelle Pick, OB/GYN NP

A big part of staying healthy is being informed. If you know what your body is saying, you can begin to think about what you can do to make positive changes. Lab results help us to track progress and provide us with power and incentive.

I would like to help you look at some vital information so you can get a better understanding of some common medical tests. By having a basic knowledge of these routine tests, you can better advocate for yourself.

•  Mammogram: assesses breast health
•  TSH  (thyroid-stimulating hormone): assesses thyroid health
•  CRP and hs-CRP  (C-reactive protein): checks for inflammatory processes
•  Iron and ferritin: checks iron levels
•  DEXA Scan (Dual energy x-ray absorptiometry): bone density test
•  Vitamin D: Checks Vitamin D levels
•  LH and FSH (Luteinizing Hormone and follicle stimulating hormone): assesses menopausal symptoms, polycystic ovary disorder, or fertility issues
•  NTx (N-telopeptide): checks for bone health
•  Blood glucose: assesses for diabetes
•  Lipid profile: assesses for cardiovascular risk

Within “normal” limits– we prefer “optimal”

Many conventional practitioners look at lab results based on a “normal” range. When I view my patient’s results, I interpret results using a narrower scale. I usually take the average of the two extremes, plus 25% on either side of that number. If my patient’s result falls outside of this range, we want to initiate some changes. By being proactive, we can often avoid complications before they become permanent or more severe.

Much of today’s medical practice is aimed at fixing problems once they occur rather than at the prevention. Many practitioners use lab testing and imaging studies to diagnosis disease rather than looking at them to paint a picture of a woman’s overall health and well-being before illness sets in. Many women tell me they had no idea they were sick until their disease had progressed to the point of requiring prescription drugs to treat their ailments.

The truth is, most medical offices are so busy most primary care physicians don’t have or take the time to go over each test result or its meaning with their patients. In today’s healthcare system, you are your own best resource and can learn to advocate for yourself.

Charting your own course to wellness

Even the very best doctor can’t know what it’s like to live in your body. We all have our own personal stories and are living our own lives. Our individual histories and our present circumstances influence our health in multiple ways, making us all unique. Blood levels which are normal for you, might not suit another woman at all, just like a weight which is healthy for me, might cause problems for someone else.

All practitioners agree some lab test results require immediate attention, no matter who the patient may be. For most patients though, we’re reviewing small changes. When I review any of the tests I’ve listed above, I compare them to past results and look at the patient as a whole. If I see a pattern, we can intervene quickly, before disease sets in or worsens.

Medical testing and modern technology, coupled with the wisdom of your own body, allow us to prevent disease and assure you of a long and healthy future. If we use our knowledge, not to react, but to proactively act by taking the steps necessary to prevent illness, we will achieve wonderful outcomes.

by Marcelle Pick, OB/GYN NP

Women’s health testing: a guide for you

When a laboratory technician looks at the section of cells that was taken from your cervix during your Pap test, they will be searching for indications of specific changes that occur within the cells (cervical dysplasia). These reveal a variety of discrete tiny characteristic changes which the cytologist will then be able to classify according to the Bethesda system. Each category within the Bethesda system (e.g. ASCUS) designates a level of risk. Your healthcare provider will plan their management strategy for your particular case on a standard of care which is directed by that category.

If you ever receive a call informing you that your Pap results are anything other than normal, you will want to know what that means. Women to Women have put some great information together to help explain some of the terminology to make it easier to understand. We hope by giving you information it will help you understand to any suggestions or recommendations your healthcare practitioner may provide. What follows here is a summary of terms and abbreviations which are commonly used to categorize Pap test results.

Normal Pap smear

A normal Pap smear result means that no cell lesions or malignancy have been found. It is important for you to note that although Pap smears are an excellent screening tool, they are not perfect. False negatives do happen on occasion. This is why it’s important to get regular exams. Some changes that can show up on a Pap test that is otherwise normal, include reactive cellular changes, cellular atrophy, and endometrial cells present.

ASCUS

ASCUS is fairly common, but it is not a normal Pap test. This result indicates “atypical cells of undetermined significance.” This is considered to be a very mild irregular reading. Completing HPV testing is the current standard of care for follow-up. If your result is ASCUS and negative for high-risk HPV strains, then repeat Pap testing is normally ordered more frequently for a while in order to watch your immune response, in the hope that you will be able to resolve any of the abnormal cells. If your result is ASCUS and positive for high-risk HPV strains, you will need to have a colposcopy for a diagnosis that is correct.

LGSIL

LGSIL, the next grade of cellular abnormality, indicates a “low–grade squamous intraepithelial lesion.” This low–grade result is seen as an indication that a higher-grade HPV viral strain is probably causing the cell abnormalities. This leads directly to colposcopic evaluation in most cases as the standard of care. It is suspected that at least 60 to 70% of all females carry the viral strain of HPV. This statistic will change as the younger generation that have had the vaccine get older. Young healthy women are likely to clear this without a serious problem, about 60% of them do, but we tend to watch them closely throughout the process. Understanding however, when an older woman’s Pap test is found with this result, it may more worrisome, and she will definitely require closer monitoring after the initial colposcopy.

HGSIL

HGSIL indicates a “high–grade intraepithelial lesion.” This concerns us more, because the HPV virus in this case is more than likely causing moderate to severe changes in the cervix. Colposcopic biopsy is definitely needed to find out what is really there. The biopsy will be sent to a pathologist so they can provide a truer diagnosis. This information will then provide the practitioner with the information they need to develop a plan.

AGUS

AGUS represents “atypical glandular cells of undetermined significance.” Atypical cells can stem from either the cervix or the uterus. Glandular lesions are harder to detect on a simple colposcopy, so a colposcopy and or endometrial biopsy may be needed for a definite diagnosis. It’s not yet clear if HPV testing is of any help with this category. AGUS is a fairly new classification, so treatment protocol with this continues to develop. See the ASCCP guidelines for more information.

Endometrial cells present

A result showing “endometrial cells present” is concerning especially for post-menopausal women. It can represent endometrial cells that have built up within the uterus, slowly leaking down to the uterus and then noted on the Pap. The overgrowth can come about as the result of higher-grade atypical cells in a location outside the cervix, the uterus being the most likely origin. Endometrial biopsy follows as the next step to provide a more definite diagnosis and to help plan management strategy. If a Pap test shows endometrial cells are present in a pre-menopausal woman, it is often due to simply having had the Pap completed toward the end of your period. Your practitioner will take the date of your last menstrual period into account when determining your need for follow up.

Remember, if you are told your Pap test results are abnormal, or if you’ve been told you have HPV, it doesn’t mean you will get genital warts later. It certainly doesn’t always mean your partner has been unfaithful, although it can be a possibility. Only in very rare cases does it mean you have cancer. These days we know so much more about the changes and what they mean, so we can observe closely if needed and treat correctly. Following your practitioner’s recommendations is vitally important.

It’s also crucial to take good care of yourself, in every area of your life. Eat well and balance your diet with nutritious whole foods which are good for you. Find ways to put away some of your stress and strain and fully relax, even if it’s only for ten or fifteen minutes a day. Rest well. See if you can work even a little exercise into your week. It doesn’t take much to feel so much better. You’re worth it! Seeing how often, when women change their diet, add nutrients, and change their lifestyle that their Paps return to normal, reminds us all that you have more control than your realize when it comes to abnormal Pap results.

For further information, read our full article on abnormal Pap Smears and HPV, including excellent steps to protecting your reproductive health.

by Marcelle Pick, OB-GYN NP

Stool tests related to your digestive well-being

At Women to Women, we have learned over the years that many laboratories don’t really offer very helpful stool studies. Several patients become discouraged when their stool analysis comes back with a “normal” result, while they are miserable with persistent digestive symptoms. Quite often, all we need to help explain what’s happening, is a test which is a little more specific.

We’ve experienced great outcomes over the past several years using two tests that are completed by a group of top-quality labs. The first test is the Comprehensive Digestive Stool Analysis (CDSA) that checks the stool for malabsorption, yeast, parasites, pH imbalance, the need for digestive enzymes and bacterial overgrowth. The second test is a Comprehensive Parasitology Test (CP x2) with a purge, which is a much more in-depth test for parasites.

These tests are not usually done in hospitals or in traditional medical offices, but they are vital for finding the source of gastrointestinal distress. They should be considered even if, and maybe especially if, standard stool testing has found nothing unusual. We suggest these labs for complete stool analysis:

Genovix: 1-800-522-4762
Metametrix: 1-800-221-4640
Diagnos-Techs: 1-800-878-3787
Doctor’s Data: 1-800-323-2784
Parasitology Center: 1-480-767-2522
Metametrix testing: 1-800-522-4762

You may contact these labs directly or request that your healthcare provider order these tests on your behalf.

The first four labs listed offer both stool studies in one test; the last lab listed only offers the CP x2. For difficult cases, I prefer to have the CDSA completed at one of the first four lab centers, and the CP x2 done at the Parasitology Center. I find that the Parasitology Center picks up on parasites that no other lab has found.

The newest of all the tests is the Metametrix test which is looking both at culture based and molecular approaches for stool based gastrointestinal diagnostics. O and P technology, which is offered at most hospitals, can only identify a limited number of parasites and is considered the gold standard methodology for parasite detection, while the PCR technology of the Metametrix GI effects test provides an expansive assessment of anaerobic gut microflora.

by Marcelle Pick, OB-GYN NP

Questions and answers about Pap testing and the human papilloma virus (HPV) 

Women are usually very surprised and worried if their Pap smear results are abnormal. They have several questions, and in some cases it’s difficult for them to even know what questions to ask their practitioner. We’ve tried to take some of the fear out of this equation by answering some of the most commonly asked questions women have about HPV and abnormal Pap test results.

• “My primary care physician called to tell me my Pap test was positive for ‘high-risk HPV.’ I’m very worried about this. She referred me to another doctor for a colposcopy, but they found nothing unusual, so sent me back to my primary physician for follow up Pap tests. What will happen next?”

It sounds as though this was the appropriate chain of events. When your primary care provider saw that your Pap was positive for high-risk HPV, his response in sending you to a specialist was perhaps because not all clinicians are skilled in performing advanced testing procedures like colposcopy. Your Pap results may have been a false alarm, or else your body is recovering from the HPV virus you were exposed to. In either case, the colposcopy results are reassuring. Continuing to have follow ups as recommended by your provider is important to make sure you remain in good health. You can support your continued healing with excellent nutrition and other good self-care activities like moderate exercise, stress management and establishing good sleep routines.

• “I’ve been told that my genital warts were caused by HPV and that I will eventually get cervical cancer from them. Is this true? My Pap tests have always been normal.”

The strains of HPV virus that are responsible for genital warts are not usually the high-risk strains that are associated with cervical cancer. We can’t know though for sure how many or which strains of HPV you have been exposed to. It’s also impossible to predict which strains of the virus you’re likely to be exposed to in the future. Prevention and good health maintenance are essential. Some studies indicate an effective immune response is triggered by using the topical wart treatment known as Aldara (imiquimod). This may be one of the best treatment measures currently available for warts, and it may also provide an element of protection from the high-risk HPV strains, as will lifestyle adaptations. What I tell my patients is “the best treatment for HPV is to change the messages that the cells are getting with great nutrition.”

• “I always practice safe sex and use a condom. How did I get HPV? How was I not protected?”

HPV can be found anywhere in the genital region. Since condoms cover only part of the penis, there is extensive room beyond the condom for genital contact to occur and HPV to be transmitted. Practicing safe sex is very important in preventing other sexually transmitted diseases, but having an open and honest talk with your potential partner about STD’s, and each of your sexual histories, prior to having sex is a very wise choice.

• “My practitioner said my Pap was ‘normal’, but she also told me ‘HPV is detected’, and wants me to schedule a follow-up appointment in six months. Is that right? From all my research it seems that an abnormal Pap is significant if HPV is detected. My practitioner also told me that my husband and I can ‘resume our normal lives’. This is confusing, because wouldn’t that mean that we were compromising our immune systems if the virus is present?”

Your results are not uncommon. Because of new viral technology, the HPV virus itself can be detected, separate from looking at the health of the tissue cells sampled. This is how the virus can be seen, even if the cells do not appear abnormal.

Different practitioners may use slightly different follow-up algorithms with this finding, depending on whether they follow the guidelines of the American College of Obstetricians and Gynecologists (ACOG), the American Society for Colposcopy and Cervical Pathology (ASCCP), or Planned Parenthood.

In most cases the virus will resolve, and remember 70% of the female population has HPV, and your practitioner will just want to watch you a little more closely, usually by retesting in six months. This is to make sure your cervical cells do stay normal and the virus becomes dormant, which means it becomes undetectable, due to the good response of your healthy immune system. So you have much more control than you think.

At Women to Women we discuss HPV in greater detail in the many informative articles on our website.

by Marcelle Pick, OB-GYN NP

If you or someone you care about has been notified that your Pap results are not normal, it is totally normal that you may be feeling anxious and worried. You may even be thinking your practitioner has gotten you confused with another patient. If your pap test has always been normal in the past, and if you always practice safe sex, how can this be possible?

The Pap smear: It can save your life

Both traditional and holistic practitioners advocate for a yearly pelvic exam and Pap smear. Why? The answer is that this standard of practice has been proven to be one of the best preventative measures found to protect a woman’s health and life. We learn so much during an annual exam that can be used to prevent problems down the road.

The Pap smear test was developed by Dr. George Papanicolaou and named for him. It’s purpose is for the early identification of cervical cancer. Soon after it’s introduction, the Pap smear proved effective at detecting precancerous lesions, which represent early and still very treatable indicators of cervical cancer risk. Scientists wish they could develop a screening device as effective as the Pap smear for identifying precancerous breast changes.

Pap testing has saved the lives of many women. Cervical cancer was once the leading cause of cancer-related death for women in the United States, but over the past 60 years it has dropped to 15th, due to Pap screening. It’s an easy, and for the most part, reliable test to perform. See our articles on routine Pap testing and pelvic exams for an explanation of what to expect during these procedures, along with a description of the new Thin Prep Pap.

Since there is so much potential benefit in having this simple test completed, it’s surprising that women sometimes get mixed messages about its worth. Cervical cancer claims the lives of around 270,000 women each year worldwide, 3700 in the United States alone. At Women to Women we encourage yearly examinations and regular Pap screenings for our patients. With the new recommendations of just doing pap smears every three years many women are confused and think they should not come for annual exams. This is not the truth, the pap may not be necessary but the annual is a great place to look at what can be done to be in the best health possible for the next year, and other pelvic abnormalities can be ruled out if changes have occurred.

Prevention and detection start early

A few preventative measures you can take as a young women are to delay first sexual encounters and limiting the number of sexual partners. All women, even young women, are at risk for all sexually transmitted diseases, which makes discussing safe-sex practices with girls very important before they start having sexual relationships. I suggest that any safe-sex plan includes a commitment to a yearly exam and a Pap smear.

Young women are encouraged to have an annual pelvic exam and Pap test starting in their teens if they’re sexually active, and a STD screening be completed each time they encounter a new partner. If a woman is not sexually active, she should have a pelvic exam by the age of 21, with a Pap smear within one to two years after her first sexual experience.

At Women to Women, we like to meet with teenaged young women for a health interview and an informative and educated exam session about reproductive health prior to her first sexual encounter. If she does become sexually active, she will be better prepared, emotionally to return for the next step, her first pelvic examination and Pap smear.

In the future, this initial meeting may be the ideal time to determine if this young woman would benefit from the HPV vaccine. With this kind of informal, but educational introduction, a young woman can be more comfortable and ready to take care of her body. This can help prepare her for a positive, worry–free and confident future.

Excellent nutrition is also an important part of prevention. We give our immune system a great advantage by maintaining a diet that’s high in folic acid, antioxidants, and essential fatty acids. Even when we eat well, we can support our cervical cell well-being by further enhancing our diet with good nutritional supplements.

How often to get Pap testing done

The American College of Obstetricians and Gynecologists (ACOG) recommends Pap screening annually until age 30, then every two to three years if a patient has had three sequential years of normal results and does not fall into a high-risk category (e.g., DES exposure, known or previously-detected HPV exposure, a prior history of cervical cancer or cervical intraepithelial neoplasia II–III, or an immunocompromised status). If a woman is taking hormones, we strongly recommend she should be checked annually and her prescription monitored. The recommended age to discontinue Pap screening varies according to a woman’s situation, and this decision is one left for the most part to her gynecologist’s discretion. We are seeing more women in their 60’s and 70’s with STD’s so we may need to consider doing Pap smears on women depending on their sexual situation.

At Women to Women, we recommend an annual Pap smear for routine screening of sexually-active adult women. Occasionally, we may suggest a more regular checkup if any minor abnormalities had been found on previous tests. The reason we suggest annual tests is because everyone’s risk factors can change over time. Also, changes in stress levels and immune response can also cause a previously normal test to become abnormal.

We view the Pap test, in many respects, as a general indicator of your overall health status. The presence of abnormal cervical cells indicates your immune system is weakened. Early testing prevents cervical cancer. When testing is delayed, you are at greater risk because the abnormal cell changes are not detected early.

If you have had your cervix completely removed, during a hysterectomy for example, and have no history of an abnormal Pap, it may be fine to discontinue the test. At Women to Women, we continue to screen our patients at regular intervals. You might want to discuss this with your practitioner. Many more practitioners are leaving the cervix intact to help maintain the pelvic structure. In that case, Pap testing would need to continue.

Abnormal Pap test results

What happens when you get an abnormal Pap reading? Let’s look at this together. Hopefully, you have a relationship with a GYN practitioner you know and trust. If so, your test results will be explained to you in a supportive and understandable way, and you will be encouraged to ask questions. If not, you may want to think about finding a provider you can feel more comfortable with, and who supports you. You are likely to be notified of anything on your Pap test that is not “satisfactory,” If the cell sample from inside your cervix was inadequate, or less than ideal, the results will be reported as insufficient, and you may be called back for a new attempt. In a case like this, if you are menopausal or at low risk, re-sampling can often wait until your next yearly exam.

Occasionally a Pap report will show an infection caused by yeast or bacteria, or even some changes in your vaginal tissues due to low estrogen levels in menopause. These results are easily dealt with and are unrelated to HPV or cervical cancer.

The scale of abnormal Pap test results ranges from slightly atypical to high–grade cellular changes. Currently, the Bethesda system is used among pathologists and healthcare providers to classify findings consistently. There is also a well established algorithmic approach to match next steps to abnormal findings. Both the classification system and suggested management are continually updated by new research findings. If needed, HPV testing/typing is considered and can be added to the Pap test analysis. Some women will electively seek this with their Pap test before anything abnormal is found, but that varies and the guidelines for this are still evolving.

The next steps — following up

A Pap test is a screening tool. It’s not exact, and a margin of error exists each time it’s used. Results can be either falsely positive or falsely negative. That’s why we recommend annual testing for women at risk, and also why we sometimes do repeat smears more often when abnormal results are found.

If you have abnormal results, your practitioner will likely repeat the Pap test or move on to other diagnostic testing, such as colposcopy or an endometrial biopsy. The results of colposcopy will help decide what is needed next. The colposcopy may also be repeated within a reasonable time-frame to ensure healing or to provide an opportunity for early intervention if precancerous changes are detected. Repeat testing is routine and ensures that nothing is overlooked.There are a number of advanced treatment procedures available, if necessary, and all geared toward removing any suspicious tissue that persists on the cervix. For persistent abnormal biopsy results or ongoing presence of abnormal cells (cervical dysplasia), these treatment procedures may be warranted. Most of these decisions are based on well-established guidelines and are made collaboratively between you and your practitioner along a tried-and-true timeline. The goal is to intervene before the dysplasia worsens and spreads into the tissue of the cervix or uterus, and to prevent true cancer.

If you have feel confused or are uncertain about your follow-up plan when you’ve gotten abnormal results following a Pap smear or colposcopy, don’t hesitate to call your provider to ask questions. Many women have abnormal readings that return to normal once their stress is relieved! In fact most of our patients that have abnormal paps return to normal within the year. Close monitoring will help make sure you get back on track.

Making a difference in your outcome

We want you, as an intelligent woman, to take charge of your health. But despite all the research and scientific information in our world, it can still be pretty frightening for a woman to get a call from her doctor about an abnormal test result. Sometimes, that fear can grow into persistent worries that aren’t rational. That’s why having all the facts can be calming and empowering. At Women to Women, we try to approach things from all directions. We provide information and offer physical and emotional support.

Providing support for both the physical and the emotional aspects of your overall health is a very positive and affirming act. With so much technology available to discover and take care of any problems, we have tremendous potential to achieve positive outcomes. We encourage you to not put off testing – early detection may save your life.

One way to help prevent an abnormal Pap test is by nurturing yourself. Make sure to eat well, fortify your diet with supplements and try to reduce your daily stress. Maybe you could consider trying yoga or relaxation through meditation. If your test is abnormal, see it as a reminder to start adding something positive to your life that will help your reproductive system heal. Your Pap test is just one small chapter in your health story. By supporting your immune function and scheduling routine follow-ups, you have the power to control your outcome. Along with dietary changes, make sure you are getting enough folic acid, at least 800 mcg daily, and eat plenty of cruciferous vegetables.

by Marcelle Pick, OB/GYN NP

If you’ve never had a pelvic exam and Pap test before…

At our practice, where we integrate conventional and alternative ways of thinking, there has never been any doubt about the importance of annual examinations and regular Pap screenings for our patients. If you are anticipating your first pelvic exam and Pap test, we know that knowledge is key, and by knowing more, women find they will worry less.

At Women to Women we want you to know what to expect during your routine Pap test and gynecologic exam. Has your clinician performed the Pap test without an explanation of what to expect and why it’s being done? As women we need to ask these questions, we need to know and understand the importance of regular pelvic exams and Pap smears. We believe this information can help you become your own best advocate, and to comprehend why this is all needed, so you can feel comfortable with the procedure.

Both traditional and alternative practitioners advocate for an annual pelvic examination and Pap smear. Why? The answer is that this standard of care has proven to be one of the best preventative combos we have to protect women’s health and longevity The Pap smear test was developed by and named after Dr. George Papanicolaou (1883–1962) for the purpose of early identification of cervical cancer. Soon after its introduction, the Pap smear proved effective at detecting precancerous lesions, which represent early — and still very treatable — indicators of cervical cancer risk.

Routine Pap testing and pelvic exam…

The Pap smear is an easy and reliable test to perform and the procedure takes only minutes to perform. So if this is your first Pap smear and pelvic exam, relax, we will explain the procedure, step by step.

First, you will be asked to disrobe from the waist down and put on a hospital gown. The clinician will ask you to sit at the edge of an exam table. Then, when instructed, you place your feet in the stirrup-style foot rests and lie back on the table (like the women in labor depicted on TV or movies). The clinician will ask you to separate your thighs and stay calm so the muscles are relaxed. The more relaxed and dropped apart your legs remain, the more comfortable you will be and the quicker the procedure will go. (If you wiggle your toes it is a great way to reduce tension in the legs, groin, or buttocks.) This position is often intimidating for women as they have their first pelvic exam but for many it gets better as time goes by.

With a gloved hand the examiner will touch the exterior of the vulva to separate the labia and view the external genitalia for normalcy. To widen the opening a speculum, which is similar to a tampon applicator with a handle, is then gently inserted into vagina. There are different sizes and styles of speculums used for different women. The speculum allows the clinician to view the vaginal walls and the cervix. The cervix is located high up in the vagina. It resembles a mini bagel projecting into the vagina, and if you were to touch it with your finger you will notice it feels like a firm, nose-like protrusion. The cervix is occasionally positioned so it is hard to see, but an experienced clinician can usually find it with a little gentle shifting of the speculum.

When the speculum is in place, the clinician will collect a sample of tissue from the exterior of the cervix (ectocervix) with a tool described as a spatula, then another from the cervical canal to the womb (endocervix) with a brush like instrument called a cytobrush. There are a number of devices which are used to gather samples, the most common being a contoured plastic spatula comparable to a tongue depressor. A little mascara-like brush is used to swish the interior of the cervical canal, and a small plastic broom-like brush is also often used. All these devices are gentle but can feel a bit odd to the patient when used, some women have a very tender cervix and may experience more discomfort than others. Several women may have a more fragile cervix that bleeds a small amount when scraped, but this is only a temporary problem with no major side effects.

These days it is pretty customary for the clinician to place the collected samples in a liquid-based container, but in some clinics the samples are still smeared onto glass slides and a fixative applied. This is by far no longer the norm. Chlamydia and gonorrhea testing is can now be done with the pap smear if is is collected using the ThinPrep methods. If there are vaginal symptoms of concern, the clinician may use a Q-tip to swab the vaginal walls and then check the sample under a microscope for signs of a vaginal yeast infection or other types of infection.

The speculum is then removed; at this point the clinician typically performs a quick bimanual examination, where she or he feels the uterus and ovaries as is possible with their skillful hands — placing two fingers of one hand within the vagina and the other hand on the lower belly. Then the clinician will press gently to feel what cannot be seen.

The Pap sample is sent to a pathology lab for the technician to review the cells under a microscope, checking for normal and abnormal features. An HPV DNA analysis can in addition be done at that time if requested, but many patients are choosing to do this as there is such a high association with HPV positive paps and cervical changes that can need further evaluation. Many of these changes do not have any symptoms. When the analysis is complete a report is sent to the clinic.

The clinic usually sends you a written notice that the pap and other tests were normal or require more follow up. For more information, read our article about pap testing results. Various clinics have a different policy and they only contact you if the results are abnormal, so if you want to be notified of the results regardless of the results, be sure to ask them to do so.

The new ThinPrep Pap smear — liquid-based technology…

In the beginning the Pap test consisted of using a small wooden spatula to sample the outermost cell layer of the cervical os (the opening to the uterus inside the vagina), then the sample was smeared onto a glass slide and a fixative solution was applied, then it was sent for further evaluation with a pathologist. (Hence the term Pap smear). Fortunately the technology and research has changed immensely over the past ten to twelve years. Now most paps are liquid based and allow the practitioner to evaluate the cervix for abnormal changes, test for the human papillomavirus  (HPV) DNA typing, as well as testing for gonorrhea and chyamydia. The HPV/DNA typing assists greatly in the management of abnormal paps.

With the new “liquid-based” Pap tests (i.e., ThinPrep® and SurePath®), the cell sample is placed in a jar of liquid fixative for rinsing and then it is transported to the lab for further processing and review. This process provides a cleaner, much easier-to-read sample and has demonstrated to have a notably lower margin of error. This has had dramatic results for women as they now have the opportunity to see changes early and can then make lifestyle changes which definitely help with abnormal pap smear management. If you do discover that you have been exposed to a high–risk HPV strain, don’t be alarmed — it just means that you will be best served by close monitoring and follow-up over time to ensure your lifelong cervical health. Most women have been exposed to HPV, but the most important thing to understand is that dietary, and lifestyle changes can make the biggest difference in turning around the HPV status.

At Women to Women, we suggest a Pap smear just about every year for routine screening of sexually-active adult women, and occasionally more often to follow any minor abnormal cells found on previous Pap smear tests. This is because women may change sexual partners; monogamous women can have partners who stray; and ultimately, everyone’s risk status can change over time. Changes in stress levels and immune response can also lead a previously normal–testing woman to suddenly test abnormal.

We view the Pap test as somewhat of a Geiger counter for your overall health — especially because we interpret the presence of abnormal cervical cells as a sign of weakened immune system function. The fact is that delayed testing can place women at greater risk, and could reduce the probability of detecting abnormal cell changes early — which is the key to preventing cervical cancer.

For more information, read our articles about Pap smears and HPV.

Additional resources for women:

• Our Bodies, Ourselves: A New Edition for a New Era (2005 edition), from the Boston’s Women’s Health Book Collective.
• Changing Bodies, Changing Lives: A Book for Teens on Sex and Relationships (expanded 3rd edition), by Ruth Bell.

by Marcelle Pick, OB/GYN NP

When you get your blood pressure taken, the cuff of a sphygmomanometer (your doctor should offer you a lollipop if you can pronounce it!) is placed manually over your brachial artery, the largest artery in your arm, and inflated by a pump. This compresses the artery and stops blood flow. The air in the cuff is slowly released while the practitioner listens with a stethoscope.

As the pressure in the cuff deflates, blood begins to pulse through the artery again. The first sound the stethoscope detects is called the systolic pressure, or peak pressure. This is the pressure that gets exerted when your heart beats, pumping blood from the arteries to the veins. Diastolic pressure, or resting phase, is the pressure in the vessels in between heartbeats. It is the lowest pressure and the last sound picked up by the stethoscope.

The following are standard guidelines for assessing blood pressure (the healthy range has been lowered in recent years).

Standard Blood Pressure Guidelines per mmHg (millimeters of mercury)

• Low        <89 / <50
• Normal     <120 / <80
• Prehypertension    120–139 / 80–89

• Mild Hypertension   140–159 / 90–99
• Moderate Hypertension    160–179 / 100–109
• Severe Hypertension    >180 / >110
• Isolated systolic hypertension   >140 / <90

How often should you get a blood pressure test?

Remember, high blood pressure is insidious. You won’t likely have a clue that you have it unless you get checked. This means you need to get checked regularly — at least annually, and more often depending on your history and risk factors.

When a woman comes in to see me for her annual exam, I always ask her, How’s your life? How’s your diet? How are your stress levels? These questions are a big part of the blood pressure equation! I like to take at least two blood pressure readings per visit, one before I examine her and another when she’s ready to leave. I may also ask her to get blood pressure tests in-between visits and have her fax or phone the readings in to me, so I can adjust for environmental factors or identify trends.

One reason for this is “white-coat syndrome,” a benign phenomenon where a patient’s blood pressure skyrockets at the mere sight of a lab coat. Other environmental factors, such as an extra cup of coffee or a stressful commute, can temporarily spike your blood pressure.

I like to see my patients somewhere in the vicinity of the optimal levels, but I always keep in mind each patient’s individual physiology and emotional status. If we get several elevated readings in a row, then I know we need to discuss dietary and lifestyle modifications now — well before you get into trouble. But what a great wake-up call!

“Owning” your blood pressure — should you buy your own cuff?

If you’ve been diagnosed with hypertension or prehypertension, you need to check your blood pressure frequently. Depending on your age, situation, and risk factors, you may want to think about buying a blood pressure cuff. There are many models available, but you can get a good one for $50–100. Here are some compelling reasons to justify this expense:

First of all, you’re investing in your health. Having your own cuff can certainly make it easier for you and your provider to keep a close eye on your levels. And it is empowering to have the ability to test yourself. Self-testing means you can know for yourself at any time, even enabling you to pinpoint triggers that might “set you off” as an individual.

For some, stopping off at the local grocery store or pharmacy for a quick check is a convenient option. On the other hand, having to do this may add just one more demand to your daily shuffle — one you can readily “blow off.” And that’s no way to take care of yourself.

In addition, readings can vary widely between blood pressure cuffs, and when you own your own, you can be sure how often it gets calibrated. Like synchronizing watches, you can bring your cuff along to your doctor’s office for ready comparison.

Another consideration is that blood pressure levels of even the healthiest people fluctuate over the course of a day, and having your own will allow you to check it at the same time for consistency. But remember that readings can also vary according to what that day holds in store for you or what it delivered in the way of frustration, stress, fulfillment, satisfaction, and relaxation. And when you adopt the consistent self-care approach we recommend, it’s a beautiful thing to watch your blood pressures return to a normal range — and stay there!

So whether you have must monitor your pressures regularly or you’re simply intrigued by your body’s vital signs, having your own blood pressure cuff is a great way to expand your healthy toolkit!

For more comprehensive information about blood pressure, read our informative article, “High Blood Pressure – Lowering the Strain.”

by Marcelle Pick, OB/GYN NP

To test or not to test – recommendations for people who choose to get vitamin D testing – and some guidance for those who don’t

• How do I know if I need testing?
• What if I decide not to get tested?
• What specific test should I request from my healthcare provider?
• Do I need to schedule my vitamin D test at a certain time, or together with other tests?
• What levels are optimal when I get my vitamin D tested?
• How much does a vitamin D test cost?
• Is testing worth it? What do I get in return for my investment?
• How do I know how much vitamin D to take to get replete?
• Should I be worried about vitamin D toxicity? How can I prevent vitamin D toxicity?
• What are the symptoms of vitamin D toxicity? Can someone be just hypersensitive to vitamin D?
• What about retesting? Do I need it?
• How can I maintain my vitamin D levels once I get them up to where I want to be?

How do I know if I need testing?

Today we know the prevalence of vitamin D deficiency is widespread, and for this reason feel testing is easily justifiable for all people. Everyone stands to benefit from knowing what their levels are and, if not optimal, supplementing their vitamin D3 intake. But we also recognize that for whatever reason, not everyone will choose to get tested.

Still, at the very minimum, people who have or are at higher risk of the following health concerns should seriously consider getting their vitamin D levels tested:

• Family history or personal history of cancer
• Hypertension (high blood pressure)
• Schizophrenia
• Depression
• Migraines
• Epilepsy
• Osteoarthritis
• Autoimmune conditions (such as lupus, ankylosing spondylitis, multiple sclerosis, rheumatoid arthritis)
• PCOS (polycystic ovarian syndrome)
• Diabetes mellitus (both types 1 and 2)
• Fibromyalgia
• Osteoporosis/osteopenia

[banner id=”single-product-vitamin-d-2000-2″]

In addition, anyone who experiences symptoms of:

• Musculoskeletal pain, including joint pain and low back pain
• Muscle weakness
• Poor balance
• Systemic inflammation

What if I decide not to get tested?

As we explain at some length in our full article on vitamin D, “Is Vitamin D Deficiency Casting A Cloud Over Your Health?,” there is a wealth of health benefits to be enjoyed when we are vitamin D replete. One way to get there knowingly is through periodic testing and vitamin D supplementation. But if you choose not to get tested, all the benefits of the sunshine vitamin are still available to you. You have two options:

Natural vitamin D production. The freest, most natural way is nature’s own: through limited exposure of your skin to the sun. Without sunblock, your skin can manufacture on average 10,000–15,000 IU vitamin D in a single “pinking” exposure. But this route has its limitations, too. Most obviously, if your skin is very, very light, or if you are at risk of or have a history of melanoma, or if you’re fearful of sun exposure for any reason, this is not a workable option for you. (Note that sunblock with an SPF of 15 or higher will block 100% of vitamin D production.) In addition, sun exposure doesn’t work equally well for everyone. It’s a given that the darker your skin, the more melanin pigment it contains, and the more prolonged sunshine exposure you will need to produce adequate vitamin D.

Take our Health Assessments and get a better understanding of what health risks you may have.

Adrenal Health Assessment

Your adrenal glands give you your get up and go – seriously! These small walnut sized glands ignite the fight or flight response when you are under stress – either real or perceived. This fight or flight response creates a tremendous amount of energy in just seconds to help keep you – or someone you are protecting – alive.

Take the Adrenal Quiz

 

Hormone Health Assessment

Hormonal imbalance is very common and often complicated, simply because we have so many hormones in our bodies. Because hormones are extremely agile and adaptive, they don’t just stop working, they often find other ways of working and adapting. Your body will try to compensate for these shifts – and you may start to experience symptoms that you’ve never had before – ones that you don’t understand and ones which you definitely would rather not have!  The great news is that we can help you shift your hormones back into balance.

Take the Menopause Quiz

Take the PMS Quiz

 

Digestive Health Assessment

A well running digestive system is crucial to good health – your digestive system is your body’s powerhouse to break down food into usable nutrients and to control toxicity by getting rid of the unused portions. Sometimes a digestive imbalance is at the root of seemingly unrelated symptoms, so it can be hard to spot. I always encourage women to evaluate their digestive health if they are having any chronic health problems. Your first line of defense is a healthy GI tract!

Take the Digestion Quiz

 

by Marcelle Pick, OB/GYN NP

Dual-energy x-ray absorptiometry (DEXA) technology was introduced in 1988 and has become the most popular tool for measuring bone density.

The National Osteoporosis Foundation recommends that all women over age 65, and post-menopausal women with at least one risk factor for osteoporosis, undergo a bone density test, which is usually a DEXA. Results from bone density tests are used to diagnose osteopenia and osteoporosis.

DEXA measures the bone mineral content (BMC) of the spine, hip, wrist, femur, or any other selected part of the skeleton. It does this by focusing an x-ray on a body site and measuring the proportion of light rays that pass through the tissue as opposed to being blocked by minerals in the bone. Using computer software, it then divides that number by the surface area of the bone being measured to create bone mineral density (BMD).

Bone density test results

After the bone density scan, a picture is printed out that shows where the patient’s BMD falls compared to the norm. The “norm” refers to the accepted standard peak bone mass (PMB) set by a selected reference group of young adults. There are no international standards of PMB because bone density varies so dramatically according to race and region.

Women are given a diagnosis of osteopenia if their T-score (see below) bone density deviates 1.0-2.4 points (standard deviations) below the norm (although we’ve seen patients who were put on Fosamax at just 1.3). Anywhere below 2.5 standard deviations is diagnosed as osteoporosis.

When you are measured against the younger reference group, it is called a T-score. When you are measured against the average BMD for your age, sex, weight and ethnic or racial origin, it is called a Z-score. Everyone loses bone density as they age, so someone with a normal Z-score might deviate significantly from the T-score. However, T-scores are the gold standard for traditional diagnosis. This means that eventually all women’s T-scores will deviate from the norm, and women with natural bone loss might appear to be suffering from a diagnosable disease. No wonder there’s an osteoporosis epidemic!

Limitations of bone density tests

Errors in DEXA measurement can be 8–10% depending on the machine — that’s almost one standard deviation! This means that you might have normal bone density by one machine, and osteopenia by another. It also means that measurements of change in bone density over time are only completely accurate if all your tests are done with the same machine.

Another problem with bone density tests is that the range of healthy bone is much greater than this test would lead women to believe. What’s “low” for one woman may be just fine for another, depending on the thickness of her bones, her ancestry, her peak bone mass from when she was in her 20’s, and other variables.

[banner id=”osteoperosis-nutritional-system”]