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Women's Health
Dr. Colleen Dy – Women’s Health
What's New in Contraception?
There are a lot of new options for women these days, things you may not be aware
about yet. Please be advised that withdrawal tramadol online is not considered a reliable form of
birth control. Although your partner may not ejaculate during intercourse, the preejaculate
does contain sperm and it only takes one sperm to make a baby! Failure
rate can be up to 30%.
Some couples use the rhythm method. This relies upon a regular menstrual cycle
calculated from the first day of bleeding to the next time you start your period. The
main premise is to have intercourse during non-fertile days. Non-fertile days maybe
calculated by your physician. Failure rate can be up to 25%. If your menstruation is
irregular you do not qualify for this method.
Condoms are a good form of birth control as long as they are used properly. Failure
rates are approximately 15% with typical use. Plan A is a form of emergency
contraception that can be purchased at your pharmacy and used <48 hours after
unprotected intercourse. There is no prescription required. Failure rate can be 20-
50%
The female diaphragm is another form of non-hormonal contraception although it
needs to be fitted . It must be in place prior to intercourse with spermicide and
remain in the vagina 6 hours after intercourse. Failure rate is approximately 20%
and maybe fitted at Willow Women’s Clinic.
If you wish to try hormonal methods of birth control there are several different
options. These are reversible upon discontinuation and do not need a “rest” period.
There is a new low dose estrogen/progestin pill called Lo lo. Samples are available
for 3 months. Side effects can include irregular bleeding x first 3 months, nausea,
breast tenderness, headaches and mood changes. There is a small but serious risk of
deep venous thrombosis. There are also patches and vaginal rings that act in a
similar manner. Failure rate is approximately 5% with typical use.
The intra uterine device (IUD) has been increasing in popularity since it is a long
acting reversible form of contraception. This can be used in women with or without
children. It takes <5 minutes to insert the device. The copper IUD contains no
hormones but may make periods slightly heavier and cram pier. It is around $80
and good for 5-10 years depending on the IUD brand. There are 2 progesterone
IUDs that will make periods lighter to having no periods at all. Failure rate is <1 %.
The Jaydess IUD is $280 and lasts for 3 years for women with no children. The
Mirena IUD is $380 and lasts for 5 years for women who have had a baby before.
Risks of IUD insertion include: risk of infection within the first 2 weeks, 0.1% risk of
uterine perforation, 2-10% risk of uterine expulsion.
Willow Women’s Clinic in Vancouver also inserts the Gyne-fix IUD which is currently
under evaluation. It is a copper rod with a knot at the top that is fixed at the top of
the uterine cavity. It is $80 for insertion. Benefits to this IUD is that is non
hormonal and doe not cause worsening of periods noted with aT framed copper
IUD.
Please contact your GP for discussion about these new and exciting to buy watson soma contraceptive
options. I would be happy to see you in consultation regarding these methods.
With summer brings celebrations of dads, grads and weddings. Graduation, new parenthood and marriage represent exciting life transitions and treasured memories for years to come. The reality is that even with positive changes, there can be difficulties adjusting, anxiety and even stress. It’s important to take time for yourself in the midst of all the excitement to make sure your mental health is being maintained.
Graduation Nerves
Here are some tips for adjusting to university from the University of Bristol:
Direct hyperlink: https://www.youtube.com/embed/OnRcYe8iFgg
Debunking misperceptions about the updated standard regarding walk-in clinics
College of Physicians and buy tramadol Surgeons of British Columbia: Registrar’s message
Misperception 1: The standard is new
To ensure quality of care in all practice settings in British Columbia, this past June the Executive Committee approved an amended professional standard entitled Walk-in, Urgent Care and Multi-physician Clinics. Contrary to what has recently been reported in the media, this standard is not new. The revised document merges and modestly revises two earlier, separate standards developed in 2008, and reiterates one basic principle that every physician must abide by: that the medical care of a patient, and not the setting of a medical practice, must guide the ethical, professional and clinical decisions around the provision of appropriate medical care.
This means that a patient is owed the same standard of care from a family physician whether treatment is being sought at a solo practice or a multi-physician clinic. While walk-in clinics may typically treat less severe medical episodes, patients who do not have a dedicated family physician and who are in need of longitudinal medical care should not be made to feel like they are on an assembly line for hurried and potentially compromised treatment.
Misperception 2: The standard has a “one visit” rule
All patients do not automatically become permanent patients of the clinic at the time of their first visit. Patients who do not identify a family physician and who regularly attend the same walk-in, urgent care or multi-physician clinic must be assumed to be receiving their primary health care from that clinic. The physicians and medical director are responsible for ensuring these patients are offered longitudinal medical care, including the provision of appropriate periodic health examinations and follow-up.
As in the past, a patient attending repeatedly at one clinic, essentially receiving all of his/her care there, is undeniably already accessing longitudinal primary care from that group of physicians. Providing such a patient with episodic care exclusively is inadequate.
Misperception 3: The standard says that patients get to choose a primary care physician at the clinic
The updated standard does not require that the ongoing care at a walk-in clinic be provided by only one physician, but rather all of the physicians and medical director collectively. The clinic must ensure there is a unified patient record that is accessed by all physicians at every visit. No individual physician working in a walk-in clinic is obliged to take a patient exclusively, nor can a patient demand that a particular physician working at a walk-in clinic become their dedicated family physician.
Overall, the updated standard outlines and strengthens the language on the expectations of physicians and the medical director. It also retains the requirement that clinics must have on-site access to PharmaNet and document appropriate review in the patient’s medical record. Accessing PharmaNet will help prevent situations like the one reported by CBC’s Go Public recently: Regulators’ investigation into prescription fraud identifies 150 health professionals. The College encourages registrants to review the revised standard: Walk-in, Urgent Care and Multi-physician Clinics.
While resolving health soma online resourcing issues falls primarily with the provincial government, the College and physicians across the province have a role to play in ensuring that British Columbians are receiving the highest quality medical care possible—whatever the practice setting.
H.M. Oetter, MD
Registrar
Read full article: https://www.cpsbc.ca/for-physicians/college-connector/2015-V03-04/01
Download: Viva Care – PPEP Assessment Task Force
Viva Care Medical Group would like to prepare all of our physicians of the CPSBC Physician Practice Enhancement Program that is rolling out across BC.
The Physician Practice Enhancement Program (PPEP) is a collegial program with three distinct components designed to proactively assess and educate physicians to ensure they meet high standards of practice throughout their professional lives. Each year, hundreds of British Columbia’s physicians participate in the program. More details of this program can be found by clicking here.
Viva Care Medical Group has established an Assessment Task Force that has the following objectives:
- Have clear and thorough understanding the of the Physician Practice Enhancement Program process.
- Developing a baseline for the clinic based on the criteria provided and address any gaps in advance of the assessment (education, process improvement, equipment purchasing, etc).
- Provide guidance and awareness to front staff and physicians on items that can be seen as focus areas for the assessment.
Question: Dear Wellness Pharmacist,
I have high blood pressure and came across the supplement, Salv-Tonic. Should I take this supplement and what benefits will I obtain by adding this to my health regimen?
Answer:
High blood pressure (HBP) also known as hypertension is when your blood pressure, the force of your blood pushing against the walls of your blood vessels is consistently too high. The primary way that HBP causes harm is by increasing the workload of your heart and blood vessels which means they work harder with less efficiency. It’s over time that the force & friction of HBP damages the delicate tissues inside your blood vessels (specifically your arteries). What happens then is the LDL or “bad cholesterol” form plaques inside the tiny tears along your arteries which signals the start of atherosclerosis. The more plaque build up you have inside your arteries, the narrower the inside of your arteries become leading to increased blood pressure & a vicious cycle that causes further harm to your heart & the rest of your body which ultimately leads to buy soma watson other cardiovascular diseases.
These cardiovascular diseases (CVD) refer to a group of disorders related to the blood vessels and/or the heart. Major CVDs include heart attack (also known as myocardial infarction, or MI), stroke, ischemic heart disease, atrial fibrillation, aortic aneurysm and cardiomyopathy, to name a few. In 2012 and 2013, 17.3 million deaths worldwide resulted from CVDs but it is estimated that 90% of CVDs are preventable. There have been a number of risk factors, some modifiable and some non-modifiable, identified as increasing your chances of getting one of these CVDs. These include age, smoking, physical inactivity, unhealthy diet, obesity, family history, hypertension, Type 2 diabetes, and high cholesterol. As you can imagine, the non-modifiable risk factors, meaning those that you cannot control, include age and family history; however, there are a number of modifiable risk factors, also known as, risk factors that people can control and change including physical inactivity, unhealthy diet, high blood pressure, high cholesterol and obesity. When these risk factors decrease, the number of CVDs improve. The development of CVD is complex & involves the interplay of various factors. For example, increased inflammation, oxidative stress (meaning an increase in the number of free radicals or reactive oxygen species, ROS) & endothelial dysfunction are a few of the factors that play a pivotal role in impairment leading to dysfunction & eventual development of CVDs. These ROS are highly reactive with the human body in the form of proteins, lipids & DNA & cause damage to these components of the body.
SalvTonic is a herbal supplement containing two Traditional Chinese Medicine (TCM) herbs. The first is Dan Shen (Salvia Miltiorrhiza) root extract and the other is Sanqi (Panax Notoginseng) root extract.
With over 3000 years of experience, TCM has a long, rich history and written tradition. The basics of TCM describe the physiology and pathology of the human body using the theories of Yin & Yang, Five Elements, Zang fu organs & the Vital substances that include Qi, Blood, Body fluids and Zing (or Essence). For the purposes of this article, I won’t go into detail regarding the specifics of each; however, here are some basic tenants of TCM:
- Qi denotes a dynamic essence that promotes the functions of our organs and tissues; therefore, if it is deficient or exhausted due to chronic disease, than various pathological changes may occur such as Qi deficiency.
- The Zang Fu organs represent more than just their anatomical substances (eg Heart, Liver, Lung, Stomach, etc). They’re classified by the different features of their functions. For example, the five Zang organs store up Qi and regulate its outflow while the six fu organs transform & transport vital substances.
- From the TCM perspective, the Heart is in charge of the blood vessels so only with ample Heart qi can the blood circulate in the vessels to nourish the whole body. If the Heart qi is insufficient, this can cause the vessels to be empty or if left untreated, the blood fails to circulate leading to a TCM disease state of blood stagnation. Blood or Qi stagnation can cause or lead to pain
- According to the Yin-Yang theory, everything in the universe can be divided into the two opposite but complementary aspects. The basic cause of disease in TCM is an imbalance between Yin & Yang, with the goal of treatment aimed at restoring a healthy balance once again in the patient.
In TCM, Dan Shen also known as Red Sage, a bitter & slightly cool herb is regarded as one of the most important herbs for the treatment of CVD. The constituents or active ingredients of this herb include Dan Shen Su which is an active phenolic acid in the dried root, salvianolic acid A and salvianolic acid B. These active ingredients had protective effects against NSAID-induced ulcer formation. Salvianolic acid A has clot busting activities which are related to its antiplatelet action. With its affinity for the TCM organs of the Heart, Pericardium & Liver, this herb is used to invigorate blood and move blood stagnation. In addition, it has been used to clear Heat in the blood & Heart. By activating circulation, it is effective against TCM conditions of blood stagnation or stasis.
Dan Shen is highly effective as an antioxidant scavenging free radicals such as superoxide dismutase (SOD). It also works to inhibit the oxidation of the characteristically known, “bad cholesterol” or LDL which play a key role in the development of plaque in the arteries, or atherosclerosis. The cardiovascular protection of salvianolic acids is not only limited by their role as antioxidants, as they also indirectly regulate immune function. Dan Shen is found to inhibit white blood cell adhesion, peroxide production and leakage of albumin through the vessel wall.
The second herb in SalvTonic is Sanqi also known as Panax Notoginseng. Notoginseng also inhibits white blood cell adhesion and degranulation of mast cells. The root extracts of Sanqi are typically dug in the spring or winter; however, the spring roots have a stronger pharmacological effect than the winter roots. The properties of the herb include sweet, bitter & warm & it has an affinity for the TCM organs of Liver, Stomach & Large Intestine. Individually, the herb works to stop bleeding & release stagnation as well as invigorate blood circulation & stop pain. It also nourishes the Blood & calm the Mind.
The combination of Dan Shen & Sanqi found in SalvTonic work synergistically on many inflammatory pathways to decrease inflammation in the treatment of CVD. Specifically studied in animals, were the combination of constituents, salvianolic acid B from Dan Shen and ginsenoside Rg1 from Panax notoginseng which improved heart rate contractility in those with documented myocardial infarction. SalvTonic helps to invigorate blood & thus improve blood stasis as well as alleviate pain in the chest due to stagnation of qi & blood flow.
In short, SalvTonic’s herbal cardiovascular microcirculation formula provides multi target protection for your heart & blood vessels. It works on specific pathways to improve circulation & blood flow, reduce plaque formation, lower total cholesterol & improve risk of thrombosis, all of which contribute to CVDs including angina, MI & stroke. In essence, SalvTonic can also reduce the complications associated with angina and diabetes.
The recommended adult dosage of SalvTonic is one capsule taken orally, three times a day. In the event of an acute episode of angina, it is recommended to open up 1-2 capsules & pour directly under the tongue allowing for faster drug absorption & thus quicker onset of action.
Those who should not use Dan Shen specifically, include patients who are pregnant, Yin deficient, dealing with post partum bleeding, hemoptysis or hematuria.
Always check with your doctor and/or pharmacist before trying any new supplement, herb, over the counter (OTC) or prescription medication to ensure that it is necessary, safe & effective for you to take. In addition, always advise your doctor and/or pharmacist before making any changes to your health or drug regimen to ensure that there are no interactions to the medications or supplements you are taking.
For more information about SalvTonic, visit https://biomedicine.com/public_downloads/BiomedSupplements/SalvTonic-2-sided-handout.pdf to download a patient handout from Biomed International.
References:
- Rongrong, W., Li, D., Guangqing, Z., Xiaoyin, C., & Kun, B. (2016). The Effects of Iontophoretic Injections of Salvia miltiorrhiza on the Maturation of the Arteriovenous Fistula: A Randomized, Controlled Trial. Alternative Therapies In Health And Medicine, 22(5), 18-22.
- Ho, J. H., & Hong, C. (2011). Salvianolic acids: small compounds with multiple mechanisms for carisoprodol cardiovascular protection. Journal Of Biomedical Science, 18 doi:10.1186/1423-0127-18-30
- Chang, C., Chang, Y., Hu, W., & Hung, Y. (2016). Oxidative Stress and Salvia miltiorrhiza in Aging-Associated Cardiovascular Diseases. Oxidative Medicine And Cellular Longevity, 20164797102
- Zhou, X., Razmovski-Naumovski, V., Chang, D., Li, C., Kam, A., Low, M., & … Chan, K. (2016). Synergistic Effects of Danshen (Salvia Miltiorrhiza Radix et Rhizoma) and Sanqi (Notoginseng Radix et Rhizoma) Combination in Inhibiting Inflammation Mediators in RAW264.7 Cells. Biomed Research International, doi:10.1155/2016/5758195
- Hou, Y. Z., Wang, S., Zhao, Z. Q., Wang, X. L., Li, B., Soh, S. B., & Mao, J. Y. (2013). Clinical assessment of complementary treatment with Qishen Yiqi dripping pills on ischemic heart failure: study protocol for a randomized, double-blind, multicenter, placebo-controlled trial (CACT-IHF). Trials, 14 doi:10.1186/1745-6215-14-138
- Deng, Y., Zhang, T., Teng, F., Li, D., Xu, F., Cho, K., & … Jiang, B. (2015). Original Article: Ginsenoside Rg1 and Rb1, in combination with salvianolic acid B, play different roles in myocardial infarction in rats. Journal Of The Chinese Medical Association, 78114-120. doi:10.1016/j.jcma.2014.10.001
- http://www.tcmbasics.com/basics_yinyang.htm
- https://www.sacredlotus.com/go/chinese-herbs/substance/san-qi-notoginseng-root-pseudoginseng-root
- Zou, C., Lu, F., Mao, W., & Liu, X. (2012). Chinese Herbal Medicine Danshen Formulations for Preventing Renal Disease in Henoch-Schönlein Purpura: A Systematic Review and Meta-Analysis. Journal Of Alternative & Complementary Medicine, 18(4), 394-401.
- https://biomedicine.com/ProductDetail/35011335_Salvtonic-60-Capsules
- https://biomedicine.com/public_downloads/BiomedSupplements/SalvTonic-2-sided-handout.pdf
- http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/What-is-High-Blood-Pressure_UCM_301759_Article.jsp#.WmZmFncZPaY
It’s true. Feel scared before you even try? What if it is tiny as thin as hair and there is absolutely NO pain? And works amazingly good for the body and mind? How’s it sound that if buy soma online a method of cupping can relieve all the tension in the body immediately?
Acupuncture and cupping developed from a philosophy that relates to the whole of nature to understand how body works and heals. It sees the human being not as separate from nature, but as an interrelated and integral part of it. And like nature, which is harmonious when it is in balance, so too the human body is healthy when it is balanced, when its organs function in harmony with one another, and when the energy within the body flows properly.
The acupuncturist sees pain and illness as expressions of an imbalance within the body’s system of energy. They are diagnosed and treated in relation to the whole person (whereas standard western medicine tends to treat only the specific symptoms of the disease). The goals of acupuncture are thus to address the imbalances that are causing the pain and illness and to restore harmony in the internal energy (qi, pronounced chee) of the body. By doing this, acupuncture facilitates the healing of illness, the prevention of further disease, and the maintenance of optimal health.
How Acupuncture & Cupping Works?
THE ART OF NATURAL BALANCED ENERGETIC HEALING
Did you know? Qi flows through pathways, called meridians. Meridians serve as channels to the internal organs and glands. The meridians are like a map of energy flow throughout the body. This map is linked throughout by an intricate series of acupuncture points. The acupuncturist gains access to the organs by placing very fine needles into specific, corresponding acupuncture points. The goal is to build up the qi of areas that have too little energy, to remove the negative excess qi from areas that have too much energy, or to encourage the flow of qi where there is a blockage of energy. Yes, it is “making a balance.”
How’s cupping? Same theory. It works best for stiff back problem for removing negative energy and promote fresh blood circulation back to flow again that has been blocking from the stress and tension. Isn’t it nice?
What other medicines can heal human body with just a needle and a cup? So as we believe it is “a God given gift.” for a human. If you don’t try, you will never know how good it is! J
Bring natural calmness & painless to your mind and body “immediately & beautifully.”
As soon as just 2 needles inserted in the body, body’s energy channel opens its door. And the patient feels immediate comfort at the beginning, and then brings entire calmness to whole body. It calms down the nerve system from stress mode to relax mode. When our body’s blood and energy circulation start to flow back to normal without any blockage, our mind gets clear and calm tramadol extra and all the unnecessary thoughts start to disappear. It is the art of natural balanced energetic healing. It has powerful effectiveness for those who have been suffering in their daily lives.
Insomnia (individual’s report of difficulty with sleep) is the most prevalent of all sleep disorders. It is believed to be a disorder of hyperarousal buy tramadol that is experienced throughout the whole day. The cognitive model suggests that stressors of life cause an individual to worry and reflect to the point that they have difficulty falling asleep or going back to sleep once awakened. Another model suggests physiological factors, based on the significantly higher metabolic rates seen in patients with insomnia compared with healthy controls.
Insomnia is more prevalent in women than men (ratio 1.4:1), elderly patients, and in patients with comorbid psychiatric or medical illness. Insomnia appears to be a predictor of psychiatric and medical comorbidities including depression, hypertension, diabetes and cardiac events, all of which contribute to an increase in health care utilization and costs.
The diagnosis of insomnia disorder is given whether it is an independent condition or a comorbidity with a mental disorder, a medical condition or a different sleep disorder.
General Sleep Hygiene Recommendations:
- Go to bed only when you are tired
- Use the bedroom only for sleep and sex
- Get up at the same time in the morning regardless of how long you slept
- Avoid napping during the day
- If unable to sleep after 15-20 minutes, get out of bed and go to another room to read in a dimly lit environment. Avoid watching television or a computer screen as the light emitted from such devices may have an arousing effect. Return to bed when feeling sleepy.
Sleep Hygiene Education:
- Fix a bedtime and an awakening time
- Avoid caffeine 4-6 hours before bedtime and minimize total daily intake
- Avoid nicotine near bedtime and upon awakening at night
- Avoid alcohol 4-6 hours before bedtime
- Avoid heavy, spicy or sugary foods 4-6 hours before bedtime
- Exercise regularly, but not right before bed
- Use comfortable bedding and pillows
- Find a comfortable temperature setting for sleeping and keep the room well ventilated
- Block out all distracting noise
- Try a light snack before bed such as warm milk and foods high in the amino acid tryptophan
- Try relaxation techniques before bed
- Don’t take your worries to bed
- Establish a pre-sleep ritual such as a warm bath or a few minutes of reading
- Get into your favourite sleep position
There are a few non-prescription medications that can be used to treat insomnia in conjunction with the above techniques. Call Viva Care Pharmacy (Guildford) at 778 293 2273 and speak to your pharmacist today to see soma watson what option will work best for you!
References:
CTMA 2
Canadian Pharmacists Association. (2016) Compendium of Therapeutics for Minor Ailments 2ndedition
Ottawa, Ontario
Introduction
The abbreviation “TMJ” refers to the joint but is often used to refer to any problems with the joints. Such problems include popping sounds in your jaw, not soma online being able to completely open your mouth, jaw pain, headaches, earaches, toothaches, and other types of facial pain. Most people with TMJ problems have pain that comes and goes, but some have chronic (long-term) pain.Signs and Symptoms
• Pain, particularly in the chewing muscles or jaw joint or an ache around your ear
• Limited movement or locking of the jaw
• Pain in the face, neck, or shoulders, or near the ear
• Clicking, popping, or grating sounds when opening your mouth
• Trouble chewing
• Headache
• Also, sometimes earaches, dizziness, and hearing problems
What Causes it?
• A bad bite, called malocclusion
• Orthodontic treatment, such as braces and the use of headgear
• Wearing away of the disk or cartilage in the joint
• Stress or anxiety. People with TMJ problems often clench or grind their teeth at night, which can tire the jaw muscles and lead to pain.
Who’s Most At Risk?
• Gender — more women than men seek treatment
• Age — people ages 30 – 50 have the most problems
• Grinding teeth, clenching jaw
• Malocclusion (bad bite)
• High stress levels
How Can Acupuncture Help the Temporomandibular Joint (TMJ)?
According to ancient theories of Chinese medicine, acupuncture acts by restoring the balanced flow of Qi, or energy. Modern research has revealed scientific reasons why acupuncture is a successful therapy: in the 1970s, reports appeared in Western medical literature suggesting that one way in which acupuncture reduces pain sensation is through direct stimulation of the nerve, which changes the quality of signaling along nerve cells.
Further studies support this idea by demonstrating that acupuncture directly stimulates the release of endorphins and neurotransmitters, among other biological actions. These are naturally occurring substances that help dampen and block pain perception by the brain. Additional research is needed to further study the mechanisms behind acupuncture since many of acupuncture’s effects can still not be explained by either of these medical theories.
Whether by affecting Qi or biological chemicals, what may be more important than the way in which acupuncture works for temporomandibular joint (TMJ) disorder is simply the evidence that it does work. Needles may be inserted in the area of the pain, around the ear and the jaw. Or, because of the interconnecting pathways between the meridians, the needles may be inserted near the elbows, knees, and big toe; these distal locations can alter the flow of Qi flowing through the jaw to relieve pain and inflammation as well. Additional acupuncture points are to address other disharmonies detected in the body; correcting the overall flow of energy in the body can help relieve stress and other possible tramadol contributing factors to your TMJ disorder.
Generally six acupuncture treatments are recommended, though a mild condition might be treatable in four treatments and chronic conditions may require more. While these treatments do lead to decreased pain, long-term treatment may be necessary to reeducate the muscles surrounding the temporomandibular joint (TMJ), preventing further complications. Complete treatment also necessitates working at the level of the cause, making lifestyle changes including posture, diet, dental work, and decreasing stress.
– taken from altMD.com