Focus 580; Womens Health

Once a month on the program we talk about women's health and that is generally on a Monday. In the 10 o'clock hour the show with. Now for many years the same guest Dr. Suzanne troupe and she is an obstetrician and gynecologist here at the practice in our area. She's also on the faculty of the med school here at U of M and she makes this regular visit to us once a month to talk about women's health. Now as I say usually that's a Monday show and it's the 10 o'clock hour. Well we've had to make a little change in the schedule this time around next Monday would have been that the time for her to be here. But we we couldn't do that but we also didn't want to go an entire month without having her so we have rearranged things. It is the different day and time. But essentially it's the same program that we have in mind. She usually comes prepared to talk about a few things that are new or that might be in the news. We will do that. And if people have questions on that that's welcome but of course the idea here is that whatever is on your mind as long as it falls in her area of practice you can call. And I also do like to try to remind people that when we have physicians on the program and we do that on a pretty regular basis that we can't

do a diagnosis over the telephone that if you have a particular concern you need to take that up with a doctor that can see you. But. We also for a long time have been doing shows here regular programs on health because we thought it offers people a place to start maybe ask some basic questions. Add to their knowledge about health and then take it from there or with their own doctors. Questions are certainly welcome and I know that the doctor will do her best to give you an answer here in Champaign-Urbana 3 3 3 9 4 5 5 we do also have a toll free line good anywhere that you can hear us that's eight hundred to 2 2 9 4 5 5. Well welcome back. Glad have yank you. Good morning. There are some particular things that you would like to talk about. Well sure there are a lot of different interesting things in the news. I think a few months back I talked about the new form of sterilization called the IE Shure procedure and their low micro inserts. There are actually

coils that are inserted through the cervix through a procedure called his draw Skippy into the fallopian tubes too. Form a barrier that then granulated in essentially fibrosis grows in and then the tubes then are blocked after about three months time and you need to get next right to confirm that they are in fact blocked and in the research studies they were found to be 100 percent effective for sterilization purposes. We've only had a few cases that have been on in our area in part because insurance hasn't really quite kicked in and picked up the inserts themselves are quite expensive so in order for for a patient to have one of these procedures her insurance would have to cover that. The technical component of the doctor inserting the device as well as the device so that's led to some slowness in terms of

implementing this technology. Can't always be done in every patient if she already has a block in in one fallopian tube or something like that. It can't always be done but. It has now been extended in terms of its effect of miss from from two years up to three years and and they are they're quoting that it's ninety nine point eight percent effective. Now this is only ninety nine point eight percent effective in the cases where both tubes do get the inserts and you get the follow up X-ray to be sure that your tubes have been completely blocked and a lot of women are really liking the idea of the procedure because it isn't. You don't have to be cut off and so it's not an abdominal surgery in any way shape or form and actually can be done under local anesthesia in an office setting. And many patients do choose to have it under general anesthesia and general anesthesia does relax those tubes and make the insertion a little bit easier in some cases but I think that that this is the method

that you're going to hear a lot more about but as you can see it's very very new We're only extending the data out to three years where of course tubal ligations have been around. Most of the 1900s I think I think they were they definitely before 1950s they were doing tubal ligation So it's definitely a good alternative for some women. OK. Well we have a caller. Why don't we talk with them and champagne. I believe Lie number one. Hello. Yes I get it. Knowing right from a person who knows about advanced grade school and did not have a history of and Ciena inspections and I have now been diagnosed with high liver and high liver enzymes by the 63 you want me to do a 39 as Pete King Brady and it should be below 50 through and around the mirrors of Candide diocese to

balance and I have read at least and I'd like to see if it stops or is an experience that I bet it can use some of the major organs. I have no problem with my liver by the dongles and excess and sassy and being a bit of a ruin rogering And I think that I have some other sense that everything's an hour and it's only so. It is so sad whenever I see that dark meat but I do get rid of all the fast and I favor a precursor of it so I never saw it in print. Fast like a local river by getting out of my diet has Hepatitis as a rule. So far your sources are me I think is whether this is a problem for us is you know has it right

or you have been considering any ideas what I see happening. Well for listeners that that may not be quite up on all the the extensor medical research you've done into this condition. Candida albicans is a yeast organism. It's quite ubiquitous in our population in fact at any one time we round up a group of women and do national cultures about one in four women will probably test positive for this organism or one of its cousin yeast organisms eventually and for women where the organism grows very rapidly and. Takes over in the vegetal floor meaning all the different microorganisms in the normal healthy vagina. If you have an unbalance of the presence of the candida it can become a candida that gentle infection and these are quite common. In fact they estimate that about 75

percent of all women have had Canada vegetal infection at some time and they're commonly available over-the-counter products that treat these infections extremely well. Now some people develop chronic VADs gentle infections and we've begun to understand some of the factors that lead to chronic vegetal infections and one of the the common reasons to develop a chronic infection other words where you treat it it gets better. Comes right back. Or you have to treat for weeks on end and one of the causes and there are several and I know we've talked about this a little bit on other shows but I wouldn't be able to spend the whole hour on that. On the subject but. Carriage of these organisms in the G.I. tract. So especially in the lower colon is actually fairly common in people that are essentially healthy same to just the condition thrush can be candidiasis of the mouth and of course

babies and children tend to get it a little bit more but it's also known in adults and sometimes can be sort of sticky to treat. It turns out that we do know that some individuals who are extremely ill for instance individuals who not only carry Hib but are very immune compromised apparently can get. Candidiasis In other words this infection of their entire system and that could include organs. It's not something that a gynecologist like myself would ever really treat and actually it's it's not something that I've ever had any of my patients have cases of. So that in a you know rote rote routine healthy population it's not something that we see a lot of oh I see a lot of the oral and of the G.I. candidiasis and. We don't know. There

was a popular book written that talked about people with these chronic vegetal yeast infections and perhaps they had more disseminated infections than even in their G.I. tract and that they they needed evaluation and treatment. And that's probably when you get to that stage the correct type of physician that usually handles that level of case would be. An infectious disease specialist most likely some internist might might handle cases like that but probably an infectious disease specialist and they would be able to know what kinds of tests to run and to be sure that the condition that you're reporting in your liver is is related to any infection that you might have because there are so many things that can lead to liver disorders. But that's about all I can tell you in a in a general basis but I can't really offer you any specific guidelines about what tests

you actually need or or treatments other than to get in with an infectious disease specialist. OK let me ask you this I know this is out of your area but maybe it can help you simply because you're a doctor in a matter of hours. If I can trigger this jogger effect would you say that surfaces from the locker and the liver that's crossing you know if the gallbladder is releasing the bio but I'm not suggesting the fat critter be some blockers. I would cry very slightly elevated And I'm Robert. Let that be a possibility. So what if it has created a level is a little higher than normal because that was an indication that liver cells are being broken down abnormally.

Yesterday there as well. Basically yes there can be bile duct or some of the major docs of the liver that that are blocked that are related to people having abnormal liver function tossed like the ass Geo. Petey and so forth. It's also possible that they can be related to the degree of John to say can be related to the degree of other symptoms like Fatty stools and diet can play a factor. Many other medications can play a factor. Exactly being able to give you a current up to date analysis of what cellular mechanisms are going on in your liver. I really probably haven't truly reviewed that information since medical school so I think we're going to have to leave that to the Internet. Yeah I think maybe you were but what what test were. So that will be the best.

So BROCK You know I I really think that if you if you see an internist and sit down and go over the types of tests that that test for both liver function and biliary function and the you know in the context of both your symptoms and your past medical history that's going to serve you the best. But thank you for calling Yeah I think that's probably about it to the extent that we can do here on this program as I said the beginning is. It's kind of tough sometimes you get into a detail of the individual's case that is and it's really not my feeling unfortunately. Well our guest this morning Dr. Susan trippin she is an obstetrician and a gynaecologist and once a month usually on a Monday when she's here we talk about women's health. We change the schedule a little bit this week. But the program the idea about the program behind the program is the same 3 3 3 9 4 5 5 toll free 800 to 2 2 9 4 5 5 questions we were talking a little bit right at the beginning about this this new sterilization Yeth that involves essentially imply putting a device into the fallopian tube then the

tube is actually scarse Squiers over and it blocks the tube. Yes it effectively making it impossible for the sperm in the egg to get together. I just in you talked about the fact that some women might might find the procedure appealing because it doesn't involve having to make an incision in the abdomen that you would do if you're going to do tubal ligation. I'm just curious for for the the majority of tuples people who have them. Are they cases where the woman is just going for that procedure. Or are there how many cases are you doing something else some other surgery and you sort of say well while we're in there well try to tie my tubes. Well actually adding in little bits of elective surgery there's been sort of a trend away from it. For instance when I first started practice it was very common to throw in an appendectomy at the same time we did a hysterectomy and so forth and so on and we just don't do us as much of that.

It is true that if a woman has had endometriosis or pelvic pain. And she's going to have diagnostic surgery to see what's going on and if she's also at that point time where she might have been considering a tubal sterilization that those two things could be combined. If somebody was having a miscarriage and they knew for sure they were not wanting more children that could be combined just like after a birth we do. We often do it a tubal ligation and often we will do a tubal ligation at the time of a scissor inspection so we do combine tubal ligations with other types of operations you might be removing a cyst or something like that. And I think that is still tubal ligations have been extraordinarily popular. If you look at our population over the age of 35 and you take into consideration the males with a sect Timmy's the women with tubal ligations and the couples that have sterile sterilization or infertility being sterile for some other kind of

reason like a tubal factor or something like that statistically over one third of the population over age 35 is using sterilization essential as their contraception so it's very popular. There is also hope that. That with the procedures that you avoid some potential risks like avoiding the risk of anesthesia and avoiding the or any complications of the instruments being introduced into the abdomen for the tubal ligation all the risks are very very low. But the e sure procedure probably isn't one that you're going to piggyback on to other procedures sometimes we do do his draw space for bleeding disorder but in that case you would probably want to evaluate what was going on medically before you make the decision about about getting a nature implant. The other consideration for the implant is that there really was 100 percent effective in the in the study so there really

haven't been any ongoing pregnancies and basically with a tubal ligation you can either get your tubes reconnected which isn't really done that much anymore or you could have a test tube baby because nothing is actually done to your uterus at the time that the surest place though there's there are some some significant benefits but it's very new very new. We have another call here DDs also someone in Champaign Let's go there line number one. Hello. Hi good morning. I have had maybe a silly question. I thought I know is having a baby and this topic came up once in a day. I know when the baby's in the uterus the umbilical cord to then provide them you know in a trance and then what happens after the baby's born and they clip dandled are what what is that connected to inside like as a grown adult inside your belly button. Is there anything there there is. Well there's a there's a remanent and it becomes this thing

called a right to send it just looks like a like a string like a collapsed sort of a string but yeah the connections to where the umbilical cord goes inside your abdomen they essentially atrophy and go away. And really there's I think a few rare rare cases where something might persist but yeah it just does shrinks up and goes away. And before that it's just basically like thing. Ames and Guerrero back and forth right we have we have won big in the umbilical cord most of us have one big vein and two arteries except they're different. The typically in our circulation veins carry carry blood back to the heart and an arteries carry blood away from the heart so arteries usually have the more oxygenated blood and in babies it's reversed because of where it's coming from. And it's that it's picking up the oxygen. And

so it's a little bit reversed circulation wise but many many babies have just one artery and one vein and when that occurs we do Warry because statistically it's a little bit more likely for a developing infant to also have other birth defects if that's what we find so we will look for them but actually periodically we do see that too. You're a free fall. Thanks for the GO other questions are welcome 3 3 3 9 4 5 5 toll free 800 to 2 2 9 4 5. Just since the subject of umbilical cords comes up I'm curious because I know that some months back one of the things you talked about was cord blood banking cord blood and then suggesting to people that now that's an option and it's also a good thing to do to think about and it has that now are more and more people doing that. Well yeah you know it took off for a little while there's been a law enacted in the state of Illinois where they're trying to get a state run

bank off the ground and essentially so many parents took advantage of contributing to that their baby's cord blood to that bank that as far as I know that the system's a little bit overwhelmed and almost on halt at the moment and says you were asking that question I was thinking I haven't I haven't asked it when they're going to start that back up. But I think they'll get that up and going more and more people are doing it individually. With the state run program I think you could opt for a thousand dollars to not have your baby go into the general pool of blood but have your baby's blood specifically saved just for your own purposes. And there are many different banks out there that are that are very reputable and two or three have easier collection devices so I like them better but over the over the past couple of years I've I've worked with a number of different banks and in my patients have generally been very happy with it and

the the big hold up is is cost. But I think also in terms of the scientific merit I think it's a great idea. The options for the kinds of things that you can do with core blood may be expanding as we learn how to use other kinds of cells to provide those stem cells that they would be getting from the cord. I don't I don't remember specifically when we talked about this but thinking about it now my guess would be that you would be talking about very much blood how much blood you can get you can get an entire unit of blood really tween the cord and the placenta. Yeah. So I think that's two hundred fifty CCS. I think. So if so it is significant. So yes then. Then later something should happen. It's like in any time if people I think about having surgery there or something is happening where it's likely they might need blood. It's always better to get your own blood back. Want to get somebody

else's blood is that well the word always goes a long way. Maybe maybe your blood isn't as healthy as somebody else's blood for certain reasons. And generally what what we say of course banking a cord blood is little bit different than banking an adult's blood adult adult blood is usually banked electively for say planned surgeries that sort of thing and it's kind of weird. There was a big push for that about. It's been 10 or 15 years ago and now they're at least in my field there's been a big swing away from banking electively blood before surgeries and the reasoning is kind of like this. The incidence of transfusion from most of the major gynecologic operations that go on and day to day basis like a hysterectomy. Your chance of needing a transfusion is somewhere between 1 and 3 percent if you were completely healthy and even certain medical factors might only drive that up

a few percentile points. So you're banking a lot of patients blood for for not not very many patients that need that blood back. But when you take the blood you're going to make your patient a little bit relatively more name. So you're going to create a situation where actually more people need transfusions post surgery because you start at a lower point and. Just because once that blood leaves your body it is possible for medical errors to occur when you get that back it's just red blood in a bag. I have to trust that that bag was labeled correctly and so forth and so on and so probably for most patients having elective surgery there's really no need that there's to bank your own blood there's good healthy blood available for you Should you ever need it. Now if a particular patient has a very odd blood a very rare type or some sort of odd

antibody situations then it may be better in fact to bank her own blood. There's also quite a bit of interest in other products that can do what a blood transfusion would do. Of course there are people that do not accept blood transfusions so we've been trying some of these strategies for many many years in that patient population and many many patients have been treated very very safely and effectively. But new formulations for intervene with iron or possible blood substitutes. There is a essentially a a kidney hormone that our body makes it worth reporting and that can be used to stimulate. Our own blood cells to be produced so possibly even in some cases if you're anemic going into a surgery there there can be things done. I know after delivery is a time when when patients lose blood and there is about a half again expansion of the blood volume of a pregnant mom

so and stead of of becoming a mnemonic after you deliver what happens to the mom is she she gets back more to what her own blood volume would have been prior to her becoming pregnant so we're sort of set up that way to lose about that amount of blood or less. Now in cases where where moms go into the delivery process a little bit anemic to begin with for one reason or another that there are a little bit more likely to need a transfusion so particularly with some patients who might have a planned surgery or a plant a known a specific type of complication where we're worried about blood loss actually banking a pregnant mom's blood can be quite safe. And it has been done. I believe in using more of the blood substitutes if at all possible. And I'm actually going to be involved in a

research study looking at a new formulation of a Veyron to treat pregnant anemic moms or postpartum anemic mom so. So there's a lot of actual good research going on in that field right now. OK well what we have about a little bit past our midpoint here certainly have time for other questions. Our guest is Dr. Suzanne Tripp and she is an obstetrician and gynecologist once a month. She is on this program to talk about women's health as usually a Monday effect is usually the fourth Monday of the month so we're doing a little change in the schedule this time around. But say it's the same program. So if you have questions 3 3 3 9 4 5 5 toll free 800 to 2 2 9 4 5. There are some other topics you like talk of. Well I always like to follow all the research on soy supplementation particularly being the state of Illinois and being so close to the industry that that produces and promotes the healthy incorporation of soy into our diets. And a lot of women have now turned to soy

supplementation as they get away from estrogen use or decrease their or their estrogen use. And I know in the past we've talked about whether or not so I supplementation can be enough to preserve your bone density and. There been some issues there were some researchers here at the University of Illinois that questioned whether or not the plant estrogens and soit might actually stimulate breast cancer growth rather than inhibit it. Just because there are these compounds are very estrogen like so there was a little bit of hesitation in building up your soy consumption very much. There's always been a from that standpoint there's always been a lot of interest in using soy to improve your your lifted profile sell better cholesterol levels and that sort of thing have pretty much been confirmed by additional research again some of this research going on here at the University of Illinois and now some researchers and off the top of

my head I don't remember exact. Who did the study. I'm thinking that it may have been out of the country but now some researchers were specifically looking at the effects of high levels of soy on the lining of the uterus which we know one of the concerns we always had about patients taking estrogen hormone in menopause would be what the effects would be on the lining of the uterus. And that's why we came up with combination hormone replacement therapy where we used estrogen plus progesterone to avoid these hyperplasia effects on the uterus and we worried that if a woman were to take estrogen alone and she still had a uterus that it might increase her risk of lining cancer of the uterus if she did that for years on end short term use apparently is pretty safe for pretty much anything. And now some researchers have looked at relatively higher doses of soy and found that in fact. So I can can also produce some of these

lining thicknesses that we've see with estrogen alone cell. It's one study it's an early study. I certainly wouldn't tell patients to stop soya intake but I think that it's one of those pieces of health information that would be good to discuss with your physician if you're really remarkably increasing your soy intake. Yeah well I think when we've talked about this in the past and there have been some questions from women who are interested in the possibility that rather than using doing a kind of our hormonal replacement therapy that they like the idea of something that would be not using a medicine but using something that would be more and more natural and more Western as well. OK can I get enough plant based estrogen to actually achieve the kind of effect that you can if you're taking the medicine if you're supplementing it that way and as I recall you seem to be saying well we're not really sure that you can eat

that much. Well there was soil there. Different issues there are actual pills you can buy that have some of that the estrogen extract and so the question is is is that extract really the key ingredient in it would that be enough. And also exactly what the levels can be because in general if we look at plant estrogens compared to other estrogens they are plan estrogens are significantly weaker. So that would that would speak to whether or not you can eat enough and also our diet sensibilities are different and if we look for instance in say a Japanese culture that has a lot of soy intake one thing we have to remember is these individuals had high soy intake from childhood on so they had to take through puberty and through their reproductive years. And whether or not then you can at the age of Menippus suddenly mimic their health benefits from soy by newly doing so Hoyo it

has has been brought into question. Aside from the fact that it it might not be the kind of diet that you're used to or have access to but. If it's enough estrogen like to help your hot flashes it might be enough estrogen like to cause some of the side effects that lead these women to stop estrogen to begin with. So one of one of the flaws with menopausal health research has been that we spent all these years studying how to best get women on hormones what dose what type. And it's just a very new concept to try to encourage women to get off the hormones or once they have stopped the hormones. What rational strategy do we have to help monitor the patient and know when we need to intervene with other kinds of strategy like things for your bones and so forth. Well we have some of the callers here let's talk with someone in Champaign 1 1. Hello.

Yes I'm just wondering what the doctor might be recommending these days in terms of a vegetarian or a flexitarian or a pesky Tarion diet. There's been like a low carb craze and people are being told to they're not being told exactly to eat more meat but that's usually the response because they're being told to reduce their simple sugars in their diet. So you were just talking about choice. Why do you think that I still a high complex carbohydrate diet would look like being for oil and not. And I kind of think I'm still a very positive thing for the benefits of health. Well my personal philosophy is that I will always. For years now I have always thought that a varied diet is important and that there are probably a lot of micronutrients that a very that you can get from food that you can't do otherwise but one of the problems is as is this obesity situation that we're all faced with.

And there's there's kind of two issues here that I think you're touching on and one is can you. Can you be Akon Slike and vegetarian. I'm not sure. And that that's a big question. And the other is is one type of dietary approach better than others in terms of maintaining weight versus say the person that's obese needs to lose weight. So really unfortunately those are big different kinds of questions and I think in a in a nutshell or you know be a little corny there. I think that we don't have enough research yet there was a big study that was just out in the New England Journal of Medicine that for obese patients comparing the high protein to low carb diet to a more regular type of diet and one of the problems with that study so many people dropped out so you know a lot of us don't really follow things so specifically. So that's a problem in even answering the

question but it looked like in the first six months that the high protein patients did lose more weight and I don't I don't read that study close enough to be able to tell you whether vegetarians in it but I don't think there were. But then by the end of 12 months both groups were about the same. And as I understand it there are going to be some bigger trials. At the NIH I know there's like a website called clinical trials dot gov that you can even look up a lot of industry trials although periodically I try to look up trials I'm involved in. They haven't yet gotten uploaded to that site but there are a lot of different trials listed there and I think they're going to try to answer some of these questions I think on an individual basis. What I usually recommend is to have a brief conversation at least with your health care provider. Hopefully your health care or primary care provider all know little bit about nutritional background and talk about what kinds of

things you're doing and what kinds of micro-nutrients that you may or may not be getting because of some of the decisions you're making in your food choices whether it be for you know social reasons or taste reasons or whatever it is and try to do some research and see how you can maybe vary your diet enough to to come up with all the nutrients and then basically what your health your energy level how are you sleeping. I talked to a color very early in the show with. With liver issues and you know there are some blood chemistries that can can be drawn to make sure that that you have say a normal calcium level in your in your diet and that sort of thing so. You're asking a great question. Maybe I'm not answering you don't know I've always been more or less you know a flexitarian I haven't really been a big meat eater in my life more of a vegetarian diet but when I started in the 70s. You know people were concerned about how can you get enough

protein on a vegetarian diet but now I meet young people and they seem to think well you can get enough protein just eating anything. So it seems to me that if vegetarians probably do need to be concerned about getting a fairly high level of protein but they wouldn't necessarily have to eat meat or very much. So I guess that was my concern or just that I was wondering I was under the impression that vegetarians had a less likelihood of having diabetes and heart disease or at least heart disease. So it seems like the. That's what they're so concerned about with you know this outbreak of obesity. So. Well I think that if if you are the type of vegetarian that that eats enough of a balance where your energy levels are stable in other words you're not taking in so many more calories than you're burning up. Then I think you're in good shape but I think we've shown that obesity is linked to diabetes and heart disease and if you're a vegetarian with a very high Say for instance cheese intake you are going to

potentially be in a heart health risk if you gain weight if you are modest about it and if your cholesterol levels maintained in a low range and you're thin in your exercise you're probably in a low risk category for heart disease. Yeah and it always comes back to the question. It benefits I was just reading that if you don't get enough cows if young girls or young people don't get enough calcium or they don't eat enough milk or cheese or whatever they are more prone to obesity. So it's always like don't get too much don't get too little. Well and there are a lot of these questions that we haven't answered. I was reading something about about bottled water and how the fact of so much bottled water doesn't isn't floor dated and I guess there's a website where you can look that up too. And and and so you know things where maybe you have crept in our society taking it for granted we can't necessarily. Yeah and then I don't know if you can answer this question. There are certain medications that say

that they could possibly increase your prolactin levels and then many many. Right and then they may say well if you have breast cancer if you've had breast cancer you should take this medication but I'm just wondering if if you've had breast cancer in the family whether you should question using such a medication. I haven't seen anything written about that. There may be nothing that still sticks in my mind but I think if you had a question prolactin it's an easy blood test. OK all right thanks a lot. Thank you. Let's continue on the next caller is in Abana L.A. I'm going back to the way in diets it's relationship to estrogen. When you say significant amounts to a product you know what are you talking about. Well in I think a Japanese anation they get about 200 and thinking milligrams and I don't

remember all the different levels. One of the problems is in most of the studies they they pick all these different random levels and there's not any really known standardization but it would probably be like getting your your diet up to Asian levels of of soy intake and then possibly even on top of that using supplements. And again that particular piece of research that I was quoting It's a new study and just one more piece that we're looking at and I don't know. That I think people are moderate. So you know if you have a little tofu in your diet and you have some miso soup and eat soy nuts now and then I think you're going to be fine. But if you're suddenly trying to incorporate this almost into three meals a day I think that that might get you up to Asian levels.

OK thank you. Good. It's continue and will go here to line number four and the call here is in Indiana. Well hello. I listened to you throughout the last few years. We have I have a number of girls in the extended family so to speak and most of them are very young 20 to 29. And their attitude towards doctors is very flippant. And so I must say rather rather well and then pass on information and try to use whatever power I have to get them to take care of themselves. The question now I would like to ask is perhaps too general but what is this. Say extra percentage overweight. A young girl or or an older woman for that goes can carry a Sansa diabetes heart problems you know just the general sense. But pop up on the screen. One girl one woman is 5 4 and has decided that she's going to take it easy for a while in terms of you know keeping the

slim body in all the ads she says she's going to be like the rest the ladies in her age class and most of them are overweight and I just have started to campaign very subtle but trying to get her to lose some weight. And if I had some facts about where you're you know 17 percent over and that means blah blah blah is can you give me any information like that. There's a tremendous amount of good information about that. And right now the best formula that we have to use is the BMI. And it's the Basal Metabolic index that's basically your height over your weight. And we categorize people from think it's like eighteen point nine so essentially 19 to 25 is considered normal weight 25 to 29 is considered overweight and. Then the next grouping for obese is 30 to 40 and the. Then it gets to I think it's very super obese and severely obese. I don't remember all the different terms. And

there are all kinds of places you can go on the web I know that the medicine dot com has a has a commune or consumer health area and you can go under Tools and you can put in your BMI You can also you know they have a great tool where you can put in your age and your weight relative to your sex. Remember feat I think you must put your height in there to consider body frame you know large bones small bones that sort of thing. That's unfortunate and I mean I haven't had much you know and I've always explained away as you are small and you do not. You're not a hundred yard absolutely lovely. I think that if you if you actually if you actually put what you're saying is absolutely right but we're talking for the whole population and then if you go even into like the American Heart Association website and American Diabetes website those things then talk about for your BMI. What risks you have and truly what's best for

all of us is to be in the normal weight range 19 to 25. I think if you're young and you exercise and you are in the 25 to 30 range 25 29 just under the obese year you're in reasonably good shape. Now the BMI of that movement thing came my mind as people walk on interests with a mask over their mouth and oh yeah this is just a this is a formula they've got actual tables. It's just based it's simple you could go on Medscape or or web M.D. you can just put BMI on under Google you're probably fine right. OK well thanks a lot I think that is its base. It's it's in books too it's a simple calculation it's just based on your height your weight. Correct there right. But you do have to do some good some conversion of the thing. But basically what it is it's it takes your height it takes your weight. It comes right a number and the and the original BMI was height weight whether you're male or female but now energy expenditure and some of the actual risks of heart disease and diabetes are of

course then linked to your age and sex. OK. West Lafayette the next line one. Hello good morning to you and I I would like to ask what's the latest idea is for management of wet I'm not sure which it is the seal wrecked the seal or urine. It's just. It'll probably happen as well. Once uterine prolapse become severe there's basically nothing you can do other than having surgery in the mild to moderate stages you can use the pus free which as a rubber device which kind of holds everything in and with Sister seals and Rectus seals again in the mild stages we usually recommend Cable's exercises which are tightening exercise. But once they get to the severe stage they really can only be repaired surgically. There are a lot of innovations in the surgery for these kinds of conditions particularly with incontinence. With these mash slings that are used that are able to be placed very rapidly and

I were relatively minor operation compared to what we used to do. And also there are some slings to correct some of the some of the pro lapses of that pelvic diaphragm which lead to the system to seal. But it's unfortunately one of those things where you got to sit down with your physician and you have to find out what your anatomy is really showing what degree and where you might be on that whole continuum of exercise and weight versus surgery. OK I I was hoping there was something really new and really easy. Thank you very much. Oh onto another caller here Chicago into hello. Hi I just wanted to give a reference for that gentleman who was calling about his relatives. I think the best book available is Paul Campos the obesity mess. Because you know he brings into question the BMI because exactly for the point that Jim and mention the with the bone size of the body and also now they seem to think

that weight gain might be related a great deal to genetics which would predispose some people to a certain size and I think the main point was that if you're not they're not really sure what is healthy and what weight it's a very individual and that the BMI is probably too gross a measure to be applied as it is. Well in those kinds of books and what you're saying has some grain of truth in absolutely you need to take your whole health picture your whole genetic picture. But the the fact of the matter is that probably only five determined percent of the population was obese. If you use any kind of cut off that the the the overall population weight gain is massively increasing in that we now have segments of our population that over half. Some parts of our population have obese adults and with

that we have skyrocketing rates of heart disease hypertension diabetes stroke gallbladder disease. We've linked breast cancer to obesity. We've linked other cancers to obesity. And you're right in that there may not there may not be this absolute. You must be 152 versus 153 pounds and so forth and so on or 150 versus 160. But there's no doubt about it in certain ranges that almost universally all the the research shows that that that's too much. He's called that into question and the primary reason that he's called into question is that they really when most of the studies that have been linked and other factors. And that begins to make a problem that what you really need to look at is a person's exercise history and the type of food that they eat in that those two factors are greater factors than the actual weight of the

person. You know like the Sunni wrestlers who are tremendously huge but in fact have a great deal of of muscle tone. So I think my main. The third is that he's talking about young women and I think you probably know from your practice. The danger with young women are having false ideas of how thin they should be. Oh there's the effort to drive that into gaining too much except that which is difficult to lose. And then all the process health problems related to yo yo dieting. I think that actually yo yo dieting hasn't been shown to be the the bad thing we thought of it before. Interesting like. Well where I'm going to jump in here and my apologies to the caller we just were at the end of the time and we're going to have to stop. I'm sure that on other days we'll get back to some of these issues. You can also look for the regular monthly show that they do on the afternoon magazine once a month dealing specifically with nutrition issues so we can do that with that and that kind of contacts too. But right now we're going to have to say thank you very much and thanks for being here. Thank you to our guest Dr. Suzanne troupe and she's an

obstetrician gynecologist. She's practice here in our area and also she teaches at the med school here in Urbana champagne.