<?xml version="1.0" encoding="UTF-8"?><rss version="2.0" xmlns:content="http://purl.org/rss/1.0/modules/content/" xmlns:wfw="http://wellformedweb.org/CommentAPI/" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:atom="http://www.w3.org/2005/Atom" xmlns:sy="http://purl.org/rss/1.0/modules/syndication/" xmlns:slash="http://purl.org/rss/1.0/modules/slash/" > <channel> <title>Other Archives - goldsteinmd</title> <atom:link href="https://www.goldsteinmd.com/category/other/feed/" rel="self" type="application/rss+xml" /> <link>https://www.goldsteinmd.com/category/other/</link> <description></description> <lastBuildDate>Wed, 22 Jan 2025 23:35:49 +0000</lastBuildDate> <language>en-US</language> <sy:updatePeriod> hourly </sy:updatePeriod> <sy:updateFrequency> 1 </sy:updateFrequency> <image> <url>https://www.goldsteinmd.com/wp-content/uploads/2017/12/cropped-header-logo-2-1-32x32.png</url> <title>Other Archives - goldsteinmd</title> <link>https://www.goldsteinmd.com/category/other/</link> <width>32</width> <height>32</height> </image> <item> <title>More Medical News – Calcium and Cardiovascular health</title> <link>https://www.goldsteinmd.com/blog/more-medical-news-calcium-and-cardiovascular-health</link> <comments>https://www.goldsteinmd.com/blog/more-medical-news-calcium-and-cardiovascular-health#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Tue, 23 Jul 2019 14:32:41 +0000</pubDate> <category><![CDATA[Bone Health]]></category> <category><![CDATA[Other]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=2664</guid> <description><![CDATA[<p>An article in the Science Section of last week’s New York Times mandates sending this out. The article was entitled, “Popular but not very effective.” The subtitle was, “Cardiovascular supplements and diets do little for hearts.” It was a relatively extensive article about a number of popular supplements and different diets based on research published … <a href="https://www.goldsteinmd.com/blog/more-medical-news-calcium-and-cardiovascular-health" class="more-link">Continue reading<span class="screen-reader-text"> "More Medical News – Calcium and Cardiovascular health"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/more-medical-news-calcium-and-cardiovascular-health">More Medical News – Calcium and Cardiovascular health</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[ <p>An article in the Science Section of last week’s New York Times mandates sending this out. The article was entitled, “Popular but not very effective.” The subtitle was, “Cardiovascular supplements and diets do little for hearts.” It was a relatively extensive article about a number of popular supplements and different diets based on research published in the Annals of Internal Medicine, which reviewed data from hundreds of clinical trials involving almost one million people. </p> <p>Obviously, I am not a cardiovascular specialist and I am not going to comment on most aspects of that article. However, it did mention that taking calcium, “increased the risk of stroke, perhaps because of increases in blood clotting and hardening of the arteries.” THIS IS NOT NEW NEWS! In January of 2017, I sent an email blast based on a cover story in the journal OBG Management that I had written entitled, “Calcium and atherosclerosis?” At that time, I described the fact that in 2001, the National Institutes of Health (NIH) had a consensus panel on osteoporosis that concluded that calcium intake was crucial to maintain bone mass and should be maintained at 1,000-1,500 milligrams per day in older adults. That panel felt that the majority of older adults were not meeting recommended intake from dietary sources and recommended calcium supplements.</p> <p>However, even at that time in 2017, large randomized, placebo-controlled trials, which, as you know, are the gold standard of clinical research, that involved calcium supplements had demonstrated concerns about their safety as well as their efficacy in possible fracture prevention. Studies show that calcium supplements increase the risk of kidney stones, as well as cardiovascular events in healthy older women. In addition, I reviewed the fact that calcium supplements are actually bound as a “salt” and, when they are broken down in the blood stream to elemental calcium, they only yield 40% of what was on the label. Thus, a 500 milligram Oscal® will give you, at best, 200 milligrams of elemental calcium.</p> <p>Since that time, I have advised so many of you to make sure that your diet has adequate calcium intake (approximately 1,200 milligrams per day). Click here for a <a href="http://r20.rs6.net/tn.jsp?f=001uCAUCTOBx18m1SW78i5Wts9-Ef4FSNFJavLpFY3EMzE2EA1w_YEb5JHmVI5JFFaE1dG4oVkgmsqvlXZBqg6iZKQjTTv80wBknDI65J0byEhKjw_sBYiN6JWiP8bHnYEGR_AUx1AlEnpC3xXDLR9lApKYOGuesIM8ZSN0cBQqrNHBGLWstAqEebzb3mgYE2m0PaGp7n4pckSO8JNxIwNDKhLc0gI5SXcDSg_SWKsSMDE=&c=-ZYoCJCNp0N46Hw-bzg7FEt1zW1q73emzgHrg17Beq4zXnLltwLbPQ==&ch=sKeckxugsJ3kXsbzEjEqAubE8DEPMHfbonXe-emDB43j_EgLEAe_iQ==" target="_blank" rel="noreferrer noopener">list of foods</a> and how much calcium they contain. Vitamin D supplementation is important and should be in the range of 1-2,000 IU/day. Next time you have blood drawn, either by me or your primary care doctor, ask them to check your vitamin D level. The optimal range is 30-50 picograms/milliliter. </p> <p>Dr Steven R. Goldstein is a <a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/" target="_blank" rel="noopener">Menopause Specialist in NYC</a> with concern for the bone health of women and Osteoporosis as they age and go through Menopause.</p> <p>The post <a href="https://www.goldsteinmd.com/blog/more-medical-news-calcium-and-cardiovascular-health">More Medical News – Calcium and Cardiovascular health</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/more-medical-news-calcium-and-cardiovascular-health/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Comment on NY Times article entitled “Birth Control Via App Gains Quiet Foothold”</title> <link>https://www.goldsteinmd.com/blog/comment-on-front-page-article-entitled-birth-control-via-app-gains-quiet-foothold</link> <comments>https://www.goldsteinmd.com/blog/comment-on-front-page-article-entitled-birth-control-via-app-gains-quiet-foothold#respond</comments> <dc:creator><![CDATA[Steven Goldstein]]></dc:creator> <pubDate>Mon, 22 Aug 2016 16:27:04 +0000</pubDate> <category><![CDATA[Other]]></category> <guid isPermaLink="false">http://goldsteinmd.com/?p=1853</guid> <description><![CDATA[<p>In yesterday’s New York Times there was a front-page article entitled “Birth Control Via App Gains Quiet Foothold”. I am compelled to comment. I acknowledge that the problem of unintended pregnancy in this country is huge. It is estimated that as many as 50% of births are “unintended”, or I guess that means “unplanned.” Fortunately, … <a href="https://www.goldsteinmd.com/blog/comment-on-front-page-article-entitled-birth-control-via-app-gains-quiet-foothold" class="more-link">Continue reading<span class="screen-reader-text"> "Comment on NY Times article entitled “Birth Control Via App Gains Quiet Foothold”"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/comment-on-front-page-article-entitled-birth-control-via-app-gains-quiet-foothold">Comment on NY Times article entitled “Birth Control Via App Gains Quiet Foothold”</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p>In yesterday’s New York Times there was a front-page article entitled “Birth Control Via App Gains Quiet Foothold”. I am compelled to comment.</p> <p>I acknowledge that the problem of unintended pregnancy in this country is huge. It is estimated that as many as 50% of births are “unintended”, or I guess that means “unplanned.” Fortunately, that is not even close to true in my practice.<br /> You see, guidelines are created as health policy and are intended for populations. I prefer healthcare that is individualized, one patient at a time, utilizing all factors such as previous personal history, family history, and my experience and knowledge to try to do what is best for that particular woman.</p> <p>Birth control pills are an excellent example. Taking into account generics and varying doses and formulations, there must be close to 100 brands of birth control pills. When I choose a particular pill for my patient, I take into account optimal dosage, type of progesterone in it, typical side effects that I want to avoid (weight gain, breast tenderness, mood changes, inadequate bone growth in women under 30) as well as factors I want to correct (existing acne, menstrual irregularities, perimenopausal symptoms like mood swings memory changes, sleep disturbances, free-floating anxiety, etc.). When a pharmacist or a healthcare provider “prescribes” pills via an app, yes they will suppress ovulation and prevent pregnancy but they will not get the fine-tuning of minimizing side effects and maximizing the non-contraceptive benefits that I strive for.</p> <p>As I’ve told so many of you, birth-control pills are actually cancer reducing agents. By suppressing ovulation there is good science that for every year you take birth control pills you reduce your risk of ovarian cancer 10%. The pill works by suppressing ovulation so the hormone in the pill is not on top of what you actually make it becomes instead of what you actually make. Thus it will actually lower hormone levels in perimenopausal women. Conversely, the lowest doses are too low for adolescents who are still growing their bone mass until age 30-35.</p> <p>In addition, suppressing ovulation is closer to “natural” than allowing one to ovulate 13 lunar months in a calendar year. The reason ovarian, uterine, and even breast cancer are on the rise in modern industrialized nations is because women are having too many menstrual cycles.</p> <p>Often, patients state that birth control pills are not “natural”<br /> So what is natural? Left to nature, women would have eight children and have to nurse them all for 12 to 15 months (there are no bottles or formula in nature). Along the way they would probably have three miscarriages. So most women who have two children and nurse them for 3 to 6 months end up with 500 or so menstrual cycles. Nature expected that you would have no more than perhaps 250 cycles. Thus suppressing the cycle with birth control pills is closer to “natural” then simply ovulating month after month after month.</p> <p>I hope this is helpful to you or someone close to you with whom you can share it.</p> <p>Dr Steven R. Goldstein is a <a href="https://www.goldsteinmd.com/services/best-obgyn-manhattan/" target="_blank" rel="noopener">Gynecologist in Manhattan</a> .</p> <p> </p> <p>The post <a href="https://www.goldsteinmd.com/blog/comment-on-front-page-article-entitled-birth-control-via-app-gains-quiet-foothold">Comment on NY Times article entitled “Birth Control Via App Gains Quiet Foothold”</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/comment-on-front-page-article-entitled-birth-control-via-app-gains-quiet-foothold/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Comment on New York Times article entitled “Bone drugs shunned for fear of side effects”</title> <link>https://www.goldsteinmd.com/blog/1851-2</link> <comments>https://www.goldsteinmd.com/blog/1851-2#respond</comments> <dc:creator><![CDATA[Steven Goldstein]]></dc:creator> <pubDate>Mon, 22 Aug 2016 16:06:03 +0000</pubDate> <category><![CDATA[Other]]></category> <category><![CDATA[bone drugs]]></category> <category><![CDATA[bone health]]></category> <category><![CDATA[bone loss]]></category> <category><![CDATA[Dexa scan]]></category> <category><![CDATA[osteoporosis]]></category> <guid isPermaLink="false">http://goldsteinmd.com/?p=1851</guid> <description><![CDATA[<p>A recent New York Times article entitled “Bone drugs shunned for fear of side effects”, is an excellent article written by the well known medical writer Gina Kolata. This is important information for all of my patients whether they are already at the age where bone loss and risk of osteoporotic fracture is present or, … <a href="https://www.goldsteinmd.com/blog/1851-2" class="more-link">Continue reading<span class="screen-reader-text"> "Comment on New York Times article entitled “Bone drugs shunned for fear of side effects”"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/1851-2">Comment on New York Times article entitled “Bone drugs shunned for fear of side effects”</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p>A recent New York Times article entitled “Bone drugs shunned for fear of side effects”, is an excellent article written by the well known medical writer Gina Kolata. This is important information for all of my patients whether they are already at the age where bone loss and risk of osteoporotic fracture is present or, if considerably younger, concerns about bone health for themselves or their loved ones should be still on their minds going forward.</p> <p>By way of background statistics: more women in the United States will suffer and a serious fracture of hip or spine than all of the heart attacks, strokes, breast cancers, and gynecologic cancers COMBINED.Truly a staggering statistic!</p> <p>Bone health and the risk of fracture from loss of bone after menopause is an important personal as well as a public health issue. It is said that a 50-year-old woman who doesn’t already have cancer or heart disease has a life expectancy of 91!! In the past when women didn’t live as long as they do now bone health and the concerns for us to prevent fracture were not as great in generations years ago. Thus maintaining bone health throughout one’s lifetime is crucial.</p> <p>It begins with what I call FAMS ( Flexibility Agility Mobility and Strength). There should be a lifelong adequate calcium ingestion ( preferably in one’s diet, rather than supplements) but also supplementation of 1000 to 2000 IU’s of Vitamin D per day. At the appropriate interval after menopause baseline Bone Density testing (DEXA scan) should be performed. Finally, it is tragic that so many women who WOULD benefit from drug therapy to reduce the risk of fracture shy away from appropriate therapy because of fear of very VERY rare side effects including the osteonecrosis of the jaw( abbreviated ONJ) and these atypical fractures of the femur which are exceedingly rare. As this article points out you only need to treat 50 people to prevent one osteoporotic fracture while fewer than one in 10,000 women on medication would be expected to have either the problem in the jaw (ONJ) or an atypical fractures. Women who do sustain a hip fracture have a 25% chance of not surviving one more year and a 20% chance of ending up in assisted-living. Another staggering statistic!</p> <p> Obviously decisions about whether or not medications are appropriate, and if so, which are the best medications for any individual patient, must be made on a case-by-case basis. As I’ve told so many of you: guidelines are created for populations medicine should be practiced one patient at a time. If you have any concerns about your bone health or one of your relative’s bone health, feel free to contact our office. </p> <p>Dr Steven R. Goldstein is a past President of the International Menopause Society, a Certified Menopause Practitioner and a <a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/" target="_blank" rel="noopener">Menopause Specialist in NYC</a>.</p> <p> </p> <p> </p> <p>The post <a href="https://www.goldsteinmd.com/blog/1851-2">Comment on New York Times article entitled “Bone drugs shunned for fear of side effects”</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/1851-2/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>CBS interviews Dr. Goldstein in regards to the link between the age at menopause and depression.</title> <link>https://www.goldsteinmd.com/blog/cbs-interviews-dr-goldstein-in-regards-to-the-link-between-the-age-at-menopause-and-depression</link> <comments>https://www.goldsteinmd.com/blog/cbs-interviews-dr-goldstein-in-regards-to-the-link-between-the-age-at-menopause-and-depression#respond</comments> <dc:creator><![CDATA[Steven Goldstein]]></dc:creator> <pubDate>Fri, 08 Jan 2016 19:02:32 +0000</pubDate> <category><![CDATA[Other]]></category> <guid isPermaLink="false">http://goldsteinmd.com/?p=1839</guid> <description><![CDATA[<p>Dr Steven R. Goldstein, a Menopause Specialist in NYC, is interviewed by Dr Max Gomez of CBS regarding the link between the age at Menopause and Depression.  </p> <p>The post <a href="https://www.goldsteinmd.com/blog/cbs-interviews-dr-goldstein-in-regards-to-the-link-between-the-age-at-menopause-and-depression">CBS interviews Dr. Goldstein in regards to the link between the age at menopause and depression.</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p><iframe src="https://www.youtube.com/embed/Q4oC3IwfP-0?controls=0"></iframe></p> <p>Dr Steven R. Goldstein, a <a href="https://www.goldsteinmd.com/services/menopause-and-perimenopause/" target="_blank" rel="noopener">Menopause Specialist in NYC</a>, is interviewed by Dr Max Gomez of CBS regarding the link between the age at Menopause and Depression.</p> <p> </p> <p>The post <a href="https://www.goldsteinmd.com/blog/cbs-interviews-dr-goldstein-in-regards-to-the-link-between-the-age-at-menopause-and-depression">CBS interviews Dr. Goldstein in regards to the link between the age at menopause and depression.</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/cbs-interviews-dr-goldstein-in-regards-to-the-link-between-the-age-at-menopause-and-depression/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>What is your true metabolic health?</title> <link>https://www.goldsteinmd.com/blog/what-is-your-true-metabolic-health</link> <comments>https://www.goldsteinmd.com/blog/what-is-your-true-metabolic-health#respond</comments> <dc:creator><![CDATA[Steven Goldstein]]></dc:creator> <pubDate>Thu, 24 Sep 2015 16:29:32 +0000</pubDate> <category><![CDATA[Other]]></category> <guid isPermaLink="false">http://goldsteinmd.com/?p=1831</guid> <description><![CDATA[<p>On 9/21/2015 Dr. Goldstein was interviewed by Dr. Max Gomez on CBS. As many of you are already aware, our Bone Density and Body Composition unit has a new program using the Dexa machine (which uses less radiation than flying on an airplane) to perform Body Composition tests. This innovative test reports your metabolic health … <a href="https://www.goldsteinmd.com/blog/what-is-your-true-metabolic-health" class="more-link">Continue reading<span class="screen-reader-text"> "What is your true metabolic health?"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/what-is-your-true-metabolic-health">What is your true metabolic health?</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p><strong><span style="color: #000000;">On 9/21/2015 Dr. Goldstein was interviewed by Dr. Max Gomez on CBS. </span></strong></p> <p><strong><span style="color: #000000;">As many of you are already aware, our Bone Density and Body Composition unit has a new program using the Dexa machine (which uses less radiation than flying on an airplane) to perform Body Composition tests.</span></strong></p> <p><strong><span style="color: #000000;">This innovative test reports your metabolic health based on your percentage of body fat, sex, and age. This method is far more accurate than using the BMI calculation that is outdated and not a sufficient measure of metabolic health. Many of you have already had this test done and can attest to how beneficial this information is to your health.</span></strong></p> <p><strong><span style="color: #000000;">Please visit the Body Composition Unit’s <a style="color: #000000;" href="http://www.nyubodycomposition.com">website</a> for more valuable information.</span></strong></p> <p><iframe title="YouTube video player" src="https://www.youtube.com/embed/exwxrBuHIUk?si=bw-KVnmcFsHW7A2x" width="560" height="315" allowfullscreen="allowfullscreen"></iframe></p> <p> </p> <p>Dr Steven R. Goldstein is the Co-Directory of Bone Densitometry and Body Composition, NYU Langone Medical Center. 1997-2016. Dr Goldstein is an <a href="https://www.goldsteinmd.com/conditions/osteoporosis-specialist-nyc-menopause-bone-loss/" target="_blank" rel="noopener">Osteoporosis Specialist in NYC</a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/what-is-your-true-metabolic-health">What is your true metabolic health?</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/what-is-your-true-metabolic-health/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Comments on Long Acting Reversible Contraception</title> <link>https://www.goldsteinmd.com/blog/another-front-page-article-in-todays-new-york-times</link> <comments>https://www.goldsteinmd.com/blog/another-front-page-article-in-todays-new-york-times#respond</comments> <dc:creator><![CDATA[Steven Goldstein]]></dc:creator> <pubDate>Tue, 07 Jul 2015 18:07:48 +0000</pubDate> <category><![CDATA[Pregnancy]]></category> <category><![CDATA[Other]]></category> <guid isPermaLink="false">http://goldsteinmd.com/?p=1812</guid> <description><![CDATA[<p>07/07/2015 There is an extremely interesting article on the front page of today’s New York Times entitled, “Colorado Finds Startling Success in Effort to Curb Teenage Births.” The article talks about a private grant that allowed free IUDs or subdermal implants to prevent pregnancy that was a six-year experiment in Colorado. During this period of … <a href="https://www.goldsteinmd.com/blog/another-front-page-article-in-todays-new-york-times" class="more-link">Continue reading<span class="screen-reader-text"> "Comments on Long Acting Reversible Contraception"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/another-front-page-article-in-todays-new-york-times">Comments on Long Acting Reversible Contraception</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p style="text-align: right;"><strong><span style="color: #000000;">07/07/2015</span></strong></p> <p><strong><span style="color: #000000;">There is an extremely interesting article on the front page of today’s New York Times entitled, “Colorado Finds Startling Success in Effort to Curb Teenage Births.” The article talks about a private grant that allowed free IUDs or subdermal implants to prevent pregnancy that was a six-year experiment in Colorado. During this period of time, the birth rate among teenagers plunged 40% and the rate of abortions fell by 42%. Apparently, this was most evident in unmarried women under 25 who had not finished high school. In addition, the article talks about how the changes were “particularly pronounced in the poorest areas of the state… where many young women have unplanned pregnancies.” Understand, from a societal point of view, preventing unintended pregnancy, especially in women who would then have an unintended child, has merit. However, the endorsement of the American Academy of Pediatrics in the use of this type of LARC (long acting reversible contraception) for adolescents as a <u>blanket statement</u> is somewhat distressing to me.</span></strong></p> <p><strong><span style="color: #000000;">When I trained, we were taught that intrauterine devices (IUDs) were best suited for patients who had had a child (the uterus grows with child bearing) and those in a stable monogamous relationship. If one catches a sexually transmitted disease from a partner, the IUD can serve as a wick helping to spread it up through the uterus and into the fallopian tubes often causing pelvic inflammatory disease (PID) and often compromising the future fertility of these patients. Thus, while I agree that in patients who because of their lack of education or socio-economic status or lack of insight cannot be counted on for appropriate contraception without a device like an IUD or an implant that does not require any participation on their part—in such patients this may, in fact, make sense and as evidenced by the Colorado experiment will cut down on unintended births and abortions.</span></strong></p> <p><strong><span style="color: #000000;">However, recently, I’ve had two young women referred to me from the student health service at NYU downtown (Washington Square) who had two IUDs each that they expelled. Each of these young women was sent to me to evaluate her uterus to see if there was some abnormality causing her to expel the IUD. Evaluation with saline infusion sonohysterogram and 3-D ultrasound revealed they had absolutely normal uteri. However, the width at the top of the uterus was only 2.9 cm in each of them, whereas, the IUD devices are 3.2 cm wide. In other words, each woman’s uterus was too small to accommodate the intrauterine device.</span></strong></p> <p><strong><span style="color: #000000;">My overall point is that decisions should be made on a case-by-case basis and individualized. Most of my patients do not need to accept even the small risk of future tubal damage from an intrauterine device in order to prevent unintended pregnancy. These forms of LARC may be appropriate for some groups of patients but I have not routinely embraced them for young women in my practice who have not had children and are not in a stable, monogamous relationship. That is not to say that occasionally the rules may be broken, depending on the individual situation.</span></strong></p> <p>Dr Steven R. Goldstein is a leading <a href="https://www.goldsteinmd.com/services/best-obgyn-manhattan/" target="_blank" rel="noopener">Obgyn in Manhattan</a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/another-front-page-article-in-todays-new-york-times">Comments on Long Acting Reversible Contraception</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/another-front-page-article-in-todays-new-york-times/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>A Message About Today’s News Concerning Ovarian Cancer and Angelina Jolie</title> <link>https://www.goldsteinmd.com/blog/a-message-about-todays-news-concerning-ovarian-cancer-and-angelina-jolie</link> <comments>https://www.goldsteinmd.com/blog/a-message-about-todays-news-concerning-ovarian-cancer-and-angelina-jolie#respond</comments> <dc:creator><![CDATA[Steven Goldstein]]></dc:creator> <pubDate>Tue, 24 Mar 2015 15:55:31 +0000</pubDate> <category><![CDATA[Other]]></category> <guid isPermaLink="false">http://goldsteinmd.com/?p=1800</guid> <description><![CDATA[<p>03/24/2015 I am writing to you from Orlando where the American Institute of Ultrasound in Medicine (AIUM) is having its annual meeting. I am the current president of this 10,000-member society and as most of you know I wrote the second book ever on transvaginal ultrasound and the first book on gynecological ultrasound. Today’s news … <a href="https://www.goldsteinmd.com/blog/a-message-about-todays-news-concerning-ovarian-cancer-and-angelina-jolie" class="more-link">Continue reading<span class="screen-reader-text"> "A Message About Today’s News Concerning Ovarian Cancer and Angelina Jolie"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/a-message-about-todays-news-concerning-ovarian-cancer-and-angelina-jolie">A Message About Today’s News Concerning Ovarian Cancer and Angelina Jolie</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p>03/24/2015</p> <p>I am writing to you from Orlando where the American Institute of Ultrasound in Medicine (AIUM) is having its annual meeting. I am the current president of this 10,000-member society and as most of you know I wrote the second book ever on transvaginal ultrasound and the first book on gynecological ultrasound.</p> <p>Today’s news about Angelina Jolie’s decision to remove her ovaries necessitates that once again I send you, my patients, an email blast.</p> <p>Some important facts; first Angelina Jolie carries the BRCA gene and that is why she had double mastectomies. In addition hers is the BRCA1 gene, which tends to cause high-grade ovarian tumors and tends to be premenopausal. The BRCA2 gene is less likely to be high grade and more likely to occur post menopausal. In addition less than 10% of ovarian cancers are related to this genetic mutation.</p> <p>Still, ovarian cancer tends to be a very lethal disease. In the “real world”, 82% of ovarian cancer presents as stage III or IV. The University of Kentucky ovarian cancer-screening program however found just the opposite. By annual transvaginal ultrasound screening, they picked up 82% of ovarian tumors at stage I or II, which is the exact opposite of the rest of the population.</p> <p>Recently a screening program in Britain, also using annual ultrasound screening, picked up ovarian cancer at an earlier stage. Still, they reported on nine women who came in less than one year after a negative ultrasound screen with a belly full of ovarian cancer—yet all nine were between 6–13 months since their negative screen. What does that tell us? If you are going to screen 12 months may be too long an interval. That is why for many years I have suggested seeing patients at six-month intervals, not for Pap tests but for vaginal sonograms. My personal motto has always been “over surveillance, under treat”</p> <p>Dr Steven R. Goldstein is a Gynecologist for <a href="https://www.goldsteinmd.com/services/cancer-screenings/" target="_blank" rel="noopener">Ovarian Cancer Screening NYC</a>. </p> <p> </p> <p>The post <a href="https://www.goldsteinmd.com/blog/a-message-about-todays-news-concerning-ovarian-cancer-and-angelina-jolie">A Message About Today’s News Concerning Ovarian Cancer and Angelina Jolie</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/a-message-about-todays-news-concerning-ovarian-cancer-and-angelina-jolie/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Properly Interpreting Specimens for Diagnosis</title> <link>https://www.goldsteinmd.com/blog/todays-ny-times-article</link> <comments>https://www.goldsteinmd.com/blog/todays-ny-times-article#respond</comments> <dc:creator><![CDATA[Steven Goldstein]]></dc:creator> <pubDate>Wed, 18 Mar 2015 20:13:56 +0000</pubDate> <category><![CDATA[Other]]></category> <guid isPermaLink="false">http://goldsteinmd.com/?p=1797</guid> <description><![CDATA[<p>03/18/2015 Once again, there is an article on the front page of the NY Times, which I feel mandates some commentary by me. And once again, I have gone back to the original article, which appears in the current issue of JAMA (Journal of the American Medical Association) rather than just the NY Times rendition … <a href="https://www.goldsteinmd.com/blog/todays-ny-times-article" class="more-link">Continue reading<span class="screen-reader-text"> "Properly Interpreting Specimens for Diagnosis"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/todays-ny-times-article">Properly Interpreting Specimens for Diagnosis</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p style="text-align: right;"><span style="color: #000000;"><strong>03/18/2015</strong></span></p> <p><span style="color: #000000;"><strong>Once again, there is an article on the front page of the NY Times, which I feel mandates some commentary by me. And once again, I have gone back to the original article, which appears in the current issue of JAMA (Journal of the American Medical Association) rather than just the NY Times rendition and summary of it.</strong></span></p> <p><span style="color: #000000;"><strong>The article is entitled “Diagnostic Concordance Among Pathologists Interpreting Breast Biopsy Specimens.” In the first place, you should all feel very comfortable and confident that there was almost 100% concordance for those patients who had actual breast cancer. In other words, this is a relatively straightforward diagnosis and something that is not often misinterpreted by community pathologists. The area where there was less good coordination was in precancerous lesions. I believe this is why it is so important for all pathology specimens to be interpreted by experts.</strong></span></p> <p><span style="color: #000000;"><strong>Certainly, in my area, that of gynecology, I have purposely always used the NYU Laboratory for pathology. These are not only experts but people who train pathologists to go out into the community and perform pathologic evaluations, in general. Some of you have experienced the following scenario, which happens all too often:</strong></span></p> <p><span style="color: #000000;"><strong>• A patient will bring her young daughter in who has had a markedly abnormal Pap smear done elsewhere. She has been told that she needs a LEEP procedure, which is somewhat destructive in that it removes a portion of the cervix.</strong></span><br /> <span style="color: #000000;"><strong> • This would triple her risk of preterm birth and incompetent cervix when she does decide to have children.</strong></span><br /> <span style="color: #000000;"><strong> • It is appropriate to do such a procedure for high-grade abnormal Pap smears.</strong></span><br /> <span style="color: #000000;"><strong> • The first thing I do is request the slides and bring them to the head of GYN Pathology here at NYU and look at them with him over a two-headed microscope. Probably four out of five times over the years that I have done this (and it seems to happen only a couple of times a year), he will end up showing me the area that this other pathologist thought was highly abnormal and is able to downgrade this to mildly abnormal or just atypical, thus allowing the young patient who hasn’t had her children yet to avoid any surgical intervention. Most physicians do not have pathology specimens re-reviewed, especially when these are sent to large commercial labs like Quest or National Health Laboratories. This is especially important if one is going to undertake a serious surgical procedure (like a total mastectomy or a LEEP of the cervix) for a “precancerous” lesion.</strong></span></p> <p><span style="color: #000000;"><strong>The final advice is something I often give to you when I see you in person, which is that your mammography (and therefore, breast biopsies and the pathologists that then look at them) should be done by facilities that are of the highest caliber and quality</strong></span></p> <p>Dr Steven R. Goldstein is an <a href="https://www.goldsteinmd.com/services/best-obgyn-manhattan/" target="_blank" rel="noopener">Obgyn in Manhattan</a> for all gynecological needs.</p> <p>The post <a href="https://www.goldsteinmd.com/blog/todays-ny-times-article">Properly Interpreting Specimens for Diagnosis</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/todays-ny-times-article/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Clarifying NY Times Article on Menopausal Symptoms</title> <link>https://www.goldsteinmd.com/blog/clarifying-todays-ny-times-article-on-menopausal-symptoms</link> <comments>https://www.goldsteinmd.com/blog/clarifying-todays-ny-times-article-on-menopausal-symptoms#respond</comments> <dc:creator><![CDATA[Steven Goldstein]]></dc:creator> <pubDate>Tue, 17 Feb 2015 20:44:15 +0000</pubDate> <category><![CDATA[Other]]></category> <guid isPermaLink="false">http://goldsteinmd.com/?p=1788</guid> <description><![CDATA[<p>2/17/2015 In today’s NY Times a story on the front page has the headline “Up To 14 Years of Hot Flashes Found in Menopause Study”. I agree totally. In my years of practice I have had many patients, some who resist therapy, and some unable to get off Hormone Replacement Therapy (HRT) who have symptoms … <a href="https://www.goldsteinmd.com/blog/clarifying-todays-ny-times-article-on-menopausal-symptoms" class="more-link">Continue reading<span class="screen-reader-text"> "Clarifying NY Times Article on Menopausal Symptoms"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/clarifying-todays-ny-times-article-on-menopausal-symptoms">Clarifying NY Times Article on Menopausal Symptoms</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p style="text-align: right;"><span style="color: #000000;"><strong>2/17/2015</strong></span></p> <p><span style="color: #000000;"><strong>In today’s NY Times a story on the <span style="text-decoration: underline;">front page</span> has the headline “Up To 14 Years of Hot Flashes Found in Menopause Study”. I agree totally. In my years of practice I have</strong> had<strong> many patients, some who resist therapy, and some unable to get off Hormone Replacement Therapy (HRT) who have symptoms even longer than that! I went to the original article published yesterday in the Journal of the American Medical Association (JAMA). This is still another report from a study called SWAN (Study of Women Across the Nation) begun in 1996 with ongoing analysis, this time through 2013. It involved 3302 women. This report was only of women who reported “frequent” hot flashes or night sweats. It was 1449 women, which is 44% of the total. Obviously to them their symptoms are important, but it also underscores the importance of not over ”generalizing”. I have always stressed to all of you that advice, and treatment decisions, must be individualized. It is never “one size fits all.”</strong></span></p> <p><span style="color: #000000;"><strong> </strong></span><span style="color: #000000;"><strong>In addition, in analyzing how long these symptoms persisted, they evaluated only 27% of the total population of SWAN. 28% of the original group had no visits where they reported “frequent” hot flashes or night sweats (recorded in the two weeks prior by an annual questionnaire) and thus were not included in the article. Another 18% of women were not included because they went on HRT because of their symptoms…so we do not know how long symptoms persist in those who DO choose therapy since this paper only included those who DID NOT.</strong></span></p> <p><span style="color: #000000;"><strong> </strong></span><span style="color: #000000;"><strong>Some other random (but hopefully worthwhile comments):</strong></span></p> <p><span style="color: #000000;"><strong> </strong></span></p> <p><span style="color: #000000;"><strong>-The study confirmed something we already knew: that African American women tend (operative word here is “tend”) to have symptoms longer, than non white Hispanics, then Caucasians, and finally Asians. This is well known and once again may be true of POPULATIONS but may not necessarily apply to INDIVIDUALS.</strong></span></p> <p><span style="color: #000000;"><strong> </strong></span></p> <p><span style="color: #000000;"><strong>-Other studies have looked at the issue of how long symptoms last and some have reported LONGER and some SHORTER. I often tell patients that by 4-5 years “out” (after menopause, that is the “Final Menstrual Period”), that about 75% of women have little or no symptoms and feel they are quite manageable (unlike the vaginal dryness and atrophy of menopause which gets a little worse the further out one gets). This study was close to that… at 5 years about 65% of women who started at menopause no longer had frequent symptoms and if the symptoms started in perimenopause it was a little more persistent (only 60% were symptom free).</strong></span></p> <p><span style="color: #000000;"><strong> </strong></span></p> <p><span style="color: #000000;"><strong>-It is important to reiterate that in those patients whose symptoms do start in PERIMENOPAUSE , 1.) pregnancy CAN still occur and 2.) traditional HRT is NOT indicated. If such patients are non-smokers and have normal blood pressure they are excellent candidates for ultra low dose birth control pills. (These are extremely safe, and will actually <span style="text-decoration: underline;">reduce</span> a number of cancers, but this is another whole topic which I have discussed with many of you.)</strong></span></p> <p><span style="color: #000000;"><strong> </strong></span><span style="color: #000000;"><strong>-Finally, the NY Times article mentions depression being higher in the women with persistent symptoms. Be careful. Is this “which came first: the chicken or the egg?”</strong></span></p> <p><span style="color: #000000;"><strong>They did NOT study women with depression and compare their hot flashes with a control group. If women are not sleeping and their lives are disrupted by symptoms this may well be the CAUSE of more depression and anxiety type symptoms. Or maybe not…</strong></span></p> <p><span style="color: #000000;"><strong> </strong></span><span style="color: #000000;"><strong>I hope this is helpful to you or someone important in your life. Share the information. The most important message though is 1.) don’t believe EVERYTHING you read and 2.) medicine is best administered one patient at a time.</strong></span></p> <p><span style="color: #000000;"><strong> </strong></span><span style="color: #000000;"><strong>Individualization, not generalization is key!</strong></span></p> <p><span style="color: #000000;"><strong> Dr Steven R. Goldstein is a <a href="https://www.goldsteinmd.com/services/female-hormone-replacement-therapy-nyc/" target="_blank" rel="noopener">HRT Specialist in NYC</a> for women going through Menopause. <br /> </strong></span></p> <p>The post <a href="https://www.goldsteinmd.com/blog/clarifying-todays-ny-times-article-on-menopausal-symptoms">Clarifying NY Times Article on Menopausal Symptoms</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/clarifying-todays-ny-times-article-on-menopausal-symptoms/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Pap Test helps prevent Cervical Cancer</title> <link>https://www.goldsteinmd.com/blog/todays-new-york-times-article-2</link> <comments>https://www.goldsteinmd.com/blog/todays-new-york-times-article-2#respond</comments> <dc:creator><![CDATA[Steven Goldstein]]></dc:creator> <pubDate>Fri, 14 Mar 2014 17:01:22 +0000</pubDate> <category><![CDATA[Other]]></category> <guid isPermaLink="false">http://goldsteinmd.com/?p=1785</guid> <description><![CDATA[<p>3/13/2014 Some of you may have seen an article on the front page of the business section of the New York Times today entitled “FDA Panel Recommends Replacement for the Pap Test.” Understand that this is simply an Advisory Committee to the FDA and this recommendation may or may not be adopted by the FDA … <a href="https://www.goldsteinmd.com/blog/todays-new-york-times-article-2" class="more-link">Continue reading<span class="screen-reader-text"> "Pap Test helps prevent Cervical Cancer"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/todays-new-york-times-article-2">Pap Test helps prevent Cervical Cancer</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p style="text-align: right;"><span style="color: #000000;">3/13/2014</span></p> <p><span style="color: #000000;">Some of you may have seen an article on the front page of the business section of the New York Times today entitled “FDA Panel Recommends Replacement for the Pap Test.” Understand that this is simply an Advisory Committee to the FDA and this recommendation may or may not be adopted by the FDA itself. Furthermore, as pointed out in the article, this does not mean that various societies like the American College of Obstetricians and Gynecologists will automatically change their guidelines. I am compelled to make a few observations: </span></p> <ul> <li><span style="color: #000000;">The article makes reference to the fact that HPV testing is more objective and Pap smear evaluations are subjective. This is in fact true, and one of the main reasons that I send all of your Pap smears to the NYU cytology lab, rather than using large commercial labs like Quest or National Health Laboratories, is that I feel the quality control here at NYU is superior. This is not unlike the comments I made about mammography after the recent article concerning mammograms (which by the way were done in Canada 30 years ago with outdated equipment). <span style="text-decoration: underline;">Any</span> of these tests are only as good as the people who perform and interpret them.</span></li> <li><span style="color: #000000;">While it is true that a negative HPV test would be somewhat reassuring, the incidence of <span style="text-decoration: underline;">positive</span> tests is so high, especially in women under 30, that this will lead to a great deal of unnecessary anxiety and intervention with testing. As I have told many of you THEY ARE TURNING HPV INTO <span style="text-decoration: underline;">THE</span> DISEASE. <span style="text-decoration: underline;">THE</span> DISEASE IS CERVICAL CANCER.</span></li> <li><span style="color: #000000;">The article correctly points out that the Pap smear has resulted in a huge reduction in deaths from cervical cancer between 1955-1992, but that rate has not declined further. In my opinion that is because 50% of these are related to patients who have <span style="text-decoration: underline;">never </span>had a Pap smear, another 10% in patients who have an abnormal smear but do not follow up.</span></li> <li><span style="color: #000000;">They quote the number that worldwide 70% of cervical cancers are associated with HPV subtypes 16 and 18, which are the ones this test detects. This data comes from all over the world and relates back to data collected in the mid 1990’s. In the United States, in an article published in 2007, in American women, of all the high risk DNA types of HPV, number 16 and 18 were number 6 and 10 in prevalence. What about all the other high-risk types?</span></li> <li><span style="color: #000000;">The new test, which they are recommending approval of, is made by Roche. Interestingly enough, Roche is the company that makes Gardasil, the vaccine being pushed onto most young women and now even young men by pediatricians. You may recall that a lobbyist for Roche was related to the Governor of Texas and that state came very close to mandating vaccinations for all young girls.</span></li> </ul> <p><span style="color: #000000;">Abandoning Pap smears for HPV DNA testing will result in a flurry of false positives, increase patient anxiety, increase invasive testing and is, in my opinion, not what I would recommend. Good Pap smear screening, with HPV testing <span style="text-decoration: underline;">where</span> <span style="text-decoration: underline;">indicated</span> as we currently perform, is in my opinion more than adequate. In more than 25 years of practice, I have had one case of invasive cervical cancer (and that woman walked <span style="text-decoration: underline;">into </span>my office with the disease).</span></p> <p><span style="color: #000000;"> </span></p> <p><span style="color: #000000;">Dr Steven R. Goldstein is a top <a href="https://www.goldsteinmd.com/" target="_blank" rel="noopener">Gynecologist in NYC</a> <br /> </span></p> <p>The post <a href="https://www.goldsteinmd.com/blog/todays-new-york-times-article-2">Pap Test helps prevent Cervical Cancer</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/todays-new-york-times-article-2/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> </channel> </rss>