1. Can CBD help aches, insomnia and stress?
Want to exercise longer, sleep better and feel less stressed? Products with cannabidiol (CBD) may be the answer—if you use them the right way. “A lot of people aren’t getting guidance when they buy, so they think they don’t work,” says Jen Hartmann.
A chiropractor and co-owner of Strafford Chiropractic & Healing Center in Wayne, Hartmann recently created Pure 4 Life, a CBD-centered offshoot, with Amie Hamel. Pure 4 Life sells physician-designed and private-label CBD products online and at Stafford Chiropractic.
CBD comes from industrial hemp plants but doesn’t contain the psychoactive ingredients of THC. It also doesn’t produce a high, but it does produce pain relief. Considered a powerful anti-inflammatory, CBD can reduce back and joint pain, arthritis and muscle aches. It may also alleviate anxiety-related stress, promote healthy sleep and aid digestion.
Hartmann and Hamel guide patients through the creams, oils and liposomal gels that line the shelves of Strafford Chiropractic. Prices range from $30 trial-size creams to a high-powered liquid that goes for $270. The most popular product is a $90 jar that lasts up to two months. Hartmann and Hamel can’t keep the stuff in stock.
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A little dab is all that’s needed with CBD products, but some should reapply it several times a day. “One of the most common mistakes is that people don’t use enough of it in the beginning,” says Hamel.
Adds Hartmann, “We believe CBD is the new multivitamin that should be in everyone’s cabinet.”
2. What do women need to know about egg freezing?
Earlier this year, malfunctions in California and Ohio egg-freezing facilities dashed the hopes of thousands of women. The incident also cast doubt on the still quite new process.
Could such a meltdown happen here? It’s highly unlikely, according to experts. Frozen egg storage relies on liquid nitrogen tanks to keep temperatures consistent, says Dr. Albert El-Roeiy of Crozer-Keystone’s HAN Fertility Centers.
Those tanks can be monitored manually and by automated computer systems. While El-Roeiy and Main Line Fertility’s Dr. John Orris use facilities that have both monitoring systems, only computers were used in facilities where meltdowns occurred. Human technicians weren’t alerted to the temperature malfunction until it was too late. “If there’s a problem, we have multiple layers of alarms notifying multiple people, because every system needs redundancy,” El-Roeiy says. “That alarm’s secure phone system is connected to a hospital generator. So even in an outage of electricity, it will work.”
In this area, fees for egg freezing begin at $4,200-$7,000 for harvesting eggs during one menstrual cycle. Annual storage fees run $500-$750. According to Orris, there’s no reason to rush into the process.“Egg freezing in your 20s is jumping the gun,” he says. “You could potentially meet a partner and have a family together. Prime time for egg freezing is early to mid-30s.”
El-Roeiy agrees that it’s an unnecessary expense for women in their 20s. Thirty-five is the age women should begin the process, he says. After that, most have fewer eggs to harvest, which reduces their chances of future pregnancies. An exception is women with illnesses that can affect their reproductive potential.
That said, women 41 and older should consider other options. “At that point, women have better chances at pregnancy if they do IVF with donor eggs,” says Orris. “Or they can create embryos and test them for abnormal genetic material. That way, we’re working only with viable embryos.”
3. How can women be proactive about their reproductive health?
Get a full physical from your gynecologist, advises Orris. Review your medical history and get blood work to evaluate estrogen, progesterone and anti-Mullerian hormone. Also known as AMH, the latter gives doctors an indication about a woman’s ovarian reserve. Ultrasounds can produce more information about ovaries and detect anatomical abnormalities like uterine fibroids that can pose reproductive challenges.
These tests can be done in your 20s. “Many women wish they’d known earlier that they’d have problems,” Orris says. “With these tests, you can.”
4. What should women know about hormones?
Feeling hormonal? PMS isn’t always to blame for crankiness, insomnia and weight gain, says Dr. Robert Denitzio. Women (and men) have hundreds of hormones, any one of which can negatively impact our health. “Usually, problems that develop in women’s health are secondary, not primary,” says Denitzio, an integrative and functional medicine specialist at Main Line Health’s Concordville center. “Primary issues involve imbalances in master hormones, including insulin and cortisol.”
Polycystic ovary syndrome, for instance, is commonly blamed on estrogen. But Denitzio points out that insulin resistance, created by something as basic as antibiotic use or an unhealthy diet, can trigger estrogen imbalances resulting in PCOS and other problems.
An OBGYN who practices integrative medicine at the Balanced Woman in Ardmore, Dr. Marialisa Lambert calls estrogen and testosterone the celebrity hormones because they’re most directly related to sex. It’s why estrogen often gets a bad rap. But high levels of cortisol and adrenaline, the bad-boy hormones related to stress, are often to blame for weight gain and mood swings. They can also create mayhem to disrupt melatonin, the hormone that induces quality sleep.
To determine which hormones are out of whack, physicians perform a variety of screenings, from menstrual histories to blood work to saliva tests. Armed with the results, they can develop detailed diet and exercise regimens for patients. Taking a pill may be easier, but that’s treating symptoms, not the underlying problems. “We’re all trained to write prescriptions, but I like to know the whole story,” Lambert says.
For example, Lambert might work her way back through a patient’s hormone imbalances to gland functioning. Vitamin B and magnesium supplements can improve adrenal gland functioning, lowering cortisol and improving sleep quality, among other things.
Sometimes, ovaries are the culprit, creating hormonal riots in women of all ages. Lambert’s first-line treatments are natural phytoestrogen supplements like black cohosh or dong quai. If those fail to produce results, she recommends bioidentical hormones specially created to match what patients need. Made by pharmacies, they come in topical creams or pellets. The pellets are injected into women’s hips and release small amounts of hormones every day for three to six months. Although Lambert emphasized their safety, bioidenticals are still controversial among physicians.
A growing number of women are turning to acupuncture for all-natural hormone balancing. “Many people, especially millennials, are now untrusting of pharmaceuticals,” says Steve Mavros, owner of Healing Arts Center in Bryn Mawr, King of Prussia, Exton and Center City. “Women want options other than the Pill.”
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Megan Conover, co-owner of Healing Place Acupuncture in Wayne, treats hormone imbalances with more than just acupuncture—her individualized patient plans include dietary recommendations and over-the-counter supplements. Acupuncture is also used to bolster adrenal glands and kidneys, build yin, and calm the shen. “We use all of the modalities available, because balancing hormones is a whole-body experience,” says Conover.
Mavros doesn’t go in for yin aspect. “Acupuncture increases blood flow to the brain and organs that produce hormones—that’s how I think about it,” he says.
Acupuncture requires two to three sessions weekly for up to three months. Denitzio and Lambert mention that nutritional changes also take time, but patients tend to see quick improvement in sleep quality and energy levels.
5. What are the latest treatments for bladder control?
“It’s a very common problem,” says Dr. Mitchell Berger, a female pelvic medicine specialist at Main Line Health’s Urogynecology Associates in Media. “But just because it’s common doesn’t mean women have to live with it.”
Initially, Berger treats overactive bladder issues with fluid management while limiting irritants like coffee, soda and wine. Pelvic exercises often help, as does bladder training. “If you go every 30 minutes, the bladder gets trained to empty then,” says Berger. “Instead, we work with patients to increase the time between bathroom visits.”
If that doesn’t produce results, Berger turns to oral medications. He also suggests neuromodulation via an implantable device that functions like a pacemaker for the bladder.
To avoid medication side effects and the surgical procedure required for the implantable device, many patients are opting for Botox bladder injections. Though it was FDA approved for overactive bladders in 2013, many people still don’t know about Botox. It works on the bladder the same way it works on crow’s feet. “Botox partially paralyzes the bladder and interferes with the way nerves and the bladder talk to one another,” Berger says. “It stops the feeling of urgency.”
Injections are done through a cystoscope that goes through the vagina to the bladder. Berger uses 100 units of Botox, far more than the five to 10 for facial cosmetic procedures. Although patients get local anesthesia, the procedure is not pain-free. Common side effects are spotting and urinary tract infections. Botox lasts for six to nine months in the bladder, and the procedure can be repeated.
6. What about lipo for knees and backs?
Fat is stubborn. Once it grows, it’s tough to remove. That makes it bad for bellies but great for joints and spines. Dr. Kelly Scollon-Grieve is using Lipogems, a new FDA-approved device, to transfer patients’ own fat into their achy knees and backs. It can be used for relieving pain from disc herniation, stenosis, osteoarthritis of spine, arthritis of joint and ligament tears.
A Premier Orthopaedics physician who specializes in regenerative medicine, Scollon-Grieve removes patients’ fat cells with a syringe. Deleterious substances are removed, and the “clean” fat is then injected into knees, hips, shoulders, spines and other areas.
It’s a fairly simple procedure, but it’s not right for everyone. Imaging is required to determine the severity of the injury. “If it’s a bone-on-bone situation, the patient may need joint replacement,” says Scollon-Grieve. “But Lipogems can be a good way to avoid surgery.”
Scollon-Grieve and her regenerative medicine colleagues have other surgery-avoiding treatments. With prolotherapy, a sugar-based substance is injected into aching tendons, ligaments and spines. The injections create small injuries, triggering the body’s healing responses. Bone marrow aspirate transplants a super-concentrated mixture of a patient’s stem cells, growth factors and cytokines to injured spines and joints, accelerating their repair.
Regenerative medicine injections typically require only one office visit. Bruising and swelling can occur, but there are no other side effects, says Scollon-Grieve. Patients feel effects within four to six weeks as their bodies heal. “Results vary injury to injury, person to person,” she cautions. “With acute injuries, like ligament or tendon tears, the healing is long-term. With chronic conditions, expectations vary.”
Scollon-Grieve says such treatments can provide one to five years of relief, after which procedures can be repeated. But because Lipogems and the bone marrow treatments are so new, long-term data on their efficacy isn’t available.
Not surprisingly, health insurance doesn’t cover these procedures, which range from $200 to $4,000. Out-of-pocket cost for surgeries are usually a lot higher, and include long recuperations.
