Live Well Ohio: August 2017

Innovative Approaches 
Three Ohio hospital systems share research, treatments and new technologies that are improving the health and lives of women. 

An informed woman is a strong woman. Understanding the latest innovations and options for treating health problems can improve lifestyle, longevity and outlook on life. Research is uncovering new ways to treat common problems women face, from a leaky bladder to depression during pregnancy. We talked to three Ohio hospital systems about innovations in women’s health that are providing more treatment options and better outcomes.

Pelvic floor concerns that disrupt daily life — bladder leakage, vaginal dryness and uncomfortable intercourse — are often brushed off as normal symptoms of aging. But that idea is shifting.

Dr. Mickey Karram, director of urogynecology at The Christ Hospital in Cincinnati and clinical professor of obstetrics and gynecology at the University of Cincinnati, says the multidisciplinary Pelvic Floor Center at The Christ Hospital is one of only a handful in the U.S. In 2014, the Pelvic Floor Center initiated the first U.S. trial using a new fractional CO2 laser developed in Italy called MonaLisa Touch.

“It’s a revolutionary laser treatment most notably for vaginal atrophy, which up until now has been treated with hormones,” Karram says. 

The laser uses dermatology technology that revitalizes skin on the face and neck using light therapy. A probe stimulates collagen production to restore tissue in the vaginal wall. The office procedure is performed in three sessions, every six weeks. 

Dr. Aparna Shah, urogynecologist at The Christ Hospital, says studies show a 70 to 80 percent improvement in vaginal health with the laser. One in 10 women age 20 to 39 have some type of pelvic floor disorder. By age 60 to 79, prevalence jumps to 1 in 3, based on a National Health & Nutrition Examination Survey. 

“Patients do not have to live with these problems,” Shah says. “As women become more knowledgeable and educated about pelvic floor disorders and the treatment options, some of which are fairly simple, they can have a better quality of life.” 

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The Cleveland Clinic’s CustomFit Physicals are tailored to women, with the goal of pinpointing common problems such as thyroid and bladder disorders, osteoporosis, cancer risk, cardiovascular problems and diabetes. “We focus on the female and her life cycle,” says Dr. Holly Thacker, director of the Clinic’s Center for Specialized Women’s Health. 

Rather than scheduling multiple screenings at different times, a dedicated nurse creates a custom doctor’s visit at the Center for Specialized Women’s Health. “It takes all of the hassle away,” Thacker says. “The focus is interdisciplinary and on the woman and her needs.” 

Thacker also addresses common concerns that women face, such as urinary incontinence, with a device that uses stimulation and biofeedback therapy to strengthen the pelvic floor muscles. Called InTone or Apex treatment, it’s the first nonsurgical, drug-free treatment for women with urinary incontinence and is FDA approved. The device sends a calming signal to the muscle that decreases spasms and retrains muscles. 

Patients go through an in-office session then use the device at home five minutes daily. After continence is achieved, the device can be used once a week. Results may take three to six months, but Thacker has also seen patients improve in a week or two. “There are no side effects and it’s easy to use,” she says.

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The Stress and Health in Pregnancy Research Program at The Ohio State University Wexner Medical Center has been exploring how stress and depression impact the health of a mother and her baby.

“There are health outcomes like birth weight, length of gestation and maternal health conditions we can measure readily in pregnancy,” says Lisa Christian, Ph.D. at The Ohio State University Wexner Medical Center’s Center for Psychiatry and Behavioral Health. 

During a study published in the Journal of Psychoneuroendocrinology, researchers found pregnant women had changing levels of brain-derived neurotrophic factor, known as BDNF. Lower levels during pregnancy can cause depression in mothers and low birth weights in babies. 

“BDNF plays a role in the development of the placenta, which is the critical organ for exchange of oxygen and nutrients to the fetus,” Christian says. “Women who had steeper drop-offs of BDNF, particularly in their third trimester, were associated with greater risk for depressive symptoms and delivering a baby of lower birth weight.”

Low birth weight, which is clinically defined as 5.5 pounds or less, makes a baby more medically vulnerable and is associated with the risk of long-term health concerns, as well as a higher risk for diabetes, heart disease, metabolic syndrome and other issues. 

Preventive measures can be taken if needed. That can include the use of antidepressants for some women. “But one key way to increase BDNF is through physical activity,” Christian says. 

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Health Checklist 
Physicians share what screenings women need to get and when.  

Your annual physical is an important appointment. It establishes a personal baseline so you and your doctor know where your health stands, and it provides time to discuss concerns or ask questions.

“Unfortunately, if you aren’t going to see your doctor every year, some issues may fall through the cracks,” says Dr. Andrew Croak of the Northwest Ohio Center for Urogynecology and Women’s Health in Perrysburg. The center offers the latest technology in treating women, from minimally invasive laparoscopic and robotic surgery to MonaLisa Touch laser therapy for menopausal concerns.

Dr. Cynthia Kravec, an internal medicine physician at Mercy Health in Youngstown adds that preventive care is ultimately what impacts people’s overall health and well-being. “We can catch diseases earlier,” she says, “and hopefully prolong life and make sure that life is productive and healthy.”  

20s: Women up to age 26 can get the human papillomavirus vaccine, a big step in preventing cervical cancers, says Kravec. Blood pressure should be checked every three to five years beginning at 18, and cholesterol checks should begin at 17 to 21. Body mass index is also important. “We are checking people at a very young age for risk factors of diabetes and talking about meeting guidelines for physical activity,” Kravec says. 

30s: Cervical cancer screenings and Pap smears are recommended every three years if normal, Kravec says. Bone health is also a focus during this decade. “I counsel all women and men, to some extent, about making sure they get 1,500 milligrams of calcium and 800 to 1,000 [International Units] of vitamin D every day,” Kravec says. Age 35 to 40 is when a woman’s risk of breast cancer increases, adds Croak, so it’s important to talk about family history and to determine when is the best time to get the first mammogram. For most, that is age 40.

40s: The American Cancer Society advocates mammograms beginning at age 40 and every year following. Women should also get their blood pressure checked annually. If cholesterol was normal in a woman’s 20s, it is checked again at age 45 and every five years after, according to Kravec. “We are starting to focus in on diabetes and checking blood sugar,” she adds. “That means a hemoglobin A1C test in anyone over the age of 40, particularly if body mass index exceeds 25.”

50s: Age 50 is when a colonoscopy should be ordered. If the test is normal, women can wait 10 years before the next one. Mammograms continue, as does monitoring bone health, blood pressure, cholesterol, blood sugar and weight. “A big part of preventive care is maximizing your health through lifestyle,” says Dr. Anita Somani, a Comprehensive Women’s Care physician at OhioHealth Riverside Methodist Hospital in Columbus. “Building muscle mass helps with changes in metabolism.”

60+: By age 65 all women should have at least one bone mineral density scan. Also important are the pneumonia and shingles vaccines. Cardiac risk is a primary concern, too. Health screenings continue through a woman’s 60s and into her 70s. “We are doing a better job now of addressing pelvic health,” says Croak, adding that includes sexual, bowel and bladder function. “Urinary leakage affects more than 60 percent of women over age 50.” Lack of pelvic strength can lead to prolapse, a problem for at least 20 percent of women in this age group, says Croak. “If we can screen those women and get them into conservative pelvic floor therapy programs ... they may not require significant interventions.”