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Gynecology

Breast Cancer: An Integrative Consultation

Beth DuPree, MD, FACS, ABIHM
It is estimated that 1 in 8 women in the United States will develop invasive (infiltrating) breast cancer at some point in her lifetime. Ductal carcinoma, which begins in the milk ducts, accounts for 80% of all invasive breast cancers, and lobular carcinoma, which begins in the lobules, accounts for 10%. Invasive breast cancers are further categorized into several molecular and genomic subtypes.

Local treatment options for breast cancer depend on the tumor size, nodes, metastasis (TNM), and molecular subtype. Systemic treatment options depend on a patient’s overall health status and lifestyle. Breast cancer surgeon, Dr. Beth DuPree, urges clinicians to address both local and systemic factors in a holistic approach to the evaluation and treatment of breast cancer. In this discussion, she explains the diagnostic flow, surgical options, factors influencing treatment, and the role that integrative practitioners can play in the evaluation and early phases of breast cancer treatment.

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Infertility

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Jaclyn Chasse, ND
Primary infertility is defined as a couple’s inability to conceive after trying for one year. It is estimated that about 10 to 15 percent of couples in the United States are infertile. Infertility affects men and women equally and in most cases, evaluation of both partners is necessary to determine the reasons for a couple’s infertility. The National Institutes of Health defines secondary infertility as a couple’s inability to get pregnant after having a live birth. With this definition, infertility can also be used to describe a woman’s inability to carry a pregnancy to full term, as is the case with multiple pregnancy losses. If standard infertility evaluation results are normal, the couple is diagnosed as having unexplained infertility. A 2008 paper revealed that 15 to 30 percent of couples have unexplained infertility. According to integrative fertility expert Jaclyn Chasse, ND, this is an area where an integrative practitioner can play a key role. Not only do the expanded integrative treatment tools lend themselves to enhancing fertility, but the integrative practitioner can likely uncover underlying causes that are contributing to unexplained fertility using functional diagnostic testing.

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Methylation and Pregnancy

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Ben Lynch, ND
Methylation is defined as the addition of 1 carbon and 3 hydrogen atoms to a compound. This biochemical reaction influences innumerable functions in the body, including genetic expression, neurotransmitter synthesis, and detoxification.

During pregnancy, with the increased production of maternal hormones and rapid multiplication of cells in the developing baby, the demand for methylation increases dramatically. Impaired methylation during pregnancy can result in spontaneous abortion, pregnancy complications, or birth defects.

Ben Lynch, ND has a unique perspective on methylation during pregnancy. Not only does he emphasize the importance of methylation assessment during prenatal screenings, but also emphasizes the need to address any impairments with a whole-body approach. The following discussion provides Dr. Lynch’s perspective on the assessment and treatment of methylation defects during pregnancy.

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Perimenopausal Insomnia

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Tori Hudson, ND
Insomnia is associated with quality of life, productivity, depression, anxiety, cognition, and even safety. Individuals with insomnia have significantly greater impairment in their living than people without insomnia. Psychomotor and cognitive performance, attention, response time, unstable work performance, errors and accidents are all disrupted and altered in patients with sleep disorders. Insomnia may also be associated with an increased risk of developing cardiovascular disease. The good news is that the impairments and risk associated with insomnia are reversible with effective treatment. Patients may need in-office testing, or may need to be referred for specific evaluations. Given the prevalence of insomnia, the impact on quality of life of insomnia, and the unique aspects in women, and in perimenopausal/menopausal women in particular, a practitioner who has a comprehensive understanding of sleep problems, and of midlife women, will enhance their ability to provide effective solutions.

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Polycystic Ovary Syndrome

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Jane Guiltinan, ND
Polycystic ovarian syndrome (PCOS) was originally described in 1935 by Stein and Leventhal, who reported several cases of women with polycystic ovaries, amenorrhea, and accompanying obesity, hirsutism, or acne. PCOS is now recognized as a metabolic and endocrine disorder that affects between 1 in 10 and 1 in 20 women of childbearing age. The condition is diagnosed when 2 of the following 3 characteristics are present: androgen excess, ovulatory dysfunction, and polycystic ovaries. Clinical features can include amenorrhea, oligomenorrhea, acne, hirsutism, male-pattern baldness, mood disorders, or obesity. PCOS is an important cause of infertility, is strongly associated with insulin resistance, and increases the risks for diabetes mellitus, cardiovascular disease, and endometrial cancer. In the following discussion, Jane Guiltinan, ND, reviews evidence-based integrative therapies for PCOS.

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Prenatal through Postnatal Nutrition

Tieraona Low Dog, MD
The prenatal and postnatal periods are critical times in a woman’s life, accompanied by dramatic increases in energy and nutrient demands. A woman who is normal weight before pregnancy will gain between 25 and 35 pounds, and her blood volume will increase by 50% (or 1.25L). At the same time, she will nourish the growth of a baby from a single-celled zygote to a 6-8 pound human being. Caloric needs increase to 300-500 calories above preconception needs beginning in the 2nd trimester of pregnancy and continuing through lactation. Conventional guidance for pregnant women advises them to follow a healthy diet, take a prenatal vitamin, and avoid foods like raw fish that might cause Listeriosis or food poisoning. In addition, research conducted within the last decade has revealed information about common nutrient deficiencies during pregnancy and lactation. Tieraona Low Dog, MD, suggests that nutritional guidelines should be refined and updated to more accurately reflect current scientific knowledge related to nutrient demands and deficiencies during pregnancy and lactation.

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