N  E  W  S  L  E  T  T  E  R JUNE 2006      Issue 10 E. Daniel Biggerstaff, III, M.D. Visit us online	In this Issue: · PMS · Getting to Know the Staff-Denise · In the Kitchen with Dr. B-Honey’s Blackberry Upside- Down Cake · Prevention of Cervical Cancer · Welcome New Patients to Our Practice
PMS PMS or premenstrual syndrome affects millions of women. The results may be minimal, not affecting normal activity, or can be severe. The symptoms of PMS occur at a predictable time in relation to the menstrual cycle. Some women have just a few days a month, usually just after menses, when they are symptom free. Common symptoms include: mood swings, depression, anxiety, irritability, difficulty concentrating, fatigability, bloating, weight gain, and breast tenderness. PMDD or premenstrual dysphoric disorder is simply a more severe form of PMS. This markedly affects normal activity. A menstrual calendar can be helpful with both the diagnosis and treatment of PMS and PMDD. Write down the symptoms and their severity on a daily basis for two months. This information should be brought to your doctor’s visit. Treatment begins with identifying what symptoms occur when. Lifestyle changes may completely eliminate the symptoms of PMS and improve those of PMDD. These include: q Dietary changes including restriction of salt, sugar, alcohol, and caffeine q Regular aerobic exercise q Adequate sleep q Avoidance of nicotine and street drugs q Stress management More specific recommendations may be found on my website www.womensdoctor.com. If medication is needed, many women respond well to SSRI’s or selective serotonin reuptake inhibitors, first developed to treat depression. The first drug that was used to treat PMS was Prozacâ. Several other medications have been developed to treat PMS and PMDD. The choice to use medication, and which one to use, should be individualized by your physician. If there are indications for hysterectomy, removal of the uterus with tubes and ovaries will eliminate the PMS/PMDD.
Getting To Know The Staff – Denise We welcomed Denise Carlier to our staff in March. Denise and her husband, Stephen, moved here a year and half ago from Portsmouth, New Hampshire. Stephen’s position with Georgia Pacific has prompted many moves over the country as well as Toronto, Canada. They have two sons, a daughter and a precious granddaughter, Sophia. Denise enjoys spending time at the beach and entertaining friends and family. Leisure time is also spent making beaded jewelry (she has taught classes) and embellishing baby clothes. An avid reader, Denise can also be found at the library or bookstores in search of the latest novels. We know you will enjoy getting to know Denise and come to appreciate her enthusiasm, sense of humor and compassion.
In The Kitchen with Dr. B – Honey’s Blackberry Upside-Down Cake My wife’s (Elisabeth) favorite birthday cake is Honey’s recipe for Blackberry Upside-Down Cake. Honey was the name given to Elisabeth’s mother by her grandchildren. Elisabeth does most of the baking at my house, but recently I had the opportunity to cook her favorite birthday cake – turned out pretty well. To cut the calories, you can substitute Splendaâ for sugar. Preheat the oven to 450°. Pastry batter 1 ¼ cup sifted flour ¼ teaspoon salt 2 teaspoons baking powder 4 tablespoons butter 1 egg, beaten ½ cup milk 1 teaspoon vanilla extract ½ cup sugar Mix flour, baking powder, and salt; sift 3 times. Cream the butter (best in a mixer), add sugar gradually, and then add the beaten egg. Gradually add the flour mixture and finally the milk. At each step, all ingredients should be well mixed and smooth before adding the next ingredient. Add the vanilla extract. Filling 3 cups blackberries (Elisabeth and I like 4 cups) ½ to 2/3 cup sugar depending on the sweetness of the berries 2 tablespoons flour 1 ½ tablespoon fresh lemon juice 1/8 teaspoon salt 1 tablespoon butter ¼ to 1/3 cup water Mix the first 5 ingredients gently in a pot, and the butter and water. Bring to a boil and pour into an ovenproof deep-dish bowl. Carefully pour the pastry batter over the filling and cook for 10 minutes at 450°, reduce the temperature to 350°, and cook for 25-30 minutes. Serve with a scoop of vanilla ice cream on top. Enjoy. Note: this is not one of the healthiest recipes I have given, but like most things is OK to eat in moderation.
Prevention of Cervical Cancer Cervical cancer used to be the 2^nd leading cancer in incidence and mortality in women. It is now 11^th in incidence and 13^th in mortality. The first major breakthrough in prevention of cervical cancer came 57 years ago when George Papanicolaou discovered the PAP smear. Since then we have developed 1) more sensitive and objective screening, 2) better management of screen positives, and 3) HPV vaccine, which will soon be available. Presence of HPV (Human Papillomavirus) is the major risk factor for development of cervical cancer. HPV is a sexually transmitted virus that can be detected by PAP smear. HPV is sub-typed into a number of different viruses, a few of which are known to be precursors to cervical cancer (so-called high risk HPV). More detailed information about PAP smears and HPV is available on my website (www.womensdoctor.com under patient health information). More sensitive and objective screening – most physicians are now using a liquid-based PAP preparation rather than the older direct application of the cervical cells to a slide. This allows for better retrieval of the cells from the cervix, and at the same time when appropriate, testing for high risk HPV. Better management of screen positives – in years past any woman with an abnormal PAP smear underwent a procedure called colposcopy with biopsy to obtain an accurate diagnosis. Under the new system of diagnosis and treatment, a colposcopy is not always necessary when an abnormal PAP smear is identified. Adolescents and younger women are frequently treated differently than older women when an abnormality of the cervix is identified. We would like to minimize procedures that will affect the integrity of the cervix and the ability to become and carry a pregnancy. Also, younger women may develop antibodies against HPV, reducing the risk of cervical cancer. HPV vaccine soon to be available – later in 2006, it is expected that a vaccine against high risk HPV will be available. The initial target population to receive the vaccine will probably be younger women before they become sexually active. Older women who are HPV negative may receive the vaccine. The company producing the vaccine has not yet announced the approach to women who are already HPV positive. If a blood test (serology) is already positive for the sub-types of HPV in the vaccine, the vaccine would be of no benefit to those women. In summary, we have made major progress in the prevention, early detection, and treatment of cervical cancer. It is still very important for women of any age to have appropriately timed PAP smears with treatment and follow-up when indicated.
Welcome New Patients to our Practice Many physician offices are no longer accepting new patients into their practices. This policy is often related to the type of specialty or the number of doctors in the practice. We want you to know that we still welcome new patients into our practice. We are never too busy to see your family members or friends as new patients. Dr. Biggerstaff no longer delivers babies, but still sees female patients of all ages. In fact, he sees pediatric patients for any GYN concerns. Besides routine and preventive care, Dr. Biggerstaff treats pelvic pain, infertility, prolapse, urinary incontinence and endometriosis utilizing the most current treatments and surgical techniques. Those of you who are already patients have experienced first-hand the professional and personalized care you receive from Dr. Biggerstaff and all the members of our staff. As we strive to continually meet and exceed the needs of our patients, we appreciate your feedback which we consider when evaluating our services. Thank you for entrusting us with your healthcare.
The information provided by Advanced Healthcare for Women and E. Daniel Biggerstaff, III, M.D. is for informational purposes only. As each woman is unique, do not rely on this information for diagnosis and treatment. We cannot guarantee the accuracy of the content and advise that you see a qualified Health Care Professional for individual needs and care.
HOW TO CONTACT US: Electronic mail General Information: gyndoc@womensdoctor.com
Telephone FAX Postal address	912/355-7717 912/355-0979 5354 Reynolds Street, Savannah, GA 31405
Previous  Issues  (Click on Date to View Content) September, 2003  Osteoporosis - Prevention and Treatment; Get to Know our Staff- Nikki; In the Kitchen with Dr. B - Fried Fennel;The Business Side of Things - Understanding Insurance February, 2004 Cosmetic Laser; Get to Know our Staff-Sylvia Baxter; In the Kitchen with Dr. B-Veal or Chicken Scaloppine; Insurance Card Numbers May, 2004 - Pelvic Pain - Common Causes; Get to Know our Staff-Nancy; In the Kitchen with Dr. B-Mediterranean Cauliflower; Credible Coverage October, 2004 - Pelvic Prolapse and Urinary Incontinence; Get to Know our Staff-Donna; In the Kitchen with Dr. B-Upside-down Chicken Salad; Get Involved February, 2005 - Decreased Sexual Drive; Get to Know our Staff-Debbie; In the Kitchen with Dr. B-Vegetable Soup; Medicare Advanced Beneficiary Notice June, 2005 - Abnormal Bleeding, Getting to Know the Staff-Dr. B; In the Kitchen with Dr. B - London Broil Steak; Large Deductible Plans, Are They For You?  Sept, 2005 – Stress in Women, Getting to Know the Staff-Wren; In the Kitchen with Dr. B-Roasted Cherry Tomatoes, How to Get the Most Out of Your Doctor - March, 2006 – New Information on Hormone Therapy; Getting to Know the Staff-Debbie & Donna; In the Kitchen with Dr. B-French Onion Soup; What’s New in Health Insurance?