Welcome to eclaireMD

Posted by on Mar 18, 2013 in Launch, News | Comments Off

We are a group of engineers, doctors, nurses, nutritionists, and other professionals who are passionate about improving health care. Our mission is to put practical tools into your hands to better control and improve the quality of your life.

Your Life, Your Health — In Your Hands

 

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eclaireMD A1C is the newest smartphone app from eclaireMD.  It enables you to track your A1C value over time without going to the lab or to your doctor’s office.  Best of all, eclaireMD A1C is free!

eclaireMD A1C Chart

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Use your smartphone to download eclaireMD A1C from the Apple App Store or from the Android Market and begin using this valuable health resource.

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Thyroid Disorders and Diabetes

Posted by on Aug 21, 2014 in News | 0 comments

Profile 2Thyroid disorders and diabetes mellitus are very common in our society. Studies showed that thyroid disorders are much more common among diabetics and up to one third of type I diabetics eventually develop some form of thyroid disorder. Both thyroid disorders and diabetes are part of endocrine disorders where problem is originated in endocrine glands. Thyroid disorders are due to overproduction or underproduction of thyroid hormones by thyroid gland.

Thyroid gland is located in front of the neck below Adam’s apple. Thyroid hormones production is controlled by another endocrine gland in the brain called pituitary gland. Thyroid hormones regulate body’s metabolism which affects many organs including heart, digestive tract, muscles and etc. Diabetes is due to lack of insulin production in the pancreas or body cells are resistant to insulin. Insulin is a hormone that regulates blood glucose. Pancreas is one of the endocrine glands (hormone producing gland) located behind the stomach.

Type I diabetes occurs when the body’s immune system destroys insulin-producing cells in the pancreas. Similarly, thyroid disorders can be due to immune system attacking thyroid gland. That is one of the reasons for thyroid disorders being more common in type I diabetes. For thyroid disorders, you can either have hyperthyroidism (too much thyroid hormones) or hypothyroidism (too little thyroid hormones). The symptoms differ in these conditions. A person with hyperthyroidism may complain of rapid or irregular heartbeats, anxiety, irritability, weight loss despite normal or increased appetite, diarrhea, tremors in the hands, muscle weakness and heat intolerance (sweating more than usual). Women may experience irregular menstrual period.

On the other hand, a person with hypothyroidism may experience fatigue, shortness of breath with exercise, weight gain despite normal appetite, cold intolerance, thin or coarse hair and constipation. Women may have menstrual irregularity. Both hyperthyroidism and hypothyroidism can interfere with your diabetes management. If you are diabetic and develop hyperthyroidism, your blood glucose will be high even when you are taking insulin or oral medications regularly. Medications or insulin could not stay in the bloodstream long enough since your metabolism is faster. Also, hyperthyroidism may be confused with signs of hypoglycemia (low blood glucose) such as sweating, racing heartbeats and tremors because both conditions present with similar symptoms. Having hypothyroidism can affect your blood glucose as well. Individuals with diabetes may experience repeated episodes of low blood glucose because medications or insulin will stay longer in the bloodstream. In addition, hypothyroidism will raise your LDL (the bad cholesterol) and triglycerides levels.

In diabetics, thyroid symptoms can be a bit difficult to diagnose because of the similarity. Therefore, serum TSH is recommended as a screening tool. When you are first diagnosed with type II diabetes, TSH should be done at that time and it should be repeated every few years. If you are diagnosed with type I diabetes, your doctor will check for antibodies (specific proteins) against thyroid hormones as well as serum TSH. If antibodies are found, TSH screening will be done every year. In conclusion, thyroid disorder should be treated promptly especially in diabetics because it will improve blood glucose management greatly.

Contributed by Patricia Hsiao M.D.
Sources: journal.diabetes.org/clinicaldiabetes, spectrum.diabetesjournal.org, thyroidscience.com, ncbi.nlm.nih.gov, uptodate.com

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Aspirin – Friend or Foe?

Posted by on Jul 11, 2014 in News | 0 comments

Aspirin 2Should I take aspirin for heart disease prevention?
You may have heard from the media, friends, family members or coworkers saying aspirin can lower your chance of heart attack. Thus, you may wonder whether you should take a daily aspirin to prevent heart disease. Before you go to the pharmacy and purchase over-the-counter aspirin, there are a few things you need to know.

What is aspirin and how does it work?
Aspirin is one of the medications in NSAIDs (nonsteroidal anti-inflammatory drugs) group. It has been used for pain relief and to reduce swelling. In recent years, low dose aspirin is used to prevent heart disease. Heart disease includes heart attack, stroke and peripheral arterial disease in which poor circulation in the legs. At low dosages, aspirin prevents platelets from clumping. Platelet is one of the blood cells and they play a role in blood clotting. Without platelets, you can bleed to death when you cut yourself or have an injury to your tissues and organs. At the same time, platelets can form clots in the coronary arteries that supply your heart and can cause decrease in the blood flow. When there is insufficient blood supply to the heart, it results in heart attack due to the death of heart muscles. Also, reduced blood flow to the brain can result in stroke. Therefore, the role of low dose aspirin is to prevent platelets from clumping and keep the normal blood flow in the arteries.

Who should take daily aspirin?
You should not take daily aspirin unless prescribed by the doctor. Your doctor may put you on daily aspirin if you belong to this group of people.

The criteria in this group include:
• If you have a history of heart attack
• If you have a history of ischemic stroke or transient ischemic stroke (TIA)
• If you have stable or unstable angina
• If you have had a coronary artery bypass graft (CABG procedure)
• If you have had angioplasty
• If you have atrial fibrillation (A-Fib)
• If you have heart valve disease

Your doctor will decide what dosage is right for you. Some people may get baby aspirin (81 mg) while others may get a regular strength (325 mg). If you take ibuprofen or other NSAIDs for chronic conditions such as arthritis, chronic pain or back pain, talk to your doctor. They can reduce blood clotting like aspirin so you are at increased risk for bleeding.

People who do not belong to the above group:
You are at a higher risk for heart disease if you have diabetes, high cholesterol, obesity and high blood pressure than general population. But it does not mean you should start taking daily aspirin on your own. Many studies have been done on men and women who did not have heart disease and who are over 55 years of age. Aspirin like many other medications comes with side effects. Side effects of aspirin include bleeding more than usual when you have a cut. Some people experience stomach bleeding especially if they have ulcer. Another concern is hemorrhagic stroke which is bleeding in the brain. Aspirin also causes stomach upset such as nausea, vomiting, heartburn and stomach pain. It can also interact with ibuprofen (another NSAID). Therefore, many studies have been conducted to see whether the benefit of aspirin on heart disease is greater than the risk of side effects.

Many studies concluded that whether you should be on daily aspirin must be determined by individual’s risks and benefits from aspirin. Some people may benefit more from aspirin while it may cause more harm to others. Hence, the decision should be made by your primary care doctor who knows about your detailed medical history.

Contributed by Patricia Hsiao M.D.
Sources: mayoclinic.com, nlm.nih.gov/medlineplus/news, ncbi.nlm.nih.gov, uptodate.com

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Staples or Sutures after Cesarean Section?

Posted by on Jun 23, 2014 in News | 0 comments

Pregnant momCesarean section or C-section is a surgical method to deliver an infant and it has been on the rise in the last two decades in the United States. It is estimated that more than 30 percent of deliveries occur via C-section today. C-section is required when the baby is too large or in a breech position or the baby is in distress. Doctors may decide to do C-section when the labor does not progress as time goes by or placenta separates from the uterus before the baby (placental abruption) or in a medical emergency.

Some of the planned C-sections are due to mother’s request as a preferred method of delivery. In any case, there are two ways to make skin incision. One is horizontal (bikini line) and the other is vertical (midline). Bikini line incision is more common because of less pain after the delivery and it heals faster. Uterine incision can also be horizontal or vertical and it depends on many factors. The goal is to deliver the baby quickly without causing trauma.

After the delivery, there are two options for closing the belly skin. Doctors can either use staples or sutures. Studies are being conducted to see which method has a better outcome and greater patient satisfaction. In one study, researchers compared wound infection rate after closure with staples or subcuticular sutures (sutures in the fatty layer below the skin). They found that women from staples group have increased rate of wound disruption or infection at 4 to 6 weeks after the C-section. No significant differences were reported in terms of pain, cosmetic appeal and patient satisfaction between women who received staples and those who received sutures.

Furthermore, researchers compared wound complications after closing the belly skin with staples or subcuticular sutures in the two groups. Again, they found a higher chance of wound complications among staples group compared to sutures group. In conclusion, suture is less likely to cause wound disruption, infection or complications. Even though it requires additional 10 minutes to close the belly skin with sutures, it seems to be a better method.

Contributed by Patricia Hsiao M.D.
Sources: mayoclinic.com, nlm.nih.gov/medlineplus/news, ncbi.nlm.nih.gov, uptodate.com

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Menopause

Posted by on Jun 2, 2014 in News | 0 comments

Menopause
Menopause is a normal, biological process in woman’s life that marks the end of the reproductive period. Menopause is defined as the end of menstruation (period) when the ovaries are no longer producing eggs. You are considered to have gone through menopause if your last menstrual period was 12 months ago. Typically, most women go through menopause between 45 and 55 years of age. The average age of menopause is 51.

Perimenopause is menopausal transition when your period starts to change and becomes irregular. It could be years before your period stops completely. During that time, your body goes through hormonal changes that result in menopausal symptoms such as hot flashes, night sweats, vaginal dryness, and sleep problems. Symptoms may be mild in some women but it can be severe and lasted longer in others. Postmenopause follows menopause and you are considered postmenopausal woman the rest of your life. Menopause before the age of 40 is considered early menopause. It could be due to certain medical conditions or unknown reason.

Here are some common questions:
Would I still have menopausal symptoms if I had my uterus removed (hysterectomy)?
Yes, you will still have menopausal symptoms because the hormones (estrogen and progesterone) are produced by the ovaries. The decline of these hormones causes menopausal symptoms.

Would I have menopause if I had my uterus and ovaries removed?
You will have menopause once your ovaries are removed due to lack of estrogen and progesterone.

What are menopausal symptoms?
Menopausal symptoms are irregular period, hot flashes, night sweats, irregular heartbeats, vaginal dryness, vaginal infection, incontinence, sleep problem and mood swing.

What happens to your period during menopausal transition?
During menopausal transition, a lot of women experience irregular period. Your period may become more or less frequent, heavier or lighter, last longer than usual. You may also have spotting between your periods or missing periods in some months.

Can I still get pregnant during menopausal transition?
Yes. The chance of getting pregnant in the late 40s or early 50s is low but still probable. Therefore, it is important to continue with the birth control pills or use condom until you no longer have period for 12 months. Talk to your doctor if you are not sure. The doctor can check your hormone levels to determine if you have gone through menopause or not.

What are hot flashes?
Hot flashes are sudden heat to the upper part of the body. Your face and neck may get red. Some women have red blotches on the chest, back and arms. Severe hot flashes can cause you to sweat at night and it may disrupt your sleep.

What kind of sleep problem will I have during menopausal transition?
You may have hard time falling asleep or waking up too early in the morning. It may also be due to night sweats.

What happens when I have vaginal dryness?
You may have discomfort or pain during sexual intercourse and more prone to get vaginal infections. Vaginal dryness is due to the decline of the hormone called estrogen.

What other problems I may encounter around the time of menopause?
Some women find it difficult to hold the urine long enough while others complain of urine leaking out with coughing, sneezing, laughing and exercise.

Would my mood be affected by menopause?
You may feel irritable, anxious or uninterested in normal activities around the time of menopause. People with history of depression are more likely to experience mood swing. Seek medical attention if you think you are suffering from depression symptoms.

Do I need treatment for menopausal symptoms?
Not everyone will need treatment for menopausal symptoms. The doctor may prescribe short-term hormonal therapy to those with severe hot flashes, night sweats and mood swing.

What medications are available for menopausal symptoms?
Hormonal therapy and non-hormonal therapy are available to treat menopausal symptoms.

What hormonal therapy is available to treat menopausal symptoms?
Hormonal therapy is for short-term basic. If you still have uterus, you will be given estrogen and progesterone. If you had your uterus removed, you will take estrogen alone. There are some risks and benefits from taking hormonal therapy and those include heart attack, stroke, cancer and blood clot. While you are on hormonal therapy, you will need regular Pap Smear, pelvic and breast exam.

What non-hormonal therapy is available?
For those who are not candidates for hormonal therapy, seizure medication called gabapentin (Neurontin) and antidepressant such as paroxetine (Paxil), fluoxetine (Prozac), citalopram (Celexa) and others are used to treat hot flashes.

What is estrogen cream for?
If you just have the vaginal dryness, your doctor can prescribe you vaginal estrogen cream.

What can I do to control the urine leakage?
Your doctor may instruct you how to perform Kegel exercise to strength your pelvic muscles to have better control of the urinary problem. First, you empty your bladder then, stop it midstream and hold it for a few seconds. After that, let it go completely. Practice this technique three to five times a day.

What conditions am I at risk after menopause?
Estrogen protects women from heart diseases, therefore; women are at lower risk for heart diseases than men before menopause. But after menopause, the risk for heart diseases is the same for men and women. Thus, it is important to have a yearly physical exam and monitor your blood glucose, blood pressure and cholesterol.

Estrogen also promotes bone health. After menopause, you are at higher risk for a condition called osteoporosis where bones become weak and fragile. Your doctor will do bone scan to check your bone density several years after menopause. You would need to increase your calcium and vitamin D to prevent from osteoporosis. Women over 51 should get 1200 mg of calcium and 600 IU of vitamin D daily.

What lifestyle changes should I adapt to stay healthy?
Eat a healthy, balanced diet with plenty of fruits and vegetables. Try to get protein from lean meats and low-fat dairy products. Engage in regular exercise such as walking or light weight-bearing training at least 30 minutes a day for four to five days a week. Quit smoking if you smoke. Limit your alcohol intake to one glass of wine a day.

Contributed by Patricia Hsiao M.D.
Sources: womenshealth.gov, nia.nih.gov, ncbi.nlm.nih.gov, uptodate.com

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What screening tests do I need for my age?

Posted by on May 16, 2014 in News | 0 comments

Doctor with clipboardA visit to an emergency room can be costly and, often time, several hours waiting period is normal for most ER if your condition is non-emergent. It is always good to know after hour urgent care centers in your area in case of minor injuries and acute care. Not only the bill will be smaller; you will get the care you needed in a shorter amount of time. The best way to prevent ourselves from unnecessary emergency room visit is to have a primary care physician even if you are a healthy individual. Many primary care physician offices have walk-in appointments for those who needed to be seen on the same day. That way you can get the care you needed in a timely manner with reasonable cost.

Preventative medicine is the key to a healthier and happier life. There are age specific screening tests for men and women as well as for kids. This article will only focus on screening tests for adults (18 or older). The purpose of the preventative screening tests is to identify and treat health problems before they get worse and assess your risk for chronic diseases. Many chronic diseases such as high blood pressure and high cholesterol do not show symptoms for many years until at later stages. Keep in mind that recommendations for screening tests may vary slightly from different organizations such as U.S Preventative Services Task Force (USPSTF), American Cancer Society, American college of Obstetricians and Gynecologists (ACOG) and etc. The guidelines for screening test are often changed whenever there is new research finding.

First, we will start with the screening tests for adults who are 18-39 years of age.
• At least two physical exams in your 20s.
• Height, weight and blood pressure screening at each visit. Blood pressure should be checked every two years if it is normal (<120/80 mmHg). Yearly if your blood pressure is between 120-139/80-89 mmHg.
• Blood glucose test if one or both parents have diabetes or your blood pressure is higher than 120/80 mmHg.
• Lipid panel for cholesterol screening (Some doctors may not do it if you have no family history of high cholesterol).
• Dental exam and cleaning yearly.
• Tetanus-diphtheria (TdAP) booster every 10 years.
• Eyes exam every two years if you have vision problem.
• Flu vaccine yearly.
• Monthly testicular self-exam for men. Ask your primary care doctor for instruction if you are not sure how to check it.
• Monthly breast self-exam for women. Contact your doctor immediately if you notice any changes in your breasts. Breast exam should be done by your primary care doctor every 3 years.
• Pelvic exam and Pap Smear 3 years after the first sexual intercourse or by age 21 whichever comes first. Every two years for women in their 20s. Every three years for women in their 30s if you have three negative results in a row.
• Screening for chlamydia infection in sexually active women (age 25 and younger).

Furthermore, the following screening tests are for adults who are 40-64 years of age.
• Physical exam every 1-5 years for both men and women.
• Height, weight and blood pressure screening at each visit. Blood pressure should be checked every two years if it is normal (<120/80 mmHg). Yearly if your blood pressure is between 120-139/80-89 mmHg.
• Blood glucose test if one or both parents have diabetes or your blood pressure is higher than 120/80 mmHg.
• Lipid panel for cholesterol screening. Recheck every 5 years if it is normal.
• Dental exam and cleaning yearly.
• Tetanus-diphtheria (TdAP) booster every 10 years.
• Eyes exam every two years if you have vision problem. Some doctors may do tonometry to check for glaucoma for those who are 45 or older.
• Flu vaccine yearly.
• Stool guaiac test yearly for colorectal cancer in men and women at the age of 50. Flexible sigmoidoscopy every 5 years. Some doctors may do colonoscopy every 10 years or CT colonography (virtual colonoscopy), which is non-invasive procedure every 5 years instead. If you have a parent or sibling with colorectal cancer, your colonoscopy will be done at earlier age (possibly at age 40 or ten years younger than the age of the relative with colorectal cancer at the time of diagnosis).
• For men who are 50 or older, talk to your doctor about prostate cancer screening. This test is based upon individual’s preference.
• For women, monthly breast self-exam. The first mammogram at age 40 for breast cancer screening and then, yearly after that. Mammogram at earlier age for those with high risk of breast cancer.
• Yearly pelvic exam and Pap Smear for cervical cancer screening in women. Every two-three years if you have three negative results in a row.

Lastly, the following are screening tests for adults who are 65 and older.
• Yearly physical exam for both men and women.
• Height, weight and blood pressure screening at each visit. Blood pressure should be checked every year if it is normal (<120/80 mmHg). If it is between 120-139/80-89 mmHg, it will be monitored closely.
• Lipid panel for cholesterol. If your cholesterol is normal, it will be rechecked every 3-5 years.
• Dental exam and cleaning yearly.
• Hearing test every year.
• Tetanus-diphtheria (TdAP) booster every 10 years.
• Eyes exam every two years if you have vision problem. Some doctors may do tonometry to check for glaucoma.
• Flu vaccine yearly.
• Pneumonia (pneumococcal) vaccine at age 65 or older.
• Stool guaiac test every year with flexible sigmoidoscopy every 5 years or colonoscopy every 10 years for colorectal cancer screening.
• For men, talk to your doctor about prostate cancer screening and bone density test.
• 65 to 70 years old men who smoke or ever smoked should get one time abdominal ultrasound for abdominal aortic aneurysm (AAA) screening.
• For women, monthly breast self-exam. Breast exam by your primary care doctor every year and mammogram every 1-2 years for breast cancer screening.
• For women, pelvic exam and Pap Smear may discontinue at age 65 to 70 if she has had three negative results in the last 10 years with the most recent test in the past 5 years.
• Bone density test (DEXA scan) for women who are 65 and older for osteoporosis screening.

Contributed by Patricia Hsiao M.D.
Sources: cdc.gov, health.nytimes.com, nlm.nih.gov, uptodate.com

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