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.

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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!

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Uterine fibroids (Q & A)

Posted by on Mar 18, 2015 in News | 0 comments

UterusWhat are uterine fibroids?
Uterine fibroids are benign growth of the uterus (womb) and they are called leiomyomas or myomas in medical terms. A woman can have one or many fibroids and they can vary in size. Fibroids develop from the same muscle tissue as the uterine wall. They can be found inside the uterus, outside the uterus, attached to the outer surface of the uterus or within the uterine wall. They have different names based on their locations and they are usually round shape. Uterine fibroids may either get bigger or smaller with time.

Are uterine fibroids cancerous?
No, uterine fibroids are benign so they are non-cancerous.

How common are uterine fibroids?
Uterine fibroids are very common. Approximately 75 to 80 percent of women have uterine fibroids at some point in their lives and many of them do not have any symptoms.

What age group is more likely to have fibroids?
Uterine fibroids can occur at any age but it is more common among women who are in their 30s and 40s. It seems to be rare among teenagers.

Are there any risk factors for uterine fibroids?
Uterine fibroids tend to run in the families. If your mother or sister has uterine fibroids, you may be at higher risk for developing fibroids. Uterine fibroids are more common among African American women for unknown reason. They tend to have fibroids at younger ages. On the other hand, childbirth and taking oral contraceptive (birth control pills) may decrease your risk of developing uterine fibroids.

What causes uterine fibroids?
Researchers do not know the exact causes of uterine fibroids. Female hormones called estrogen and progesterone appear to be associated with fibroids. Since estrogen and progesterone stimulate the growth of uterine lining to prepare for pregnancy during the monthly cycle, it also promotes the growth of uterine fibroids.
In early pregnancy, fibroids may grow in size due to increased estrogen but it shrinks after childbirth. In addition, uterine fibroids tend to shrink after menopause when estrogen and progesterone are decreased significantly.

What are the symptoms of uterine fibroids?
Many women with uterine fibroids do not have any symptoms. Common symptoms include heavy or prolonged menstrual period and spotting between periods. Too much blood loss during menstruation can cause iron deficiency anemia where you have low blood count and most common symptom is fatigue. Furthermore, you may experience pain or pressure in your lower belly. The pain can be either sharp or dull and you may have pain during sexual intercourse.
If the fibroid is large, it can obstruct nearby structures. For instance, if it is pressing on the bladder, you may experience frequent urination or difficulty urinating. If it presses on the rectum, you will have constipation or difficulty with bowel movement. Some women experience cramps and enlarged uterus. Depending on the location of the fibroids, you may have difficulty getting pregnant. Fibroids can cause miscarriage but it is not common.
Pain the lower belly could be from uterine fibroids.

How are uterine fibroids diagnosed?
Uterine fibroids are often found during a pelvic exam when a woman has no symptoms. Your doctor will notice the irregular shape of the uterus. Pelvic ultrasound is used to confirm the diagnosis. Ultrasound uses sound waves to take pictures of the uterus and the surrounding organs. The probe can be placed on the belly or inside the vagina (transvaginal ultrasound).
Other imaging tests are available but they are often not necessary. Pelvic CT or MRI is hardly used to diagnose uterine fibroids. If a doctor wants to see the fibroids inside the uterus, he or she can use hysteroscopy in an office setting. It is a small device inserted through the vagina. Sonohysterography is a procedure in which fluid is put into the uterus before the ultrasound exam to get better images of the uterine lining. Hysterosalpinography is a procedure that allows doctors to see both uterus and fallopian tubes (uterine tubes).

Does everyone need treatments for uterine fibroids?
No. However, it depends on many factors such as symptoms, age, fertility, size and location. If you are premenopausal, fibroids tend to shrink after menopause. Without any symptoms, treatment may not be necessary.
Treatment is required when it interferes with getting pregnant. Some fibroids grow very slowly or not at all then, treatment is not required. In that case, your doctor will monitor it with pelvic exam and ultrasound periodically.

What are medical treatments for uterine fibroids?
There are several medications available to treat uterine fibroids and those include birth control pills, long-term birth control methods, NSAIDs, GnRH agonists, iron supplement and other medicines.

How do birth control pills affect fibroids?
Oral contraceptive or birth control pills help regulate period so they reduce symptoms such as heavy period and menstrual cramps. However, they do not shrink uterine fibroids. You can get the same benefit from skin patch and vaginal ring. It may take a few months before you see any changes in your period.

What are long-term birth control methods?
Intrauterine device or IUD is a long-term method of birth control and it releases hormone called progestin. The doctor will place it inside the uterus. Even though it has no effect on the fibroids directly, it can reduce heavy period up to five years. Another option for long-term birth control is depo-Provera shot every three months and it also contains progestin hormone. These are good options for women who do not plan to start a family in the near future.

Do I need iron supplement?
If your period is heavy, taking iron supplement may help lower the risk of anemia.

What other medicines can I take for menstrual cramps?
NSAIDs or nonsteroidal anti-inflammatory drugs are recommended for cramps and pain but they do not reduce heavy bleeding. You can obtain over-the-counter ibuprofen (Motrin, Advil) and naproxen (Aleve, Naprosyn) for pain relief.

What medication can reduce the size of fibroids?
Gonadotropin-releasing hormone (GnRH) agonists and androgen (Danazol) are medicines that can reduce the size of fibroids. GnRH agonist is often given three to six months before the surgery to shrink the fibroids. Androgen is a steroid hormone and less commonly used due to its side effects such as weight gain, unwanted hair growth, acne, reduced breast size, mood swing and depression.

How do GnRH agonists work?
GnRH agonists work by decreasing estrogen and progesterone which are made by the ovaries. Without these hormones, fibroids shrink. However, it also stops your period so put you in menopause temporarily. You may experience menopausal symptoms such as hot flashes, vaginal dryness and sleep problem. It is not used for long-term because of high risk for osteoporosis (thinning of the bones).

What types of surgery are available to treat fibroids?
Surgery options are often discussed after medical treatment fails or shows very little improvement. Hysterectomy and myomectomy are surgical procedures for treating fibroids. If you do not want to have any more children, hysterectomy will be an option for you. The surgeon will remove your entire uterus and it is an invasive procedure. You may leave the ovaries so you do not go into menopause.
Myomectomy is a procedure where the doctor only removes the fibroids, leaving your uterus in place. There is a chance that fibroids may come back in the future and you may need treatment again. It is an option for women who still want to have children.
There are different ways to do myomectomy and it depends on the size and location of the fibroids. For larger fibroids, abdominal myomectomy is required. The doctor will make an incision in the lower belly to remove the fibroids. Smaller and fewer fibroids can be removed by laparoscopic myomectomy where only very small incisions are made in your belly to insert the camera and tools. If the fibroids are completely inside the uterus, the doctor can perform hysteroscopic myomectomy. The doctor will remove the fibroids through vagina and cervix.

Are there any less invasive procedures beside surgery to treat fibroids?
Yes, there are a few less invasive procedures to treat fibroids. They include endometrial ablation, uterine artery embolization (UAE), magnetic resonance guided focused ultrasound and others.

What is endometrial ablation?
Endometrial ablation destroys the lining of the uterus by heat or electric current. It can only be used for fibroids inside the uterus and it is done to reduce heavy period. In some women, endometrial ablation may stop the period. Pregnancy is not recommended after endometrial ablation, therefore; you will need some forms of birth control after the procedure.

What is uterine artery embolization (UAE)?
Uterine artery embolization (UAE) is a procedure that cuts off the blood supply to the fibroids by injecting tiny particles into the blood vessels leading to the uterus. Without adequate blood supply, fibroids shrink within weeks or months. Pregnancy is not recommended after the procedure so you will need some forms of birth control afterward.

What is magnetic resonance guided focused ultrasound?
This procedure uses multiple ultrasound waves to directly destroy the fibroids through the skin and it is guided by MRI machine. Again, pregnancy is not recommended after the procedure.

Are there any complications with uterine fibroids?
Pain, discomfort and anemia from heavy period are common complications from fibroids. If the fibroid is outside the uterus and attached to it by a stem, it can get twisted. When it happens, you may have sharp pain in the lower belly and nausea.
Fibroids usually do not interfere with pregnancy and may not require treatment. Some fibroids depending on the location may require removal because it may block the uterine tube in order for conception to occur or prevent implantation of the embryo in the uterus.

Contributed by Patricia Hsiao M.D.
Sources: uptodate.com, acog.org, mayoclinic.com, medicinenet.com, ncbi.nlm.nih.gov

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Fighting childhood obesity with healthy snacks

Posted by on Feb 25, 2015 in News | 0 comments

ObeseThe term “obesity” refers to having too much fat while overweight means having excess body weight. Childhood obesity has increased significantly in the last three decades in the United States and it is becoming more of a medical condition rather than just a social aspect. Majority of the time, childhood obesity is due to overconsumption of foods and lack of physical activity. Genetic factors and hormonal imbalance may contribute to childhood obesity but those are not common causes. Childhood obesity places children at greater risks for developing diabetes, high blood pressure, high cholesterol, sleep disorder, bone and joint problems. It also affects psychological factors such as having low self-esteem, poor self-image and being bullied at school. These problems can be lead to depression and suicide later in life.

Many of the weight loss diets recommend smaller, more frequent meals than having one large meal a day while watching out the calories you eat. Researchers found that children today eat on average of three snacks per day compared to one snack per day three decades ago. Meanwhile, children consume more sugar-sweetened beverages, high calorie, non-nutritious snacks nowadays. One study showed that kid’s meals today have very high content of salt. In addition, children spend more time in front of TV and play video games in today society than in the past decades.

To fully understand the underlying problems in childhood obesity, researchers conducted a study where they analyzed different types of snack and measured the satiety in children after the snacks. The study group consists of 183 children and average age is around eight. BMI on each child were recorded and 38 of those children are considered overweight while 43 were considered obese. BMI measurement for children (2-20 years old) is different from adults. Please refer to CDC (The Centers for Disease Control) for standard BMI calculator for children.

In this study, children were randomly placed into four different groups where different snacks were given while watching TV for 45 minutes. One group was given potato chips and the second group was given only vegetables. The third group was given cheese and the fourth was given combination of cheese and vegetables. Researchers used three questions on nine points scale to measure the satiety. Furthermore, the parents of the study group children filled out 20 questionnaires regarding mealtime habits and family involvement in mealtime activities.

For the surveys, the children were questioned before the snack, immediately after the snack, and 20 minutes after the snacks. The cheese group and vegetable group were considered control groups and researchers compared the satiety measurements from the other groups to these. The average of 620 calories was consumed in the potato chips group and 200 calories in the cheese group. The vegetables group consumed about 60 calories on average and 170 calories in the combination group. The study showed that combination of cheese and vegetables fulfilled satiety faster than the potato chips with fewer calories. Often times, obesity results from calorie imbalance (more intake than you use for energy). In conclusion, healthier snacks can meet satiety with lesser amount while getting fewer calories. Furthermore, replacing junk foods with healthier snacks may be more reasonable approach than eliminating junk foods all together in children’s diet.

Contributed by Patricia Hsiao M.D.
Sources: pediatrics.aappublications.org, cdc.gov, mayoclinic.com

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Physical activity on bone health

Posted by on Jan 21, 2015 in News | 0 comments

Running womanPhysical activity plays a major role in fighting obesity and management of chronic conditions such as heart disease, diabetes, high blood pressure and high cholesterol. Exercise or physical activity helps children build bones and strengthen muscles and joints. In older adults, physical activity improves strength and mobility, which in turn reduces falls and fall-related injuries.

In a recent study on premenopausal women, researchers found an increase in bone formation markers and high serum IGF-1 (positive effector on bones) in women who have more than 120 minutes of physical activity per week than sedentary women. One study was conducted on women over 65 years of age and participants were randomly placed into either the exercise group or control group. At the end of the 18 months study, researchers measured bone mineral density on both groups. It showed that women in the exercise group have higher bone mineral density than control group. Bone mineral density tells us the amount of calcium and minerals in your bones. Lower bone mineral density indicates higher risk for osteoporosis.

Furthermore, physical activity is important part of the treatment and prevention of osteoporosis. In osteoporosis, weight bearing and strengthening activities are crucial and effective. Physical therapist can help you design an exercise program that is right for you. In conclusion, any amount of physical activities would help you stay healthy and have positive impact on your bone health.

Contributed by Patricia Hsiao M.D.
Sources: medscape.com, jamanetwork.com, ncbil.nlm.nih.gov, uptodate.com

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Lipid lowering dietary supplements

Posted by on Dec 5, 2014 in News | 0 comments

SupplementsIf you have high cholesterol, you might want to pay close attention to what you eat. Diet plays a major role in treating chronic conditions such as diabetes, high cholesterol and high blood pressure. There are many commercial products and herbal supplements that claim to lower blood cholesterol. Make sure you talk to your doctor before you start taking any herbal supplements because some may interact with the medications you are taking. On the other hand, there are some dietary supplements you can take to lower your cholesterol. Research studies have shown that fish oil or omega-3-fatty acid, fibers and some nuts have effects on cholesterol.

Fish oil or omega-3-fatty acid
Fish oil has been studied for many potential health benefits and some populations who eat a lot of fish products have lower rate for heart disease. You may hear that fish oil is good for many medical conditions but not all of them have been proven by scientific studies. However, we know for the fact fish oil or omega-3-fatty acids have effect on high cholesterol and high blood pressure. Many studies were done on laboratory animals and some were done on humans for high cholesterol. Studies concluded that fish oil reduces triglycerides (a type of cholesterol) level by large amount in patients with high triglycerides. It may also raise HDL (good cholesterol) level by small amount. It is recommended to consume at least one or two servings of oily fish a week. Fish with lots of omega-3 include tuna, salmon, mackerel, mullet, anchovy, trout, sardines, halibut and herring. You can also get omega-3-fatty acids from flaxseed oil, canola oil and soybean oil. If you do not like to eat fish, you can take fish oil supplement (1 gram daily). Talk to your doctor if you are concerned about your daily dose of fish oil supplement along with your other medicines. Fish oil supplements may contain small amount of vitamin E. You should not take more than the recommended dosage.

We know that fibers are good for your intestines and it can help prevent colon cancer. Studies showed that soluble fibers in psyllium, wheat, celery, oatmeal and oat bran can reduce LDL cholesterol (bad cholesterol) level. You can also get fibers from eating fruits. Therefore, it is recommended to have 5-10 grams of fibers a day.

Studies showed that walnut has effect on lowering total cholesterol and LDL cholesterol (bad cholesterol). Similar effects are found from almonds and pistachio as well. You should try to consume a handful of nuts a few times a week. Make sure to get the ones which are unsalted or not sugar-coated. Some studies indicated that people who consume nuts more than two times a week may benefit from lowering the risk of heart disease.

Others with small effect on cholesterol level
There are a few studies done on green tea on cholesterol level and researchers found that drinking unsweetened green tea can reduce LDL cholesterol in a small amount. In addition, soy products are rich in unsaturated fats and fibers compared to protein from meats. Studies showed that soy protein improves cholesterol level and blood pressure.

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

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Nutrition in Pregnancy (Q & A)

Posted by on Nov 19, 2014 in News | 0 comments

Healthy pregnancy
What is the best diet in pregnancy?
There is no single diet for women during pregnancy yet, eating well-balanced, healthy foods is important for your health as well as your baby. The baby inside you needs a lot of nutrients to grow and to attain normal development. Regardless of what diet you choose, it should contain a lot of vegetables, fresh fruits, whole grains, lean meat and low-fat dairy products.

What are the recommended servings for carbohydrates, protein, fruits, vegetables and dairy in pregnancy?
The recommendations may vary slightly depending on what sources you are looking at. Generally, about 9 servings of carbohydrate, 3 or more servings of protein, 2 or more servings of fruits, 3 or more servings of green vegetables, and 4 servings of dairy products are recommended during pregnancy. Limit fat consumption to about 2 servings per day and try to drink 8 glasses of water a day.

Do I need extra calories during pregnancy?
Yes, women need to consume more calories to support the growing baby during pregnancy. Daily calorie intake needs to be increased by 300 kcal per day in second trimester (4-6 months) and over 400 kcal per day in third trimester (7-9 months).

How much weight do I need to gain during pregnancy?
The amount of weight you need to gain during pregnancy varies and it depends on your weight before pregnancy. Check with your obstetrician about how much weight you should put on in your pregnancy. The following is a recommended weight gain for general population:
BMI before pregnancy Recommended weight gain during pregnancy
Underweight (BMI of less than 18.5) 28-40 pounds
Normal weight (18.5 and 24.9) 25-35 pounds
Overweight (BMI of 25 to 29.9) 15-25 pounds
Obese (BMI of 30 or greater) 11-20 pounds

Why should I monitor my weight gain?
We encourage women to have better control over their weight gain during pregnancy to prevent large infant, preterm birth and post-term birth. Overweight and obese women are at higher risk for developing gestational diabetes (high blood sugar during pregnancy) and preeclampsia (high blood pressure in pregnancy). Babies are also at higher risk for birth defects and birth-related injuries.

What foods should I eat to get the extra calories?
The extra calories should come from various food sources such as carbohydrates, protein and low-fat dairy products. You can get carbohydrates from whole grain products, cereal and starchy vegetables. Protein is also essential nutrient for fetal growth and development especially in the second and third trimester. Your diet should include more lean meat found in poultry and fish (certain types), tofu, dried beans and peas. Protein can be obtained from dairy products such as egg, milk, yogurt and cottage cheese as well.

What are good sources of protein if I am a vegan?
Soy products, beans, peas and peanut butter are rich in protein.

What is folic acid?
Folic acid or folate is vitamin B that prevents neural tube defects (defects of brain and spinal cord). Brain formation occurs as early as four weeks after conception. You can find folic acid in fortified cereals, green vegetables (spinach, broccoli, asparagus, okra and brussel sprouts), dried beans, peas and citrus fruits (orange, grapefruit, papaya and strawberry).

Can I take folic acid supplement?
Yes, you can take 400 to 800 mcg (micrograms) of folic acid daily. Some prenatal vitamins contain folic acid but the amount varies among different brands. Let your doctor know if you are taking medications for seizure, diabetes, asthma, lupus or inflammatory bowel disease. You may need a higher dose of folic acid. You will be given a higher dose of folic acid if you had a baby with brain or spinal cord defect or you have a family member with spinal bifida. In that case, the doctor will prescribe you 4000 mcg of folic acid daily, which is ten times higher than the normal dose.

When should I start taking folic acid supplement?
Even when you are just planning to get pregnant, you should start eating healthy foods and take multivitamin with folic acid (400 to 800 mcg daily). Brain and spinal cord form very early on in pregnancy before most women find out they are pregnant. On the other hand, neural tube defects are very much preventable with folic acid during pregnancy.

What other vitamins and minerals do I need during pregnancy?
During pregnancy, women need increased amount of iron, calcium and vitamin D. If you are a vegan, you may also need vitamin B12 supplement as well as iron, calcium and vitamin D.

What is iron for?
Iron is part of the red blood cells and red blood cells carry oxygen to the brain, organs and tissues. Your body demand for iron is higher in pregnancy since your baby also produces his or her own blood supply.

What is anemia?
Anemia is a condition where you do not have enough red blood cells to carry oxygen to the organs and tissues. During pregnancy, iron-deficiency anemia is more common and it is due to inadequate iron to make red blood cells. Common symptoms include fatigue, weakness, pale skin and headache.

What types of food are rich in iron?
Iron is found in meats, iron-fortified cereal, spinach, beans and nuts.

How much iron do I need daily?
You need 27 milligrams of iron daily and most prenatal vitamin supplements contain iron.

What are calcium and vitamin D for?
Calcium and vitamin D are needed for bone formation and to strengthen bones.

What foods are rich in calcium and vitamin D?
You can get calcium and vitamin D from milk, yogurt, cheese, eggs, spinach, asparagus, broccoli, cereal and fortified orange juice. Vitamin D is also from sunlight through your skin.

How much calcium do I need daily?
You need 1000 milligrams of calcium daily. If you are a teen mom, you need 1300 milligrams of calcium daily.

How much vitamin D do I need daily?
You need 600 IU (international unit) of vitamin D daily.

Can the daily requirements of iron, calcium and vitamin D be fulfilled by taking prenatal vitamins?
No, prenatal vitamins are supplement to your diet. You still need to eat nutritious foods to meet your daily requirements of iron, calcium and vitamin D. Most of them do not contain 1000 milligrams of calcium.

Are there any foods I must avoid during pregnancy?
Yes, there are certain categories of food you must avoid during pregnancy. Those include fish with high mercury content, raw meat, some seafood, unpasteurized milk and cheese products.

What types of fish are high in mercury?
Fish with high mercury content are found to be associated with central nervous system damage and those include swordfish, tuna steaks, mackerel and shark.

What fish are safe to eat during pregnancy?
It is safe to eat canned light tuna, salmon, tilapia, catfish, crab and shrimp up to two times a week.

What other seafood do I need to avoid?
You should avoid oysters and clams as well as sushi that are made with raw fish.

Can I eat organ meats?
No, because they contain too much vitamin A, which are toxic for the fetus.

What foods should I avoid to prevent myself from bacterial food poisoning?
You can get bacterial food poisoning from raw, undercooked meat and poultry and it can be harmful to your baby. If you eat processed deli meats and eggs, make sure they are cooked thoroughly. It may be wise to avoid eating raw sprouts such as clover, radish and alfalfa because it is impossible to wash out the bacteria inside the seeds.

What other hygiene should I adapt to prevent myself from food-borne illnesses?
Always rinse the vegetables and fruits thoroughly before eating. Make a good habit of washing your hands before and after handling foods.

What is listeriosis?
Listeriosis is a condition caused by bacteria called listeria. While it causes mild-flu-like symptoms such as headache, fever, nausea and vomiting in a mother, it is more fatal to the fetus. It can cause miscarriage and stillbirth.

What foods should I avoid to prevent myself from listeriosis?
You must avoid unpasteurized milk or juice, soft cheese, foods that are made from unpasteurized milk, raw or undercooked meat, poultry and smoked seafood. Soft cheese includes Camembert, feta, Brie, blue cheese and Mexican-style cheeses (fresco, queso, blanco and panela).

Can I have caffeine during pregnancy?
Some studies suggested that too much caffeine is associated with miscarriage and preterm birth but not enough evidence to support it. However, it is recommended that pregnant women should consume less than 300 mg of caffeine, which is about two cups of coffee a day.

Are herbal products safe to consume during pregnancy?
We have limited data to support whether herbal teas and products are safe to consume or not. Thus, you should stay away from herbal products during pregnancy.

What other lifestyle modifications do I need to adapt in pregnancy?
As we all know that alcohol causes fetal alcohol syndrome (mental retardation and developmental problems), pregnant women must avoid all alcoholic beverages including wine. In addition, quit smoking if you smoke. Try to exercise for 30 minutes a day as many times as you can in a week.

Contributed by Patricia Hsiao M.D.
Sources: acog.org, ncbi.nlm.nih.gov , mayoclinic.com, ghc.org, uptodate.com

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