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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Bunions (Q & A)

Posted by on May 20, 2015 in News | 0 comments


What is a bunion?
Bunion is an abnormal bony bump at the base of the big toe. Medically, it is referred to as hallux valgus deformity. This enlarged and misaligned joint causes the big toe to point toward the second toe instead of staying straight forward in a normal position. Sometimes, it may even overlap the second toe. The pressure from the big toe may cause the little toes to be misaligned as well. The skin covering the joint may look red and inflamed.

Can you have bunion on the other toes?
Yes, you can have bunion on the base of your little toe (fifth toe). It is called bunionette or tailor’s bunion.

Are bunions painful?
Yes, bunions can be very painful especially with walking. Larger bunion may cause difficulty with walking.

What are the complications of bunion?
Bunion causes your big toe to look distorted and misshapen cosmetically. In addition, the fluid-filled sac around the joint can get inflamed and a condition called bursitis may develop. Over a long period of time, arthritis may develop on the affected joint.

Do bunions affect both genders?
Yes, bunions affect both men and women. But it is estimated that bunions are ten times more common in women than men.

Do bunions run in the families?
Yes, bunions run in the families. If you have a defect in the structure of your foot, you are more likely to develop bunions.

What are the causes of bunions?
Bunions develop from wearing a tight-fitting, narrowed or pointy toe shoes or high heels. It could also be genetic or due to abnormal structure in your foot that you are born with.

What are the signs and symptoms of bunions?
Common symptoms include pain, swelling, redness and tenderness around the joint on the big toe. Common signs are having abnormal bony bump on the side of the big toe and big toe points toward the little toes. The pressure from the big toe may cause the crowding of the little toes and develop a condition called hammertoe. The skin on the bottom of your foot may get thickened and calluses may develop on the skin along the big toe. If bunion is large and severe, you may have pain with walking.

How are bunions diagnosed?
There are no specific tests to diagnose bunions. The doctor will make the diagnosis based on the examination of your foot. He or she will look for redness, swelling, inflammation and the skin changes on your foot and big toe. The doctor will assess the range of motion of the joint on the big toe. Some doctors may order X-ray of the foot to see if you have deformity or abnormal structure of the bone. X-ray can also detect arthritis of the foot.

How are bunions treated?
Treatment depends on severity of pain and effects on your daily life. If you have mild pain that comes on and off, the doctor may try conservative treatments first. He or she will recommend that you wear comfortable shoes with wide toes or sandals. You can find over-the-counter arch support, pads for your soles and spacers between the toes. There are some orthopedic shoes or devices you can get with a prescription.

As for pain, you can take acetaminophen (Tylenol) or ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn) or NSAIDs (Aspirin, Ecotrin). You may apply ice pack to the affected area to help reduce inflammation and swelling. If you have a more severe pain, your doctor can give you corticosteroid injection to the area.

If you do not find relief with conservative treatment and pain medication, surgery is an option. There are different surgical procedures available and the doctor will discuss the right one for your case. You can go home on the same day for bunion surgery. Bunionectomy is one of the surgical procedures in which abnormal bony growth is removed and the big toe is realigned back to the normal position. The doctors will instruct you to wear proper shoes after the procedure to ensure a recovery and prevent new bunions from forming. Surgical option is available for bunionette (bunion on fifth toe) as well.

Surgery is not an option for teenagers because the bones are not fully grown yet. Bunions in teenagers are often treated with conservative treatments.

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

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Cervical Cancer (Q & A)

Posted by on Apr 22, 2015 in News | 0 comments


Female anatomyWhat is cervical cancer?
Cervical cancer is cancer of the cervix, which is part of a woman’s reproductive organ. Cancer occurs when cells are dividing rapidly and abnormally. Eventually, it becomes a tumor. Cancer cells can spread to other organs such as liver, lungs and bones by traveling through the blood vessels.
There are two types of cell in the cervix and the name of the cancer indicates which type of cells is involved.
The middle and right images showed how cervix looks from the vagina.

Where is cervix located?
Cervix is located in the pelvic and it is the lower end of the uterus (womb), connected to the vagina. Uterus is where the baby grows during pregnancy. During pregnancy, the cervix is tightly closed and it is opened at childbirth.

How common is cervical cancer?
In the U.S and developed countries, cervical cancer is declining due to preventative screening test. However, in the developing countries, cervical cancer is still the second most common cancer in women.

What are the names of the cervical cancer?

Squamous cells, which are on the outer layer of the cervix, are involved in squamous cell carcinoma of the cervix. Columnar cells are involved in adenocarcinoma of the cervix and they are the lining of the cervical canal. Squamous cell carcinoma of the cervix is a more common one.

What causes cervical cancer?

Cervical cancer is associated with human papilloma virus or HPV infection. While there are many strains of HPV, only infection with HPV 16 and 18 are high risk for developing cervical cancer. HPV is passed from one person to another via sexual intercourse. There are many women who are infected with HPV but not all of them will develop cervical cancer. In some women, the infection goes away on its own. HPV infection can also cause genital warts, which is a non-cancerous condition.

Who are at risk for cervical cancer?
All women who are sexually active are at risk for HPV infection. But it does not necessarily mean they are at risk for cervical cancer. The following are risk factors for cervical cancer.

• Having multiple sexual partners
• Engaging in sexual activity before the age of 18
• Having a history of sexually transmitted infections (STIs) such as gonorrhea, chlamydia, HIV and syphilis
• Having a dysplasia of the cervix
• Having a weak immune system
• Having a family history of cervical cancer
• Having a mother who took a medication called DES (diethylstilbestrol) during pregnancy
• Smoking

What is dysplasia of the cervix?
Dysplasia refers to the changes in the cells before they become cancerous. It takes several years in order for dysplasia to progress into cervical cancer. There are a number of treatments available for dysplasia. Therefore, early detection via routine screening is an important step in preventing cervical cancer.

What are the signs and symptoms of cervical cancer?
Early cervical cancer does not present with any signs or symptoms. As the cancer advances, a woman may have abnormal period that lasted longer or heavier than usual. Some women may experience bleeding between periods or having period after menopause or bleeding after sexual intercourse. Some may notice abnormal bloody discharge, pelvic pain, back pain and fatigue.

What is the screening test for cervical cancer?

Pap Smear is the screening test for cervical cancer and it detects abnormal cells in the cervix. During Pap Smear exam, your doctor will take a small sample of cells from the cervix and send it to the lab for examination under the microscope. HPV test is also available for women over 30. It may be ordered along with Pap Smear or some doctors may order it after Pap Smear came back abnormal. HPV test is to see if a woman has been infected with certain strains of HPV.

How is cervical cancer diagnosed?
After the abnormal Pap Smear, the doctor will do more tests to see if it is cervical cancer or not. He or she will perform a pelvic exam to see if there is any abnormality in the uterus (womb), ovaries (eggs) and vagina.
Colposcopy is a procedure in which the doctor looks at your cervix with a colposcope (magnifying lens) and takes small sample of tissues from the abnormal area for biopsy. Then, the tissue sample will be sent to the lab for examination under the microscope. Colposcopy is often done in the doctor’s office. Some doctors may do cone biopsy where cone-shaped tissue is taken for biopsy and it contains deeper layer of cells. Once the diagnosis of cervical cancer is made, your doctor will refer you to a cancer specialist.

What is staging?
Once the cervical cancer is diagnosed, your doctor will do staging to determine the extent of the cancer. Staging is based on the size of the cancer, whether it has spread to the surrounding tissues and other organs or not. Staging helps doctors to formulate treatment plan.
Cervical cancer has stage I to stage IV. In stage I, cancer is only in the cervix. Stage II cancer has spread beyond the cervix and it may include uterus. In stage III, cancer has spread to the lower part of the vagina and may include pelvic wall (tissues that line the body). In stage IV, cancer has spread to bladder, rectum or other parts of the body. As part of the staging, your doctor will order other imaging tests such as chest X-ray, CT scan of the pelvis, MRI of the pelvis, cystoscopy to see inside of the bladder, colonoscopy to look at the entire colon and etc.

How is cervical cancer treated?
Treatment of cervical cancer depends on a number of factors such as your age, staging of the cancer and your health condition. There are several surgical options, radiation therapy and chemotherapy available to treat cervical cancer. It is important to have family members and close friends for emotional support during the treatment. Counseling and support groups available for you to meet other women who have been diagnosed with cervical cancer.

What types of surgery are available?

If the cancer is in very early stage, simple hysterectomy can be done. It is a procedure to remove the cervix and uterus. A lot of doctors prefer radical hysterectomy even in early stages of cervical cancer. In this procedure, the doctor removes the cervix, uterus and part of the vaginal, leaving the ovaries (eggs) in place. It can either be done by incision in the belly or laparoscopic procedure in which only small incisions are made to insert the instruments and camera.

What is radiation therapy?
Radiation therapy (RT) uses high energy X-ray to stop the cancer cells from growing and there are two ways to give radiation therapy. In brachytherapy, the device is placed in the cervix and it gives high dose of radiation to the cancerous area. In external beam radiation therapy (EBRT), the radiation is given from outside of the body and it is given five days a week for about 5 to 6 weeks in a clinic setting. In early stages of cancer, your doctor will use one of the radiation methods. For advanced cancer stages, both methods may be used.

What is chemotherapy?
Chemotherapy uses medicines to stop or slow the cancer cells from growing and it is used to enhance the effect of radiation therapy. Medicines are usually injected into a vein once a week. For advanced cancer stages, chemotherapy and radiation are used before the surgery to shrink the tumor.

Is cervical cancer preventable?
Yes, cervical cancer is very much preventable with a routine Pap Smear exam. Also, HPV vaccines are available for girls 9 years of age to 26 years old women who have not been sexually active yet.

How can I prevent myself from getting cervical cancer?
Practice safe sex by using condom, limit the number of sexual partners, do not engage in sexual activity at early ages, get Pap Smear exam routinely, get HPV vaccination and quit smoking if you smoke.

What are the names of the HPV vaccines?
The vaccine called Gardasil prevents infection from HPV strains (6, 11, 16 and 18). Another vaccine called Cervarix prevents infection from HPV strains 16 and 18. Both vaccines are given in a series of three shots over six months.

What are the recommendations for Pap Smear?
You should get your first Pap Smear at the age of 21 or three years after your first sexual intercourse. For women between 21 and 29 years of age, most organizations recommended to have Pap Smear every two years. If you are between 30 and 65 years of age, the recommendation is every three years or every five years with HPV test. If your Pap Smear shows abnormal cells, you may need more frequent Pap Smear. Once you are 65 or older, you can stop having Pap Smear if you have had three normal results within the last ten years. Your last Pap Smear exam must be in the last five years.

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

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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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