Archive for September, 2014
By David Kreiner MD
September 30th, 2014 at 10:41 am
Tagged with acupuncture for headache, David Kreiner MD, distending headache, heavy sensation headache, Infertility, Infertility Treatment, Long Island IVF, supraorbital Headaches, TCM and fertility, TCM and headaches, TCM and infertility, Trying to Conceive
“Not tonight, dear, I’ve got a headache.” That well-known phrase is commonly used by both fertile and infertile couples. According to Traditional Chinese Medicine (“TCM”), there are several types of headaches and each relates to several other areas of the body. So, what causes a headache?
The head is the dwelling of the confluence of yang in the body and is closely connected with the organs through meridians and vessels. When external or internal factors impede the flow of Qi or nutrition to the head or blocks the head orifices headaches can occur. People experience a variety of headaches with different symptoms related to different syndromes.
Supraorbital headaches may be one- or two-sided above the eyebrow and may spread over the entire forehead. TCM believes that this pain is caused mainly by invasion of wind heat pathogens or wind pathogens that cause stasis of the flow of Qi to the head. In addition, dysfunction of the stomach and gallbladder meridians are thought to play an important role in causing the headache.
When wind heat is responsible there may be a distending feeling in the forehead accompanied by a teary red eye that is sensitive to the light. Patients may have exterior symptoms such as fever and aversion to a blowing wind. The tip of the tongue is red and a thin yellow coating is typically seen on the surface of the tongue. The pulse is felt strongest with the lightest of pressure over the radial pulse, a so-called “floating” pulse and is rapid.
Wind stasis that blocks the flow of Qi to the head typically induces a stabbing pain over the eyebrow associated with light sensitivity. It is exacerbated with pressure. The tongue has a purplish color to it and the pulse is said to have a taut guitar string like quality.
Distending or splitting headaches in TCM are usually the result of abundant Qi and blood flowing into the head that lead to localized stagnation, and disturb the head orifices. The usual disharmony patterns are: Invasion of wind heat, liver yang rising and flaming up of liver fire.
Invasions of wind heat induces a splitting sensation in the head accompanied by fever, aversions to wind, thirst, redness in the face as well as eyes and tongue which is also typically covered by a yellow coating. The pulse is felt very superficially (“floating”) and is rapid. Treatment is aimed at expelling wind and clearing heat using herbs and/or acupuncture.
Liver yang rising induces a distending headache associated with dizziness, tinnitus, numbness and/or tingling in toes and/or fingers, insomnia, lumbar pain, weakness in the knees and redness in the face and tongue which has a yellow coating. The pulse is said to feel like a “guitar string” and is rapid. These symptoms may be exacerbated by emotional stress. Treatment is geared towards calming the liver, subduing yang and nourishing kidney and liver which also is accomplished with herbs and acupuncture.
Flaming up of liver fire likewise causes a distending headache but said to be more severe splitting accompanied by bloodshot eyes, a bitter taste, lower chest discomfort, irritability, dreams that disturb sleep, a red tongue that has both a yellow and greasy coating and the pulse is “guitar string”-like and rapid. Treatment is to clear the heat and eliminate dampness.
Heavy Sensation Headaches
Patients sometimes describe headaches that are characterized by a heavy feeling in the head. This feeling is commonly seen in tension headaches, headaches from stress felt in the neck or headaches due to functional disorders.
According to TCM, dampness is the most common factor causing the heavy sensation headache. As dampness pathogens are said to be turbid and heavy in nature, they tend to obstruct the flow of Qi in the meridians. Other disharmonies such as stagnation of the liver, dysfunction of the middle burner and improper ascending of lucid yang can also result in a heavy sensation headache.
Wind dampness obstructs the flow of Qi inducing the heavy sensation headache accompanied by fatigue, heavy sensation in the limbs, chest stuffiness, lack of appetite, urinary problems, loose bowels and a greasy white tongue coat. The symptoms may be aggravated during humid or rainy weather. Treatment is to dispel wind and eliminate dampness.
Damp heat will cause heavy sensation headaches or distending headaches associated with a red face and tongue covered by a yellow coating. Patients describe a hot sensation in the body, irritability, lack of appetite, chest stuffiness, abdominal distension, scanty yellow urine and constipation. Typically symptoms worsen in the afternoon. Treatment is to clear the heat and eliminate dampness.
Phlegm dampness obstructs Qi flow in the meridians to the head causing the heavy sensation headache typically also with dizziness and a foggy feeling. Patients may also experience chest oppression, stomach upset, excessive sputum, fatigue, a bulky tongue with teeth marks and a greasy white-coated tongue. Treatment is to invigorate the spleen eliminate damp and phlegm and restore the flow of Qi.
Stagnation of the liver can cause headaches with heavy sensation and dizziness, chest discomfort, stomach upset, belching, depression, forgetfulness, lack of appetite and loose bowels and dreams that disturb sleep. Symptoms worsen with emotional stress. Treatment is to sooth the liver, regulate Qi and harmonize the organs of the upper abdomen known as the middle burner.
Qi deficiency of the middle burner (including Spleen, Stomach and Gall Bladder) in addition to causing the heavy sensation headache can cause dizziness, paleness, fatigue, shortness of breath, lack of appetite loose bowels and a pale tongue. Invigorating the middle burner, replenishing Qi and promoting the ascent of lucid yang are treatments for this ailment.
With all this going on, is it any wonder people often use headaches as a lovemaking excuse?
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Have you ever used…or would you consider using… acupuncture to treat chronic or severe headaches?
By Tracey Minella
September 26th, 2014 at 3:11 pm
Tagged with Captain Clutch, coping with infertility, Derek Jeter, Infertility, Infertility Support, IVF Long island, Jeter retires, Jeter's last home game, Long Island IVF, New York Yankees, stress of infertility, Tracey Minella, Trying to Conceive, TTC, yankees captain
He sure looks good in pinstripes. He also looks good in heather gray.
He’s your captain and has been right there for as long as you can remember. Just a touch away from the couch.
“Captain Clutch”. He always comes through when a miracle is needed.
He’s not like other men. He’s special. Almost magical.
He always goes above and beyond the call, defying odds. There is no physical task he can’t perform when the demand is made and the pressure is on. He is the master of his domain.
He’s the definition of a team player. You could not admire him more.
He builds up his team, deflects attention from himself, and downplays his important contributions.
He wants to win. It’s his only goal… his only focus… 24/7. Year after year. It has been that way since the journey began long ago.
He has sacrificed everything in pursuit of his dream. He tries to hold in his emotions.
He sees children in his future.
Who is he?
He is your husband.
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By the way…Thanks for the memories, Derek Jeter! You’re awesome, too. I’m tipping my hat (pictured above) to you!
By Tracey Minella
September 16th, 2014 at 6:03 pm
Tagged with Best In Vitro Practice 2015, Best OBGYN, Best of Long Island, BOLI 2015, Daniel Kenigsberg MD, David Kreiner MD, Infertility Treatment, IVF, IVF Long island, Joseph Pena MD, Long Island IVF, Long Island Press 2015, Steven Brenner MD, Trying to Conceive
Long Island IVF is so pleased to announce that it has been nominated “Best In Vitro Fertility Practice” in the Long Island Press “Best of Long Island (“BOLI”) 2015” Contest. (This is a new category. Prior to this year, our doctors had to be nominated in the OBGYN category.)
Four of our doctors were also on the nominee list: Daniel Kenigsberg MD, David Kreiner MD, Steven Brenner MD, and Joseph Pena MD. (You’ll find Dr. Brenner in the OBGYN category).
Thank you to all of our patients and their families for nominating us in this public opinion-based contest. Word-of-mouth recommendations have always been the cornerstone of our practice and we appreciate you taking a moment to cast a vote in our favor. It really is an honor to be nominated. Now that nominations are done, voting for a winner begins shortly.
The voting period to determine the one ultimate winner in each category begins on October 1 and continues until December 15 and voters may cast one vote per day. For those interested in voting for any of the many businesses or service providers who have been nominated, you may do so at: http://bestof.longislandpress.com/voting
Again, thanks for making our day by nominating us “Best In Vitro Fertility Practice”. We love what we do.
And that begs the question: How did YOU come to hear of Long Island IVF?
Was it a recommendation from friends or family? Your gynecologist? A print or radio ad? The internet? Research into our success rates and innovative programs? Something else? What brought you into the practice? (Curious minds want to know.)
Photo credit: Long Island Press, reprinted with permission
By David Kreiner MD
September 12th, 2014 at 2:30 pm
Tagged with David Kreiner MD, Long Island IVF, OHSS, ovarian hyperstimulation, PCOS, PCOS and infertility, PCOS and pregnancy, PCOS Awareness Month, PCOS medication, PCOS symptoms, PCOS treatment, TTC
PCOS is the most common hormonal disorder of reproductive age women, occurring in over 7% of women at some point in their lifetime. It usually develops during the teen years. Treatment can assist women attempting to conceive, help control the symptoms and prevent long term health problems.
The most common cause of PCOS is glucose intolerance resulting in abnormally high insulin levels. If a woman does not respond normally to insulin her blood sugar levels rise, triggering the body to produce more insulin. The insulin stimulates your ovaries to produce male sex hormones called androgens. Testosterone is a common androgen and is often elevated in women with PCOS. These androgens block the development and maturation of a woman’s ovarian follicles, preventing ovulation resulting in irregular menses and infertility. Androgens may also trigger development of acne and extra facial and body hair. It will increase lipids in the blood. The elevated blood sugar from insulin resistance can develop into diabetes.
Symptoms may vary but the most common are acne, weight gain, extra hair on the face and body, thinning of hair on the scalp, irregular periods and infertility.
Ovaries develop numerous small follicles that look like cysts hence the name polycystic ovary syndrome. These cysts themselves are not harmful but in response to fertility treatment can result in a condition known as Ovarian Hyperstimulation syndrome, or OHSS.
Hyperstimulation syndrome involves ovarian swelling, fluid accumulating in the belly and occasionally around the lungs. A woman with Hyperstimulation syndrome may become dehydrated increasing her risk of developing blood clots. Becoming pregnant adds to the stimulation and exacerbates the condition leading many specialists to cancel cycles in which a woman is at high risk of developing Hyperstimulation. They may also prescribe aspirin to prevent clot formation.
These cysts may lead to many eggs maturing in response to fertility treatment also placing patients at a high risk of developing a high order multiple pregnancy. Due to this unique risk it may be advantageous to avoid aggressive stimulation of the ovaries unless the eggs are removed as part of an in vitro fertilization procedure.
A diagnosis of PCOS may be made by history and physical examination including an ultrasound of the ovaries. A glucose tolerance test is most useful to determine the presence of glucose intolerance and diabetes. Hormone assays will also be helpful in making a differential diagnosis.
Treatment starts with regular exercise and a diet including healthy foods with a controlled carbohydrate intake. This can help lower blood pressure and cholesterol and reduce the risk of diabetes. It can also help you lose weight if you need to.
Quitting smoking will help reduce androgen levels and reduce the risk for heart disease. Birth control pills help regulate periods and reduce excess facial hair and acne. Laser hair removal has also been used successfully to reduce excess hair.
A diabetes medicine called metformin can help control insulin and blood sugar levels. This can help lower androgen levels, regulate menstrual cycles and improve fertility. Fertility medications, in particular clomiphene are often needed in addition to metformin to get a woman to ovulate and will assist many women to conceive.
The use of gonadotropin hormone injections without egg removal as performed as part of an IVF procedure may result in Hyperstimulation syndrome and/or multiple pregnancies and therefore one must be extremely cautious in its use. In vitro fertilization has been very successful and offers a means for a woman with PCOS to conceive without a significant risk for developing a multiple pregnancy especially when associated with a single embryo transfer. Since IVF is much more successful than insemination or intercourse with gonadotropin stimulation, IVF will reduce the number of potential exposures a patient must have to Hyperstimulation syndrome before conceiving.
It can be hard to deal with having PCOS. If you are feeling sad or depressed, it may help to talk to a counselor or to others who have the condition. Ask your doctor about support groups and for treatment that can help you with your symptoms. Remember, PCOS can be annoying, aggravating even depressing but it is fortunately a very treatable disorder.
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Do you suffer from PCOS? Do you have any advice to share for other “cysters”?
By Tracey Minella
September 11th, 2014 at 1:40 pm
Tagged with Infertility, Infertility Support, IUI, IVF, LI-IVF, Long Island IVF, memories of 9-11, patriot day, remembering 9/11, stress of 9/11, Tracey Minella, Trying to Conceive, twin towers fall, where were you on 9-11
You will always remember where you were that fateful day. And so will I.
I was working as a medical assistant for Long Island IVF. I was also a patient there…and about 9 weeks pregnant with my son. Could life be any happier on a blindingly clear, crisp September morning?
It started out as a typical day, with the usual morning rush. Lots of busy women…many trying to get their blood and sono done so they cold hurry off to work. A few rushing to catch a train to the city. Men dropping off specimens on their way to the office. Some trying to catch a train to the city.
A train to the city.
By the time news of the second plane crash hit, most of the morning’s patients had already been seen and were gone. Disbelief was quickly followed by panic as we and the rest of the nation scrambled to figure out if our friends and family who worked in NYC were ok. And what about our patients?
Doesn’t “So-and-So” work downtown? Isn’t “Mr. X” a trader on Wall Street? We spent the morning pouring over the employer info in the patients’ charts, making calls on jammed phone lines, and accounting for everyone’s whereabouts. We went through the motions of the day on auto-pilot, glued to a 13” black and white TV in the nurse’s station, watching the horror unfold. What kind of world was I bringing this baby into?
But just as there were stories of heroism, good deeds, and miracles amid the atrocity of the attacks, there was something positive that day in the IVF office.
A patient learned that, despite the chaos unfolding around her, it was indeed going to be her insemination day. When it’s your day, it’s your day. Not even an act of war will intervene. And 9/11 was to be her only day. One insemination. That afternoon. Amid the sadness and silence and muffled sobs of the patient and everyone in the office.
And we came to learn a couple weeks later, that on the day the Twin Towers and the lives of so many innocent people were lost, we had participated in one ironically beautiful beginning. That patient got pregnant and had…twins.
Usually, it’s the patient who is thankful to the doctor and staff. But I will always be grateful to that patient for giving us one little happy something…well, actually two…to remember from that fateful day. And for being a sign to me that the world would go on, that we’d keep making babies, and that maybe it was going to be alright.
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Where were you?
By David Kreiner MD
September 8th, 2014 at 5:49 pm
According to the ancient Chinese text, “The Yellow Emperor’s Inner Classic (Huangdi Neijing, 黃帝內經) “, written about two thousand years ago, the emperor Han asked his physician minister why his people in one town were all sick with colds but not elsewhere in the empire. The wise minister, credited for accumulating and developing much of what is considered Traditional Chinese Medicine (TCM), answered almost in song…”the answer my friend is blowin’ in the wind…the answer is blowin’ in the wind”.
The common cold as we know it in Western Medicine is caused by viruses of a variety of types and species. Today in Western Medicine, we have the capability of identifying the specific affecting virus. TCM focuses on the syndrome of symptoms the patient exhibits from his/her illness. The “common cold” typically causes fever and chills, headache, perhaps body aches, nasal congestion and mucus and avoidance of cold. TCM since the time of Emperor Han and before has classified this set of symptoms as the Wind Cold… caused by “bugs” carried by the wind… which attacks the exterior of the body through the nose and the skin. The wind pathogen invades the body surface which is blocked by the defending Wei Qi that as a result of the attack stagnates causing the fever. The Wei Qi is also responsible to warm the body so as it is weakened by the pathogens it will induce chills in the affected individual.
Over the course of hundreds of generations, various herbs… which may include parts of a variety of plant species, animal species and minerals… have been observed to diminish the course of the illness as well as ameliorate the symptoms. These herbs are prepared in numerous different ways depending on the illness and symptoms being treated, but often include cooking and drinking the finished product as a type of tea. In the case of the Wind Cold, a feature of the herbal decoction, Ma huang tang, is to induce sweating in an effort to expel the affecting pathogen through the skin pores. Acupuncture applied to specific points of the body can also induce sweating and “release of the exterior” pathogen so that it is eliminated from the infected superficial layers of the body.
In TCM, a variation of the common cold that is notable for inducing more fever than chills, a sore throat, and sweating is referred to as the Wind Heat. Treatment, like for the Wind Cold, includes “releasing the exterior” as the pathogens are attacking the superficial layers much like they do with the Wind Cold. However, therapy utilizes cooling herbs rather than warming herbs. In TCM, the nature of a syndrome was established in conjunction with the development of an effective treatment. Since, the “cooling” herbs were noted to benefit patients beset with the Wind Heat, not only did the treatment become standard, but it helped define the syndrome itself. This is the way syndromes and treatments become established in TCM over the course of generations of experience.
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Do you use herbal teas or other herbal treatments to help prevent or recover from colds and flu? What do you use and has it helped?
By David Kreiner MD
September 3rd, 2014 at 7:46 am
Tagged with David Kreiner MD, Ferring rebate program, Infertility, Infertility Support, Infertility Treatment, IVF costs, IVF financing, IVF grants, IVF Long island, LI-IVF, Long Island IVF, Micro-IVF, Save on IVF, SET, Single Embryo Transfer, TTC
A pharmaceutical company started a new program designed to attract a larger market share by discounting its fertility medications by 50%. What a novel idea!
Who would not choose to save over a $1000 if given the choice? It got me thinking…
Do patients know about the many discounts offered by Long Island IVF?
Here at Long Island IVF, a full stimulation IVF cycle is offered to qualifying patients earning under $100,000 per year at $7,500 and somewhat higher to those earning up to $200,000 per year. Anesthesia is an additional $525 and medications… including the savings through the new Ferring® rebate program… would range in cost from $1500- $3500 depending on the needs of the patient. For example, an “average” patient receiving 20 amps of Bravelle® (FSH) and 10 amps of Menopur® would pay about $1,050 for these medications and hundreds more for Novidrel® (hCG) and Endometrin® (progesterone). Of course, those requiring more medication would have proportionally higher costs for their medications.
We offer other cost-savings programs at Long Island IVF including up to three frozen embryo transfers for the cost of one and free cryopreservation to patients electively transferring a single embryo in their fresh cycle. More details on our Single Embryo Transfer (SET) Program and its financial incentives are available here: http://bit.ly/WpzCvv
We also offer a minimal stimulation IVF, also known as Micro IVF, at $3900. Because patients using this treatment protocol use less fertility medication to achieve their minimal stimulation than is used in in a full stimulation IVF cycle, there are significant savings on medication costs as well. Patients are encouraged to ask their doctors if they are candidates for Micro-IVF. More details on our Micro IVF Program are available here: http://bit.ly/12ZjvaD
Most importantly, these cost savings programs are available with the same high level of service and comparable success that Long Island IVF is famous for where we offer patients as good a chance of achieving a pregnancy as nearly anywhere in the nation.
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Have you researched the many grants and other cost-savings programs available at Long Island IVF?
By Tracey Minella
September 2nd, 2014 at 10:51 am
Tagged with back to school blues, back to school stress and infertility, coping with infertility, Infertility, Infertility Support, IUI, IVF, LI-IVF, Long Island IVF, stress of infertility, Tracey Minella, Trying to Conceive, TTC
It’s right up there with Christmas morning and Mother’s Day. The first day of school.
Today, many area school children go back to school. They’re out there in droves on the street corners, decked out in the latest trendy clothes, complete with cool backpacks. Suddenly, navigating the neighborhood can feel like some twisted horror movie for many infertile folks longing for a child of their own.
If you’ve ever gotten stuck behind a big yellow bus, you know the special pain of driving about 3 miles per hour and stopping at every other corner to allow yet another pack of 15 kids on board.
Am I really the only one in the neighborhood without a kid on that bus?
And what’s the etiquette on waving back? When following the bus, do you avoid eye contact and pretend you don’t notice the 4 little monsters waving their arms at you madly from the back seat? Or do you muster the courage and quickly wave or smile…only to find your acknowledgement has fueled their relentless and continued arm-flailing! Have you ever *gasp* made an ugly face back at them in a weak moment?
And you’re not off the hook once you get off the road. Beware the Facebook assault as every fertile person you’ve ever known floods your newsfeed with pictures of their children and grandchildren getting on the bus this morning. And just to twist that knife, they’ll throw in a complaint about having to wake up early.
The first day of school is a lousy day for infertiles. Alter your routine… if you can… to minimize the exposure. Tweak your travel time or route. Stay off social media. And treat yourself well today.
If you have room in the budget, consider something many moms burdened with back-to-school expenses may not indulge in often…like a nice massage, a romantic dinner, or buying that new bag you’ve wanted. Or commit to something new that could impact your fertility plan…like exercise, healthy eating, acupuncture, or a mind-body program. For info on Long Island IVF’s recommended acupuncture and mind-body counseling programs click here: http://bit.ly/16Kn5go
And remember, next year you may be looking at things differently. That long ride behind the bus isn’t so bad when there’s a sleeping newborn in your car seat. You may even find yourself smiling and flailing…
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What do/did you do to get through the first day of school?