Monthly Archives: April 2013

Menopause and Hormone Therapy | Fullerton, CA

iStock_000014235018SmallMenopause is a natural occurring event that all women will experience, usually in their early 50’s, when their ovaries cease producing estrogen. Post-menopause is diagnosed when a woman has not menstruated for one year and marks the end of the reproductive period of her life. Gunn Center of Fullerton, CA offers some interesting and useful information on menopause and hormone therapy.

Peri-menopause is diagnosed when the menstrual cycles vary in frequency and length and may be associated with psychological, emotional and/or physical symptoms (discussed later). These disturbances are due to a declining ovarian production of estrogen, progesterone and testosterone that may be periodic or continuous. Women born prior to the 1930’s had a life expectancy of about 50 yrs. Today, a woman can expect to live well into her 80’s with over one-third of her life occurring after menopause and be subject to the physical changes discussed later in this paper.

The history of hormone replacement in women has seen many swings in popularity over the past few decades. In 1991 the National Institutes of Health (N.I.H.) launched the Women’s Health Initiative (WHI) study involving about 161,000 healthy postmenopausal women aged 50-79 years with an average age of 63 years. The study was designed to test the effects of hormone therapy on heart disease, bone fractures, breast cancer and colon cancer. One group of women who had undergone a hysterectomy received oral estrogen (Premarin) alone [estrogen replacement therapy or ERT]. A second group received a combination of Premarin and progesterone (PremPro) [combination hormone replacement therapy or HRT]. A third group received a placebo, which contained no hormone. In 2002 the study was stopped because the Provera group was associated with a slight increase in the incidence of breast cancer, heart attack, stroke and blood clots.

Millions of women in the U.S. stopped their hormone out of fear and they entered into “hot-flash hell”. A recent careful re-analysis and follow up review of the data has revealed that the actual risks of breast cancer, stroke and heart disease were NOT increased over time and were, in fact decreased; especially in women who were perimenapausal when they initiated hormone therapy.

In April 2011 the Journal of the American Medical Association (JAMA) published a follow-up study of the women in the WHI who took estrogen alone. The finding: a statistically significant reduction in breast cancer over time. Further, those women who did develop breast cancer were 63% less likely to die from their disease. Among the women with a prior hysterectomy treated with estrogen alone and followed for 11 years, there was NO increased risk of heart attack, stroke, blood clots, hip fracture, colon cancer or mortality. Importantly, there was a persistent decrease in the risk of breast cancer. This finding is now contrary to the persistently held belief that estrogen causes breast cancer and increases the risk of heart attacks.

After a decade of fear and confusion regarding the risks and benefits of estrogen replacement therapy, medical studies have now clearly established its safety and its health benefits. In March 2012 the North American Menopause Society released a statement that supports these findings, stating that combination hormone therapy (both estrogen and progesterone) initiated around the time of menopause is safe.

Contact Dr. Gordon Gunn today at (714) 912-2211 to schedule an appointment.

Dr. Gordon Gunn also proudly serves Buena Park, La Mirada, Yorba Linda, Diamond Bar, Walnut, and surrounding areas.

Gynecology Robotic Surgery is the Future | Fullerton, CA

Pure, Natural, BeautyGynecology robotic surgery is robotic assisted surgery for several gynecological conditions. Using a robot, this enables the doctors of Gunn Center in Fullerton, CA to perform the surgery with the utmost control and precision and with only a few small incisions.

Gynecology robotic surgery can be used for the following conditions:

  • Ovarian cysts and masses
  • Fibroids
  • Prolapse of pelvic organs
  • Cervical cancer
  • Endometrial cancer
  • Some endometriosis
  • Ask your doctor about the many other procedures offered

Robotic surgery is less evasive than traditional surgery that involves making a large incision in the abdominal area. The benefits of a smaller incision are less pain during recovery, less scarring and quicker recovery time.

Surgery doesn’t have to be complicated, contact Dr. Gordon Gunn to learn more about the treatment options available at (714) 912-2211 to schedule an appointment.

Dr. Gordon Gunn also proudly serves Buena Park, La Mirada, Yorba Linda, Diamond Bar, Walnut, and surrounding areas.

Urinary Incontinence in Women | Fullerton, CA

iStock_000000705315MediumFor a conservatively estimated 10 million Americans (85% of whom are women), incontinence of urine is socially embarrassing, physically limiting, or a significant disability. In fact, after psychiatric and neurological disorders, the uncontrollable or accidental loss of urine is the second most common reason individuals are placed in nursing home facilities. The true number of non-institutionalized women who have quietly altered their lives because of accidental loss of urine is actually unknown because they are reluctant to discuss their disability. Women are frequently embarrassed and hesitant to admit their problem to their family, friends or even to their personal physician. Among women, between ages of 45-64, 40% are estimated to have experienced incontinence of urine. Women often perceive that their problem is a normal result of bearing children and getting older, and therefore just cope with it. However, they also limit exercising, dancing, traveling and other activities, which would otherwise require them to be away from nearby toilet facilities. They frequently will change the style of clothes they wear to avoid embarrassment. I want my patients to know that urinary incontinence is a symptom of a condition, which is not normal and usually can be successfully treated to restore normal bladder function.

The U.S. Department of Health and Human Services estimates the annual direct cost of care for persons with urinary incontinence to exceed $10 Billion, 70% of which is spent for persons who are not in nursing home facilities. Over one-third of the female sanitary pad market is for coping with incontinence of urine and not menstruation. Product advertising frequently focuses on coping or hiding the problem rather than education and treatment. Regardless of the cause of urinary incontinence, this problem can be cured or significantly improved in most cases.

In women, the most common type of urinary incontinence is called urinary stress incontinence or USI. USI occurs when there is a sudden increase in abdominal pressure during certain activities such as laughing, coughing, sneezing, running, bending, lifting, etc. The primary cause of the problem is a weakness of the pelvic tissues (called prolapse), which normally supports the bladder (called cystocele) and its sphincter. The amount of urine loss with each episode of stress, varies with the degree of weakness, the volume of urine in the bladder, and the intensity of the abdominal pressure. The correction of USI is usually surgical restoration of the prolapse supporting pelvic tissues to a normal position so the bladder sphincter mechanism can function properly.

Another type of urinary incontinence is urge incontinence, in which women perceive the urgent need to urinate, rush to the bathroom, and fail to get there in time. The amount of urine loss can vary with the cause of the urge, the volume of urine in the bladder, and the strength of the pelvic tissue. Urgency and urge incontinence are often associated with frequent urination (called frequency) and getting up at night to urinate (called nocturia). Women who regularly experience urgency and frequency, with or without nocturia, have what is called urinary urgency syndrome, with or without incontinence.

The causes of urinary urgency syndrome can be both physical and non-physical. The most common physical cause is infection of the bladder (cystitis) and/or urethra (urethritis), and it is corrected with treatment of the infection. There are other causes such as chronic inflammation of the bladder, polyps or tumors and certain medications. When no physical cause can be found after a complete medical evaluation, the cause is usually a result of a learned habit. Treatment may include medications, bladder retraining programs and pelvic floor muscle exercises (Kegel Exercises).

Mixed urinary incontinence is a combination of both stress and urge incontinence. Often a woman experiencing USI “learns” that if she empties her bladder more frequently, she will be less likely to leak as much urine. Unfortunately, over time the awareness of having a “full bladder” occurs with an ever-decreasing capacity of urine, and she will urinate at more frequent intervals. When the stress component of her incontinence is surgically corrected, she can then retrain her bladder so she will choose when to go to the bathroom. In postmenopausal women, Estrogen replacement therapy will improve the elasticity of the vagina, bladder and urethral tissues, and improve both stress and urgency symptoms.

There are other less common, but important types of urinary incontinence:

Overflow incontinence is a frequent spilling of small amount of urine when the bladder is over-distended, and can occur with certain medications, after pelvic surgery or trauma.

Reflex incontinence is the loss of urine when the person is completely unaware of the need to urinate, such as while sleeping or washing their hands. This type of incontinence may indicate an underlying neurological disorder.

The first step in correcting urinary incontinence is sharing the problem with your physician. Before your visit, you will be given a “Patient History for Urinary Function”. This form should be completed prior to your office consultation. You may also be given a two-day “Voiding Diary” to record the amount of liquids you drink and the number of times and amount you urinate during the day and night. You will also list the circumstances under which you regularly experience urinary urgency or incontinence. After your patient history, physical examination and voiding diary is completed and reviewed, simple office tests are performed which will further identify the primary cause of your incontinence. Once the cause (or causes) is determined, the proper treatment and alternative will be recommended and explained.

Treatment begins with having a thorough understanding of normal urinary function, the cause of your urinary problem, and your treatment alternatives. Successful treatment is a patient-physician team mission, and is an achievable goal.

Contact Dr. Gordon Gunn today at (714) 912-2211 to schedule an appointment.

Dr. Gordon Gunn also proudly serves Buena Park, La Mirada, Yorba Linda, Diamond Bar, Walnut, and surrounding areas.


Timed Voiding Bladder Program | Overactive Bladder | Fullerton, CA

iStock_000005142700SmallThis is an important part of your bladder-retraining program. When followed consistently you will have significantly improved control over your urgency symptoms, including any urge incontinence. This program started when you monitored the amount and the type of fluids you consumed each day in your Voiding Diary. A normal fluid intake is between 1500-2000 cc (50-70 oz.) per day, which should produce 1200-1500 cc (40-50 oz.) of urine output. The normal bladder capacity before you feel any sensation of urge is about 300 cc (10 oz.). Normal voiding volumes are 210-300 cc (7-10 oz.) with the first morning voiding usually being the largest at 400-500 cc. Your Voiding Diary record will have indicated if any modification is required in the volume or type of fluids you drink.

Your goal with the Timed Voiding Program is to increase your bladder’s capacity and prolong the time interval between urinating up to a minimum of three or more hours. The initial time interval between urinating will be determined by the frequency of urination as recorded in your Voiding Diary.

Attached is a “Voiding Chart for Bladder Retraining” on which you will chart your daily progress for the first week. [Please make five additional blank copies of the Voiding Chart to insure you have a total of six weekly charts.] The Chart is a daily record of your Scheduled (predetermined voiding interval), Unscheduled (when you are unable to suppress the urge without the risk of accidentally urinating), and accidental.

Follow the instructions on the chart as indicated: (incontinence) urinating episodes.

  • Fill in the following on each sheet: Your Name, Date, and Voiding Interval (Hrs.) at the beginning of each
  • Fill in the time for any of the types of urinating (Scheduled, Unscheduled, or Accidental) and place a check mark in one of the three columns:
  • Dark Gray Column: Urinating at the Scheduled Time.
  • Light Gray Column: Urinating at any Unscheduled Time. (when you cannot suppress the urge)
  • White Column: If you Accidentally urinate (incontinence incident), place a checkmark at the time it occurred and add a “D” for Damp or “W” for Wet beside the check mark to indicate the relative amount of urine loss.

Keep your Chart nearby along with a pencil and a clock or timer. Most importantly, maintain your determination to stay with this six-week program.

For more information on overactive bladder or any bladder or bowel incontinence problems you may have, Contact Dr. Gordon Gunn today at (714) 912-2211 to schedule an appointment.

Dr. Gordon Gunn also proudly serves Buena Park, La Mirada, Yorba Linda, Diamond Bar, Walnut, and surrounding areas.