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Is Natural Progesterone Cream Safe and Effective? Learn from Tampa and St Pete’s Expert

Posted by Anne Hermann on Fri, Apr 13, 2012 @ 04:39 PM

Anne Hermann, MD

Bioidentical hormones are exactly the same molecule as those produced in our own bodies.  Most standard hormones are chemically different than the hormones made by our bodies.  Progesterone is a hormone that is also converted to other hormones in our bodies.  So, when we take the bioidentical form, we are not only replacing progesterone, but also the other hormones that are made with progesterone.  Standard, synthetic progesterone cannot be converted into other hormones in our bodies.

As early as the late 1990’s, I saw patients who used natural progesterone cream for menopausal symptoms.  At that time, most doctors had no knowledge about the difference between standard hormone therapy and bioidentical hormones.   When I spoke with one expert in the field, he told me that “in order to absorb enough progesterone through the skin, you would have to wear a progesterone patch the size of a vest”.  I knew this could not be correct as my patients were having real benefit from the progesterone creams they were using.  I set out to perform a study to determine how much natural progesterone is absorbed from the creams.  At Bassett Hospital, a Columbia University Hospital, where I did my residency, I worked with two clinical pharmacologists, Joe Bertino, PhD and Ann Nafsiger, MD.  They helped me develop a protocol to compare the FDA approved oral natural progesterone, Prometrium to over the counter progesterone cream.  The results were surprising to many (but not to me):  40 mg of progesterone cream twice a day gives same blood value of progesterone as 200 mg per day of Prometrium!

Because we already know that prometrium is effective against endometrial cancer, we can say that progesterone cream is equally effective at this.  The cream provides additional benefit because it does not yield as many by-products as the oral form.  Now, research is leaning towards bioidentical progesterone as being less likely to cause breast cancer than synthetic progesterone.

All progesterone use should be used under medical supervision.

For more blogs on bioidentical hormones, check out http://www.doctorhermann.com/blog/?Tag=Bioidentical+Hormone+Therapy.

To schedule your consult with Dr. Anne Hermann, call 813-902-9559.

This post was written by Anne Hermann. Follow Anne Hermann on Google, Facebook, Twitter & Linkedin.

Bioidentical Hormone Therapy from Tampa and St Petersburg’s Own Expert!

Posted by Anne Hermann on Wed, Apr 11, 2012 @ 04:10 PM

Anne Hermann, MD

What You Need to Know about Bioidentical Hormone Therapy from Tampa and St Petersburg’s Own Expert!

This article focuses on female hormone therapy.  On my blog, I also post articles focused on male hormone therapy.  As an author of nationally recognized research on bioidentical hormone therapy, I have been treating men and women for 9 years in Tampa Bay.  I recommend hormone replacement therapy when non-hormonal and natural therapies do not work in treatment of menopausal symptoms including:

  • hot flashes
  • weight gain
  • sleep disturbance
  • “brain fog”
  • poor libido
  • vaginal dryness
  • skin changes

The medical community is learning that some forms of hormone replacement, called bioidentical hormones, have less side effects and less danger than standard hormones.  Less risk does not mean no risk, and I always discuss these pros and cons with my patients.

Hormone therapy is not recommended for women with the following:

  • · Current or past history of breast cancer (standard hormone therapy increase risk of breast cancer)
  • · Coronary heart disease especially if older than 60 or went through menopause more than 10 years ago
  • · A previous blood clot, heart attack, or stroke (standard therapy increase risk of blood clots and stroke)
  • · Women at high risk for these complications

Benefits:

  • Reduces the risk of bone fracture caused by osteoporosis.
  • Lowers risk of colon cancer
  • Make women with menopausal symptoms feel better

The North American Menopause Society, the Endocrine Society, the International Menopause Society, and guidelines from the European Menopause and Andropause Society for the management of menopausal women all favor the use of bioidentical forms of hormone replacement in women with high risk of blood clots.  Unlike standard estrogen treatment, bioidentical estradiol does not increase risk of blood clots or stroke (doses ≤ 50 μg).  Bioidentical progesterone also has less risk of blood clots and breast cancer than standard therapy. Based on these data, which are now included in the guidelines, the use of transdermal estradiol and micronized progesterone could reduce the excess risk of blood clots, stroke, and possibly even breast cancer associated with hormone use.  Simon JA. What’s new in hormone replacement therapy: focus on transdermal estradiol and micronized progesterone. Climacteric. 2012 Apr;15 Suppl 1:3-10.

I was the first author in the study that demonstrated that the bioidentical form of progesterone cream is absorbed as well as progesterone pillsOver-the-counter progesterone cream produces significant drug exposure compared to a food and drug administration-approved oral progesterone product.  Hermann AC, Nafziger AN, Victory J, Kulawy R, Rocci ML Jr, Bertino JS Jr.J Clin Pharmacol. 2005 Jun;45(6):614-9.  Look out for my blog on this topic in the future.

Anne Hermann, MD is double board certified in Internal Medicine and as a Physician Nutrition Specialist. To schedule your consult, please call 813-902-9559.

This post was written by Anne Hermann. Follow Anne Hermann on Google, Facebook, Twitter & Linkedin.

MIC B vs B12 Shots for Weight Loss in Tampa and St. Petersburg

Posted by Anne Hermann on Wed, Apr 04, 2012 @ 12:46 PM

Anne Hermann, MD

Why MIC B Shots are Better than B12 Shots for the Best Weight Loss

We are often asked if we do B 12 shots for weight loss.  To be accurate, there are better shots for weight loss than B12.  We recommend and use a MIC combo shot that provides a combination of amino acids and vitamins to aid in weight loss.

B12 shots (which we do offer for B12 deficiency) contain very high concentrations of B12, but do not have any other vitamins in them.  Before we give either shot, we usually check your blood level of B vitamins.   If you are low in B12, then you will feel better with the concentrated B12 shot.  If your B12 level is normal to high, adding more B12 will not make you feel any better or aid in weight loss.

So, for people with normal B12 concentrations, we recommend the MIC combo which has:

  • Methianine, Inositol and Choline: Amino acids that aid in the maintenance of muscle tissue
  • Vitamin C to boost immune system and skin health
  • Methylcobalamin, pyridoxine, niacin, riboflavin and thiamine, which are B vitamins that help prevent fatigue while you are on a calorie restricted diet.

Our formula also contains lidocaine to ensure that the injection is comfortable.  If you are receiving B shots for weight loss, please ask your provider if you are getting B12 or a B complex.  If it is just B12, be sure that the doctor monitors your blood levels so that you do not get too much.

For more information, we offer consults at 813-902-9559 or 727-278-3992.  Anne Hermann, MD is double board certified in Nutrition as well as Internal Medicine.

This post was written by Anne Hermann. Follow Anne Hermann on Google, Facebook, Twitter & Linkedin.

Best B12 Shots in Tampa St. Petersburg

Posted by Anne Hermann on Wed, Apr 04, 2012 @ 01:00 PM

Anne Hermann, MD

Learn why we have the best B12 shots in Tampa and St Pete: Methylcobalamin vs Cyanocobalamin

B12 shots are given to people with low levels of B12.  A reputable weight loss clinic may use a B complex shot for weight loss, but should only use B12 if you have bloodwork that shows low B12 levels.  For more on B shots for weight loss: http://www.doctorhermann.com/blog/?Tag=B12

The other name for B12 is cobalamin and the best form of B12 injection is methylcobalamin or mythyl B12.

Most clinics use cyanocobalimin, or cyano B12, which has very small traces of cyanide attached to the B12.  In order for the more common, cyano B12 to be used by the body, our own metabolism must break the ‘cyano’ particle off from the B12.

Methylcobalin is a natural form of vitamin B12 and can be used much more easily by the body.  Be sure to ask your doctor which form they use before you start injections.

If you are looking for B12 for weight loss, make sure the doctor checks your level first.  If your B12 levels are already middle to high, you should have a B shot that gives less B12 and more other B vitamins such as folate, niacin, thiamine and sometimes amino acids that help maintain muscle.

Things that B12 helps with are:

Bell’s Palsy: methyl B12 reducesed the recovery time in Bell’s palsy. Jalaludin MA. Methylcobalamin treatment of Bell’s palsy. Methods Find Exp Clin Pharmacol 1995;17:539-544.

Diabetic Neuropathy  Alternative Med Review. 1998 Dec;3(6):461-3.

Heart Disease:   in one subgroup study, people with high B12 levels given additional B12 had a 34% reduction in stroke, death and heart attack.  Spence JD, Bang H, Chambless LE, Stampfer MJ.  Vitamin Intervention for Stroke Prevention Trial: an efficacy analysis. Stroke. 2005, 36(11): 2404-2409.

Anemia: B12 deficiency causes pernicious anemia and the only treatment is B12 shots

Fatigue:  Because we need B12 to prevent anemia and nerve damage, low B12 causes fatigue

To schedule your consultation with Dr. Hermann, please call 813-902-9559 or 727-278-3992.  Anne Hermann, MD is double board certified in Nutrition as well as Internal Medicine.

This post was written by Anne Hermann. Follow Anne Hermann on Google, Facebook, Twitter & Linkedin.

Celiac Disease vs Wheat and Gluten Sensitivity in Tampa St Pete, FL

Posted by Anne Hermann on Thu, Mar 29, 2012 @ 10:03 AM

Anne Hermann, MD

I have many patients who think that if they do not have celiac disease, they do not have a wheat or gluten sensitivity.  This is not true: celiac disease and food allergies are two different diseases.  Celiac disease is a severe, genetic disease that can result in vitamin deficiency, osteoporosis and intestinal cancer.  Gluten sensitivity (also termed wheat allergy) is usually less severe.  It can still cause inflammation, gas, bloating and rashes, but will not result in cancers or nutritional deficiencies.

Celiac disease is also called celiac sprue, nontropical sprue and gluten-sensitive enteropathy.  It occurs in 1 in 133 people and is more common in people with family members who have celiac disease, autoimmune thyroid disease, and type I diabetes.  Signs that you may have celiac disease are diarrhea, constipation, gas, iron, vitamin D and B vitamin deficiencies.  The diagnosis is made by bloodwork for specific antibodies and colonoscopy while eating gluten.  If you have been avoiding gluten for more than two weeks prior to testing, these tests may be falsely negative.

Wheat allergy or gluten sensitivity is an allergic reaction that releases antibodies different than the ones in celiac disease.  If the allergy is extreme, you can have shortness of breath or rashes and should be seen by a doctor.  More common wheat allergies, cause gas, nasal congestion, bloating, diarrhea or constipation.   It will not affect your ability to absorb vitamins and will not cause osteoporosis or cancer.

I always check for celiac disease first, because it is the more serious illness and we don’t want to miss it.  If you have problems digesting wheat and we find that you do not have celiac disease, then I test for gluten sensitivity.  If you are interested in this topic, please check out my blog on food sensitivity testing and elimination diets.   I am board certified in Internal Medicine and as a Physician Nutrition Specialist and have offices in Tampa and St Petersburg, FL.  Please call 813-902-9559 to schedule your appointment.

This post was written by Anne Hermann. Follow Anne Hermann on Google, Facebook, Twitter & Linkedin.

Acupuncture Treatments Tampa St Pete: Acupoint Injection Therapy

Posted by Anne Hermann on Tue, Mar 13, 2012 @ 09:13 AM

By Terry Graham, D.O.M., A.P., L.M.T

Acupuncture has long been recognized as an effective means to prevent and treat a wide range of diseases and health concerns. An adjunct technique developed over the past sixty years sought to combine the principles of traditional acupuncture and Oriental medicine with modern injection therapies.

This technique was first called Biopuncture in Europe, and in the United States is recognized by the term Acupuncture Point Injection Therapy (APIT). APIT is thus defined as:  the injection at an acupuncture point of a small amount of one or more sterile biological substances in order to gain the dual benefits of stimulation of the acupuncture points with the pharmacological effect of the selected substance. Some of sterile substances successfully used for APIT might include: normal saline, nutritional substances – such as vitamin B1, B6, or B12, homeopathic solutions, and Chinese herbal extracts. Acupoint Injection Therapy employs very gentle injection techniques with very fine gauge needles similar to those used for insulin injections. In general the insertion is shallow – within the dermal layers of the skin.

A representative list of diseases that have often responded successfully to treatment with acupuncture combined with point injection therapy include:

  • Chronic pain, and inflammatory conditions, including arthritis, carpal tunnel syndrome, plantar fasciitis, and others
  • Autoimmune disorders such as fibromyalgia and, chronic fatigue syndrome
  • Chronic and latent viral disease – shingles, hepatitis
  • Sports injuries, including “tennis elbow”, “golfer’s elbow”, back pain
  • Cosmetic acupuncture – facial rejuvenation, wrinkle reduction, tissue toning, cellulite reduction

Acupuncture point injection therapy has the potential to broaden the scope of any condition responsive to acupuncture, often providing a more rapid initial response with longer lasting effects as the medication is directed to the target area through the carefully selected acupuncture points.

Terry Graham has a background in nursing and has been a licensed and Board Certified Acupuncture Physician since 2008. To book your appointment in our convenient locations in Tampa, St. Petersburg/Clearwater or St. Pete Beach, call 813-902-9559.

This post was written by Anne Hermann. Follow Anne Hermann on Google, Facebook, Twitter & Linkedin.

Botox vs Xeomin: Which Treatment is Right for You?

Posted by Anne Hermann on Mon, Mar 12, 2012 @ 01:30 PM

Dr. Anne Hermann

The three cosmetic Botulinum toxins are Botox, Dysport and Xeomin (incobotulinumtoxinA).  My patients often have questions about the difference between Botox, Dysport and the latest competitor, Xeomin, and which product will give them the best result.   I have taken the time to share what I tell them in the article below.

Botox has been FDA approved for muscle spasticity for over 20 years.  It was FDA approved for cosmetic treatment of fine lines and wrinkles in 2002. Botox is made by Allergan, the same company that makes Juvederm.  Prices will vary; we charge $10 to $12 per unit.  Typically 0.01 cc of Botox is one unit of Botox.  So, an average amount of Botox for frown lines is 25 units.  If you receive 25 units, you will be receiving 0.25 cc of Botox.  At $12 per unit, 25 units cost $300.

 

Xeomin is made by the company that makes Radiesse.  It has been in use in Europe since 2008 and received FDA approval for use in the US in November 2011.  Unlike Botox and Dysport, Xeomin has no additives.  This may lessen the chance of developing antibodies to the product.  Also, it works slightly faster than Botox.  Otherwise, Botox and Xeomin are virtually interchangeable.  Both will last 3 to 6 months.  Because Xeomin is new to the market, it is priced better.  At $9 per unit, a treatment that would cost $300 in Botox will cost $225 with Xeomin.

The active ingredient in both of these products is a naturally occurring protein derived from the bacteria Botulinium.  The protein temporarily prevents muscles from contracting for three to six months.  The results of both Botox and Xeomin treatments are gradual.  With both treatments, you will begin to notice results anywhere from three days to one week after treatment, reaching maximum benefit at two weeks.

Most often there is no bruising from the injections, and if there is any bruising, it is typically small.  However, we advise that if you want to look your best for an occasion or event, get the treatment two weeks prior to that event.   This will give any bruising time to heal and botulinim takes 10 to two weeks to reach maximum benefit.

Post treatment instructions are not to lie down on the treated area for 4 hours and no deep massage of the area for two days.  It is okay to wash your face and apply make-up.

Price Difference of Botox vs Xeomin:

  • Brow lift or 11 lines average $225 with Xeomin or $300 with Botox*
  • Upper forehead lines vary greatly based on what people need.  Can be anywhere from $50 to $250*
  • Crows feet average $215 to $288 with Botox and $162 to $216 with Xeomin*
  • Sweaty underarms $450 for Botox and $390 for Xeomin, last over six months*
  • Neck bands or Platysma muscle: $300 per band with Botox and $225 per band with Xeomin

Other areas that Botulinum helps include downturned mouth, gummy smile (show too much gum when you smile), chin wrinkles, bunny lines (lines on upper nose when you smile)

*Please note, men have larger muscles than women and require 50% more than women and cost increases accordingly

To schedule your appointment in either our Tampa or St. Pete Beach office, please call 813-902-9559.

This post was written by Anne Hermann. Follow Anne Hermann on Google, Facebook, Twitter & Linkedin.

How to Treat Food Allergies in the Tampa-St Pete Area

Posted by Anne Hermann on Mon, Mar 12, 2012 @ 01:30 PM

Dr. Anne Hermann

We all know that severe food allergies, caused by IgE antibodies, can be lethal.  But food allergies, caused by IgG antibodies, are more subtle.  We sometimes call the IgG allergy a food sensitivity because it will not kill you.  IgG allergies do cause sinus congestion, headache, achiness, constipation, diarrhea, rash, autism and a variety of vague symptoms.

There are two ways to determine whether you have a food sensitivity.  One is to do an elimination diet.  If, after eliminating specific foods from the diet, you feel better, then we know that something you are eating is causing your symptoms.  Then, we add back one food at a time to determine what food or foods caused the symptom.  The second and easiest way to determine whether you have a food sensitivity is blood testing.  A blood test will tell you if you have an allergy and how severe the allergy is.

In the old days (not too long ago), if someone had a food allergy, their only option was to eliminate that food from their diet.  This is difficult to do because certain foods, like soy, wheat, corn, dairy, and egg are found in small amounts in many food items.  Now, patients have the option of taking sublingual allergy drops by Allergy Easy.  These drops provide treatment for 59 different foods.  Allergy drops have allowed us to help many people who have multiple food allergies and have not been able to fully eliminate the foods they are allergic to from their diet.

We are proud to be offering the full spectrum of food sensitivity testing and treatment in a safe medical environment.  Anne Hermann, MD is double board certified in Internal Medicine and as a Physician Nutrition Specialist.  She has been practicing in Tampa Bay since 2003.

To schedule your appointment in either our Tampa or St. Pete Beach office, please call 813-902-9559.

This post was written by Anne Hermann. Follow Anne Hermann on Google, Facebook, Twitter & Linkedin.

Botox vs Dysport: Which Treatment is Right For You

Posted by Anne Hermann on Thu, Mar 08, 2012 @ 12:29 PM

Anne Hermann, MD

The three cosmetic Botulinum toxins are Botox, Dysport and Xeomin.  My patients often have questions about what the difference is between Botox vs Dysport and which product will give them the best result.   So, I have taken the time to share what I tell them in the article below.  Since Xeomin is the newest of these products, I discuss that in another post.

Botox has been FDA approved for muscle spasticity for over 20 years.  It was FDA approved for cosmetic
treatment of fine lines and wrinkles in 2002. Botox is made by Allergan, the same company that makes Juvederm.  Prices will vary; we charge $10 to $12 per unit.  Typically 0.01 cc of Botox is one unit of Botox.  So, an average amount of Botox for frown lines is 25 units.  If you receive 25 units, you will be receiving 0.25 cc of Botox.  At $12 per unit, 25 units cost $300.

Dysport was FDA approved for cosmetic use almost three years ago.  It is made by Medicis, the company that makes Restylane and Perlane.  Dysport costs around $5 per
unit, but the dosing is different.  With Dysport,

0.01 cc contains two units.  However, a typically brow treatment would be 50 units.  So, at $5 per unit for 50 units, you would pay $250.  This makes Dysport about 10 to 20 percent less expensive than Botox.

The active ingredient in both of these products is a naturally occurring protein derived from the bacteria, Botulinium.  The protein temporarily prevents muscles from contracting.  Because Botox is a protein, your body breaks it down within three days of the injection.  Even though the botulinum proteins are metabolized in days, the effect lasts three months after injection with Botox and three and half to four months after Dysport injection.  If you continue to use Botox or Dysport, the effects will last longer, so that after a while, you may only need treatments every six months.

The results of both Botox and Dysport treatments are gradual.  Dysport spreads out more after injection.  This makes it ideal for areas that you want to cover a lot of space, like the forehead and crows feet.  Because Botox does not spread as much, it is ideal for the brow and eleven lines.  This is because if the injection spreads too far over the eye area, the patient can get an eye droop.  With both treatments, you will begin to notice results anywhere from three days to one week after treatment and reaches maximum benefit at two weeks.

Most times there is no bruising from the injections, and if there is any bruising, it is typically small.  However, we advise that if you want to look your best for an occasion or event, get the treatment two weeks prior to that event.   This will give any bruising time to heal and botulinim takes 10 to two weeks to reach maximum benefit.

Post treatment instructions are not to lie down on the treated area for 4 hours and no deep massage on the area for two days; is ok to wash your face and apply make-up.

To give you an idea of price difference of Botox vs Dysport:

  • Brow lift or 11 lines average $250 with disport or $300 with Botox*
  • Upper forehead lines vary greatly based on what people need.  Can be anywhere from $50 to $250*
  • Crows feet average 215 to 288 with Botox and 180 to 240 with Dysport*
  • Sweaty underarms $450 for 50 units, last over six months*
  • Neck bands or Platysma muscle: $300 per band with Botox and $250 per band with Dysport

Other areas that Botox help include downturned mouth, gummy smile (show too much gum when you smile), chin wrinkles, bunny lines (lines on upper nose when you smile)

*Please note, men have larger muscles than women and require 50% more than women with cost increases accordingly

The medical offices of Dr. Anne Hermann are conveniently located in Tampa and St. Petersburg, FL.  To schedule your appointment, call 813-902-9559.

This post was written by Anne Hermann. Follow Anne Hermann on Google, Facebook, Twitter & Linkedin.

Complementary Treatments: More than Standard Medical Care

Posted by Anne Hermann on Wed, Feb 29, 2012 @ 10:31 AM

Anne Hermann, MD

Comprehensive patient care is the concept of treating the entire person and not just the disease.  At the offices of Dr. Anne Hermann, we provide medical care, x-rays, bloodwork, medication and complementary therapies.  Complementary therapies provided effective, non-pharmacologic treatments that reduce many of the symptoms of disease.  We provide acupuncture, massage, nutrition, physical therapy, hormone balancing and reflexology.  Massage and reflexology decrease the symptoms with effects lasting at least two days following treatment.  Acupuncture is very beneficial for symptom management without adverse consequences.  It is proven to reduce pain caused by a variety of factors, nausea, hot flashes and stress.  Regular exercise and healthy dietary habits can significantly decrease side effects of medication.  Anti-inflammatory diets reduce allergies and pain.

Our on-site medical doctors track the progress of those who choose to use complementary
services.  All of the therapies can be used in conjunction with standard medical treatments.  As a Board Certified Internist, Dr. Hermann, MD, can communicate with other
doctors to ensure that a treatment is appropriate and to provide comprehensive patient care.  Our goal is to ensure that you get the healthcare you need while minimizing the use of medication and invasive procedures.

The medical offices of Dr. Anne Hermann, MD, are conveniently located in St. Petersburg and Tampa, FL.  To schedule your appointment, call 813-902-9559.

This post was written by Anne Hermann. Follow Anne Hermann on Google, Facebook, Twitter & Linkedin.