Medications That Help with Breast Cancer And Bone Loss Prevention Part 2: Dr. Steven R. Goldstein1/26/2020 Dr. Steven R. Goldstein MD is an expert Obgyn in Manhattan, considered one of the nation’s top doctors in gynecology. In private practice for over 25 years, Dr. Goldstein has had patients who were excellent candidates for Evista (raloxifene) because of its dual effect of reducing breast cancer risk and preventing and treating osteoporosis. Another type of drugs, Aromotase inhibitors, also reduce the risk of breast cancer. These aromatase inhibitors are pure anti-estrogens (unlike the first two drugs, which are selective for the breast but not in all aspects of the body) these drugs contribute to osteoporosis, joint pain, vaginal atrophy, etc. Thus, in my opinion, while the aromatase inhibitors are excellent drugs for women with advanced breast cancers and can be lifesaving in such cases, their use for prevention of breast cancer, in women who don’t already have that disease, is inappropriate and unnecessary, especially in light of the high treatability when breast cancers are detected early. Furthermore, bone health, is as, if not more, important of an issue for long term healthy aging and quality of life as breast health. Since early detection of breast cancer will almost always result in a favorable outcome, and since women are routinely living much longer lives than previous generations, a fracture, especially of the hip, of a woman can be a much more life threatening and devastating event than an early breast cancer. Thus, drugs to prevent breast cancer that actually cause bone loss, like the aromatase inhibitors, in my opinion, make no sense for this purpose. To find out more about Dr. Steven R. Goldstein MD, an expert Obgyn in Manhattan, or schedule an appointment to discuss your gynecological conditions, visit www.goldsteinmd.com.
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Dr. Steven R. Goldstein MD is one of the best obgyns in NYC. In private practice for over 25 years, Dr. Goldstein may encounter patients with suspected urinary tract infections (UTI), which he would treat as a courtesy instead of sending them to a urologist or their primary care physician. Dr. Goldstein has long held to the belief that there is a rising problem of antibiotic resistance, mainly with urinary tract infections primarily because many physicians and urgent care centers will do simple tests looking for a substance called leukocyte esterase in a patient’s urine. If it is found, then they begin treating it with antibiotics that are broad-spectrum, enough to kill virtually any organism in the urine. As one of the best obgyns in NYC, Dr. Goldstein prefers to treat presumed urinary tract infections by first taking a culture while starting the patient on a medication to take the discomfort (burning, urgency, frequency, sometimes even blood) away. If the culture shows bacteria in the urine, then the least broad-spectrum antibiotic for those particular bacteria would be prescribed. If the culture shows no true infection then such urinary tract inflammation can be successfully treated with one week of the urinary anesthetic (the drug that turns your urine in a dark orange color). This approach lowers the risk of antibiotic resistance. In the July 14th 2019 New York Times, a front-page article was entitled, “As a common infection evolves, drugs falter and patients suffer.” This article went into great detail talking about common urinary tract infections now requiring treatment with heavy duty intravenous antibiotics as a result of increasing drug resistance. In fact, the article mentioned that last year researchers reported in a study that one third of all urinary tract infections in Britain were resistant to “key antibiotics. Dr. Steven R. Goldstein MD is one of the best obgyns in NYC. Visit his website at www.goldsteinmd.com for more information or to schedule an appointment. Doctor Steven R. Goldstein MD is a top New York City gynecologist, specializing in Menopause and Perimenopause. He is a Certified Menopause Practitioner, a past President of the North American Menopause Society (NAMS), and President elect International Menopause Society and has helped thousands of women cope with the symptoms of menopause in his over 25 years of practice. In menopausal women the ovaries are no longer functioning and there is no production of estrogen or progesterone. Thus there is no stimulation of the endometrial lining so there should be no bleeding whatsoever. Therefore there must be an evaluation of the uterus. Dr Goldstein uses non-invasive methods such as a transvaginal ultrasound to do this evaluation. These are simple, inexpensive, well tolerated office procedures to triage these post-menopausal women into three basic categories. Based on the precise, clear, high resolution images from these procedures, a determination can be made as to whether the patient’s condition can be treated hormonally, are candidates for blind sampling, or are in need of visually directed sampling. Doctor Steven R. Goldstein, a top New York City gynecologist, is a Certified Menopause Practitioner and a past President of the North American Menopause Society (NAMS). He is also the Director of Gynecologic Ultrasound at New York University Medical Center and Past President of the American Institute of Ultrasound in Medicine. He is well qualified to evaluate any case of menopause bleeding with non-invasive vaginal sonograms and discuss with patients. If you are a woman who is either in menopause or are post-menopausal and are experiencing unscheduled bleeding, schedule an appointment with Dr. Goldstein by visiting his website at www.goldsteinmd.com. Dr. Steven R. Goldstein MD - Obgyn in Manhattan Solving the Problem of Acne in Younger Women12/10/2019 Dr. Steven R. Goldstein MD, is an expert Obgyn in Manhattan and considered one of the nation’s best gynecologists. In private practice for over 25 years, Dr. Goldstein sees patients of all ages and many of his patients have him as their Gynecologist since their youth. It is not uncommon for these patients, many now middle aged, to bring their daughters to Dr. Goldstein’s practice for their gynecological needs. Many adolescents and women in their early 20’s have severe cases of acne, which often have a large hormonal component. Dr. Goldstein has seen numerous women who have been to a multitude of dermatologists and used all kinds of systemic and topical agents for treatment of their acne, who, when given an appropriate birth control pill, have had tremendous improvement. Much of acne is tied to hormonal imbalances and there are some particular choices of birth control pills that are notoriously good at treating and controlling such acne. If you or your daughter has been in such a situation consult with Dr. Goldstein about appropriate hormonal control for improvement in such cases of acne. Dr. Goldstein, a top Obgyn in Manhattan, is also a Professor of Obstetrics and Gynecology at New York University School of Medicine, a Past Chairman of the American College of Obstetrics and Gynecology, New York Section, President elect of the International Menopause Society and many more positions held. Over the years Dr. Goldstein’s clinical research has had a significant influence on the way gynecology is practiced. You can schedule an appointment with Dr. Goldstein by visiting his website at www.goldsteinmd.com. Doctor Steven R. Goldstein MD a is a Top New York City Gynecologist. Too often pregnant women experience “spotting” or bleeding during their pregnancy with some combination of pain, weakness, cramping and then they proceed to the emergency room to be told that they have miscarried. This miscarriage did not take place when the pain or cramps or spotting to outright vaginal bleeding began. In fact the pregnancy may have been lost one to four weeks earlier. Miscarriage is just the spontaneous passage of the pregnancy tissue. This is why Dr. Goldstein closely monitors all his pregnant patients by transvaginal ultrasounds to make sure that the pregnancy is meeting its very predictable milestones indicating the well-being of the embryo. Dr. Goldstein currently serves as Director of Gynecologic Ultrasound at New York University Medical Center. He is a Fellow of the American Institute of Ultrasound in Medicine and is currently its President. Dr. Goldstein has also served on the board of directors of the American Registry of Diagnostic Medical Sonographers. He has contributed several books on ultrasound and invented the Goldstein catheter, the smallest and most comfortable catheter on the market. Dr. Goldstein, a Top New York City Gynecologist, uses this vast experience with these non-invasive ultrasounds to personally perform each transvaginal ultrasound to monitor his patients’ pregnancies. By using early ultrasound and monitoring a pregnancy to see that it is developing normally, when a pregnancy does fail, Dr. Goldstein can virtually always detect that before it is spontaneously passed. This prevents ending up in the Emergency Room at 4AM and needing an emergency D&C. In addition, this allows chromosomal analysis of the pregnancy tissue to give the couple a better understanding of why the pregnancy may have failed, possibly preventing recurring miscarriages in the future. For more information on Dr Steven R. Goldstein MD, a Top New York City Gynecologist, or to schedule a consultation regarding pregnancy monitoring in order to detect miscarriages early, please visit his website at www.goldsteinmd.com. Dr. Steven R. Goldstein MD is a top Gynecologist in NYC. is also a Professor of Obstetrics and Gynecology at New York University School of Medicine, Director of Gynecologic Ultrasound at NYU Langone Medical Center and is regarded as one of the best Gynecologists in the US. More than a decade ago, I wrote an editorial entitled, “If it ain’t broke, why are we fixing it.” This was in reference to the Pap smear, which, other than the polio vaccine, may be one of the single best epidemiologic triumphs of the last century. There are approximately 5,000 cases of invasive cervical cancer a year in the United States. One half of these women have never had a Pap test and another 10% have an abnormal Pap test, who then go into denial and do not follow up. In over thirty years of practice, I have had one patient with invasive cervical cancer and that patient presented with it already and did not develop it under my observation. Yes, many patients have had very early, minimally abnormal cervical findings, which we still very easily treat, in most cases, with laser vaporization in an office setting (something that most younger physicians have not seen and do not perform). The goal is to prevent cervical cancer, that is the disease. Pap smear screening is integral in the detection of cervical cancer and should be performed at least annually. Further pap smear frequency and level of concern and surveillance, in my opinion, should be based upon sexual history and activity. This, however, requires individualizing patients care rather than following published guidelines. Dr. Goldstein is an expert Gynecologist in NYC. For more information on Dr. Steven R. Goldstein MD visit his website at www.goldsteinmd.com where you may also make an appointment. Female Hormone Replacement Therapy Cures Hot Flashes & Night Sweats: Dr. Steven R. Goldstein MD11/4/2019 Dr. Steven R. Goldstein MD is a Certified Menopause Practitioner, North American Medical Society and a Past President of the North American Menopause Society. He is an expert on Female Hormone Replacement Therapy and co-author of the book “The Estrogen Alternative”. Women in menopause usually experience hot flashes and night sweats (hot flashes that happen while you’re sleeping. What can be done about these symptoms? In addition to Female Hormone Replacement Therapy, here are some other measures you can take. You can sleep in a cool room. If you’re already in a thermostat war with your partner, point out that while a person can always cover up in extra blankets to get warmer in a cold room, a woman going through a phase of hot flashes can do nothing to ease those waves of warmth in a hot room with no ventilation. A cooperative mate should understand why the thermostat needs to be turned down during this time-limited period. You may need separate blankets you can kick off without disturbing another person’s sleep. Forget the top sheet. Regardless of the thread count, it usually doesn’t breathe and you can wake up feeling like you’re wrapped in a plastic pool of sweat. Avoiding chocolate, red wine, caffeine, white sugar, and alcohol is also something you can do. These are well known hot flash triggers for many women. Go without them for two weeks and see how you feel. More to follow in later articles. Dr. Steven R. Goldstein MD is an expert on Female Hormone Replacement Therapy, and has been in practice for over 25 years. He is also a Professor of Obstetrics and Gynecology at New York University School of Medicine, Director of Gynecologic Ultrasound at NYU Langone Medical Center and the author of over seven books on Gynecology. He is regarded as one of the best Gynecologists in the US. Visit his website at www.goldsteinmd.com for more information on menopause and its symptoms or to schedule an appointment. Dr. Steven R. Goldstein MD one of the Best Gynecologists in NYC and has been in practice for over 25 years. Dr. Goldstein is also a Professor of Obstetrics and Gynecology at New York University School of Medicine, the Director for Gynecologic Ultrasound, Department of Obstetrics and Gynecology at New York University Langone Medical Center, and serves on the editorial board of more than 6 scientific journals. Dr. Goldstein practices evidence based medicine and individualized patient care. This is particularly important in the diagnosis and treatment of abnormal uterine bleeding or bleeding during menopause because the reasons for abnormal uterine bleeding are many. Some of these reasons include, but are not limited to fibroids, cancer, uterine polyps, hormonal imbalances or miscarriage. In older women, it may be because of the beginning of menopause. Any bleeding during menopause needs to be investigated as soon as possible. For any of the above, the standard of care in the past has been Dilation and Curettage (D&C), exploratory surgeries, or endometrial biopsies as a first means of diagnosis. Due to Dr. Goldstein’s significant contributions in the field of gynecology, the use of non-invasive procedures such as transvaginal ultrasounds or saline-infused solution sonohysterography is now the recommended methods as a first means of diagnosis. These painless, inexpensive, non-invasive procedures produce clear, high-resolution images that allow Dr. Goldstein to see the root cause of any bleeding. All transvaginal ultrasounds and sonohysterography is personally performed on patients by Dr. Goldstein, one of the most highly recognized and regarded individuals in the field of vaginal probe ultrasounds. Women with abnormal uterine bleeding or menopause bleeding can schedule an appointment with Dr. Goldstein, one of the Best Gynecologists in NYC by visiting his website at www.goldsteinmd.com. Dr. Steven R. Goldstein MD is the Best Obgyn in NYC. In private practice for over 25 years, Dr. Goldstein’s research has made significant contributions to gynecology and his clinical research has had a significant influence on the way Gynecology is practiced. He is also a Professor of Obstetrics and Gynecology at New York University School of Medicine, Director of Gynecologic Ultrasound at NYU Langone Medical Center and Past President American Institute of Ultrasound in Medicine. Dr. Goldstein is also a Past Chairman of the American College of Obstetrics and Gynecology, New York section. He is a Certified Menopause Practitioner and holds many other positions and accreditations. Regarding acne in younger women, many adolescents and women in their early 20’s have severe cases of acne, which often have a large hormonal component. Dr. Goldstein has seen numerous women who have been to a multitude of dermatologists and used all kinds of systemic and topical agents for treatment of their acne, who, when given an appropriate birth control pill, have had tremendous improvement. Much of acne is tied to hormonal imbalances and there are some particular choices of birth control pills that are notoriously good at treating and controlling such acne. If you or your daughter has been in such a situation consult with Dr. Goldstein, the Best Obgyn in NYC, about appropriate hormonal control for improvement in such cases of acne. At Dr. Goldstein’s practice, individualized patient care is the focus and an “old school” approach where he personally sits with the patient from start to finish of their visit. However, he is also on the cutting edge of the latest in the medical field. You may visit Dr. Goldstein’s website at www.goldsteinmd.com to learn more about him, view his credentials and to make an appointment. Dr. Steven R. Goldstein MD is a top Gynecologist in Manhattan who strongly recommends women have a Pap Smear exam done annually to help detect the presence of any cervical cancer cells. Cervical cancer has been on the decline over the last decade thanks to pap smears. Abnormal pap smears are no need for alarm, as all they indicate is that there has been a change in the cervical cells can be due to infection, inflammation, or changes in the menstrual cycle. In some cases pre-cancerous or cancerous cells are present. We now understand that abnormal cervical cells are related to the HPV virus. There are over 100 strains of HPV. Virtually all sexually active women will be exposed to HPV but most clear the virus on their own. Pap smear recommendations should be closely aligned with sexual history and number of partners not just age. In these cases Dr. Goldstein will carefully review your case and determine if further tests are needed or if necessary advise of the best available non-invasive treatment options available to you. There are several additional tests which can be performed in the case of abnormal pap smear results such as colposcopies, endocervical curettage, or biopsies. If treatment of the abnormal cells is needed, then cryotherapy, laser therapy, or Conization are all possible options. Dr. Goldstein personally performs all these exams. If you are in need of a pap smear or have had a pap smear with abnormal results, then contact Dr. Steven R. Goldstein MD, a top Gynecologist in Manhattan by visiting his website at www.goldsteinmd.com. |
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