Welcome to Geriatrics MD

What is Menopause? It refers to the time when menstruation ceases completely. THe ovaries decrease their output of estrogen and progesterone and women begin experiencing the effects of suboptimal levels of these hormones. IN addition to signifying the end of a woman’s ability to have children, declines in these feamle hormones affect the entire endocrine system. This is a process that takes approximately 3 to 5 years to complete. The early phase or transitional phase is referred to as the climateric or peri-menopause. Menopause is considered complete when a woman has had no period for a full year. Although timing varies from woman to woman, menopause is generally completed by the time they reach their early 50s.

What to expect at Menopause and Beyond? Every woman is an individual, of course, but there are number of side effects that can generally be anticipated.Though some side effects may be considered temporary nuisances to be “toughed out”, the reality is that the decline of a woman’s hormonal levels results in changes that can seriously affect her physicial and mental health as well as her prospects for longevity.

The most common side effect associated with menopause are hot flashes, a sudden sensation of intense heat.Some women break out with red blotches on their chest, back or arms, some sweat profusely, some also experience cold and shivering until their bodies readjust. Hot flushes are considered to be a direct result of decreasing estrogen levels and they can linger for years.

Other changes are vaginal and urinary changes such as thin, less elasticity and more susceptibility to infections. As well as uncomfortable intercourse. Also incontinence and development of urinary tract infections. Also Loss of libido, emotional changes (emotional peaks and valleys and depression). Also osteoporosis. One out of every two post-menopausal women will suffer some degree of osteoporosis. In osteoporosis bones become fragile, thin and more prone to fracture. Also there is an association with cardiovascular disease. As a result of estrogen deficiency, LDL cholesterol increases and HDL decreases. Early recognition, lifestyle changes and hormone modulation have been shown to be very effective in reducing the incidence and severity of cardiovascular disease in post-menopausal women.. In addition to diminished levels of estrogen and progesterone, testosterone (also produced in the ovaries) and growth hormone are also reduced during menopause..

Hormone Modulation can help: Much of the medical field agrees that hormone theraphy:

- Reduces the risk of osteoporosis, reduces hot flashes, reduces the risk of cardiovascular disease, improves mood and psychological well-being, iresults in firmer body and more youthfull appearance, improves mental alertness, focus and concentration, increases energy and vitality, improves desire for sex, increases physical stamina and muscle strenght, reduces body fat.

How safe is Hormone Replacement therapy? THere has been controversy about the use of estrogen and progestin in healthy post-menopausal women. This controversy is a result of an article published in the July 17, 2002 issue of the Journal of the American Medical Association that reported on the results of the Women’s Health Initiative Trial. The results of this trial linked the ise of Premarin and progesterone to the development of health risks that, in the opinion of the authors, exceed benefits.

Many authorities believe this study was poorly designed and has many flaws. One of the major concerns is that premarin and provera, the drugs used in the study, are not bio-identical of human estrogen and progestin. Premarin, in fact, is obtained from horse urine and contains nearly three-dozen horse estrogen compounds, only three of which are found in humans. Another concern is that during the course of the study, all subjects received the same doses of hormones with no consideration given given to the adjsuting dosing on blood levels. It is reasonable to conclude that many of the subjects had hormone levels that greatly exceeded normal physiologic levels that greatly exceeded normal physiologic ranges-ranges we would consider unsafe. Finally, we could also argue that there was a sex bias in the study. A similar study of men and testosterone replacement therapy based on the administration on non-bioidentical hormones (obtained from ground-up horse testicles for example) would be quickly dismissed and viewed with great suspicion by the medical community, but the same circumstance was allowed for thousands of women in the WHI study and recommendations are now being made based on that study. We beleive bio-identical estrogen and progestin replacement therapy that is performed in a controlled clinical setting where therapeutic levels are closely monitored and dosing is adjusted accordingly will dramatically improve a woman’s quality of life. While there are still contraindications for some women ( e.g., those with history of breast disease and uterine cancer), many physicians now feel that the benefits far outweigh the risks.

GERIATRICSMD- It is offering the newest advancement in testing and technology to evaluate the aging population in this country. Located in central florida, in Lake Mary. The center provides the “geriatric assessment” that goes more and beyond the traditional one. This test takes between 1 to 2 hours to be done. It offers comprehensive blood testing, focus on markers related to aging. Also includes DNA (SNP) test to look at the DNA sequences alterations, related to cardiovascular disease, bone health, cholesterol metabolism, antioxidant and free radical. All those factors related to damage to DNA. After the evaluation, a comprehensive summary is given to the patient as well as their primary care physician. Geriatricsmd offers comprehensive geriatric consultations, from memory loss, cardiovascular, parkinson’s, alzheimer’s disease, diabetes management and any disease affecting the elderly. Our facility is equipped with all the technology to rejuvenate and improve quality of life as well as vitality and energy and vigor. Geriatricsmd offers a VIP service to all their clients. The founder Dr Carlos Mercado and his team provides care one to one and makes sure that all needs are covered in an environment that is friendly. Please call for a consultation at 407-771-0404 or visit our webpage to see our programs at detail www.geriatricsmd.com

One of the theories why we age, is a decline on our hormones. Starting at the age of 30’s we starting noticing a decline in several hormones such as growth hormone, testosterone, DHEA and also a detrimental increase in some hormones such as cortisol or noticing insulin resistance. The concept is that it might be a correlation between the decline and the development of diseases such as cancer, stroke, heart disease, osteoporosis as some examples. It is clear that in adolescent or children you will rarely see this diseases. They ocurr but they are not as common as in the elderly.

 It is perhaps important to keep your hormones under physiologic levels. At geriatricsmd, a state of the art testing is done. Remember that hormones are like an “ocrhstra”. They need to be in sinchrony all the time. Since the release of hormones most of the time is by “Peaks”, small releases that are difficult to detect by regular blood samples. For example in times of stress we might release some hormones when they are needed. So then it is important to check the metabolites of this hormones, using special technology in 24 hour urine collection. In general with this test all the metabolites of the hormones are checked. Meaning that we will know if the hormone was effective inside the cell and its metabolite was formed or not. It is also important to check if the treatment was adequate or not.

At geriatricsmd, we offer complete testing plus a careful clinical evaluation done by Dr Carlos Mercado, MD, board certified geriatrician and Age management specialist. Call for a consultation at 407-771-0404.

There are many types of dementia in the elderly such as Alzheimer’s, lewy body dementia, vascular dementia and mixed type ( combination of alzheimer’s and vascular).
Family members sometimes start noticing that their loves one is becoming isolated(remains at home instead of going out), or changes in behavior or changes in personality or sometimes refusing to take a shower or eat. Their memory loss is progressive and eventually start affecting their activities of daily living such as taking a shower, hygiene, cooking, shopping or doing accounting. Usually patients denie that they are having a “memory problem”, instead they do the opossite, they do a “cover-up” and pretend that there is no memory loss. As the disease progresses, the memory loss becomes more evident and changes in behavior and personality and ability to remember vocabulary and eventually patients might end-up in a nursing home. Complications of dementia includes pneumonia, urinary tract infections, pressure ulcers, malnutrition, failure to thrive, blood clots and others. It is important to do an evalaution as soon as possible, so the earlier the more interventions can be done.

 Vascular Dementia: Usually patients have Diabetes, history of heart attacks, cardiac arrhtymias such as atrial fibrillation. Then patient develops a transient ischemic stroke or a stroke leaving the patient with motor deficits or paralyzed on one side. Then the memory loss appears and then there is some improvement but then after a second stroke the memory gets worse. Patients will need to have a CT scan or MRI of the brain. The treatment focus on treat the underlying diseases that triger the stroke such as the high blood pressure or the hyperlipidemia.

 Please call for an appointment at 407-771-0404 or www.geriatricsmd.com

Geriatricians are becoming difficult to find. The training in geriatrics is generating less number of physicians. However the elderly population is getting bigger, especially in Central Florida. Dr Carlos Mercado, MD board certified geriatrician provides  a comprehensive program for the elderly. This program includes evaluation for dementia or memory loss, lack of energy, depression, fall evaluation and use of multiple medication and other common geriatric syndromes. At GeriatricsMD, our geriatrician focus on diseases of the elderly and how to evaluate them and treat. The clinical presentation of many diseases in the elderly is different than diseases in younger people. For example UTI’s (Urinary tract infection) presents more often with gastrointestinal symptoms such as nausea and vomiting instead of burning sensation with urination. Memory loss is sometimes difficult to evaluate, since many medications and its side effects and depression as an example can mimic dementia. Our geriatrician at GERIATRICSMD will be able to disect the patient’s symptoms and put them in perspective and treat appropiately. Please call for an appointment at GERIATRICSMD at 407-771-0404 or go to our website www.geriatricsmd.com

Thanks

Our center specialize in the care of the elderly. Our geriatric assessment program screens for the most common geriatric syndromes in the elderly. For example falls, memory loss, use of multiple medications, failure to gain weight, problems with erections, fatigue, lack of energy, depression. Symptoms of depression can be confused with dementia. Our program is very comprehensive because Dr Carlos Mercado, MD spends time with the patient, at least 2 hours with a comprehensive history and physical examination. Blood tests such as the VAP test, DNA test to evaluate the patient as a whole. The VAP test evaluates specifically all subtypes of cholesterol. In other words the cholesterol is fractioned. For example LDL (bad choelsterol) is fractioned and it is determined if the patient will need medications for cholesterol or not. Dr Mercado, once all the information is collected he designs a customized plan for the patient as well as recommendations on medications, exercise and life-style. Call at 407-771-0405 and ask for our “geriatric assessment program” or go to our website www.geriatricsmd.com and see all our information.

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