Our Services

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What is HPV? Human Papilloma Virus (HPV) is the name for a group of viruses that cause cervical cancer, genital warts and several other diseases. There are more than 120 different types of HPV. Many of them are spread through sexual contact and affect the genital areas of men and women. Although most types of HPV do not increase the risk of cancer, some types spread through sexual contact can cause cancers in male or female genitals, the anus, or the throat area. This is not a an infection spread through the exchange of secretions, but though skin to skin contact, and sometimes spread when the virus gets under fingernails. Condoms does not adequately protect against this virus. What is this HPV vaccine, Gardasil? Gardasil is the first vaccine ever sold in the U.S. to prevent cancer: cervical cancer. The FDA approved it in June 2006 for use among girls and women and now men, between the ages of 9 and 26. It helps protect them from 4 of the more than 120 types of HPV. It provides protection against HPV 6 and HPV 11, which cause 90% of genital warts, and against HPV 16 and HPV 18, which are responsible for 70% of cervical cancer cases. In addition to protecting girls, boys, women and men who were never before exposed to HPV, it can also protect a sexually active girl or woman who were previously exposed to HPV from getting re-infected. What is the best age to get vaccinated with Gardasil? We recommend all women to get vaccinated with Gardasil, Health officials recommend that girls get vaccinated at age 12 before they are sexually active. What are the risks involved? As of August 2008, more than 20 million doses of Gardasil had been distributed in the U.S. and there were 10,326 reports registered through the CDC’s Vaccine Adverse Event Reporting System (VAERS). Minor side effects, such as pain or tenderness at the injection site, are quite common.
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What is HPV? Human Papilloma Virus (HPV) is the name for a group of viruses that cause cervical cancer, genital warts and several other diseases. There are more than 120 different types of HPV. Many of them are spread through sexual contact and affect the genital areas of men and women. Although most types of HPV do not increase the risk of cancer, some types spread through sexual contact can cause cancers in male or female genitals, the anus, or the throat area. This is not a an infection spread through the exchange of secretions, but though skin to skin contact, and sometimes spread when the virus gets under fingernails. Condoms does not adequately protect against this virus. What is this HPV vaccine, Gardasil? Gardasil is the first vaccine ever sold in the U.S. to prevent cancer: cervical cancer. The FDA approved it in June 2006 for use among girls and women and now men, between the ages of 9 and 26. It helps protect them from 4 of the more than 120 types of HPV. It provides protection against HPV 6 and HPV 11, which cause 90% of genital warts, and against HPV 16 and HPV 18, which are responsible for 70% of cervical cancer cases. In addition to protecting girls, boys, women and men who were never before exposed to HPV, it can also protect a sexually active girl or woman who were previously exposed to HPV from getting re-infected. What is the best age to get vaccinated with Gardasil? We recommend all women to get vaccinated with Gardasil, Health officials recommend that girls get vaccinated at age 12 before they are sexually active. What are the risks involved? As of August 2008, more than 20 million doses of Gardasil had been distributed in the U.S. and there were 10,326 reports registered through the CDC’s Vaccine Adverse Event Reporting System (VAERS). Minor side effects, such as pain or tenderness at the injection site, are quite common.
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Who should administer Botox? While it may look easy to administer Botox, this is a specialized medical procedure that requires medical education in the anatomy and physiology of the facial muscles, nerves, blood vessels, etc. You must know exactly where to place it and how much to use. That is why we recommend physicians and those under the supervision of a physician. You want to obtain a refreshed and younger look; you want to avoid an unnatural or an altered appearance. How long before Botox results? Generally results can be seen within 2-3 days, and full results within one week and results usually last 5 -6 months. What results should I expect? For before and after pictures and more general information please visit: http://www.botoxcosmetic.com/en/SeeResults/BeforeAfter.aspx
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What is a Bone density exam? A bone density test determines if you are at risk for developing the disease or already have osteoporosis — a disease that causes bones to become more fragile and more likely to break. How does it work? A bone density is a non-painful, simple test, without exposure to radiation that measures how many grams of calcium and other bone minerals are packed into a segment of bone. The bones that are most commonly tested are located in the spine, hip and forearm. When is this exam performed? There are some signs that point at a patient possibly having osteoporosis.

  • People who have lost at least 1.6 inches in height
  • Bone fractures as an adult, especially hip, vertebral or wrist.
  • Long term use of steroid medication
  • Patients who have received an organ transplant
  • Long history of low estrogen levels
  • Heavy smoker
  • Heavy drinker
  • Parent with hip or vertebral fracture
  • Rheumatoid arthritis, seizures, hyper-parathyroid disease, renal decease
  • Chronic low calcium or low Vitamin D levels

At what age should I have a bone density exam? All postmenopausal women under the age of 65 with risk factors present, all women age 65 and older, men aged 50-69 with risk factors for osteoporosis, and all men aged over 70.
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You should begin with a pre-pregnancy visit:

  • A review of medication and dietary supplements are made to ensure they are not a danger to a future pregnancy.
  • Verify vaccinations are up to date.
  • Review or prescribe recommended health maintenance examinations that are due according to your age and pre-existing health conditions.
  • You should be taking folic acid 400 mcg to 1 mg daily.
  • Rule out any pre-existing medical diseases, which you as the patient may not be aware of. Especially diabetes, hypertension and thyroid disease.
  • Review nutritional status, and make recommendations.
  • Stop use of toxic substance to a developing pregnancy, such as certain dietetic supplements, alcohol, smoking, and beauty aids.
  • Recommend genetic testing for available congenital diseases, as predisposed by personal history.

Once pregnant our board certified obstetric team will offer emergency care 24/7 for emergencies, and provide excellence in pre-natal care with most test in the comfort of our office.
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There are a variety of options: lasers, surgeries, and sclerotherapy (injections) that erase varicose veins or spider veins. My preferences, when possible, are for sclerotherapy, its quick, has little downtime, reliable and predictable effects, and require no anesthesia.
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What laser do you use? At our practice we use the E-laser, which is the fastest diode laser on the market and proven to deliver safe hair removal on the widest variety of skin and hair color. It is important in our Caribbean island, using lasers on Hispanic women to avoid burning women who have a darker skin color. E-laser combine radiofrequency as well as optical light energy (laser energy) so we can reduce the amount of laser energy and avoid the pitfalls of using al laser on dark skinned women. What are some possible risks? In the hands of the right physician using the appropriate device set at the correct settings, side effects from laser hair removal present a very minimal risk. However, if the settings are incorrect any of the following may occur: blistering, darkening of the skin, erosions on the lip, development of cold sores, redness and persistent pain. Most of these are temporary and can be avoided by proper preparation of the treated area prior to the procedure being performed and if performed under the direct supervision of a certified physician. If too little energy is used the patient is not going to achieve hair reduction. It is also important to note, that if there are any hormonal disorders present that are causing abnormal hair growth, these must be medically corrected. Who will administer the laser hair removal? At our practice a physician will always be present during the laser treatment, either performing the treatment or supervising one of our technician. How many sessions will I need? Most people will need 4-6 treatments, within specific intervals of 4-6 weeks, to achieve permanent results.
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What is Labiaplasty? Labioplasty is a procedure to help improve the aesthetic appearance of the external genitalia. This area is typically comprised of the clitoral hood, labia majora, and labia minora. Most women are trying to either reduce elongated or hypertrophied Labia that get stuck in their underwear or during sex, or achieve a symmetric look, when one is longer than the other. What is the recovery time? The recovery time is usually 2-3 days off your feet, and then 4-6 weeks before any rigorous exercise or sexual activity. Where is the procedure done? The procedure is done in the office, usually with local anesthesia. What type of results can I expect from the procedure? We ask patients to demonstrate the specifics of what they desire to be improved. We then create a customized surgical plan to help them achieve the look and feel of what they hope to achieve with labioplasty surgery. Most women want their labia minora to be flush with their labia mayora and symmetric. For before and after pictures and reviews on labioplasty visit : http://www.realself.com/Labiaplasty/reviews
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What is vaginal rejuvenation? Vaginoplasty is a surgical procedure where the excess vaginal tissue is removed, the size of the vaginal opening is reduced and   other supportive tissues in the vagina are repaired. It is used to reduce the effects on the vagina from vaginal births, aging, and the effects of pulling on all our tissues from gravity. Some women complain of a vaginal bulge resulting from the prolapse of part of their reproductive organs. What are the results of vaginal rejuvenation? The goal of the surgery is to increase the friction experienced by sexual partners during intercourse, hence improving pleasure. It is also used to restore to normal and correct prolapse of surrounding organs (hernia repair of bladder or rectum). Women often feel greater self-esteem after the procedure and improved confidence; they also feel relief from the pulling sensation when a hernia is present (cystocoel / rectocoel repair). How long does this procedure take? The surgical time depends on the extent of the procedure and the degree of defect being corrected. In general, the procedure takes about one hour. What are the surgical risks of vaginal rejuvenation? Vaginal rejuvenation is a safe procedure with low risk. Like any surgery, the risks are hemorrhage and infection; these are less than 1%. If one requires work on both the upper and lower vagina, then there is risk of injury to the bladder and the rectum. This is very rare. Although rare, there are anesthetic risks also depending on the type of anesthesia. What is the recovery time? The recovery time can vary but we recommend staying off your feet for a few days and refrain from sex for 2-3 months.
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What is Juvaderm? Juvaderm is smooth gel filler, made of hyaluronic acid, which your doctor uses to instantly smooth away wrinkles around your mouth and nose. With just one treatment, you’ll get smooth and natural looking results that last up to a year. What should I know before the procedure? You should avoid taking anti-inflammatory medications such as Aspirin and Ibuprofen as it might cause bruising. How long should I start seeing the effects? You can usually see the effects immediately after the procedure. What is the recovery time? You can resume normal activity immediately after the procedure. Some patients might experience some minor bruising but that should go away within 1-2 days.
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As is warranted, we try to offer non-surgical or minimally invasive surgeries to resolve woman’s health problems. We offer when surgery is necessary laparoscopic solutions, that minimize hospital stays, down time, and post operative pain. We offer laparoscopy assisted vaginal hysterectomy, and laparoscopy for ovarian pathology when possible. We do a variety of in office ambulatory surgeries: • D & C hysteroscopy (polyps, abnormal uterine bleeding, miscarriages) • LEEP (pre-cancerous cervical disease) • Cryosurgery (HPV desease) • Minor skin surgery of vulva (cysts, abscess, Bartholin’s cyst/abscess, tags, warts, etc.) When ever possible we believe in preserving reproductive organs, we offer palliative alternative medical care. Even when a woman has completed her family, reproductive organs have a key hormonal and sexual role in our lives.
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What is the HCG diet? It is a diet formulated to get rid of the unhealthy fat that is difficult to remove with normal dieting. A body shaping, where only unhealthy fat is lost. It is a combination of HCG shots over 26 days and a strict 500 cal diet. What type of results can I expect from the HCG diet? You won’t be hungry or tired you will be using up calories from the unwanted fat that is most difficult to get rid of of without muscle wasting and help your body fix the underlying problem that causes obesity to begin with. Usually we recommend no more that 36 lbs per treatment, if more needs to be lost we will recommend an about 6 week break. What is the schedule for HCG diet? 125IU of HCG mon – sat except during your menses Until 3rd injection forced feeding After 3rd injection, 500 cal calorie diet to be continued until 72 hours after the last injection. For the following 3 weeks, all food allowed except starch and sugar in any form. After 3 weeks, very gradually add starch in small quantities What are some possible side-effects? How much will it cost me?
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What is a sonogram? Ultrasound uses ordinary sound except it has a frequency (or pitch) higher than people can hear. Ultrasound is sent into the body from a scanning instrument (transducer) placed on a patient’s skin. The sound is reflected off structures inside the body and is analyzed by a computer to make a picture of these structures on a monitor similar to a television screen. Is it safe? There are no known harmful effects associated with the diagnostic use of ultrasound. Widespread clinical use of diagnostic ultrasound for many years has not revealed any harmful effects. What is a sonogram used for? A sonogram can be used to examine the ovaries, uterus, bladder, pregnancy and several other parts of the body to detect abnormalities or other complications. It can be used for the treatment of infertility and a variety of medical diseases like endometriosis, abnormal vaginal bleeding, fibroids etc.
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What STD testing do you provide? We provide testing for Chlamydia, gonorrhea, urinary tract infections and HPV. How often should I get tested for STDS? If you are sexually active and 25 or younger we recommend getting tested for STDs every year and more often depending on the amount of sexual partners you have. You should also be tested every time you change sexual partners. Why should I get tested? A majority of people who have STD’s do not know they have it. A lot of STDs can be cured with modern medicine, or treated to minimize the symptoms. It is also out of respect to your current and future sexual partners to be informed and prevent spreading the disease. What happens if I’m positive? If your results are positive there is no reason to be freaked out. You should be proud of yourself for taking control of your sexual health and becoming informed. There are many treatments available and for some STDs it is completely curable. For more information on living with STDs and general information visit: http://www.cdc.gov/std/
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What is a pap test? The Pap test is a screening test to look for abnormal cells on the uterine cervix (the opening of the uterus). Who should have a pap test and how often? All women regardless of sexual activity should have testing starting at 21 years of age. Thereafter they should continue regular testing at 1 to 2 year intervals for life. Woman who are older that 65 can decrease interval testing for pap smears, if she has been having normal results. Woman who have had a hysterectomy and have not had an abnormal pap can discontinue testing. However even if a woman no longer needs testing she should still be getting regular gynecologic evaluations for other health maintenance evaluations. Why should I have my pap test done? A pap test is done to see if you have HPV, which if untreated could lead to cervical cancer. Pap smear can also detect pre-cancerous lesions that can be taken care of simply, without loosing reproductive organs. I feel fine should I still have a PAP test? Yes, HPV is a common outcome of being sexually active, with 4 out of 5 people testing positive for some type of HPV virus during their lifetime, usually with no symptoms. What if my pap smear is abnormal? An abnormal result doesn’t usually mean you have cancer. Almost all abnormal results are caused by HPV. Sometimes these go away on their own, and sometimes you may need treatment to stop them from developing into something dangerous to your health. There are also other causes for an abnormal pap results e.g. Polyps, hormonal changes, inflammation, infections that can be managed simply.
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Is there really a way to combat aging? The most important thing you can do in this area is to have a commitment to adopt a healthy life style. Eat right, a diet with abundant fruits and vegetable with rich colors full of antioxidants and vitamins. Avoid toxins, smoking or excessive alcohol. Avoid sun damage, excessive sun is the worst offender for premature aging of the skin. Use plenty of sun block every day and avoid direct exposure to the sun between 10 to 5, especially in the tropics. Regular exercise, and weight bearing exercise especially after 30, when if preventive measures are not undertaken muscle wasting and weight gain begins. You have to get regular check up, many diseases go asymptomatic and if there not taken care of early your health will deteriorate. Estrogen is THE hormone to decrease skin aging. It will keep skin plumpy, reduce wrinkling, keep skin moist and tight. Estrogen also keeps hair and nails looking healthy. Advances in aesthetics medicine can turn the clock back years, avoiding wrinkles and treating wrinkles that are already present. Do they really work? What type of results should I expect? Treatment with fillers are immediate and last up to 1-2 years. Botox take 3 – 7 days to kick in, effect is usually a refreshing younger look without a Change in the real you. No down time is necessary with these treatments. Hormone therapy is a more gradual restoration that last while therapy is maintained. How much would these treatments cost me? Hormone replacement is covered by most insurance. Fillers will cost between $700 a $1,400, depending on how much is used. Botox will go for $ 250 plus, also depending on how much is used. At what age should I start thinking about anti-aging? Always, it’s never to early or to late to start taking care of your self. Prevention is best, but treatment also has amazing effects. What other help is available that don’t include shots or medication? There are very good creams that provide eliminations of abnormal increase in skin pigment, reduction of fine lines and increase moisture to the skin. Also creams to reduce break- outs and skin inflammation.
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What are the initial symptoms of menopause? The most common are changes in your menstrual period. They either come late, early, too little or to much, you start skipping periods until you get no more. The usual definition we use for menopause is the lack of a menstrual period for one whole year. Another common symptom is hot flashes. Episodes of facial flushing or sensation of heat lasting for about a minute that occur in clusters, common at night. What can I do to offset some of these symptoms? It depends on how severe the symptoms. If periods are to irregular you want to do something about it, especially if excessive bleeding is occurring and you become anemic. Usually short term progesterone is given cyclically to regulate them. Hot flashes if there severe may be causing sleep and mood disorders. There a variety of natural aids you can try, primrose, black cohosh, valerian root, soy, flax products, light clothing to bed. Hormone replacement if not contraindicated will resolve these right a way, but you will need a check up and a prescription. At what age does menopause in women usually happen? On average menopause occurs between 50 – 52 year of age; it can be earlier if women have had a hysterectomy even if there ovaries were left behind. If you have ever had ovarian cysts removed and lost part or all of your ovaries it can also come early. Of course, if both ovaries are removed then you have a surgical menopause, symptoms then are often dramatic and requires medical treatment. Im 40 is there anything I should be doing now? This is a great time to take charge of your life and your health. Make sure your at a healthy weight and engaged in an exercise program. Don’t smoke and get a check up. Make sure you get your blood pressure cheked and that your getting enough vitamin D. Labs that are important include getting a cholesterol and glucose test. Many women have diabetes or hypertension and don’t know it. You should be having regular mammograms and Pap test. I’m experiencing painful sex, can this be part of menopause? Menopause can be associated with sexual issues, often lack of lubrication, pain at intercourse or painful urinaiton after sex. These can easily be resolved with a local estrogen cream that rejuvenates the vagina without health risk since the estrogen is not absolved by the body. You can also use water soluble lubricant during sex or vaginal moisturizer. Don’t be shy and ask your gynecologist with help in this area.
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