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The Importance of Following Through With Advice, Treatments & Change

I see so many people who have been ‘missed’ and ‘dismissed’ and who have suffered in silence with their disease state.

But the biggest shame is when those that are offered real help, then do nothing with that advice and continue on the vicious, merry-go-round cycle of their disease.

My motto is “No Stone Left Unturned” and I apply that to every patient that I see. My initial consults are usually 1-2 hours in length and I also do lots of preliminary work prior to see a patient as well. I make sure all my patients are now only sent health appraisal questionnaires, but are also evaluated with mood and stress questionnaires for their mental health too. I really want to delve into every fine detail of a persons life to see what may be driving their disease state and symptoms. It is to also help with diagnosing those that have not been properly diagnosed either. I then write up a comprehensive report for all my patients, with everything they need to do, the changes they need to make, the medicines they need to take, the investigations and testing they need to have and all their step by step health management moving forward. No Stone Is Left Unturned as I mentioned before

As I mention in this video blog is that the greatest shame is those that come to get the advice and help and then do nothing with it. Just remember that if you do not change anything, or do the work needed, then nothing changes. The key to real change is actually within you.

If you so need help with a particular health issue, or you just aren’t getting the right answers and care, then please book in a time to see me and let me be your guide to better health and getting your life back to normal.

 

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Food additives and emulsifiers may increase inflammation and anxiety

A wide range of foods contain ingredients that we call emulsifiers. A new study has shown that these compounds can produce both physiological and behavioural changes.

Bread and many other common foods we eat daily contain emulsifiers and other additives.

Food additives have always generated a great deal of attention as they can lead to exacerbating many health conditions, or even be the cause of some health issues as well. Recently, emulsifiers have been drawing fire and rightfully so.

Manufacturers have been using these chemicals to alter food’s texture and extend its shelf life for years and they are not good for our health. These emulsifiers are found in many foods such as bread, chocolate, margarine, processed meats, and more.

Earlier studies have shown that emulsifiers can alter the microbiome of mice, causing low-grade inflammation and increasing the risk of obesity and metabolic disorders. But now a study in humans concluded that gut bacteria “can be directly impacted by these commonly used food additives, and these additives also subsequently drives intestinal inflammation.”

Recently, researchers from Georgia State University in Atlanta set out to see if these emulsifiers also influenced mental wellbeing. The focussed on two commonly used emulsifiers — carboxymethylcellulose (CMC) and polysorbate-80 (P80).

The Microbiome and Psychological health

In many recent studies scientists have already described a clear pathway between the gut and the brain. These studies have shown that our gut health and the health of our gut bacteria can have a substantial influence on our mental well-being. Most of the studies concluded that lack of good bacteria in the gut and overuse of antibiotics could significantly alter the microbiome, anxiety levels, and social behaviour over the long-term.

This most recent study investigated whether P80 and CMC might alter our mental state. The team added CMC and P80 to the drinking water of recipients for 12 weeks. They then measured the changes in the microbiome, behaviour and other physiological changes as well. The results showed that these emulsifiers caused general systemic inflammation, which extended to the brain and to behavioural changes. The researchers published their findings in the journal Scientific Reports.

The impact of emulsifiers

The scientists showed that the emulsifiers did impact good gut bacteria, but in different ways for male and females. They also showed that the changes in behaviour were different between the sexes. Males tended to have an increase in anxiety, where the females tended to have a reduction in social behaviour.

While it is not known how these emulsifiers affect behaviour, it is speculated that the inflammation they produce affects signalling pathways in body tissue and parts of the brain. The gut also contains branches of the vagus nerve, which has a direct link to the brain. The researchers said that more research is needed into this very important area of medicine.

In recent years there have been increase levels of anxiety and mood disorders in our western society. While there are many other factors to the increase of anxiety and mood disorders, such as stress and lifestyle changes, the researchers have questioned if these additives may also be playing a part in this as well.

For now, the researchers recommend that we should really look at how these food additives impact our microbiome and gut bacteria and increase systemic inflammation in the body. It is great to see that science has now showing, beyond a shadow of a doubt, that the microbiome plays a significant role in our overall health. Not just our physical health, but our mental and emotional health as well.

This is why I always recommend health diet and lifestyle changes for every condition I help with. This is also why I promote the use of healthy beneficial bacteria (probiotics) daily in our diet as well. Good health always starts with good diet. Good health always starts with a healthy gut/microbiome as well.

Take care

Regards

Dr Andrew Orr

-Women’s and Men’s Health Expert

-No Stone Left Unturned

01 Dr Andrew Orr 1

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Poor Diet, Stress and Sedentary Lifestyle ups Risk of Developing PCOS

Polycystic Ovarian Syndrome (PCOS) is a hormonal/endocrine/reproductive issue  and is on the rise due to unhealthy food habits, low physical activity and high stress levels, a new study has found.

It has long been known that insulin resistance and poor dietary and lifestyle habits increase the risk factors for developing PCOS. While being overweight is a risk factor for PCOS, women can be of any body type and still develop PCOS. Women of all body shape can still have poor dietary and lifestyle habits and this is every increasing in our modern world.

Increased refined foods, increased refined grains, increased refined sugars and a sedentary lifestyle are big factors in developing PCOS and also other health conditions such as Diabetes and Heart disease.

We also know that high stress levels can lead to high cortisol levels and high inflammation in the body and then also be drivers of PCOS and many of the conditions that go with this disease state.

What is PCOS

Polycystic ovary syndrome (PCOS) is the most common hormonal/endocrine/reproductive disorder among women of reproductive age. Symptoms can include include

  • Irregular or absent menstrual cycle
  • facial hair growth and excess body hair (hirsutism)
  • Acne
  • Increase weight and increase body fat (all body types can have PCOS)
  • Infertility and difficulty conceiving

The condition has many physiological implications as well. It also results in emotional and psychological agony in affected women. For more information on PCOS, have a read of my page about “Polycystic Ovarian Syndrome”

A recently concluded study published on the 12th January 2019, has revealed that uncontrolled or untreated PCOS can raise the risk of diabetes, heart disease and infertility. It has also been concluded that psychological issues such as anxiety and depression can also be the consequence of untreated PCOS. This study fits in with many other recent studies and has prompted changes to PCOS guidelines.

The study was conducted on two groups — one group of 150 patients with untreated/uncontrolled PCOS and the other group of 150 women who had controlled PCOS. The study found that those affected with PCOS followed a poor lifestyle, consumed excessive junk food, had no or low physical activity, more intake of refined carbohydrates and high stress levels.

The study also discovered that there was lack of awareness among the affected women and about 40 per cent were seeking information online. This is a major cause of concern as there is a lot of misinformation on the internet and this is leading to women trying to self-diagnose and go off recommendations of friends and internet groups, rather than healthcare professionals who specialise in this area.

During the study, one group was taking probiotics along with maintaining good lifestyle, while the other group was only maintaining good lifestyle. While both groups showed improvement, the group taking probiotics had additional improvement.

Good gut health and restoring the microbiome is something that I have always promoted in women, not only with PCOS, but other gynaecological/reproductive issues as well. New research has shown that healthy levels of good gut bacteria not only help with restoring the microbiome and gut and digestive health, but also help with reducing inflammation, helping with a healthy immune system and helping with psychological health and wellbeing as well.

Women with PCOS need to be properly diagnosed first and then treatments require a multimodality approach with diet and lifestyle interventions as well. Women with PCOS also need to be properly monitored and managed by a healthcare professional and not go off self-diagnosis and recommendation of untrained people.

The long term consequence of mismanaged, or unmanaged PCOS can be damaging on many levels many patients are not aware of this. The problem these days is that everyone wants a quick fix, or a magic pill, and when things don’t seem to be working, they get impatient and either change treatments, or opt advice from untrained people, or friends and this can be very dangerous.

While self-education is very important, self-management can also be detrimental as conditions such as PCOS requires constant motivation, guidance and proper healthcare management. This was also highlight as part of this recent study.

The study also highlighted that the top 3 issues with PCOS were irregular periods, hirsutism and weight issues. Irregular periods, or absent periods affect about 7 in 10 women with PCOS. Hirsutism or the extra hair on face or other parts of body are seen in 70 per cent cases, while 70 per cent to 80 per cent of women with PCOS are either overweight or obese.

But, women of all body types can have PCOS so this also needs to be noted. Many women put off being investigated for symptoms of PCOS because they believe they need to be overweight to have this condition. There also older healthcare practitioners who still believe this to be the case and this is why it often takes up to 3 years for a woman to be properly diagnosed with PCOS.

There are also other symptoms of PCOS that are often overlooked. Acne, dark patches on the skin on back of neck and others areas, skin tags, hair loss, anxiety, depression, difficulty in getting pregnant, recurrent miscarriages and sleep apnoea are other symptoms that a woman may have PCOS.

What the study concluded

Besides the known factors such and diet and lifestyle, the study highlighted that many women with PCOS suffered in ignorance and isolation. Many women with PCOS are often take up to 3 years to be diagnosed and many are misdiagnosed on the way.

The study also showed that many women with PCOS were unaware of the long term fertility and health consequences, and many hardly have any information given to the about this disease. Many women with PCOS are dependent on internet, friends, other people with the disease etc, as their main source of information.

The study also showed that while routine treatments for PCOS are needed, they can be expensive and less effective than proper dietary and lifestyle control.  Poor diet and lifestyle and increased stress levels are a major reason for the rising prevalence of the disease.

In the study diet and lifestyle changes had a comprehensive impact in controlling other health problems like insulin resistance, diabetes, and hypertension. When women were overweight, or obese, and they reduced body fat, there was also improvement in the symptoms and their testing reports.

Probiotic supplementation also had an overall additional benefit in reducing the abdominal fat, LH:FSH ratio, total testosterone, LPS level, menstrual regularity and also preserving the gut and digestive function. The addition of probiotics to any treatment regime for PCOS needs to be looked at as it could be a new PCOS treatment modality in future.

There are many things women can do to help PCOS and the associated symptoms and the short term and long term health consequences of the disease. While diet and lifestyle interventions needs to be part of this and is the number one treatment for PCOS, women with PCOS do need to be carefully monitored by a qualified healthcare practitioner. This then ensures proper care, management and also accountability and also ensures the disease in properly monitored along with any other changes in symptoms. It also helps with monitoring future fertility and future health issues as well.

If you do need help in the treatment, management, or even diagnosis of PCOS, please give my clinic a call, or please a healthcare professional who specialises in PCOS.

Regards

Dr Andrew Orr

-Women’s Health Expert

-No Stone Left Unturned

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New Year’s Microbiome Reboot & Restore

Most people often need lose the Christmas and New Years Cheer put on through all the goodies we all consume. This also means our gut and Microbiome and Gut health is out of balance and needs to be rebalanced and restored with beneficial bacteria.

Weed, Repair and Restore

This needs to be done properly and involves weeding out the bad bacteria, repairing the gut mucosa and then restoring the gut and microbiome with beneficial bacteria. These good bacteria also need the right food sources to grow and this is all part of repairing and restoring the microbiome/gut.

Microbiome Reboot and Restore Program

We are offering a Microbiome Reboot and Restore to help you with weight management, help your immune system and also get your gut and digestive system working properly again. It will also help reduce inflammation in those with chronic disease states and help with moods and healthy brain function too. The program also incorporates healthy eating principles.

Let’s start the New Year right by getting your gut health right too.

Please give the clinic staff a call for more details and pricing.

Regards

Dr Andrew Orr

-No Stone Left Unturned

-Women and Men’s Health Advocate

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Why Iron Deficiency and Anaemia Should Be Take More Seriously

One of the common things I am seeing in women of all ages is iron deficiency and anaemia. Many women have very low levels of iron and are unaware of the dangers this may pose to their short term, and long term health. We are also seeing women being hospitalised and seek emergency help due to iron deficiency and anaemia and this highlights that there is inadequate management and detection of a very preventable condition. It also means that many women are not taking this matter seriously enough and often put off seeking screening and then aren’t having their iron levels managed properly.

I need to let all women know that having low iron can be very dangerous. It is something that should not be glossed over, or taken lightly. Iron deficiency can and does cause short term and long term health complications.

Iron deficiency can raise the risk of the following health conditions

  • Coronary heart disease
  • Stroke
  • Osteoporosis
  • Compromised immune system
  • Increased risk of infections
  • Tachycardia
  • Heart failure
  • Enlarged heart
  • Lung problems
  • Muscle aches and cramps
  • Restless leg syndrome
  • Delayed growth and development (mainly in children)

These are just some of the health issues that being low in iron can cause and it very important that we start educating all women and healthcare providers about the importance of iron.

What are the symptoms of Iron Deficiency and Anaemia?

  • Fatigue
  • Weakness
  • Dizziness
  • Fainting, or feeling of feeling faint
  • Pale skin
  • Breathless
  • Frequent headaches
  • Palpitations or racing heart
  • Easily irritated
  • Difficulty in concentrating
  • Cracked, or reddened tongue, sore tongue
  • Loss of appetite
  • Strange food cravings such as wanting to eat dirt, or clay
  • Cold hands and feet
  • Brittle nails
  • Hair loss
  • Tingling, or crawling feeling in the legs

Iron deficiency is a very common cause of fatigue and other health issues in women and men, but is more commonly seen in women. Iron deficiency is also the most common cause of anaemia.

What are the causes of Iron Deficiency and Anaemia?

  • Heavy menstrual bleeds
  • Endometriosis
  • Adenomyosis
  • Fibroids
  • Polyps
  • Coeliac disease
  • Inflammatory Bowel Disease
  • Stomach or intestinal ulcers
  • Pregnant and Breast Feeding Women
  • Certain Cancers
  • Vegetarians and Vegans
  • Eating disorders and food restriction
  • Girls going through puberty
  • Certain illnesses

Heavy menstrual bleeds and gynaecological condition’s such as Endometriosis, Adenomyosis, Fibroids and Polyps are some of the main causes of iron deficiency and anaemia in women. This is closely followed by dietary inadequacies and food and nutritional restriction.

Many women have undiagnosed gynaecological conditions which are the cause of their iron deficiency and anaemia. Some of these gynaecological conditions will require surgical interventions to be diagnosed properly.

How are Iron Deficiency and Anaemia Diagnosed?

Your healthcare provider can organise routine blood tests to test for iron deficiency and anaemia. These will include the following

  1. Full Blood Count (FBC)
  2. Iron Studies

These tests will provide the following information on :

  • The Total Iron level in your blood
  • Ferritin levels
  • Total iron-binding capacity (TIBC)
  • Iron saturations levels
  • The red blood cells size and colour (RBCs)
  • The white bloods cells (WBCs)
  • Haemoglobin
  • Hematocrit ( the percentage of blood volume that is made up of RBCs
  • Blood platelets

Other tests

There are other tests to check for the cause of iron deficiency and anaemia and these could include stool analysis (check for blood in stool), endoscopy and colonoscopy ( surgical intervention gastrointestinal bleeding) and laparoscopy (key hole surgery for gynaecological conditions)

Treatments for Iron Deficiency and Anaemia

Diet– A healthy diet that is rich in proteins, vegetable and iron rich foods is the best way to ensure your iron levels stay at optimum levels. A proper diet should include leans meats, seafood, nuts, seeds, healthy oils, green leafy vegetables and other coloured vegetables, and moderate fruit intake.

Supplements– Supplements will help to keep iron levels and vitamin B12 levels in optimum ranges. Iron supplements are very much needed if you are vegetarian, or vegan. There is now research to show that women who experience fatigue will benefit from supplemental iron, even if their iron levels and ferritin are within normal range. Those with heavy menstrual cycles, or those whom have inflammatory bowel issue should also be supplementing

NB- All iron supplements should be taken with vitamin C to help with absorption. Many iron supplements also cause constipation and therefore you should get a good one that does not interfere with your bowel habits and is more easily absorbed. Many of the mineral based iron products are not absorbed well and do cause gastrointestinal upset.

I always recommend a specific practitioner only brand to my patients because it is better absorbed, and it does not interfere with the bowel habits.

Iron Infusion– Sometimes when iron gets too low, supplements just will not be enough to get iron levels up to where they should be quick enough. This is where iron infusions can be very effective. Please see my post on when you need to use and iron infusion. (Click here)

Treating the underlying cause of bleeding

Supplements will not help if the cause of the iron deficiency and anaemia is from excessive bleeding. It may help a little, but it will not be enough. Even iron infusions will only be short lasting if you don’t treat the underlying cause of the bleeding issue. Extreme cases may even need a transfusion to get iron levels and blood levels back up to optimum.  This is why it is important to screen for underlying gynaecological conditions that can cause heavy and excessive bleeding.

If you are getting low in iron if means there is something wrong and there is a deficiency that needs to be addressed. Please do not take iron deficiency lightly and always be prompt to find the causes and restore optimum levels of iron in the body.

Prevention is a must

Prevention is always the best way to treat any health condition and this goes for iron deficiency as well. Ensuring you eat a healthy diet with iron rich diet is a great start. As said before, vegetarians and vegans are going to have to supplement and work really hard with their diet to ensure they get adequate iron. Even then it can still be hard as plant based foods just do not have the iron levels that meats, eggs and seafood’s have.

Make sure you also have lots of vitamin C in your diet to help with iron absorption and it is a good idea to supplement with vitamin C to ensure you get the right daily intake.

Final Word

If you do think you might be low in iron or have anaemia, please make sure you talk to your doctor, or your healthcare practitioner. Please do not supplement with iron without checking your levels first. Having too much iron can be dangerous and you also need to make sure you do not have hereditary high iron (hemochromatosis), which can present with the same symptoms as low iron.

If you are found to be low in iron, then please make sure you take prompt action to restore your iron levels and also make sure you are screened as to why you are low in iron in the first place.

Iron deficiency and Anaemia can be very serious and should never be taken lightly. Please always consult with your doctor, specialist, or healthcare practitioner for the most effective ways to keep your iron levels in healthy ranges.

Take care

Regards

Dr Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

01 Dr Andrew Orr 1

 

 

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The Importance of Electrolytes

The reason for this post is to talk about Electrolytes and how important they are for the body. I also need to let people know what proper electrolytes are.

Electrolytes are so important for the body and we actually need to replenish them on a regular basis. Water alone is not enough to hydrate you properly and therefore we need electrolytes for proper hydration and to carry fluids around our body. They also have so many other important actions.

Every single one of us needs electrolytes to be able to survive. Many of our bodily functions require an electric current to function, and electrolytes provide this charge. Electrolytes are substances that help to conduct electricity when it is dissolved in water. These Electrolytes also interact with each other and the cells in the tissues, nerves, and muscles. A balance of different electrolytes, in the right ratios, is so important for everyone to function daily and to support optimum health.

What are Electrolytes and what do they do for us?

As mentioned before, electrolytes are chemicals that help to conduct electricity current in the body and they also regulate our nerves and help our muscles to function. They also help with the rebuilding of damaged tissue. Muscles and tissue rely on electrolytes to hydrate the cells and the fluid inside them. The heart, muscles and nerves cells also use electrolytes to carry electrical impulses to the cells and other parts of the body.

Their most important function of Electrolytes is hydrating the body, but they also help to balance blood acidity and blood pressure as well. Without proper electrolyte balance people can die. This is why they are so important and people need to know about them. As mentioned before, while water is important for hydration, electrolytes are just as important.

Common electrolytes include are sodium, potassium, calcium , bicarbonate, magnesium, chloride and phosphate. When these substances become imbalanced, it can lead to either muscle weakness or excessive contraction. All our muscles needs calcium, sodium, and potassium to contract. The heart, muscle, and nerve cells use electrolytes to carry electrical impulses to other cells.

These electrolytes also need sugar to help transport them and I will talk about this later. To maintain hydration, there needs to be a balance of electrolytes and sugar, in very specific ratios.

Symptoms of Electrolyte Imbalance

Symptoms will depend on which electrolyte is out of balance. The symptoms of electrolyte imbalances can show as the following:

  • Muscles Spasms and cramping
  • Muscles Twitching
  • Weakness and fatigue
  • Excessive tiredness
  • Dry mouth and throat
  • Not able to quench ones thirst
  • Irregular heartbeat and palpitations
  • Changes in blood pressure
  • Bone disorders and aching bones
  • Confusion and lack of mental clarity
  • Headaches and Migraines
  • Seizures
  • Numbness
  • Nervous system disorders
  • Convulsions
  • Loss of appetite
  • Nausea
  • Feeling faint
  • Dizziness
  • Moodiness and Irritability

Causes of Electrolyte Imbalances

There are many reasons for an electrolyte imbalance and especially those suffering from dehydration symptoms. These include:

  • Prolonged periods of illness, such as vomiting and diarrhea
  • Severe Dehydration
  • Not staying hydrated before and after exercise
  • Prolonged periods in Air-conditioning (due to drying affect)
  • Bladder issues (excessive urination, frequent urination, incontinence)
  • Pregnancy (due to frequent urination)
  • Kidney disease
  • Poor diet and nutrition
  • Incorrect acid and alkaline balance in the body
  • Congestive Heart failure
  • Cancer treatments
  • Some drugs, such as diuretics steroids
  • Eating disorders
  • Menopause
  • Age, as the kidneys become less efficient as we get older

Monitoring and Testing for Imbalances

If you are feeling any of the symptoms above, or have any of the known causes of electrolyte imbalance, taking a proper electrolyte solution is a good idea. If you are feeling symptoms of dehydration, you should take an electrolyte solution anyway.

There are ways to tests for electrolyte imbalances and these are more fined tuned for which electrolyte may be out of balance. This test is called a Electrolyte panel and this is used to screen for imbalances of electrolytes in the blood and measure acid-base balance and kidney function. Your doctor may order this test to also monitor the progress of treatment relating to a known imbalance. Many drugs and hormone treatments can affect our electrolyte imbalance and it is important to monitor these effects.

Oral Hydration Therapy

Most people will know of oral hydration solutions for dehydration, or after long periods of illness. This treatment is used mainly for people experiencing an electrolyte shortage alongside dehydration, normally following severe vomiting or diarrhea.

It is important to know what proper electrolyte solution is because some of the so called sports drinks (Powerade, Gatorade) are not electrolytes and should not be used as such. These are really just highly colored cordials with a bit of extra salt in them.

Those so called sports drinks are not electrolytes and are really over commercialized cordials. They are not even allowed to call themselves an electrolyte solution and nowhere on the bottle will you find the word ‘electrolyte’. They may be able to call themselves re-hydration fluids, but they cannot call themselves and electrolyte, because that would be false advertising. Any drinkable fluid can call itself a re-hydration fluid.

People taking these so called sports drinks thinking they are an electrolyte, could be seriously putting themselves in danger using them thinking they have a therapeutic value.

The World Health Organization (WHO) has approved a solution to be used in oral re-hydration therapy that contains:

  • 6 grams (g) of sodium
  • 5 g of potassium chloride
  • 9 g of sodium citrate

These are dissolved in 1 liter (l) of water and given orally.

There are now proper electrolyte solutions available through chemists and drugs store.

The ratios of Electrolyte solutions are important

When using a proper electrolyte solution, it is important that the ratios of electrolytes are in the right proportion. It isn’t just about taking an isolated electrolyte, especially when it comes to dehydration. The world health organisation has standards that these electrolyte ratios should be at, especially for proper hydration after illness.

Electrolyte levels can change in relation to water levels in the body as well as other factors. Important electrolytes are lost in sweat during exercise, if someone is urinating too much, through air-conditioning, illness, certain medications, taking hormones and so much more.

The most common electrolytes imbalances are usually sodium and potassium. The concentration can also be affected by rapid loss of fluids, such as after a bout of diarrhea or vomiting. Water alone will not hydrate someone after an illness and if someone is dehydrated. This is why it is important to get proper ratios of electrolytes into a person after an illness otherwise they could become severely ill, or even die.

Sugars Role in Re-hydration

These days people are worried about any solution that contains sugar. I often get people telling me they don’t want to have proper electrolyte solutions because they contain sugar. But, all electrolyte solutions need to have a certain amount of sugar in them. This is the one of the only times I will look at sugar in a positive light. Sugar plays an important role in replenishing and transporting electrolytes around the body and into cells. What many people do not understand is that rapid and effective hydration depends on the active co-transport of glucose and sodium molecules through the small intestine. In other words, this means that the sugar is needed to help you absorb the electrolyte. If there’s no sugar in your electrolyte solution, it will not activate the co-transport of glucose and sodium for your body to rapidly replace fluid and electrolytes you’ve lost through sweating, illness, or other factors. It is all about the ratios of what is in the electrolyte solution and these need to be very specific to have a therapeutic value.

When there is too much sugar, such as in these so called sports drinks, you can be left feeling bloated and uncomfortable. Too many of them can also put your diabetes risk up too.  Because there are not proper ratios of electrolytes in these drinks, you are not getting a therapeutic value out if it either. Research has shown that drinks with high sugar concentrations can lead to unpleasant feelings of fullness, and delayed emptying of the stomach. These sugar drinks can also lead to other health issues as well. Many of them are full of additives and colourings as well. This is why it is important to know what a proper electrolyte solution is, and know the difference between sports drinks and a proper therapeutic electrolyte drink

Coconut Water

While coconut water does contain some electrolytes, we cannot regard it as a therapeutic electrolyte. Too much coconut water can also cause stomach upset as well. Coconut water can be used as part of your daily hydration and is another way of maintaining some crucial electrolytes in the body.

Foods and Electrolytes

There are many foods that we eat daily that contain sodium, calcium, potassium, chloride and magnesium. It is still vital to have these foods to maintain electrolyte balance in the body. Just remember that when you are sick, or are severely dehydrated these electrolytes get depleted and this is why you need an electrolyte solution for rapid hydration.

Fertility, Gynaecology, Pregnancy and Electrolytes

Many of the hormones used in IVF and gynaecology can interfere with our electrolyte balance and why I recommend the use of electrolytes to my patients.

Long term pain, use of steroids, pain medications, hormones etc, can all interfere with certain electrolytes and their absorption into the body. Some medications and hormones actual cause depletion of crucial electrolytes too.

Electrolytes can help with pain management and muscle spasms etc, that many gynaecological conditions, such as endometriosis can cause.

Electrolytes are also needed for a dangerous condition called Ovarian Hyper-stimulation Syndrome (OHSS). This dangerous condition is caused by hormones hyper-stimulating the ovaries, which can lead to the painful and sometimes fatal condition. Yes, OHSS can kill you if it isn’t monitored and managed properly. One of the things that helps with the prevention, and the treatment of this syndrome, is proper therapeutic electrolyte solutions.

Pregnancy is also a time where electrolytes can be out of balance. This can be due to excessive urination and also because the baby stripping you of nutrients and electrolytes also.

If you are Pregnant, or undertaking IVF, or fertility treatments, have a gynaecological condition etc, electrolytes should be a part of your treatment and management.

Final Word on Electrolytes

Electrolytes are a very important and vital part of a person’s chemical makeup, and an imbalance can affect the body’s ability to function properly. Regular monitoring and consuming electrolytes after intense exercise, profuse sweating, illness and even certain medications can help to preserve your body’s levels.

So next time you are drinking lots of water and not quenching your thirst, it may be time to get some electrolytes into you. If you feel faint, or dizzy, or have muscles cramps etc, this could be one of the reasons also. We all need them on a regular basis. Just make sure they are a proper electrolyte and not the lolly water rip offs that line the supermarket shelves. Please remember to stay hydrated at all times and while water is needed for this to happen, electrolytes are a very important part of this also.

Take care and stay hydrated and healthy

Regards

Dr Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

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Why Early Puberty Is More Common Than Ever

In today’s modern world we are seeing more and more young girls going through puberty much younger than they used to. We do know that girls as young as 7 years old are getting their menstrual cycle and going through all the changes of puberty, yet these poor children aren’t able to fully comprehend the emotional changes that go with it, or what this means for them on a reproductive level. Researchers Blame Childhood Obesity, Endocrine Disruptors and I will discuss this at length for you all.

It wasn’t that long ago the average girl would begin menstruating around the age of 16 or 17. On average, the general consensus would have been that girls could be starting to begin menstruation around the age of 14 years old. By early 2000’s, that age had fallen to less than 13 years old and now it has fallen again to being as young as 7 years old.

What we forget is that even before a girl gets her first period, there are signs of maturation that signal impending changes, and these come even earlier. So actually, some of these girls are beginning their puberty phase when they are 5 years, or 6 years old. A generation ago, less than 5 percent of girls would see these changes in their bodies— being breast growth, body hair, acne, pubic hair and all the other things that go with puberty. But now many of these young girls are seeing this around 7 years old, with an average age being 8 years old, for all of these changes to start to happen. This is definitely becoming the increasing norm and some experts think this age is still falling. Some doctors see fit to begin assessing girls for puberty-related changes at age 6.

Early Puberty

Classically, precocious puberty has defined puberty that begins before age 8 in girls and 9 in boys, but this is no longer universally accepted. In general experts are now saying that 7 years old is now probably a normal age to have some signs of puberty. While they are some that may not agree, we do need to start asking the big questions as to why this is happening?

So far, researchers haven’t proven any physical risks that come with early maturity. Although this could pose a significant risk to their ongoing fertility, bone health and also be putting women into menopause earlier too.

Many researchers have suggested that the main risks that come along with precocious puberty are not biological. Recent studies have found that girls who began the process early had an increased risk of depression during their adolescent years. There are also social risks that can disrupt a girl’s healthy development.

Puberty can be very confusing and emotionally damaging for girls, as they may face “sexual innuendo or teasing” long before they’re ready for it, according to researchers and experts. Early puberty may change the way a girl behaves, along with the way others behave towards her. This could pose other significant risk factors such as early pregnancy, but also exposure to STI’s and many other things these young girls are too young and too naive to know. This could even lead to earlier use of alcohol and drugs as well.

Why Is It Happening?

One of the biggest issues for young girls, and women in general, is changes in diet and higher use of highly processed foods and high intake of grains. This leads to higher levels of insulin and then the body storing more fats and stops the burning of fats and this then also creates inflammatory disease in the body. High insulin levels also lead to higher levels of estrogen in the body too. This is leading to more children being overweight and problem with changes to hormones, their cycles and gynaecological conditions. Childhood obesity rates have increase exponentially in the past 30 years, with more than one-third of children and adolescents weighing in as overweight, or obese. What people fail to realize is these Fat cells produce estrogen ( now known as Obestrogens), which plays a central role in stimulating breast growth in girls, causing problems with hormones, causing gynaecological conditions and playing a major factor in them getting their cycles much younger.

Researchers and experts are saying that obesity is leading to earlier puberty and this theory is well supported by the fact that these girls’ breasts are developing at a much younger age, and the age at which they start to menstruate has declined. The ovaries control menstruation, signaling that earlier breast development may be occurring because of different variables such as diet and environmental factors

There may be are other factors at play, other than diet, lifestyle and obesity though. Girls at a normal weight have been starting puberty earlier as well, though at a lower rate than these girls whom are overweight, or obese. Chemicals known as endocrine disruptors, such as the phthalates used in the production of plastics, as another potential contributor to early puberty have been cited as the most likely cause. They mimic estrogen and also cause disruption to the reproductive function and could therefore cause precocious breast growth and issues with the menstrual cycle. We know that there are over 87,000 chemical found in our foods, plastics, and preservatives and even in our water ways from detergents and even small traces of the contraceptive pill making its way into our water we drink as well. Others have said stress during childhood can play a role in prompting puberty as well.

Many children now face far more stresses that did in generations gone by, with many children growing up in families with a lot of domestic violence, arguing at home, or violence in their neighborhood are more likely to develop earlier. There have been studies and research that has suggested that girls who grew up without their biological father were twice as likely to get their period before age 12.

Scientists are even researching prenatal variables. Researchers now know that the parental mode of inheritance, through genes, is one way parents health, diet and lifestyle is being passed onto children. One study found that overweight mothers who developed gestational diabetes while pregnant gave birth to daughters who would start puberty earlier in life, regardless of what the girls themselves weighed. But, we also now know that the sins of the fathers can play a part in a child’s development. If the father isn’t healthy at the time of conceptions, or has genetic abnormalities, or genetic issues, these can be passed through the sperm and then onto a child, who then is affected with this issues that get expressed later, or now early, in life.

Regardless of whether its cause is environmental, genetic, biological, or some combination, precocious puberty may be reaching a biological breaking point.

This is why we need to be more aware of our children’s health early on, but we also need to be aware of our own health, before conceiving too, as we can pass our genetic disposition onto our children.

Teenagers and younger women are not too young to have gynaecological issues

Early intervention and prevention is the centre of managing any issue such as this and this is why we need to teach our children better eating habit, having a healthy active body and also being in touch with their bodily functions and emotions at a young age

Period pain and menstrual irregularities are not normal and we need to teach young girls this. We know that teenagers and younger women are not too young to have gynaecological issues such as Endometriosis and PCOS. Please see our article of what a proper menstrual cycle should be like to familiarize you and your daughter with this. The earlier you get onto menstrual issues and gynaecological issues, the better long term prognosis they have for their health and future fertility overall.

If you or your daughter need help with menstrual issues and know more about better menstrual health, please book in and see me sooner than later. As I have said before, the earlier we start educating young women on what is right, then better is for them later on in life and for their future health and fertility

Take care

Regards

Dr Andrew Orr

“The Brisbane Baby Maker” & “Women’s and Men’s Health Crusader”

-Leaving No Stone Left Unturned

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Excess Body Fat Can Cause Gynaecological Conditions, Lead to Menstrual Irregularities and Also Lead to Infertility

When women come to see me for help with gynaecological conditions, or couples who come to see me for help with having a baby, one of the first things I ask all of them to address is excess body fats and look at diet and lifestyle modifications.

Women, men, and couples who are underweight, need to look at this also, because being underweight can be just as bad as being overweight, but for the purposes of this post, we are going to look at how excess fats can not only interfere with fertility, but they can be a major driving factor in gynaecological and men’s health conditions that many face on a daily basis. Worse still, excess body fat can also lead to many cancers that both men and women get also.

One of my biggest challenges with men, women and couples is getting them to look at how excess body fat is playing a big part in their current health. It can also be challenging to show how excess body fats, or having too little body fat, can affect the gynaecological condition they have, or how it is affecting their fertility.

I always get all sorts of excuses from “My friend was overweight and he/she does not have my condition”, or “The next door neighbour is overweight and she has had 3 children” and all many of excuses that seem to be a big block in actually taking responsibility for one’s health. I get that it can be hard to get started and hard to make the steps for a better life, but at the end of the day, all these things I hear are just excuses really.

Yes, the next door neighbour may not have your health issue, but they may also have some other health issue, or be at risk of another health issue. Yes, your friend might be overweight and has had a couple of children easily, but they may also be younger than you and many of the health issues they face because of their weight may not have caught up with them yet, but it will. I always have to get people to stop focusing on others and get back to looking at themselves, because other people are different. Other people are not you. We are all different individuals with different weaknesses in the body and what may affect one person, may not affect another, but this does not mean we can sit back and just do nothing about our health, or keep comparing our life to another.

Looking at a person’s body fat is paramount for any health condition that the body faces and we need to look at the individual, not at the masses. Research shows us that excess body fat can lead to diabetes, heart disease, cardiovascular events, cancers, gynaecological issues, infertility, men’s health issues and many other complaints in the body. It can also lead to an early death too. This is a fact and no matter how many excuses people want to make, nothing is going to change the fact that excess body fat is not good for us and it causes problems with our health and now costing the health systems dearly too.

Excess body fat produces excess estrogens in the body and we are now calling these “Obestrogens”. These excess estrogens can not only have an effect on testicular and ovarian function, but they also interfere with other hormones, increase inflammation in the body and then add as drivers for other health issues in the body. These “Obestrogens’ can also interfere with your DNA and can also be passed on to your future offspring through the DNA of the sperm and eggs and also pass genetic conditions onto them as well.

Eating too many grains, sugars, alcohol and refined foods are a big cause of excess fats in the body. These foods lead to increased blood sugar levels, which in turn lead to excess insulin in the body. This then leads to the body storing fat and also stopping the burning of fat. This then leads to high levels of inflammation in the body and a big driver behind many of the major health complaints in the body and even our leading causes of death, in both men and women. When people ask me how refined foods and grains lead to excess fats I also ask them “How do we fatten up cattle and livestock?” The answer is we give them high amounts of grains which increase hormone levels, which then lead to excess growth and also lead to higher amounts of fats in their bodies.

How Excess Body Fats Affect Our Health

Excess body fats are a big contributing factor in PCOS, Endometriosis, Fibroids, Cysts, Polyps, Sperm quality issues, Prostate issues, Diabetes, Infertility, Cardiovascular disease, Heart disease and Cancers in both men and women

For women excess body fat can lead to menstrual irregularities and heavy periods too, without necessarily having a known gynaecological condition. These excess fats produce estrogens, which are needed to thicken the uterine lining. But when there are too much circulating estrogens, the lining becomes too thick and unstable, eventually leading to bleeding. This can be unpredictable, and often very heavy, lasting a long period of time. These excess estrogens can then lead to, or be a driver of gynaecological conditions such as PCOS, Endometriosis, Fibroids etc. They can also be a big contributing driver of cancers in women.

These excess fats can also lead to men growing breasts, feminisation, having prostate cancers, prostate issues, sperm issues, diabetes, heart disease, infertility, erectile dysfunction, and many cancers that men face.

With many of the developed western countries have a population with over 70% of its people being overweight, or obese, now more than ever we need to look at ways of educating people about eating better, exercising more and looking after their health. While we need governments to intervene, we also need people to take personal responsibility too. Here in Australia we do have healthy eating guidelines that is set by the government and while they are not perfect, they do tell us about the dangers of excess body fat.

With so much health information about the dangers of refined foods, processed foods, sugars, grains and alcohol, we really do have lots of resources that we never used to have available to us. There really is no excuse any longer. If you really do not know what a good diet is supposed to be, there are qualified health professionals, such as nutritionists etc, who can help you.

If you truly are eating a proper healthy diet and exercising, then you shouldn’t be overweight. If you are doing all the right things, then there could be other underlying issues that need to be addressed by an appropriate healthcare professional. But many times I find that what people think is a healthy diet, or appropriate exercise, is very far from what a healthy diet and appropriate exercise is. It is all about what people have been taught by their family and what their perception of a healthy lifestyle is.

If you do have a gynaecological condition, have a men’s health issue, are having problem with fertility, or just need to get healthier, now is the time to act. We can no longer deny that excess fats are a major concern for the population and are causing so many health issues across the board.

Just so people know, it isn’t necessarily about weight and measuring yourself with scales. Scales do not show the amount of body fat we have and muscle weighs more than fat per cubic cm. We need people to get out the tape measure to truly see how much fat they have and start to look at waist measurement, rather than weight measurement.

A health male needs to have a waist measurement of 94cms or below and a woman needs to have a healthy waist measurement of 80cms or below. If a male has a waist measurement about 94cm or more, or a woman has a waist measurement of 80cms or more, both he and she are at increased risk of health issues. A measurement of above 102 cm (for men) or 88 cm (for women) is one of the components of Metabolic Syndrome, which puts you at increased risk of diabetes, cardiovascular disease and cancers.

Maintaining a healthy lifestyle is vital protection against many of the health issues we face. Regular exercise, limiting alcohol, non-smoking, a nutritious diet, reducing grains and refined foods and stress reduction are all important.

The lower GI diets (Primal, Paleo, Ketogenic, Zone etc) have been shown to be much better than others for people who are overweight, obese and have excess body fats. Part of any of my treatment plans involve a healthy diet. A healthy diet, along with other nutritional support,  has been researched and shown to benefit health and longevity. It has also been shown to increase fertility and assist with many health issues we all face.  Diet and lifestyle changes are a big part of my overall treatment and health management for everybody that comes to see me for help.

When I help people with weight issues I always say that I am there to help you, not judge you. It is about helping people help themselves have a better life and have better health and that is the main priority.

Regards

Dr Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Expert

Dr Andrew Orr Logo Retina 20 07 2016

Dr Andrew Orr Logo Retina 20 07 2016

PCOS

Why it is important to manage PCOS properly via a multimodality approach

The one thing I see daily in practice is that many women with PCOS are not being managed properly with regards to their symptoms and future health implications.

Many women, who actually do have PCOS, have been misdiagnosed, undiagnosed, dismissed, or are not being managed properly at all. This is quite concerning as PCOS can have long and short-term term health implications and can also have an effect on fertility.

Every day I see women, who have irregular cycles and symptoms of PCOS (Acne, Hirsutism, weight issues, emotional issues etc), being told that they do not have PCO, or PCOS. Just today a colleague and myself had to call a radiology centre and get their head radiologist to go back and look over a scan of a woman who had been told she did not have Polycystic ovaries, and from the scan that we were viewing actually showed that she did have Polycystic Ovaries. There was a big rush around and a major apology and an updated scan report sent with the notation saying the patient has multiple cysts on the ovaries consistent with PCOS. This is exactly why so many women with PCO and PCOS are misdiagnosed, or not even diagnosed at all.

Just so everyone knows, scans and blood tests are not always accurate in the diagnosis of PCOS and new guidelines, published recently, for the diagnosis of PCOS now highlight this. https://www.mja.com.au/journal/2018/209/7/new-evidence-based-guideline-assessment-and-management-polycystic-ovary-syndrome

The point I am trying to make is that many women are not aware they have PCO, or PCOS and the ones that do have the diagnosis, just are not being managed properly.

The main symptoms of PCOS

  1. Irregular or absent menses
  2. Acne
  3. Hirsutism (excess hair growth)
  4. Weight issues
  5. Emotional Issues (depression, anxiety etc)

Women with PCOS may only have 1-2 of the symptoms, or may have all of the symptoms combined. Up to 90% of women with acne will have PCOS, especially when combined with menstrual irregularities.

Many women with PCO and PCOS are completely unaware of the serious future, and sometimes present, health implications as a result of their disease state.

Women with PCO and PCOS are at very real danger of the following

  1. Type 2 diabetes
  2. Gestational diabetes
  3. Cardiovascular disease
  4. Infertility
  5. Recurrent Miscarriage
  6. Mood disorders (Depression and Anxiety)
  7. Weight issues (Obesity, Eating disorders etc)

All of the above are well known health risk factors for women with PCO and PCOS and this is not often explained to the patient.

Women with PCO and PCOS need to be educated that a multimodality approach is needed to treat and manage their disease state properly. The number one treatment for PCO and PCOS should always be diet and lifestyle modifications and interventions. The main focus should be on treating the main driver, being insulin resistance. Once this is achieved, many of the symptoms of PCO and PCOS will settle down as well. If remaining symptoms do not settle, then other treatments and health care management should be used.

The Pill

While the oral contraceptive pill can offer symptomatic relief of the symptoms of PCOS, it is not going to treat the underlying cause of the disease, nor is it going to be a cure. The other issue is that many women are having their underlying symptoms being masked by the contraceptive pill and completely unaware of the future health and fertility issues that can still be present. Women need to be made aware of this and often aren’t.

Metformin

While metformin is routinely used for women with PCO and PCOS, it does have a high side effect profile. Gastrointestinal and digestive upset are one of the major reasons many women stop taking it. It is also a category C drug and should not be used in pregnancy, as it is could affect the unborn baby. Metformin also has risk factors for depleting Vitamin B 12 and can lead to anaemia if used long term. Long-term use of metformin can also damage the liver and kidneys.

There are some very effective alternatives to Metformin, without the high side effect profile, and these can be discussed with you healthcare practitioner.

Modalities that assist PCOS

As mentioned before, PCO and PCOS can be effectively managed and assisted using a multimodality approach, which could include the following:

  1. Medical treatments and interventions
  2. Hormonal Therapies
  3. Surgical Intervention (Ovarian Drilling)
  4. Diet and Nutritional advice and modification
  5. Exercise
  6. Complementary Therapies and Complementary Medicines
  7. Vitamins and nutritional supplements
  8. Acupuncture
  9. Psychology and counselling
  10. Lifestyle changes
  11. Mindfulness
  12. Relaxation and meditation

Women with PCO and PCOS may need a few of the modalities combined and some may need all of them combined together. It would all depend on the individual and how bad their presenting symptoms are. A healthcare practitioner who specialises in this area will be able to tell you which modalities and therapies will be best for your individual needs.

PCO and PCOS can have long-term and short-term health consequences and some of these can be very serious. We need for practitioners and patients to know this. Education is key for any disease state and the facts also need to be presented as part of this education as well.

New guidelines have just been published by an Australian led international collaboration, to help improve the care, health outcomes and quality of life of women with PCO and PCOS. Key changes in the new guidelines include refinement of individual diagnostic criteria focusing on improving accuracy of diagnosis; reducing unnecessary testing; increased focus on education, lifestyle modification, emotional wellbeing and quality of life; and emphasising evidence-based medical therapy and appropriate fertility management.

A multimodality approach is something that I always talk about and has always been a part of my clinical approach to assisting women with PCO and PCOS. It is also something that I educate my fellow colleagues and practitioners on as well. Women who suffer from PCOS also need to be educated about this as well and why I will always continue to write these posts.

If you do have PCOS, or suspect that you may have PCOS, please make sure you get the help and care you should be getting and do not leave it too long to get that care and assistance as well. Make sure the person that you see also specialises in PCOS as well. If not, then find somebody who does. You can always book in to see me, in person, or via online consult, as well. I help people from all over the world.

 

Regards

Dr Andrew Orr

-No Stone Left Unturned

-Reproductive Medicine and Women’s Health Medicine Expert

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No matter what you do, some days are just going to be bad days and that is OK

The one thing I have learn about life and having to live with a chronic disease is that no matter what you do sometimes, some days are just going to be bad days and that is OK

You can have the best diet in the world, you can have the best emotional outlook, you can exercise, and you can have the best support, but some days “Shit Happens”

Some days the disease state just flares up, or your immune system just doesn’t work as well as it should, or the body just wants to take a break and those are the days when you sit there wondering what you have done, or ask yourself “why is this happening?”

This week I had one of those weeks. I am sure many people can relate. My lung capacity was at half of what it should be and I was really struggling to get on top of it all. I had to work really hard to get back to a state of normalcy and it was really concerning me and also frustrating me. The whole week was a struggle and then by the end of the week, I was starting to feel back to normal again. But, it took some really hard work to start to feel normal again.

“Why?” I kept asking. My diet is good and I am taking my medicines and trying to stay positive and I have been getting to be early, so why is this happening?

Well the truth is that sometimes, when you are living with a chronic disease, no matter what you do, you are just going to have bad days. People can say what they want, or try to justify it being this, or that, but some days there is just no reason why.  But, the main thing is that even though you have bad days, as long as the good outweigh the bad, then you are moving forward and probably in a better place than you previously were. We aren’t invincible. We are humans. We get sick. We get tired. We get stressed. We cannot expect to be in perfect health all the time and sometimes we just have to realise this. Then, if you have a chronic disease state, there is more chance of having some bad days and again, that is OK.

Having said that, if you do all of a sudden have a flare up of symptoms, it is good to do the system check and evaluate what may be causing you to have a flare up, or have a bad day, or not feel so great, or feel so tired etc.

The things you need to ask yourself are:

  • Have you been eating well?
  • Have you been eating too many bad foods?
  • Have you been stressed?
  • Do you have negative people impacting you and your health?
  • Are you exercising and moving the body to keep fit?
  • How is your emotional outlook?
  • When was your last holiday?
  • When was the last time you took some time out for you?
  • Have you been taking you medications? (if needed)
  • Have you been following the advice from your healthcare practitioner?
  • When was the last time you had a health check-up?
  • Have you been drinking enough water?
  • Have you been drinking too much alcohol?
  • Have you been getting enough sleep?
  • Have you had a virus, or a cold, or a flu, or some other illness recently?

All these things you need to ask yourself and are some of the things I asked myself recently. If you aren’t getting enough sleep, stressing too much, not exercising, not eating well, aren’t being positive, aren’t drinking enough water, not taking your medications, not following healthcare advice etc, and then all these things can lead to a flare of symptoms. Sometimes it is just a bit of everything that builds up and causes you to feel poorly, or have a flare of symptoms. Sometimes it may just be one thing alone. No matter what it is, you need to do a check and see if there is anything that needs to be changed in order for you to feel better.

Some of the things you can do to feel better:

  • Eat health whole foods and no refined foods
  • Go and do some exercise, or go for a nice walk in the fresh air
  • Drink more water
  • Take your medicines
  • Take some time out for self
  • Do some mindfulness training
  • Do some meditation
  • Book in with your counsellor
  • Book into see your healthcare practitioner
  • Get some acupuncture
  • Do some yoga
  • Get a massage
  • Go for a swim
  • Read a book
  • Get a funny movie out and have some laughs
  • Be supported by friends
  • Make love
  • Get cuddles
  • Be positive

There are many other things you can do to make yourself feel better and help get your health back on track.

As I said, we are humans and we aren’t perfect, but we also need to sometimes stop and take check of our lives and look at what may be causing our health to suffer, or our disease states to be exacerbated and flare symptoms. It is about being proactive and being honest with one’s self and then making the necessary changes to help yourself get better. There is no “try” there is only “do”.

Lastly, just remember to not be harsh on yourself. Be kind to yourself. Just remember that you are human and it is OK to have a bad day. If those bad days continue, it just means you need to get some help and get back on top of your health again and that is OK. Never be scared to ask for help when you need it and ask for support from those around you.

Now, off you go, and be the best version of you and go and have a good day.

Take care

Regards

Dr Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

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