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Network for Optimal Aging and Wellness
Located in Watkinsville,Georgia

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Pap Smears - What you should know about this simple test.
   By Elizabeth L Schultz, DO, FACOG

Women should begin to have annual pap tests at the age of 21 or when they become sexually active. Pap smears should also be repeated 4 to 6 months after changing a sexual partner if your annual pap is more than 6 months away.

    Why do you have this test done? I've asked many groups of women this question and few if anyone can answer "because I am trying to protect myself from cervical cancer."

    And, when questioned, no one can ever tell me where this cancer comes from.  That is because only recently (within the last 10 to 15 years) could the medical community even begin to answer that question.  Today, we know that cervical cancer is sexually transmitted by the Human Papilloma Virus (HPV). There are over 100 known papilloma viruses......some of them cause warts on our hands, on our feet, men on their penis, women on their cervix, and in both men and women warts on their genitals.  These warts have to have the right "soil" or anatomical site to grow....and some of these warts that grow on the cervix and penis, can cause cervical or penial cancer. We have also come to know that they may cause throat cancer from oral sex and rectal cancer from rectal sex. No orifice is safe if you have sex with someone who is carrying the HPV-cancer causing viruses and your immune system is unhealthy.

    Recently, we've become aware of host resistance/susceptibility factors that play a part in people acquiring these viruses.
  The goal, with this research, is to develop a vaccine [It's been done and the initial vaccine is called Gardisil.] so that every sexually active person can be vaccinated against this disease...thus eliminating it.  Elimination is the future and not now, even still. For always, prevention and reducing risk is the key! Read the Down side of Garadsil Vaccination to be fully informed.

    Your chances of developing cervical abnormalities increases with every new sexual partner. Every time you have sex with someone, you are having sex with every other person they have ever had sex with.....it's just that simple!  If you and your partner are virginal, you have less of a chance of introducing viruses into your relationship.  If you are virginal and your partner has had many partners, your chances of being exposed to these cancer producing viruses increases significantly.   It only takes once with the wrong partner.

    In the past, physicians use to blame our mothers for passing on these viruses during our birth through the vaginal canal.  In the case of infants developing warts on their vocal cords, we know this is true.  Today, we're less certain about transmission during birth.  What seems to prevail is that complications from surgical delivery for every women with HPV infections are higher and associated with more deaths than care of HPV problems from vaginal births.

DECREASING RISK: 

    Women who smoke, are vitamin deficient, have been infected with the herpes virus, genital warts, or HIV are at an increased risk of developing cervical abnormalities. About 5% of all paps in the US note cervical dysplasia.  Younger women also seem to have more aggressive viruses when they are diagnosed with cervical dysplasias.  

Risk Factors for Developing Cervical Abnormalities 
"RISKY BEHAVIOR"                                  RELATIVE RISK
Age at first intercourse(<18)                                                2.76
Deficient diet intake of beta-carotene(<5,000 IU/day)         2.814
Smoking(10+ cigarettes/day)                                                3.06
Multiple sexual partners(2 - 5)or                                          3.46
 Partner with multiple partners                                                3.46
 Oral contraceptives(5 - 8 yrs)                                               3.66
   Deficient diet intake vitamin C(<30mg/day)                             6.717

   The lesson here is simple, modify your lifestyle and reduce your risk!
More about this later.

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WHAT PAP SMEAR SHOULD BE DONE AT MY ANNUAL EXAM?

   The ThinPrep is routine at NEWS since 1996.  We have been using this test for over 14 years now and are convinced that this is the best cervical cancer detection test to date.  Many studies point to its 65% increased accuracy when compared to the traditional pap smear.

    As the triage care is better defined with this testing, physicians and insurance companies alike will yield to it's superiority. Today in 2010 they have.

        FACT: ThinPreps are around $48 now and we are worth it.

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PAP SMEAR REPORTING:

     All of the following conclusions are drawn from the ThinPrep and HPV-ASSAY performed at the Reference Pathology Services in Utah.  Dr David R Bolick has been a most accessible clinician and is clearly a dedicated professional.  I thank him for all of the discussions we've had in the past and will have in the future!

    When you get your results from your pap smear, it will be reported in one of the following modes.  The sophistication of your physician or the lab they use will be exposed when the results are reported to you. If they report a "class" result, this is an outdated system.....the newest system is the Modified Bethesda System.
    IF YOUR HEALTHCARE PERSON DOES NOT GET BACK TO YOU WITH THE RESULTS, FIND ANOTHER HEALTHCARE WORKER!!!!!
    Get a copy of your report and know what was on your report!  This doesn't take a rocket scientist to understand.

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Comparison of classifications systems for reporting pap smears.

    CLASS     DYSPLASIA                         CIN*                         MODIFIED BETHESDA SYSTEM
     I              Benign                                  Benign                                 Normal       
     II             Benign with inflammation     Benign with inflammation      ASCUS**
     III            Mild dysplasia                       CIN I                                     Low grade SIL***(LGSIL)
     III            Moderate dysplasia              CIN II                                    Low grade SIL (LGSIL)
     III            Severe dysplasia                 CIN III                                   High grade SIL (HGSIL)
     IV          Carcinoma in situ                  CIN III                                    High grade SIL (HGSIL)

* CIN = Cervical intraepithelial neoplasia
**ASCUS = Atypical Squamous Cells of Undetermined Significance, favor inflammation
**ASCUS = Atypical Squamous Cells of Undetermined Significance, favor dysplasia
***SIL = Squamous intraepithelial lesion

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UNDERSTANDING YOUR PAP SMEAR RESULTS:

    The Bethesda System is the latest classification and the easiest to understand.  Your pap smear results are either "NORMAL," "ASCUS," "LGSIL," or "HGSIL."

If NORMAL, repeat your pap yearly or 4 to 6 months after changing a sexual partner if your annual pap is more than 6 months away.
If ASCUS or LGSIL, have a HPV-ASSAY done. This test will inform you, within the confines of the test, what your next step in monitoring your reproductive health should be.

   HPV-ASSAY FACTS:

The incidence of HIGH RISK-HPV (HR-HPV) in specimens with ASCUS and LGSIL is markedly greater than the incidence of LOW RISK-HPV (LR-HPV).
If you test positive for LOW RISK-HPV , you may be followed every 6 to 12 months intervals with repeat pap testing.  During this time, follow life-style modifications presented below.
If you test positive for HIGH RISK-HPV , you need an immediate colposcopy from a Gynecologist.

ASCUS patients that test positive for HR-HPV:

*show an increased frequency of LGSIL and HGSIL at colposcopy
*when a lesions is not seen on colposcopy at the initial exam, that patient has a significant increased incidence of developing a HGSIL within one year

ASCUS patients that test positive for LR-HPV as compared to those with negative LR-HPV:

*show an increased incidence of LGSIL at colposcopy
*show a decreased incidence of HGSIL at colposcopy

ASCUS patients that test negative for HR-HPV have a very low probability (<5%) of having a HGSIL at colposcopy.

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THERAPY FOR NORMAL PAP SMEARS:
    The best way to ensure a continued normal pap is to decrease or eliminate the risk factors that cause abnormal paps.  So simply...don't engage in sex before the age of 18, don't smoke or have a sexual partner who does smoke (nicotine is carried in the ejaculate secretions!), limit the number of partners (and pick partners who also limit their partners).  Oral contraceptives in and of themselves are not at fault here, with the risk of pregnancy lowered, women may engage in more sexual encounters than they normally would have if they were unprotected. OC use also leads to the decrease of Vit. C, B6, B12, folic acid, riboflavin, and zinc.  The main culprit here seems to be the decrease in folic acid within the cells of the cervix.

    Adopt a natural health program that includes exercise and a nutrient rich, toxin free diet. Take additional supplements if necessary.  Support your immune system and organs like your liver and kidneys, that help clean the body's cells. 

THERAPY FOR ASCUS, LGSIL:
    First, all cervical abnormalities will not always progress to cervical cancer.  Many of these abnormalities will clear up on their own.   The problem is we don't which ones will and which ones won't. There is, however, increasing knowledge to help us determine which lesions we can take a "wait and see," "change life-styles and see," or a need to "immediately intervene medically." This knowledge comes from the HPV-ASSAY.

    NEGATIVE LR-HPV and NEGATIVE HR-HPV
    What is going on here?  The HPV-ASSAY is only testing for the more prevalent viruses and therefore may not be picking up the virus that is causing the abnormal pap.  In these cases, I generally do a colposcopy to rule out any abnormal colposcopic findings.  If there are none, I use life-style modifications.  If I find abnormalities on the colposcopy, I do biopsies to rule out dysplasias.

    POSITIVE LR-HPV and NEGATIVE HR-HPV 
        Because Dr. Bolick's study, showing a decreased incidence of HGSIL in ASCUS or LGSIL patients with +LR-HPV's, is the same conclusion I am finding with my patients,I am more convinced that using lifestyle modifications and follow-up paps every three to six months until normal paps are again obtained, is a viable option. I need to caution you that these conclusions are only valid if your pap findings are based on the ThinPrep and HPV-ASSAY.
    I define persistence as the same or worsening pap smear on two 3 month occasions and I then treat as noted below.

THERAPY FOR PERSISTENT OR RECURRENT ASCUS, LGSIL:
Treatment should be according to the ACOG (American College of OB-GYN) guidelines and carried out by a trained physician.

THERAPY FOR HGSIL:
Is carried out according to the ACOG guidelines.(more later on this point)

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LIFESTYLE CHANGES FOR ALL ABNORMAL PAPS

   DECREASE RISK FACTORS:

* Don't smoke or have a sexual partner who smokes (nicotine is carried in the ejaculate secretions!
* Limit the number of partners (and pick partners who also limit their partners).
*
Oral contraceptive use, in and of themselves, are not at fault here. But their use can lead to the decrease of Vit. C, B6, B12, folic acid, riboflavin, and zinc.  The main culprit being the decrease in the folic acid within the cells of the cervix.  So supplement these nutrients in the following amounts as long as you are not pregnant and don't plan on becoming pregnant during this treatment time:
* *Do the following for three months:
---- Folic acid: 10 mg per day
---- Vitamin B1 & B6: 100 mg per day in divided doses.
---- Vitamin B12[Methylcabolamine]: 1 mg per day
---- Beta-carotene: 25,000 - 50,000 IU per day
---- Vitamin C: 3000 mg per day in divided doses
---- Vitamin E: 400 IU per day
---- Selenium 400 mcg per day
**Do the following until the pap normalizes:
---- Folic acid: 3 mg per day
---- Vitamin B1 & B6: 50 mg per day in divided doses.
---- Vitamin B12: 1 mg per day
---- Beta-carotene: 25,000 IU per day
---- Vitamin C: 2000 mg per day in divided doses
---- Vitamin E: 200 IU per day
---- Selenium: 200 mcg per day
**Do the following for always!
---- Folic acid: 1 mg per day
---- Vitamin B1 & B6: 50 mg per day in divided doses.
---- Vitamin B12: 1 mg per day
---- Beta-carotene: 10,000 - 25,000 IU per day
---- Vitamin C: 1000 mg per day in divided doses
---- Vitamin E: 200 IU per day
---- Selenium 100 mcg per day
**There are additional vaginal herbal suppositories that Dr. Schultz uses to help your immune system combat the viruses in your vaginal tract. THese are used according to your pap test results and need a professional to prescribe.
* Maintain an adequate diet and decrease the intake of animal products especially animal fats.
* Normalize your gut flora by increasing acidophilus and bifidus bacteria via supplementation.  Eat yogurt. Take digestive enzymes with each meal to increase absorption.

LIVER SUPPORT:

* This is a complex topic all by itself and will be addressed in another article. For now, the simple use of Mega-Silymarin will nutritionally support liver and bile functions.

STIMULATE YOUR IMMUNE SYSTEM:

* Avoid fried foods, caffeine, and refined sugar in any form because they can increase inflammation and reduce immune function.   Inflammation in and of itself from any source increases free radicals which may stimulate an already overtaxed body to develop tumors
* The easiest way to stimulate your immune system is by using Esberitox by PhytoPharmica.  Esberitox has been used in Germany for over the last 20 years and is available through our CompanyStore.

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These guidelines should not be a substitute for medical care.  If your HealthCare practitioner will not consider Functional Medicine Therapies, then you need to find another HealthCare practitioner who will!  There always is a point that disease has taken over the body and traditional medicine needs to be employed. You need to have someone help you monitor your individual health in a partnership mode.

Don't assume your own healthcare find a trained professional to be a partner!

*Encyclopedia of Natural Medicine. Michael Murray, ND and Joseph Pizzornro,ND. Rocklin, CA, Prima Publishing, 1998.

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