Meet harmonié . Bio-identical hormone replacement therapy

Anti-Aging at the Couri Center:

The proper balance of hormones is vital to a woman’s health. Recent studies show that women are experiencing menopause at much earlier ages. By age 40, most women are totally depleted of normal levels of estrogen and have lost nearly all their progesterone and more than half of their testosterone. While a normal part of aging, these changes can greatly affect the way we feel. Untreated, imbalanced hormones cause a variety of undesirable symptoms.

Symptoms of hormone imbalance:

  • Anxiety/Depression
  • Fatigue/Loss of energy
  • Weight gain
  • Decreased libido/Sex drive
  • Hot flashes/Night sweats
  • Hair loss
  • Insomnia
  • Loss of muscle tone
  • Brain Fog/Loss of memory
  • Irritability
  • And more…

Dr. Michele Couri, MD, FACOG, ABIHM has specialized in gynecology and women’s health for over 18 years.  Passionate about treating changing hormones & symptoms of menopause, the Couri Center is the leader in women’s bio-identical hormone replacement therapy pellets.  Trust the experts.

If you suspect fluctuating hormones are causing undesirable changes in your body, it’s easy to get your hormone levels checked:  Schedule here: info@couricenter.com or call 309 692-6838.

 

 

 

 

 

 

Seared Shitake Mushrooms and Spinach Salad By Chef Golda Ewalt

Ingredients:

For the dressing

1 tablespoon red wine vinegar

1 tablespoon fresh lemon juice

2 garlic cloves, finely minced

Salt and freshly ground pepper to taste

1 teaspoon Dijon mustard

⅓ cup extra virgin olive oil

 

For the salad

2 cups (6 ounces) shiitake mushrooms, stemmed and sliced (discard the stems or use for stock)

2-teaspoon olive oil

Salt to taste

1 6- or 7-ounce package baby spinach, rinsed and dried (arugula works great too)

2 celery stalks, sliced very thin

2 tablespoons broken walnut pieces, lightly toasted

¼ cup shaved Parmesan cheese

 

Directions:

  1. Whisk together the vinegar and lemon juice with the garlic, salt, pepper, and Dijon mustard. Whisk in the olive oil. Set aside.
  2. Combine the spinach, nuts, celery and cheese in a salad bowl.
  3. Heat a pan over medium high heat. Add 1 teaspoon oil and when very hot, add the mushrooms. Shake the pan once, then let the mushrooms cook without moving them around until they begin to sweat and soften (watch closely). After about a minute or two, when they have begun to sear and release moisture, you can move them around in the pan. Cook for about 5 minutes, season to taste with salt and pepper and remove from the heat.
  4. Add the mushrooms to the spinach mixture and toss with the dressing. Serve at once.

 

Makes 4 salads

Shingles. Are You at Risk? By Dr. Kaleb Jacobs, DO

The Centers for Disease Control and Prevention (CDC) estimates that approximately 30 percent of people in the United States will experience shingles during their lifetimes. Age is the most important risk factor for the development of shingles.

 

Key Facts (from the CDC)

  • Shingles and chickenpox are caused by the same virus called varicella zoster virus.
  • An estimated 1 million people get shingles each year in the United States.
  • Anyone who has had chickenpox can get shingles, and you can get shingles at any age.
  • Your risk of getting shingles and having more severe pain increases as you age.
  • The shingles vaccine called Shingrix is recommended for people age 50 or older to protect against shingles and the long-term pain that it can cause.

 

Varicella-zoster virus (VZV) causes two clinically distinct forms of disease: varicella (chickenpox) and herpes zoster (shingles). Your first VZV infection results in the rash we call chickenpox. This rash will resolve and the virus will remain dormant in nerve roots. Re-activation leads to shingles. Shingles is a painful rash that typically affects only one side of the body, forms small fluid-filled sacs in what is called a dermatomal distribution.

 

Shingles manifests typically as a rash and acute inflammation. The rash changes from red and fluid-filled sacs to crusted sores over about 7 to 10 days. In healthy adults, at this point they are no longer considered infectious. The upper chest/back and lower abdomen/back are the areas most commonly involved. Acute neuritis is the medical term assigned to the painful symptoms most common with shingles. Nearly 75% of patients will experience this type of pain, which can begin before the rash develops. The pain is often described as burning, throbbing, or stabbing where the rash eventually appears.

 

Complications as a result of shingles is possible and the most common complication is postherpetic neuralgia (PHN). Up to 15% of patients with shingles will develop PHN, which may last beyond four months from the initial onset of the rash. Symptoms include pain, numbness, and pain worsened by movement in the affected dermatome. People older than 60 years account for 50% of these cases.

 

Similar to other viral or bacterial infections, prevention is key, and vaccination is paramount in preventing both the reactivation of herpes zoster and shingles, as well as, the possible complications associated with the disease.

 

There are two types of vaccines, recommended based on age. Current evidence suggests Shingrix is the preferred vaccination because of better efficacy and less waning of immunity over time, for people 50-60 years old. People over 60 years old should receive the shingles vaccine Zostavax®, regardless if they have had chickenpox or not. The CDC does NOT recommend Zostavax® in people between the ages of 50 through 59, because the protection from the vaccine may not provide adequate protection later in life, when the risk is greatest. Even if you have had shingles previously, you should still receive the vaccine to prevent future occurrences.

 

Based on my research, Medicare Part D plans cover the shingles vaccine, but you may have to cover some of the cost or copay. Medicare Part B does not cover the vaccine. Most private health insurance plans cover the vaccine, but this may only apply to those over 60 years old. For clarification, please contact your insurance provider. Walgreens and CVS in Peoria, do carry both vaccines. The pharmacist can give the injection, but may require a prescription from your primary care physician. The cost without insurance may be around $250 to $350. Other pharmacies may carry the vaccine – call your local pharmacy to confirm.

 

Prevention Tips (from the CDC)

  • People who have a weakened immune system should talk to their healthcare provider to see if it is safe for them to get the shingles vaccine.
  • People who have previously had shingles or Zostavax® should still get Shingrix to help prevent future occurrences of the disease.
  • The shingles vaccines are available in pharmacies and doctors’ offices. Talk with your primary healthcare provider if you have questions about the shingles vaccines.
  • If you have shingles, don’t touch the rash, keep it covered and stay away from pregnant women who aren’t protected against chickenpox, premature infants, and people with weakened immune systems until the rash crusts over.

 

For more information: https://www.cdc.gov/shingles/

 

Kaleb Jacobs, DO

 

 

Couri Girl Spring 2018

At the Couri Center, we specialize in women’s health.  With years of advanced medical training and decades of experience, our success is easily measured in volumes of patient praise.  From traditional gynecology & surgical procedures, integrative health programs & aesthetics, take comfort in knowing you can trust the Couri Center with:

  • Well-Woman Exams
  • Urinary Incontinence
  • Menopausal Management
  • Family Planning
  • Contraception
  • Pap Smears
  • Pelvic Ultrasounds
  • Treatment of Heavy Menstrual Bleeding and/or Fibroids
  • Treatment of Abnormal Pap Smears
  • da vinci® Robotic Surgery
  • MonaLisa Touch™ Vaginal Laser
  • harmonié Bioidentical Hormone Replacement Therapy
  • Food Sensitivity Testing
  • Customized Nutritional Supplements
  • TLC™ Integrative Lifestyle Programs
  • Weight Loss Programs
  • Infrared Sauna Therapy
  • Aesthetic Studio:  Laser Hair Removal, Wrinkle/Age Spot Removal, Scar & Stretch Mark Removal, Rosacea & More
  • Injectables:  BOTOX®  & KYBELLA®
  • LATISSE®
  • Pro-Niacin® Skincare by NIA24®

New patients welcome!  Schedule today: 692-6838  

Summer 2018 Total Lifestyle by Couri

Let’s face it.  The more you know about your health, the better equipped you are to achieve your wellness goals.  Dr. Michele Couri’s personalized, integrative wellness programs include:

  • detoxification
  • food sensitivity
  • hormone balancing
  • metabolic labs
  • nutrition
  • exercise

Schedule your free consultation today:  info@couricenter.com or 692-6838.

Enroll today and receive a FREE Fitbit!

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Vote: Couri Center for BEST Customer Service

For years, YOU have been telling us what excellent customer service we provide.   Thank you so much for allowing us the opportunity to take care of you!  Providing you with outstanding medical care & patient service is our priority and it’s our privilege to give our best to YOU.

Each year, Peoria Magazines conducts a Best of Peoria contest whereby you can nominate “the best of” in multiple categories.  Please cast your vote now to select Couri Center for the category: BEST CUSTOMER SERVICE

Voting is EASY.  CLICK HERE TO VOTE

Thank you, we are grateful for your time.

Welcoming NEW Gynecology Patients

 

Welcome to the Couri Center for Gynecology & Integrative Women’s Health.  We are accepting NEW patients and look forward to meeting you!

At the Couri Center we specialize in women’s health.  With years of advanced medical training and decades of experience, our success is easily measured in volumes of patient praise.  From traditional gynecology & surgical procedures to integrative health programs and aesthetics, take comfort in knowing you can trust the Couri Center.

LEARN MORE ABOUT THE COURI CENTER HERE

If you would like to schedule your new gynecology visit with one of our providers, please call 309-692-6838.  To expedite your appointment process, please complete the below forms and return them to us. 

What do I need to bring to my appointment?

To allow us to better serve you, and expedite your check-in process, we have included the below forms for you to fill out at your convenience at home:  Patient Information Form, Gynecologic Questionnaire and Medical Release. Also, please include a copy of the front and back of your insurance card. Please complete and return all forms to:  Couri Center, 6708 North Knoxville Avenue, Suite 1, Peoria, Illinois, 61614 or email to info@couricenter.com.  Unfortunately, if we do not receive these forms two weeks prior to your appointment, we will ask you to reschedule. We take pride in providing the utmost in compassionate and comprehensive gynecologic care and your paperwork helps us do just that right from the start.

Thank you so much, we look forward to meeting you!

Regards,

The Couri Center for Gynecology

If you are a NEW PATIENT: Please plan on arriving 15 minutes early.

Please complete the below (3) forms as follows:

A.  Print all (3) forms and fill in by hand. Then either:

  1. Mail to our office.  Or
  2. Scan completed documents and email to info@couricenter.com.

OR

B. Complete forms online as .pdf:

  1. Please open each form and save it on your computer, preferably add your last name to the file name while saving
  2. Open the saved documents and complete each fill in form
  3. Save completed documents.
  4. Email completed documents as attachments to:  info@couricenter.com

 

Yes, You Can Get Relief From GSM! By Dr. Kaleb Jacobs, DO, OB/GYN

Vulvovaginal atrophy, also referred to as vaginal atrophy, urogenital atrophy, or atrophic vaginitis, results from estrogen loss and is associated with vulvovaginal complaints like dryness, burning, and painful intercourse in menopausal women. Urinary complaints are not uncommon, including frequency and recurrent bladder infections, which is why a newer term “genitourinary syndrome of menopause” or GSM was introduced a few years ago.

The hallmark symptoms of vulvovaginal atrophy include lack of vaginal lubrication and pain with intercourse. Up to 45% of women around the time of and after menopause will suffer from these issues, but few will seek help or treatment from their gynecologist. Hot flashes associated with menopause tend to improve over time, but vulvovaginal atrophy typically does not.  It has the potential to negatively impact a woman’s sexual health and quality of life beyond the time classically thought of as menopause. Menopause is not a finite event – not like flipping a switch – but a transition in a woman’s life.

Symptoms women often report include dryness, irritation of the outside of the vagina (vulva), burning or pain with urination, and pain with sexual intercourse (dyspareunia). Pain from vulvovaginal atrophy can lead to decreased interest and eventually avoidance of sex. It is not uncommon that women report bleeding with intercourse or with wiping, due to the thin and brittle vaginal tissue. Left untreated, the vaginal tissue can become ulcerated, tear, or narrow (stenosis) – further leading to pain with sex.  Estrogen receptors are present in the vaginal tissue, so low estrogen states, most commonly natural menopause, are most likely the culprit of this condition.

When women report symptoms or upon routine enquiry of possible unreported conditions at an annual well woman exam suggests vulvovaginal atrophy, additional detail is sought and a pelvic exam performed to evaluate the possible causes.  Other possible causes of these symptoms may include infection, irritation from soaps, liners, or clothing, or even another condition entirely like lichen sclerosis. These need to be excluded before treatment.  Some conditions which present similar to vulvovaginal atrophy may require a biopsy of the vaginal or vulvar tissue. Once the diagnosis of vulvovaginal atrophy is confirmed, the goal of treatment is relief of symptoms.  Options to alleviate symptoms of atrophy include nonhormonal lubricants and hormonal vaginal estrogen.

There are several lubricants available on the market, including water, silicone, and oil-based products. Some women find coconut and olive oil therapeutic.  There is little information in medical journals to report the effectiveness and safety of these products, but many women report favorable results with their use.  Some lubricants may cause irritation, especially on thin (atrophied) tissues. We recommend that patients test products on a small patch of skin for 24 hours before using intravaginally. Not all products are appropriate for use with condoms as they can erode the material (especially latex), creating an ineffective barrier for contraception or prevention of sexually transmitted infections.

Vaginal estrogen is the preferred option when a patient’s symptoms are restricted to the vagina. Several medical studies confirm the effectiveness of vaginal estrogen; showing decreased vaginal dryness, decreased pain with intercourse, and decreased urinary tract infections (UTIs). Other evidence of the treatment effectiveness is observed on pelvic exams with thickening of the vaginal tissue and visibly less irritation of the tissue.

Vaginal estrogen is safe in well-selected women without risk factors. The estrogen levels measured in labs collected from women treated with vaginal estrogen are below the average level for postmenopausal women. This shows that the medication is having its effects locally and very little is absorbed through the rest of the body. Because of this limited systemic (whole body) absorption, a progestin is generally not required for women using low-dose vaginal estrogen.  The North American Menopause Society (NAMS) advises avoiding sexual activity for at least 12 hours after using vaginal estrogen to avoid absorption by your sexual partner.

There are other treatment options beyond vaginal estrogen or lubricants for vulvovaginal atrophy, including other topical creams, oral pills, and vaginal lasers (e.g. MonaLisa Touch ®). If you have symptoms, please know there are treatments available and reach out to our office for evaluation.

Best,

Dr. Kaleb Jacobs

 

 

 

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Understanding the Pap Smear By Dr. Kaleb Jacobs, DO, OB/GYN

No other cancer screening test has seen the success of the pap smear.

Sir John Williams, in the late 1800s first described what would eventually be known as carcinoma in situ (CIS) of the cervix, or abnormal cervical cells that remain in the place where they first formed. Some refer to CIS as precancer. Identifying cancer early when treatment options can prolong the length and quality of a person’s life is the cornerstone of preventive medicine.

In the early 1900s, several scientists discovered that changes inside cervical cells could be seen before cervical cancer was recognized. Pathologists in this early part of the century relied on microscopic examination of tissue biopsies, which meant there was a visible abnormality on the cervix which could be seen by the naked eye. This unfortunately translated to being “too late” for many women, because cancer had taken hold already.

In the 1940s, as the cervical smear was being developed, scientists learned that changes inside cervical cells could be seen several years before cancerous growths, visible by the naked eye, had developed. This process of viewing cervical cells under a microscope is termed cytology. The discovery that individual cells from the cervix have features which may be used to diagnose carcinoma (cancer) is attributed to the “father of cytology,” Dr. George N. Papanicolaou. His landmark publication in 1941 marked the beginning of cervical cancer screening with cytology and the test that bears his name, “the pap smear.”

The finding of abnormal cervical cells on a pap smear, which have the potential to grow into cervical cancer, was a breakthrough in preventative care for women. As a result, the pap smear over the last 40 to 50 years has decreased the incidence of cervical cancer by 75%.

Overtime, cervical cytology (the pap smear) as a means of screening for pre cervical cancer has changed. Most notably and recently, with the addition of testing for human papillomavirus (HPV). It is recognized that an infection with HPV is required for the development of most cervical cancers. It is also established that most women with HPV will NOT go on to develop cervical cancer. A woman’s healthy immune system and other personal risk factors, contribute to her ability to “clear” this virus, thus decreasing her risk for the development of cervical cancer.

Through extensive research and collaboration, two prominent societies, the American Society for Colposcopy and Cervical Pathology (ASCCP) and the American College of Obstetricians and Gynecologist (ACOG), have made recommendations for cervical cancer screening with the pap smear.

The most recent guidelines were published by the ASCCP in 2012 which changed the frequency of screening for women and placed a larger emphasis of combined screening with HPV testing. These changes were made to balance the benefit of screening with the risk of over (and sometimes unnecessarily) treating women for abnormal pap smears.

The nuances of the screening recommendations are many, but there are several steps you as a patient can take to maximize your health:

  • Annual Well Woman Exams with your gynecologist
  • Get pap smears per your gynecologist’s recommendations
  • Do NOT smoke or use other tobacco products – tobacco promotes the abnormal cells which can develop into cancer
  • Get yourself vaccinated or your children (girls and boys) vaccinated for HPV per the CDC recommendations

Last minute facts:

  • About 60% of women diagnosed with cervical cancer have NOT been screened in the past 5 years or longer
  • The lifetime risk of acquiring a genital HPV infection is about 80%
  • HPV-16 and HPV-18 (both covered by all of the HPV vaccines on the market) are present in upwards of 70-80% of cervical cancers

There is a myriad of information available about cervical cancer, screening, and HPV. If you would like more information please reach out to us on the portal.

 

Dr. Kaleb Jacobs

 

 

 

 

 

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