A message from Dr. Michele A. Couri: Knowledge is Power: Tips to

April 2015
A message from Dr. Michele A. Couri: Knowledge is Power: Tips to Help us Handle the Truth
There has been much attention paid in the media lately to
the breast cancer gene mutations called BRCA 1 and 2.
Angelina Jolie’s story of BRCA positivity has been quite
interesting and inspirational to me. Her family history of
female-related cancer spans generations. Angelina lost
her mother, Marcheline Bertrand, who died at 56 after
battling ovarian cancer for a decade. But it turns out that
the risk of illness has spanned generations on that side of
Jolie's family. Australian magazine W oman's Day reports
that Jolie's maternal grandmother, Lois Bertrand, died of
cancer at 45, 18 months before Angelina was born; and
Lois' mother, Angelina's great-grandmother Virginia
Gouwens, died at 53 of ovarian cancer. In addition,
Marcheline's sister and Angelina’s aunt Debbie
succumbed to stage 4 breast cancer in 2013.
environment
influencing
the gene’s
expression
that changed:
diet, exercise,
and other
lifestyle
behaviors.
Alter the
environment
and you alter
the way genes
express
themselves in
response. In
BRCA1 and BRCA2 are human genes that produce
the end, the
tumor suppressor proteins. Specific inherited
health
mutations in BRCA1 and BRCA2 increase the risk of
outcome is
female breast and ovarian cancers, and they have been
greatly
associated with increased risks of several additional types dependent on
of cancer, just as prostate and pancreatic cancer. In terms how our environment is interacting with our genes. It all
of breast cancer, 55 to 65 percent of women who inherit a depends on the message the gene receives. This is why
harmful BRCA 1 mutation and around 45 percent of
personalized medicine combined with a healthy lifestyle
women who inherit a harmful BRCA 2 mutation will
is so vitally important.
develop breast cancer by age 70 years. In contrast, about
12 percent of women in the general population (without Because BRCA 1 and BRCA2 gene mutations are
BRCA mutations) will develop breast cancer sometime
relatively rare in the general population, most experts
during their lives. In regard to ovarian cancer, about 1.4 agree that mutation testing of individuals who do not
percent of women in the general population will develop have cancer should be performed only when the
ovarian cancer sometime during their lives. By contrast, person’s family history suggests the possible presence of
39 percent of women with a BRCA 1 mutation and 11 to a mutation in BRCA1 or BRCA 2. Several screening
17 percent of women with a BRCA2 mutation will
tools are now available to assess family history factors
develop ovarian cancer by age 70 years.
that are associated with an increased likelihood of having
a harmful mutation in BRCA1 or BRCA2, including:
Breast cancer diagnosed before age 50 years
Of interest, before 1940, the incidence of breast
Cancer in both breasts
cancer developing in women with the BRCA mutation
Both breast and ovarian cancers
was 24 percent. By 2013, the incidence was greater than
Multiple breast cancers
85 percent. What changed to cause that extraordinary
Two or more primary types of BRCA1 or BRCA2 related
leap in the occurrence of the disease from this mutation?
cancers in a single family member
Cases of male breast cancer
Not the gene; genes can’t and don’t change. It was the
Ashkenazi Jewish ethnicity
6708 North Knoxville Avenue, Peoria, Illinois
309.692.6838
www.CouriCenter.com
A note from Dr. Michele Couri continued...
Angelina Jolie recently wrote an article entitled “Diary of
a Surgery” about her recent procedure to remove her
ovaries and fallopian tubes, and it was featured in The
New York Times. She states, “I wanted other women at
risk to know about the options. I promised to follow up
with any information that could be useful, including about
my next preventive surgery, the removal of my ovaries
and fallopian tubes.” Two years ago she wrote about her
choice to have a double mastectomy. I feel that Jolie’s
candor and sincerity about her own personal journey has
helped countless women who are in similar situations.
What I also particularly liked about Jolie’s article is her
statement about options. She says, “I did not do this
solely because I carry the BRCA 1 gene mutation, and I
want other women to hear this. A positive BRCA test
does not mean a leap to surgery. I have spoken to many
doctors, surgeons, and naturopaths. There are other
options. Some women take birth control pills or rely on
alternative medicines combined with frequent checks.
There is more than one way to deal with any health issue.
The most important thing is to learn about the options and
choose what is right for you personally.” She continues,
“In my case, the Eastern and Western doctors I met
agreed that surgery to remove my tubes and ovaries was
the best option, because on top of the BRCA gene, three
women in my family have died from cancer.” I cannot
stress how important it is to be your own best
advocate as you consult with physicians regarding your
personal clinical situation. Ask questions, talk with other
patients, join support groups – do everything you can to
gain as much information to help you make appropriate
decisions for YOU. You have heard me say over and
over, “One size does not fit all in medicine.”
Her decision was one that comes with multiple factors to
consider. Jolie, who is only 39 years old, is now
menopausal due to the removal of her ovaries. With that
comes an array of changes that her body will experience.
The symptoms of hot flashes and night sweats, vaginal
dryness and mood changes are just the tip of the iceberg.
What lies deeper is an increased risk of cardiovascular
disease, osteoporosis, and Alzheimer’s disease. One large
population-based study of 127,000 nurses found that
women who had surgical menopause and never took
estrogen were 2.2 times more likely to develop coronary
heart disease then women who reach natural menopause
and never took estrogen. Taking estrogen, however,
eliminated this increased risk in women with premature
menopause. I have seen and counseled several patients
that, because they carry the BRCA mutation, have entered
into premature surgical menopause and are dealing with
very bothersome symptoms. My message to them is that
they don’t have to live with it. If they don’t have a
personal histor y of br east or ovar ian cancer , they can
safely use bioidentical hormone replacement to not only
reduce the severity of menopausal symptoms but to also
decrease some of the risk for future chronic disease. In
fact, Angelina Jolie is now on bioidentical hormone
replacement.
My preference for bioidentical hormone replacement is
subcutaneous hormone pellet therapy. This type of
hormone replacement therapy has been around since 1939
in Europe, the United States and Australia. It has proven
to be the most effective and safest modality to replace
hormones for both women and men. In a study of 976
women receiving bioidentical estrogen and testosterone
pellet therapy, there was only 1 case of breast cancer and
1 case of endometrial cancer in these women over a
ten-year time frame. That incidence is less than the
baseline population’s risk. Not only do the pellets
eradicate menopausal symptoms, increase libido, help
with fat burning and muscle building, they also increase
bone density at a rate of 8 percent per year and also
decrease the risk of cardiovascular disease and
Alzheimer’s. If you would like to learn more about
bioidentical hormone replacement options, don’t hesitate
to call us for an appointment. There would be nothing
more fulfilling for us than to help you through this
journey.
“It is not easy to make these decisions.
But it is possible to take control and tackle
head-on any health issue. You can seek
advice, learn about the options and make
choices that are right for you. I feel feminine
and grounded in the choices I am making for
myself and my family. Knowledge is power.”
-Angelina Jolie
To Your Health, Dr. Couri
Open enrollment for TLC
ends April 15.
The next enrollment period
will begin October 2015.
“Restoring Health to Women’s Healthcare.”
Stress Urinary Incontinence
Do you have a leaking problem? Stress incontinence (SUI) is a familiar problem and it is thought that 1 in 5
women over forty have some degree of incontinence. It tends to occur when someone coughs, laughs, lifts or
exercises. SUI presents itself when the muscles that control your bladder function, known as the pelvic floor
muscles, are stretched and weakened. Childbirth, injury, obesity, menopause and medication may cause these
muscles to weaken.
If these symptoms are noticed, talk with your provider. After an exam and urinalysis, further testing may be
completed such as a urodynamic test. After testing your provider will take into consideration your symptoms and
discomfort. Behavioral suggestions such as decreasing fluids after a certain time at night, ceasing smoking, losing
weight and voiding more frequently might be suggested. Other options include visits to physical therapists who
specialize in pelvic floor issues and doing Kegel exercises to help strengthen the pelvic floor muscles.
Vaginal pessaries are used to help support a leaking bladder. Many women who wish to avoid surgery choose this
option. Pessaries do need to be removed by the patient for cleaning or replacement when necessary. Medications
are also used to help strengthen nerve impulses. Injections are another option. These injections are inserted into the
surrounding tissues to help improve your bladder’s sphincter strength. Because every patient is so different,
correcting and improving stress urinary incontinence may take several tries before the right “blend” is found.
Surgery may also be an option. Each patient’s symptoms and test results are different. Remember that stress
urinary incontinence cannot be improved or eliminate if it is not addressed. Please do not suffer in silence. Talk to
your provider.
Sue Lang, APN, CNM, MS
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6708 North Knoxville Avenue, Peoria, Illinois
309.692.6838
www.CouriCenter.com
Sexual Abuse Awareness
April is Sexual Assault Awareness month. Sexual
violence is a very serious public health problem that
affects millions of women and men. In the United States
alone, 1 in 5 women and 1 in 71 men have been raped in
their lifetime. Nearly 1 in 2 women and 1 in 5 men have
experienced other forms of sexual violence at some
point in their lives.
Locally, the Center for Prevention
of Abuse offers many services and
support to those who have been
sexually abused. The offer shelter,
support, therapy for all age groups
including children and the elderly.
Not only do they offer these services for the abused, but they also
strive to eliminate the problem by
working with abusers to help build
positive and respectful relationships that are violencefree.
Sexual violence is any sexual activity where consent is
not freely given. This includes any action that pressures
or coerces someone to do something sexually that they
don't want to do. The sad truth is that statistics
underestimate the problem because many victims do not
tell the police, family, friends or health professionals
The Center for Prevention of Abuse is hosting a
about the violence.
community walk on Friday, April 3rd at noon. A
survivor will be there to share her story. Participants are
It is so important to bring awareness to a topic that
encouraged to wear teal to show their support. If you or
rarely gets discussed. At the Couri Center, we strive to someone you know has been a victim of sexual abuse,
care for your mental, physical and spiritual health. If
please tell your healthcare provider, call local authority
you have been a victim of sexual abuse, we understand or The Center for Prevention of Abuse at 691-0551.
the toll that the abuse takes on all parts of who you are.
Please know we are here to help guide you to local
Hope Placher, PA-C, MMS
resources to begin the road to healing.
6708 North Knoxville Avenue, Peoria, Illinois
309.692.6838
www.CouriCenter.com
St. Patty’s Day Leftovers? Make Sauerkraut!
The time has passed for corned beef and cabbage, but save the leftover cabbage! Sauerkraut and other
fermented foods such as yogurt, soy sauce, kefir and pickles are full of health benefits. Historically
speaking, sauerkraut is the food of peasants and sailors. Peasants used this humble, disparaged food to
help provide food and nutrients during the winter months when food was scare and true
malnourishment was a threat. Sailors used sauerkraut to prevent scurvy. Many sailors would suffer
from this Vitamin C deficiency due to long trips at sea and lack of nourishment. They noticed as time
when on that if they ate sauerkraut, the scurvy went away.
Not only does sauerkraut provide the vitamin C that prevents scurvy, but it is also loaded with
probiotics and prebiotics, fiber, vitamin K and iron. Because of these ingredients, research has shown
sauerkraut helps defend our body against osteoporosis, cancer and heart disease.
Probiotics and prebiotics are necessary for a healthy gut. Unfortunately, due to the overuse of
antibiotics, medications and even the chlorine in our water, the healthy bacteria our guts needs are
often beaten down. Fermented foods can contain as many of eight good bacteria including:
Lactobacillus acidophilus, Lactobacillus bulgaricus and Lactobacillus brevis. Not only do fermented
foods provide good bacteria, but they also feed your good bacteria with prebiotics in order to keep the bacteria abundant and plentiful.
Sauerkraut is made by adding salt to broken down cabbage. Fermentation is an anaerobic process, therefore needing an oxygen-free
environment. The cabbage is then left to sit for as little as one month, and up to 6 months in a room-temperature place. The longer the
cabbage ferments, the more tangy or intense the flavor.
It should be noted that heat kills live bacteria. Homemade sauerkraut and pickles will not have any problem, however, when purchasing
sauerkraut and other fermented foods, be sure to look for fresh sauerkraut or brands that add live bacteria after pasteurization.
Leslie Rusch-Bayer, RD, LDN, CPT
Couri Center 2015 Wellness Series
April 28
May 19
July 21
September 15
November 10
5:30 PM
6:00 PM
6:00 PM
6:00 PM
6:00 PM
Spring Clean Your Body In 7
Advanced Lipid Testing-Do You Know Your Numbers?
Essential Oils 101
Detoxification: Household & Beauty Products
Blood Sugar Management
All Classes are FREE but require RSVP, as space is limited!
Register on our website: www.couricenter.com
6708 North Knoxville, Suite 1, Peoria, IL 61614
6708 North Knoxville Avenue, Peoria, Illinois
309.692.6838
www.CouriCenter.com
Do you suffer from Allergies?
Try D-HIST!
Replace your allergy medication with
Natural D-Hist. Take 2 capsules thr ee
times daily for 7 days, then 1 capsule daily as
maintenance during allergy and sinus season.
Buy one, Get one 50% off!
Expires 4/30/15
Cannot be combined with any other offer or promotion.
MEDICARE PATIENTS!
Did you know that if you have a BMI>30
your Medicare benefits include a full
year of nutritional consultations?
Call the office for more information!
Meet our staff:
Dr. Michele Couri M.D., FACOG
Hope Placher PA-C, MMS
Susan F. Lang MS, APN, CNM, LCCE
Terry Polanin MS, APN, FNP-BC
Leslie Rusch-Bayer BASC, RD, LDN, CPT
Physician of Gynecology and Integrative Medicine
Physician Assistant
Advance Practice Nurse
Nurse Practitioner
Registered Dietitian, Certified Personal Trainer
6708 North Knoxville Avenue, Peoria, Illinois
309.692.6838
www.CouriCenter.com