Viewing the Solar Eclipse - MacArthur Medical Center

Will the Solar Eclipse Hurt My Baby?

We are all very excited to witness something as rare as a solar eclipse but while this event has some of us rushing to find eclipse sunglasses, it can be a stressful event for pregnant women.

Some cultures have superstitions about an eclipse during pregnancy. For example, women in Mexican cultures are told to avoid it because an eclipse could cause a child to be born with a cleft lip (paladar leporino in Spanish). This superstition can be traced back to the Aztecs. They believed that a normally benign deity named Tzitzimitl would turn into a monster during an eclipse and attack pregnant women. A woman would have to have an obsidian knife (a knife with a blade made from volcanic rock) placed on her belly to protect her. The superstition is still common today but women use small metal objects like safety pins attached to the pants instead of knives.

In the Indian culture it is believed that women and their family members should stay inside during the eclipse and refrain from any activity including working, eating, etc. They believe any object that is touched during the eclipse could cause the baby to be born with a malformation urban birthmark in the shape of the object that was touched!

We now know that pregnancy complications have a variety of causes including genetic and environmental however none are attributed to the eclipse. Pregnant women should be able to go out and participate in witnessing this phenomenon without any concerns of this affecting their pregnancy. Women and men should both take precautions to protect their vision during this time, though. Looking at the eclipse without special protective lenses could cause permanent vision damage so be safe folks!

Allied Health Professionals - MacArthur Medical Center

Allied Health Professionals: What Are They and Why Should I Care?

Many people think the only person that can provide medical care in a doctor’s office is their doctor. This is a common misconception, as nowadays, there are many different healthcare providers that work together to provide you better care. In our office, we employ physician assistants, nurse practitioners, and certified nurse midwives in addition to our doctors and medical assistants. It is the combination of all of these different providers that makes our office run smoothly. Some of you may have already seen one of these allied health professionals and may wonder why you are not seeing your doctor. Allied Health Professionals help to fill in the gaps when physicians cannot be in the office. As an OB/GYN, you can imagine this happens rather often. When doctors leave for deliveries or surgeries, the physician assistants and nurse practitioners help to see their patients so they are not forced to reschedule or wait for several hours to see their doctor. Midwives perform deliveries at the hospital so that the doctor can spend more time at the office seeing their patients. They also have more flexibility with their schedules, often times having same-day appointments available when your physician’s schedule is booked out several weeks in advance. Together, we work cohesively as a team to better your overall experience at MacArthur OB/GYN.

Some of you might be wondering, what are the qualifications of Allied Health Professionals? All Allied Health Professionals complete rigorous training and education through a certified program. All are able to complete physical exams, prescribe medications, make diagnoses and order lab testing, amongst other things. Here is a chart outlining some of the differences between the 3 types of AHP’s in our office.

Physician Assistant
A PA is a nationally certified and state-licensed medical professional. PA’s practice medicine on healthcare teams with physicians and other providers. They practice and prescribe medication in all 50 states.

Master’s Degree

6 – 7 years

Broad, educated in all medical fields; may choose to do a residency in one field, but not required

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Nurse Practitioner
As clinicians that blend clinical expertise in diagnosing and treating health conditions with an added emphasis on disease prevention and health management, NPs bring a comprehensive perspective to health care.

Master’s Degree or Doctorate Degree depending on program

6 – 8 years

Typically specialized to one field, i.e. women’s health

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Certified Nurse Midwife
CNMs are licensed, independent health care providers with prescriptive authority in all 50 states. CNMs are defined as primary care providers under federal law.

Master’s Degree or Doctorate Degree depending on program

6 – 8 years

Specialized to women’s health; perform deliveries and assist with cesarean sections

5 Secrets to a Healthy Vagina

All women should be concerned about their vaginal health. There are many suggested tips you can follow to provide a healthy vaginal environment.

1. Maintaining a normal pH balance is important for a healthy vaginal environment.

It is recommended to avoid douching, using harsh soaps or feminine fragrances. Any alteration in the vaginal pH could lead to an overgrowth of yeast or bacteria, leading to infection. Some women have a difficult time maintaining a normal vaginal pH, despite their greatest efforts. There is an over the counter product, RepHresh (available in a variety of forms), which can help normalize the vaginal pH.

2. It is imperative to practice safe sex.

Using condoms will reduce and protect you against transmission of sexually transmitted diseases (STD’s). Some of the  more common STD’s are Chlamydia, Gonorrhea, Trichomonas, Human Papilloma Virus (HPV) and Herpes. These STD’s  commonly cause vaginal discharge, odor, itching, burning, lesions or painful ulcerations.

3. Vaginal hygiene is another important key to a healthy vagina.

The genital area should be kept clean and dry. A mild soap, like Dove, is recommended. Proper wiping techniques (front to back) will prevent contamination of bacteria into the vagina. This is especially important after a bowel movement. Cotton under garments should be worn and thongs should be avoided. It is important to remove wet bathing suits and work out clothes after use to avoid creating a warm and moist environment allowing the perfect environment for yeast production.

4. Adequate vaginal lubrication is another important aspect of vaginal health.

Vaginal dryness can potentially lead to labial and vaginal irritation, chafing, tearing and pain during intercourse. There are several over the counter products (KY and Replens, to name a few) which offer daily moisturizers and vaginal lubricants. If you are in your menopausal years, your vaginal dryness could be a result of decreased estrogen production, and you would likely benefit from a vaginal estrogen cream supplement to aid in your dryness and comfort.

5. Your overall health also plays a major role in your vaginal health.

If you are a diabetic, it is important to control your blood sugars. Chronic elevated blood sugars can increase yeast production in the vaginal tissue. Managing your weight is strongly recommended as well. Being overweight in the abdominal region can lead to weakness of the pelvic, bladder and vaginal muscles, which can result in poor control of urine and prolapse of the bladder and/or your uterus. If you are a smoker, you should quit! Smoking can have devastating effects on all organs. Smoking weakens your ability to fight off infection. Smoking will also increase your likelihood of developing cervical and vaginal cancers.

In conclusion, it is important to see your provider yearly for your annual pap smears to screen for cervical cancer. It is advised to seek medical evaluation for vaginal symptoms including: discharge, odor, itching, burning, dryness, lesions or ulcerations, and pain during or after intercourse.

Labor Pain: Should I Get an Epidural - MacArthur OBGYN

Labor Pain: Should I Get an Epidural?

Pain relief during labor is a huge question that weighs on any expectant mother’s mind. No one likes pain and the mere anticipation of labor pain is a scary thought for most. I make it a point to review all pain relief options with all of my pregnant patients prior to delivery. One of the most common questions that I get is whether to get an epidural or not, and what are the risks and alternatives?

What pain relief options are available?

There are two main options available for patients who are in labor. The first is intravenous (IV) pain medications. The second is regional anesthesia usually in the form of an epidural, which is a catheter placed in your back in which medication is infused around the spinal nerves to make your belly and pelvic region numb.

Which method is the best?

Epidurals, by far, relieve labor pain most effectively. The epidural medications cause you to lose feeling in your belly and pelvic area by blocking nerve signals from the lower spinal nerves. Epidurals are very targeted and block pain directly from nerves that supply the uterus and vagina. IV pain medications, on the other hand, simply cause a decreased perception of pain and don’t necessarily target any specific organs. Their effects often wear off quicker as well.

How is an epidural placed?

An epidural block is performed by an anesthesiologist. A small area in your lower back is cleaned and made sterile. A needle is inserted into your back and a catheter is threaded over it into the epidural space (space just outside the spinal cord). Medication is then infused via the catheter, which blocks the targeted nerves. This infusion of medication is set at a constant rate but can be altered using a small pump. Since you will not be able to fully feel your bladder sensations after the epidural is placed, you will have a catheter to drain your bladder.

What are the “side effects” of an epidural?

There aren’t many major side effects of an epidural although some do exist. One possible side effect is low blood pressure. If you experience a drop in blood pressure, there is medication used to raise it to ensure good blood flow to your baby. Epidurals can also cause post-delivery headaches if spinal fluid leaks out. Rarely, a spinal hematoma, which is a blood collection around the spinal cord, can develop however the incidence of this is very rare at less than 1 in 250,000. Other minor side effects include fever, shivering, nausea, or vomiting. One last important side effect is a prolonged second stage of labor (“pushing” stage). This is due to an inability to feel the anything in the vaginal region which then makes pushing less effective. While you may push a little longer, the vast majority of women still deliver vaginally.

Will an epidural increase my chances of a C-section?

No. Studies have shown that epidurals do not increase your risk for C-section.

Is there any reason why I can’t get an epidural?

There are a few rare conditions that preclude a patient from getting an epidural. These include a low platelet count, a coagulopathy (clotting disorder), a space occupying brain lesion, or an allergy to the medications in the epidural.

What if I don’t want an epidural or pain meds? Are there any other options?

During labor, the main pain relief options are IV medications or an epidural. The only other options would be a pudendal nerve block or local anesthesia. A pudendal block is a numbing medication that is directly injected around the pudendal nerve through the vagina. This is typically performed as a mother is pushing as its effects are relatively short-lived. Local anesthesia is given as a direct injection of numbing medication into the vaginal tissue to temporarily numb the area. This is typically done after the delivery however, and only used when a vaginal tear has to be repaired.

Urinary Incontinence

12 Fast Facts About Urinary Incontinence

  1. UI occurs twice as often in women as in men.
  2. 1 in 4 women over the age of 40 will develop UI in their lifetime.
  3. Thirty percent of women will experience symptoms of UI immediately after child-birth. Most will see a resolution of symptoms 3 to 6 months after their delivery.
  4. There are several types of UI:
    • Stress incontinence – Leakage happens with coughing, sneezing, exercising, laughing, lifting heavy things, and other movements that put pressure on the bladder. This is the most common type of incontinence in women. It is often caused by physical changes from pregnancy, childbirth, and menopause. It can be treated and sometimes cured.
    • Urge incontinence – This is sometimes called “overactive bladder.” Leakage usually happens after a strong, sudden urge to urinate. This may occur when you don’t expect it, such as during sleep, after drinking water, or when you hear or touch running water.
    • Functional incontinence – People with this type of incontinence may have problems thinking, moving, or speaking that keep them from reaching a toilet. For example, a person with Alzheimer’s disease may not plan a trip to the bathroom in time to urinate. A person in a wheelchair may be unable to get to a toilet in time.
    • Overflow incontinence – Urine leakage happens because the bladder doesn’t empty completely. Overflow incontinence is less common in women.
    • Mixed incontinence – This is 2 or more types of incontinence together (usually stress and urge incontinence).
    • Transient incontinence – Urine leakage happens for a short time due to an illness (such as a bladder infection or pregnancy). The leaking stops when the illness is treated.
  5. Modest weight loss, approximately 8% of your body weight, can result in a 50-75% reduction in UI symptoms.
  6. Pelvic floor exercises, commonly called Kegel exercises if done properly can improve some symptoms of UI. However, using weighted Jade stones or Kung Fu vaginal exercises (non-medically suggested or supervised “therapies”) can result in over-stimulation of the pelvic muscles and result in voiding dysfunction or pelvic pain.
  7. Pelvic Floor Rehabilitation is a medically supervised program of muscle stimulation and pelvic floor exercises. This can be used to treat both stress and urge incontinence. It also has benefits for some women with fecal incontinence and chronic pelvic pain (CPP).
  8. Urge incontinence can be managed in several ways: behavioral modification, medication, pelvic floor rehabilitation, Botox injections and nerve stimulation.
  9. Surgery to treat stress incontinence typically involves placement of a sling which can be one of several types. This oftentimes can be performed as an outpatient surgical procedure.
  10. Women who have urinary incontinence may also have symptoms related to pelvic organ prolapse (POP). The treatment of these symptoms may require additional therapy or surgery.
  11. A Urogynecologist is a physician specially trained in treating Urinary Incontinence in women. These physicians will typically be board-certified in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). Dr. Kevin O’Neil is board-certified in FPMRS and is a physician at MacArthur OB/GYN.
  12. You don’t have to live with urinary incontinence. The first step to getting better is to say something to your physician. The physicians at MacArthur OB/GYN want to help and we have the experience and tools available to work with you to improve your condition.
Menopause: Am I Crazy?

Menopause: Am I Crazy?

As you approach menopause, has this question crossed your mind? Many patients feel that they may be going crazy as their hormones become unbalanced or as the common phrase says “out of whack”. It may be you or your husband or other family members that notice it first, but at some point you may ask yourself this question.

As women age and approach 50 years old, which is about the age of menopause, they began having symptoms which include night sweats, hot flashes, mood swings, vaginal dryness, skin dryness, painful intercourse, and just feeling like they are in a fog all day long. Symptoms of menopause can occur as much as 10 years prior to the actual event, which is usually at age 51. You may have only one or two symptoms, or you may have a group of symptoms, all related to hormone imbalance. Your kids may not want to be around you much, and your husband may look at you and say “honey, I think you need to go to the doctor. You are acting really weird! Are you OK?” And of course, that is when you ask yourself “am I crazy?”

The answer to that question is obviously a resounding “NO!” But, you still feel like it. The good news is that there is help for this problem. There are at least six different hormones that can affect you physically, emotionally, psychologically, and physiologically. These include: estrogen, progesterone, DHEA, testosterone, and the two components of your thyroid, T3 and T4. All it takes is coming to the office and having blood drawn, which takes about a week to get the results back. We then sit down together and go over your symptoms, and the test results. I can then tell you exactly what your deficiencies are in the hormone range, and prescribe exactly what you need. It takes about two weeks for the hormones to get into your bloodstream and began working, as your tissues have been without these hormones for some time. Once you start feeling better, your family will like you again and you will actually like your family again. The key to this is to follow-up in three months with lab work drawn again to make sure that your levels are getting close to normal.

There is no reason to put up with this any longer when natural, bio identical hormones are available from local compounding pharmacies. All it takes is your first step, which is coming to the office. There is help available, and you don’t have to think that you are crazy.

Sexually Transmitted Infections - MacArthur Medical Center

18 Facts About Genital Herpes

  1. Herpes affects about 1/5 adults.
  2. It is spread through close skin contact, typically during sexual activity.
  3. You cannot catch herpes from toilet seats, hot tubs, or any other objects.
  4. Once exposed to the virus, herpes never leaves your body; however, not everyone who is exposed will develop symptoms
  5. The most common symptoms of an active herpes outbreak are small, fluid-filled blisters on the genitals, buttocks, or mouth. They typically are very painful and may burn.
  6. You may experience flu-like symptoms (fever, muscle aches, fatigue) a few days before the lesions develop. These are called prodromal symptoms.
  7. The first herpes outbreak is typically the most painful and typically lasts longer than recurrent outbreaks.
  8. About 90% of people who have an initial herpes outbreak will develop a subsequent outbreak.
  9. We diagnose herpes by two methods – either by a skin culture or by blood work. Typically both are used together in addition to a physical exam.
    • The skin culture can only be done when you have an active lesion. A positive result confirms the diagnosis of herpes, but a negative result does not rule it out.
    • The blood work will show us if you have been exposed to herpes in the past but may not confirm if a genital lesion is an active herpes outbreak
  10. There is no cure for herpes, but we can treat the symptoms with antiviral medication.
  11. You do not have to take medication for the rest of your life if you have been diagnosed with herpes. Many people only take medication during active outbreaks.
  12. If you have frequent recurrent outbreaks, you can take the antiviral medications daily to help suppress future outbreaks.
  13. Recurrences tend to be triggered by stress or a weakened immune system.
  14. A healthy diet and regular exercise can help to reduce stress and boost your immune system, decreasing your chances of recurrence, but not eliminating them.
  15. If you develop herpes during pregnancy, we can treat it with the same antivirals. You can still deliver your baby vaginally, if you do not have an active herpes outbreak at the time of delivery.
  16. You should not be sexually active if you have an active outbreak, as you will transmit the virus to the other person.
  17. Using a condom can reduce the risk of transmission, but does not protect against all cases.
  18. Herpes cannot be cured, but the symptoms can be treated. With the use of medications, most patients are able to lead a normal, healthy life despite the diagnosis.
Immunizations - MacArthur Medical Center

Gardasil-9: The Facts

What is Gardasil-9?

Gardasil-9 is the newest HPV vaccination on the market. It now provides protection against 9 high-risk types of Human Papilloma Virus (16, 18, 6, 11, 31, 33, 45, 52, and 58).

What is Human Papilloma Virus?

HPV is the most common sexually transmitted infection in the U.S. 75-80% of males and females will be exposed to HPV during their lifetime. Many people clear this virus on their own, however, in certain people, the virus is not cleared and can lead to certain types of cancers (cervical, vaginal, vulvar, and anal) and can also cause genital warts. While there are over 40 different strains of HPV, only about 12 are considered high-risk.

Wasn’t there already a vaccine for HPV?

Yes! The previous vaccination, Gardasil, has helped provide protection against 4 high risk types of HPV (16, 18, 6, and 11). While this has been very helpful at decreasing people’s risk for cervical, vaginal, vulvar, and anal cancers, the newest vaccination now provides protection against an additional 5 strains!

So what’s the big deal about 5 more strains?

The new vaccination provides protection against 20% of cervical cancers not covered by the previous vaccine.

So how can I get the vaccination?

The Gardasil-9 is now being offered at MacArthur Medical Center. It has been approved for females AND males ages 9-26. It is given in 3 doses with the second and third 2 and 6 months out, respectively. Come in today and ask your doctor about protecting yourself against cervical cancer!

Acessa: A New Way To Treat Uterine Fibroids

Uterine fibroids are noncancerous tumors that originate from the muscle layer of the uterus. They are the most common tumor of the uterus and occur in up to 70% of women, however vary in incidence depending on ethnicity and family history. Uterine fibroids (also called leiomyomas) can range from a small pea size to even the size of a grapefruit or softball! As you can imagine, the larger a fibroid becomes the more problematic it can be, with pelvic pain and heavy and irregular bleeding being the most common symptoms women experience.

In the past, fibroids have been treated in various ways. Birth control pills, progesterone injections, and intrauterine devices (IUDs) have all been tried, but often with only modest success. Most often fibroids require surgery in the form of either a myomectomy or a hysterectomy. A myomectomy is the surgical removal of fibroids from the uterus. Unfortunately, even after removing them, new fibroids can still grow back. Hysterectomy is the most definitive form of surgery for fibroids, however this involves removing the entire uterus. While this surgery will eliminate any chance of fibroids returning, women often require large incisions (especially when the fibroids are large), lose their ability to have children, and also require a lengthy recovery time of up to six to eight weeks.

The good news is that a new technique called Acessa has been developed as a more minimally invasive way to treat uterine fibroids. It involves tiny incisions, good success rates, and short recovery times, all while preserving the uterus and without having to remove any native tissue or organs. Acessa is performed laparoscopically and uses radiofrequency ablation through a probe tip that is inserted through the belly and directly into the fibroid using ultrasound guidance. Once the tip is inserted into a fibroid, tiny microarrays are deployed directly into the tissue and heat is applied to destroy the fibroid from within. This procedure is performed on as many fibroids as are found by the ultrasound probe. Acessa is performed in a hospital or ambulatory surgical center under general anesthesia and usually takes around 1-2 hours. Patients are discharged the same day and typical recovery time is only around 3-7 days!

The success rates of the Acessa procedure are excellent. Clinical studies have shown that the vast majority of patients experience a significant reduction in their bothersome symptoms and an improvement in their quality of life.  In fact, in recent surveys, 98% of patients have reported overall satisfaction with the procedure and would recommend it to a friend.

If you think that you may have uterine fibroids because you suffer from either heavy or irregular periods, anemia, or pelvic pain, we encourage you to discuss this with your doctor at MacArthur OBGYN. Myomectomy or hysterectomy may still be good options for you.  However, we are now performing Acessa, a new minimally invasive way to treat your fibroids with small incisions, shorter recovery times, and preserving the uterus all at the same time!

Zika Virus Blog - MacArthur Medical Center

The Zika Virus: Your Questions Answered

You have likely heard a lot in the news in recent days about the Zika virus and the serious birth defects that are believed to be associated with it if a pregnant woman becomes infected. Cases have now been reported in 23 countries internationally, and the World Health Organization plans to convene a committee in the days to follow to determine whether this outbreak is to be considered an international public health emergency. Moreover, the Center for Disease Control and Prevention (CDC) published a warning this month advising pregnant women to avoid travel to certain areas in Central and Latin America with high reports of the Zika virus. And it may already be hitting closer to home, as a case of an infected woman in Texas has been revealed. With all the media craze, it’s understandable that many of my pregnant and even my non-pregnant patients have very pertinent questions regarding their travel plans, their risks, and what symptoms to look for. Here are some of the questions being asked.

wud_zika_video

What is the Zika virus, and what areas are being affected by it?

The Zika virus is transmitted by the Aedes species of mosquitos, which can also carry the Dengue, Chikungunya, and West Nile viruses. The first reports of the Zika virus were in Africa, and since then, the virus has spread across Asia and to the Americas. In March 2015, the first case of Zika virus infection was reported in Brazil, and the last few months have seen a rapid increase in the number of cases in Brazil and in other areas of South America, Mexico, and Puerto Rico.  So far, the largest outbreak has been in Latin America.

Has it reached the U.S.?

There have been several diagnoses of the Zika virus in the U.S., however these individuals are believed to have contracted the virus during recent trips to Latin America. There is concern that if the virus does spread to the U.S., the states of Texas and Florida may be especially vulnerable given patterns of the mosquitos that carry it and the fact that these states tend to see a significant amount of commercial and business travel to and from Central and South America. However, at this time there have been no reports of anyone actually contracting the virus in the U.S., and there are no travel warnings against any region of the U.S.

What are the complications of a Zika virus infection?

In general, infection with this virus can cause mild symptoms such as fever, joint and muscle aches, rash, and red watery eyes, however only about 1 in 5 individuals with a Zika virus infection will actually develop any symptoms at all. An individual who has such symptoms and who happens to have traveled to Central and South America in the week prior to the onset of these symptoms should be evaluated for a possible infection.

In pregnancy, there may be more dangerous consequences as there is concern that the virus may be associated with microcephaly, a condition in which the infant’s head is significantly smaller than the heads of other infants of the same age and sex. Microcephaly can have several effects on a baby, ranging from developmental and intellectual delay to hearing or vision loss to seizures.  It can also cause infant death. With the large increase in cases of Zika virus in Brazil and Latin America, the number of cases of infants born with microcephaly has seen a parallel increase (3500 cases in Brazil so far).  Also, several infants who have died with suspicion of Zika virus infection have been tested and found to have Zika virus within the tissue or amniotic fluid.  Although there is no definite proof that the Zika virus causes microcephaly, these cases are serious enough to prompt the CDC to make its recent statements and recommendations. And, according to the CDC, as the virus only remains in a person’s blood for up to one week, an infection out of pregnancy does not pose a risk of birth defects for future pregnancies.

Is there treatment for the Zika virus?

There are no medications available to fight the Zika virus and there is no vaccine to prevent someone from becoming infected with it. The CDC advises to treat symptoms by staying in bed, staying hydrated, and taking Acetaminophen as needed. It is also recommended that pregnant and non-pregnant patients suspected of having the Zika virus avoid Aspirin and other non-steroidal anti-inflammatory drugs, or NSAIDs. Most importantly, those with a possible infection should stay indoors and in isolation for at least one week after the onset of symptoms, to avoid getting bitten by another mosquito and then transmitting the virus to another person.

How can I protect myself from it?

First of all, heed all travel warnings, particularly if you are pregnant.  This is especially important for the public to recognize given the upcoming 2016 Olympics that will be held in Brazil. If you are considering travel, make sure to look for the travel advisory on the CDC’s website for the updated list of areas to avoid or postpone.

Use insect repellant and cover up. Apply insect repellant frequently and wear long sleeve shirts and long pants to help protect yourself from mosquito bites.  Use screens on your doors or windows if you must leave them open. Get rid of standing water around your home to prevent mosquito breeding.

And of course, if you are pregnant and have any questions or concerns regarding your recent travel or plans for any upcoming travel, see your doctor.

For more information, visit www.cdc.gov/zika.

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