5 Secrets to a Healthy Vagina

/in /by

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

Labor Pain: Should I Get an Epidural?

/in , /by

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.

Menopause: Am I Crazy?

/in /by

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.

18 Facts About Genital Herpes

/in /by
  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.

Gardasil-9: The Facts

/in /by

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

/in , /by

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!

The Zika Virus: Your Questions Answered

/in , /by

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.

Are Vaccinations Safe in Pregnancy?

/in , /by

Keeping your baby safe during pregnancy is likely the most important concern on your mind if you are pregnant, and it depends on many factors. Just like taking your prenatal vitamins and keeping your doctor’s appointments, one of the best things you can do for the health of your baby is to protect him or her from getting sick, and many women go through pregnancy without realizing that they can prevent certain diseases simply by keeping up with all recommended vaccinations.

What are vaccines?

Vaccines contain substances that prepare your body’s immune, or defense, system so that it can fight off certain infections when exposed to a particular virus or bacteria in the future. In this way, your body is trained to resist a disease, and you become immune to it. Vaccines can help prevent certain infections and serious complications during your pregnancy and in the first few months of your baby’s life.

Are vaccines safe in pregnancy?

Certain vaccines are safe in pregnancy and certain ones are not. In general, vaccines that contain inactivated or killed viruses are considered safe, while those that contain live viruses may be harmful to an unborn baby, and are therefore not given during pregnancy.

Which vaccines should I get during pregnancy?

Two vaccines are routinely recommended for all pregnant women and will be offered to you during your prenatal visits. They are the influenza vaccine and Tdap.

Influenza –  You may think of  having “the flu” as having a fever, runny nose, and muscle aches, however this infection can actually be especially dangerous in pregnant and post-partum women and can lead to serious complications including hospital stays and even ICU admissions. The influenza vaccine, or flu shot, can help prevent these serious complications. And by delivering protective antibodies to your baby through the placenta during pregnancy and through breastfeeding post-partum, the flu shot also helps protect your baby during his or her first few months of life, as babies cannot receive the flu shot before they are six months old and can also get very sick from an infection. The flu shot is recommended for all women who are pregnant or who might be pregnant during the flu season (typically October through March). It can be safely given at any week of pregnancy (even in the first trimester), and is in fact recommended as soon as it becomes available during a season and ideally before the outbreak of the flu in the community. While the inactivated influenza vaccine, which is given in an intramuscular injection, is safe in pregnancy, the nasal spray influenza vaccine is made from a live virus and is therefore avoided during pregnancy.

Tdap – The tetanus toxoid, reduced diptheria toxoid, and acellular pertussis, or Tdap vaccine is safe in pregnancy and is recommended to be given to all pregnant women between 27 and 36 weeks. It most importantly protects against Pertussis, or the “whooping cough,” a bacterial disease that can spread through air droplets by coughing or sneezing. This disease has the most severe consequences in infants less than three months of age, and in the 1900s before the vaccine was available, it was a major cause of sickness and death in babies and children. After the vaccine was developed, the number of cases significantly decreased, however in recent years we are again seeing a rise in the disease and it is important for everyone to get vaccinated. You likely received DTaP, another form of the vaccine that is given in five doses during childhood, however Tdap is a booster you need to get in every pregnancy (even if you just got it during your last pregnancy) in order to protect you from getting sick and allowing for transfer of protective antibodies through the placenta to protect your baby during the first few months of life when he or she is too young to get vaccinated. If TDap is missed during pregnancy, it should be given immediately postpartum so that your baby can receive the protective antibodies through your breast milk. The TDap booster is also recommended for all teenagers and adults who have not previously received it and especially for household members who will be having close contact with an infant.

Should I receive any other vaccines during pregnancy?

You may need a certain vaccine to be given during pregnancy if you are at risk for a particular infection due to travel, a certain job, or other risk factors. These may include Hepatitis A or B, meningococcus, Yellow fever, or others. Don’t forget to tell your doctor if you plan on international travel, especially to tropical areas of South America and sub-Saharan Africa, although travel to such places should be avoided during pregnancy if possible.

What if I’m not pregnant yet but planning for pregnancy?

It is important to be up to date on all your vaccines and boosters prior to pregnancy. This can help prevent certain serious complications when you do become pregnant. Besides routine vaccines that you should have received as a child or teen, it is also important to receive immunity against measles, mumps, and rubella (MMR) and varicella (chicken pox) if you are not already immune. The reason is that these vaccines cannot be given during pregnancy as they contain live virus, and getting one of these infections during pregnancy can have serious consequences such as miscarriage or birth defects. If you do receive one of these vaccines, it is recommended to wait at least one month (or 3 months with varicella) prior to conceiving. You should see your doctor for a “preconception counseling visit” during which your doctor will review your vaccine history (bring your immunization record if you have one) and possibly draw some blood tests to help identify what vaccines if any you should receive in order to prepare for a healthy pregnancy.

Influenza vaccination during pregnancy. Committee Opinion No. 608. American College of Obstetricians and Gynecologists. Obstet Gynecol 2014;124:648–51.

Update on immunization and pregnancy: tetanus, diphtheria, and tetanus vaccination. Committee Opinion No. 566. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013; 121:1411-4.

Labor 101: When Am I in Labor and What Do I Do?

/in , /by

A lot of my time in the office is spent on educating patients about their bodies and the changes that occur during pregnancy. As women get closer to their due date, many questions come up about pelvic pressure, belly pain, and contractions. Pregnancy is a time of great physical stress on a woman’s body and changes do occur that are foreign to most women. These physical changes can be unusual and even scary for some patients. There is a lot of confusion surrounding the following questions: “When exactly does my labor begin?  When will my baby be born? When should I go to the hospital? What can I do about labor pain?” We doctors are responsible for educating all patients early and often on these topics so that they feel prepared and comfortable with the labor process.

“My doctor gave me a due date. Is that when my baby is going to be born?”

Finding out a “due date” is very exciting for mothers and fathers to be. Once a due date is given, patients often mark it down on their iPhone calendar or due date app or immediately text it to family members and close friends. However, I always caution them about this and tell them that a “due date” is NOT THE EXACT DATE when the baby will be born. It’s actually a calculated date that tells us when you are exactly 40 weeks and is based on your last menstrual period and first ultrasound of your pregnancy. Your baby could come a little earlier or a little later than that date depending on when your body is ready for labor. Labor is defined as when a woman experiences regular contractions with progressive cervical dilation (opening). Dilation from 0 to 4 centimeters takes days to weeks, however dilation from 4 or 5 centimeters to 10 centimeters (when a woman is ready to push) only takes hours! For this reason, you are not considered “in labor” and not required to stay in the hospital until you have reached 4 or 5 centimeters. Consequently, you may be allowed to go home if your cervical dilation is less than 4 cm although you may be feeling contractions.

“How do I know if I am in labor?”

The natural follow up questions that patients have are “How do I know when I am 4 centimeters? Can I tell by my contractions? How do I know when to go to the hospital?” Great questions. The answer is there is no way to know for sure unless you get checked by your doctor or at the hospital. My recommendation is to time your contractions. Look at the clock to see how often your contractions are coming and for how long they have been lasting. If they are irregular, on and off, or coming every 15 to 30 minutes apart, just wait. These are Braxton-Hicks contractions (false labor). They are not associated with labor but can be uncomfortable. Once your contractions start coming every 3-5 minutes for more than 30-45 minutes then you should go to the hospital.

“Should I go to the hospital for anything else other than contractions?”

Yes. You should go to the hospital if you are experiencing leakage of fluid or vaginal bleeding. The “bag of water” is the amniotic sac. It holds the amniotic fluid that bathes the baby. The bag of water can rupture on its own at any point during labor or even prior to labor. Once the bag has ruptured there is no longer a protective layer around the baby, and infection can potentially set in. For this reason, you should go to the hospital immediately when your water “breaks”, and if you are found to be less than 4 centimeters, your labor will be induced. Regarding bleeding, it is never normal to have bleeding, however bleeding isn’t always an ominous sign. Sometimes, bleeding can occur after a cervical check in the office or just from cervical dilation during labor. However, bleeding can also be a sign of fetal distress so my recommendation is that vaginal bleeding should always be evaluated by your doctor at the hospital.

“What things can I do to relieve labor pain from contractions?”

Labor is appropriately named because having a baby is very hard work! Whether false labor, early labor, or real labor, pain from contractions can be very uncomfortable and at times, downright intense. Contractions can affect your ability to sleep, your appetite, can make you feel nauseated, or your ability to move around like normal. The first thing to remember is that contractions are a normal part of late pregnancy as you approach your due date. Don’t be scared. Being of sound mind and not panicking is key when contractions start. There are also several things that you can do to help relieve some of the pain from your contractions. First, you can perform breathing exercises in order to relax your body. Controlling your breathing and establishing a regular breathing pattern will help alleviate some of the pain and the anxiety that comes along with labor. Next, taking a warm bath can help relieve pain as immersing your belly in water will have a soothing effect. Just ensure that the water is warm and not too hot. Massages are another helpful option. Involve your significant other with this. Gentle rubbing of the lower back, shoulders, or sides can provide a lot of relief. Other things that can relieve the pain from contractions are applying warm or cool compresses to your belly, putting yourself in a low stress/quiet environment, and continuous movement to get to a comfortable position (on your right or left side, on your back, leaning against pillows to optimize back/front support).

“What about an epidural?”

Labor pain is intense, and I always feel bad for patients who are experiencing a great deal of pain. Standing at the bedside and watching an expecting mother go through labor pain is not an easy sight to see. Luckily, we now have epidurals and medications that weren’t around in the past to help us alleviate the pain you feel from contractions. An epidural is a small catheter that is placed in your back, whereby medications can be administered that will numb the areas from the top of your belly to the vaginal area to decrease the pain sensation from contractions. Epidurals are safe for the baby and are the most effective way of relieving pain from contractions. Epidurals are only given to women who are in labor (4 centimeters or more) or who have already ruptured their bag of water (regardless of cervical dilation). With an epidural, you will be much more relaxed, your baby will tolerate labor better, and you can enjoy the childbirth experience much more. As always, I leave the decision up to the patient as to if and when she wants an epidural, but I believe that epidurals are a great way to take your mind off labor pain so that you can better focus your attention to what’s really important, which is having your baby.