Clinical Trial: Suffering from Recurring Yeast Infections?

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Vaginal yeast infection, also known as vaginal thrush or vulvovaginal candidiasis, is a common fungal infection of the vagina. This infection occurs when there is an overgrowth of yeast in the vagina.

Up to 75% of women will experience this infection at some point in their lives, and approximately 5 – 8% will have recurring episodes. Common symptoms include: itching, burning, inflammation, abnormal vaginal discharge, discomfort and pain. Women who suffer recurring infections may have Recurrent VulvoVaginal Candidiasis also known as RVVC.

Each study has specific inclusion and exclusion criteria. Patients generally receive the study medications for free and are compensated for their time. In order to participate, a patient may be identified by one of our doctors as being potentially eligible, or a patient can contact our office and express an interest in participating; in which case they would be scheduled to see one of the doctors who is either the Principle Investigator or Sub-investigator for the particular study.

If you have Recurring Yeast Infections contact Veronica Almanza, CRC at 214-367-8400 ext. 402. She can explain the study to you in more detail and arrange a visit with one of our physicians. We are here to help.

If you would like more information, you may also go to yeastinfectionstudy.com.

The Truth About Condoms

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Are Condoms still needed?

As an OBGYN, I discuss birth control and STD prevention on a regular basis, sometimes multiple times a day, and sometimes even multiple times with a single patient. Read more

Miscarriages: Tough Questions and Tough Answers

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I chose to become an OBGYN because I love delivering babies and bringing joy to expectant parents. It is by far the MOST REWARDING part of my job. Seeing the sense of pride on a new dad’s face, the joyful tears in a happy mother’s eyes, or the inquisitive look of a young big brother or sister is priceless and makes my “job” feel more like a privilege. Bringing a new life into the world is an opportunity that all of us OBGYNs keep sacred and is the main reason why many of us chose the field. But like all things in life there’s a downside to everything, and my job is no different.

Miscarriage is a topic that no one likes to discuss, myself included. It’s something that no expectant mother even wants to think about. Similarly, no athlete wants to discuss the possibility of a career ending injury, no pilot wants to talk about plane crashes, and no CEO wants to discuss the possibility of his or her company going bankrupt. Women who have miscarried are usually reluctant to discuss their experiences or share their feelings about it, which is totally understandable. It’s a private and personal matter for most that can often bring back painful memories and feelings of uneasiness. It can make women feel isolated, fearful, heartbroken, and at times, even guilty. In addition, it raises many questions like “Did I do something wrong?” “Is there something wrong with my body?” “Can I get pregnant again, and if so, when is the best time to try?” But the most important question for women and couples is “Why did this happen?” Unfortunately, the answer is one of the most challenging and elusive to provide.

Why?

Studies have shown that people are often misinformed when it comes to understanding the causes of miscarriages. In a recent survey of the general public, people were asked what they thought was the most common reason for a miscarriage. The top 7 answers were:

  1. A traumatic event
  2. Stress
  3. Lifting a heavy object
  4. An STD
  5. A previous miscarriage
  6. An IUD
  7. Woman not wanting to be pregnant

The answer to the question of “Why?” is very important for women who have experienced a miscarriage. Finding an answer or cause can lead to a sense of closure, the possibility of a solution, and a plan moving forward as most couples will want to get pregnant in the near future. The truth is that there are many causes of miscarriages none of which include the above. Various causes do include uterine or cervical anatomic problems, immunologic disorders, diabetes, thyroid disease, advanced age, smoking, alcohol, drugs, or environmental toxins. However, the vast majority of miscarriages are from chromosomal abnormalities (problems with the genetic makeup of a fetus), which cause over 50% of all miscarriages. When a genetic abnormality occurs, a woman’s body recognizes that the embryo’s genetic integrity is faulty and aborts or rejects the pregnancy. In a sense, nature is able to tell when development is abnormal and triggers a response to “start over”.

The important thing for women to understand is that while some of the above mentioned factors can be controlled such as smoking, alcohol, or environmental exposures, most of them cannot. For instance, many women are born with anatomical abnormalities or are diagnosed with chronic diseases during their childhood or adult life. Due to social reasons, some women may not be able to start a family until later in life when they are older. Because these causes cannot always be controlled, I tell my patients that they should never feel like it’s “their fault” and understand that sometimes unfortunate things just happen. I always reiterate to patients that they did nothing wrong and there was nothing that they could have done to prevent the miscarriage from happening.

Is there anything I can do?

Unfortunately, preventing a miscarriage from happening is impossible. My main advice to women who are considering conceiving is to optimize their health and body in preparation for a healthy pregnancy. These are some recommendations that I give to my patients.

  1. Eat a balanced diet that includes fruits, vegetables, meats, and carbohydrates. This will provide your body with essential nutrients, minerals, and vitamins for a healthy pregnancy.
  2. Maintain a healthy body weight. Being overweight or underweight can affect the health and the outcome of your pregnancy. It can also lead to complications later in life.
  3. Optimize your well-being if you have chronic medical diseases such as diabetes or thyroid disorders. For diabetics, your hemoglobin A1c level should be low and you should keep a daily log of your sugars and review them with your doctor. If you have a thyroid disorder, remain compliant with your thyroid medications and check with your doctor to make sure that your thyroid levels are within the normal limits.
  4. Stop bad habits. Quitting smoking and alcohol are some of the most important things you can do for a healthy pregnancy.
  5. Eliminate environmental exposures (lead, arsenic, radiation). No amount of exposure is considered “safe” especially if you have a very early pregnancy.
  6. Ensure sufficient folic acid intake. You should start taking prenatal vitamins with adequate amounts of folic acid (at least 400 micrograms daily) ideally 1 month prior to conceiving. Prenatal vitamins can be purchased over the counter at any local pharmacy or grocery store.

What now?

As vital as it is to take appropriate time for grieving and questions, most women will want to find closure and move forward. You should discuss with your doctor what the next steps are, your future plans for children, and how soon you wish to get pregnant if you so desire. You should also discuss the chances of a successful pregnancy and any interventions that may be needed for the next pregnancy. Some women may need laboratory testing or imaging procedures for some of the previously stated causes while others may not. Birth control is also an option as some women do not want to get pregnant for a certain period of time after a miscarriage. Lastly, it’s important for you to understand that while this was a tragic and disappointing time, you should not be afraid to get pregnant again. Even after a miscarriage, the vast majority of women will have no issues conceiving and will go on to have completely normal, healthy pregnancies. With my patients I strive to provide a sense of support, hope, and optimism through this process.

Air Travel During Pregnancy: Is It Safe To Fly While I’m Pregnant?

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A common question I often hear is “Can I fly while I’m pregnant?” Air travel brings a whole new set of concerns and stress to an expectant mother, and rightfully so. Nowadays air travel is much more common with most Americans traveling at least twice a year if not more often than that! With every pregnancy lasting about 9 months, it’s almost impossible to put off flying during pregnancy. Plus, you’d hate to miss a special graduation, a family member’s wedding, or Christmas with loved ones just because of pregnancy, right? This topic always brings up questions for patients but hopefully I can provide some tips that will make the answer a little more simple.

In general, occasional air travel while pregnant is considered safe for healthy, uncomplicated pregnancies. Fetal heart rate is unaffected by flying if the mother and fetus are healthy. During flight, the body adapts to accommodate the higher altitude and small changes in cabin pressure. This is seen by an increase in the mother’s heart rate and blood pressure as well as a significant decrease in aerobic capacity.

Most commercial airlines allow pregnant women to fly up to around 35 weeks. Beyond this time, they fear that you will be approaching your due date and therefore deliver on the airplane without a doctor. However, each airline is different so the best thing to do is to check with the airline regarding their individual policy. Some airlines even want you to provide documentation of gestational age for them. Check with your OB doctor as well as some doctors do not recommend flying after 32-34 weeks.

There is no optimal time to fly during pregnancy. Women should be made aware that the most common OB emergencies occur in the first and third trimesters. In addition, during the second trimester, women are usually beyond morning sickness and the risks of miscarriage that occur in the first trimester as well as avoiding the physical discomforts and demands of the third trimester at which time the uterus is largest.

While flying is considered “safe” there are some special considerations that pregnant women should take note of. Here is my list of tips/advice if you are planning on flying while pregnant.

  • First and foremost, clots can develop from prolonged periods of sitting in the same position. Long periods of sitting in one position is not healthy for anyone but especially for pregnant women. All pregnant women are in a “hypercoagulable” state or a propensity to develop clots (especially in your legs). This is dangerous as these clots in your extremities can dislodge and travel to your heart and lungs. To prevent this, you should walk the aisles and stretch your legs periodically. Taking quick, frequent bathroom breaks to prevent any blood stasis can go a long way. In addition, compression stockings or hose can be placed on your legs to prevent any pooling of blood.
  • Second, stay hydrated! The airplane cabins usually have slightly lower humidity making it easy to get dehydrated. Dehydration can lead to contractions, preterm labor, and sometimes even problems with blood circulation to your baby. Periodic sips of water will help you stay hydrated especially during longer flights.
  • Third, pregnant women should wear seatbelts continuously throughout the flight as unexpected turbulence can lead to falls and trauma to the belly, which can cause problems for the unborn baby. The seatbelt should be worn low on the hipbones below the abdomen and not directly on the pregnant belly.
  • Fourth, air travel is not recommended at any time during pregnancy for women who have complicated medical or obstetric conditions that may be exacerbated or worsened by flight. Inform your doctor anytime that you are planning on flying. He or she will let you know of any risks of flying with your specific medical condition.
  • Lastly, arrangements and planning should be made regarding your destination. Knowledge of the closest hospital and ER should be sought prior to travel. You should ensure that these facilities have the capability of managing pregnancy complications, performing C-sections, and caring for preterm or ill babies. In addition, general health insurance policies may or may not provide coverage for pregnancy-related problems if traveling overseas. You should inquire about your individual health insurance policy and assess the need for a possible supplemental plan or temporary coverage while out of the country.

Air travel during pregnancy can be a tricky and daunting task. It brings new medical issues to the forefront for both mom and baby. But with a good understanding of the risks, effective communication with your doctor, and early planning and preparation, you can ensure safe travels for both you and your baby.

Got fibroids? Got polyps?… Get Symphion!

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What is Symphion?

It is a hysteroscopic (very small camera/telescope that goes into the uterus) tool used to remove fibroids and/or polyps without having to cut or remove any part of the uterus. Also, it’s an outpatient procedure, so you can go home the same day.

So, what are fibroids?

wud_myosure02These are very common non-cancerous tissue growths in the uterus. The size and number of these fibroids is variable… can be a single fibroid or multiple fibroids, and can range from very small to the size of a cantaloupe. They can be found on a stalk inside or outside the uterus. They can also be found in any layer of the uterus: in the muscle wall (intramural), under the outer layer (subserosal), or just below the inner lining of the uterus (submucosal).

 

So, what are polyps?

wud_myosure03These are small protrusions of the uterine lining (endometrium) that grow, become fragile, and start to bleed. Here is a picture of two polyps and the Symphion device.

 

 

 

So, are polypectomies and myomectomies safe? Effective?

With a hysteroscopic approach or with Symphion, the complication rate is less than 1%. The procedure is 90% effective in reducing heavy bleeding and recurrence rates at 2 years are less than 10% for fibroids and less than 3% for polyps.

What are the steps of the procedure?

  1. Your doctor will gently open your cervix and insert a very slender camera into your uterus.
  2. After visualizing the polyp or fibroid, a slender wand-like device is passed through the camera/telescope into your uterus. This wand suctions and cuts the fibroid or polyp into very small pieces and removes the tissue.
  3. Once the polyp/fibroid is completely removed, the wand and camera are removed. Nothing is left in your body after the procedure.

What’s the recovery like and what can I expect after the Symphion procedure?

Some women have mild cramping, for which most only need over the counter pain medicine. Most women are back to normal activities within a day or two. You are unlikely to have any complications, but call your doctor immediately if you have any of the following:

  • Fever > 100.4°F
  • Increasing pain not relieved by pain meds
  • Nausea, vomiting, dizziness, shortness of breath
  • Bowel or bladder problems
  • Greenish vaginal discharge

When will I know how well the procedure worked?

This varies for every woman, but plan to give your body approximately 3 months to fully heal. By then you and your doctor should be able to tell what your cycles are going to be like.

Contraception Counseling Impacts Unplanned Pregnancy

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Of the 6.7 million pregnancies in the US each year 48% are unplanned. Disturbingly,  about half occur in women who were using contraception at the time of conception. That statistic haunts me. As health care providers we must take that to heart and change the way we think about birth control counseling. Is there more that we can do to help prevent unplanned pregnancy in those who are actively using birth control?

When we break down the statistics and focus on young people the numbers are even more striking.  Shows like TeenMom and 16 and Pregnant draw media attention to teen pregnancy. Ironically, young women ages 15-19, are the most likely group to have used birth control the last time they had sex. The problem is this age group typically chooses methods with higher failure rates such as cycle timing, condoms, withdrawal method and birth control pills. The result is unsurprising — unplanned pregnancies.

Young patients often ask me, “what is the best birth control?” My answer is always the same – “The one that YOU will use.” There is no “right” answer. Effective contraceptive counseling involves not only providing information and options,  but also matching the right method to the right person.

Research shows that pregnancies occur less often when one chooses a contraception option that requires the least amount of effort. This is not a surprise.  Condoms work great unless you never take them out of your pocket. Birth control pills also are effective but not if you forget to swallow them. Despite the many contraception options available many patients are unaware of the choices. Linguistically speaking the phrase “birth control” is synonymous with oral contraceptives for many people. Birth control refers to many more methods than just birth control pills. Health care providers should never assume patients know all of the alternatives. Pregnancy can be prevented with a variety of nondaily options that are safe and easy to use.

When discussing  contraception with young patients, start with methods that require the LEAST amount of effort and then work backwards to the methods that require the Most effort. Direct patients to the options that have the best track record. Keep in mind that efficacy has a direct correlation with compliance. The more effort the birth control method demands from the patient the less effective it will be long term.

At Macarthur Ob/Gyn we always start with Mirena IUD, Paragard IUD and Nexplanon. We discuss the risks, benefits and potential side effects. These methods involve one visit for insertion and one for removal providing coverage for 5 years, 10 years and 3 years respectively. These methods have the highest efficacy rates and excellent continuation rates. They have excellent safety profiles, few side effects and few medical contraindications. Despite that, nationwide less than 10% of adolescents are using these methods collectively referred to as LARCS (Long Acting Reversible Contraception.) We focus on LARCS because they have the highest success rate at preventing unplanned pregnancy. We spend time addressing fears, misconceptions and myths. We make sure our patients are aware of these options. We use technology in the office via an on screen waiting room power point presentation highlighting the birth control options. We use social media platforms to educate our patients on their birth control choices. As a result a much higher percent of our young patients are choosing LARCs as their preferred method of contraception.

While the patient should ultimately choose the best for her, the health provider should be guiding her to the methods that can best meet her goal of preventing pregnancy. By increasing the use of LARCs we can dramatically impact the number of young women struggling with unplanned pregnancy while using contraception.

Adolescents and long-acting reversible contraception: implants and intrauterine devices. Committee Opinion No. 539. American College of Obstetricians and Gynecologists. Obstet Gynecol 2012;120:983–8.

Abnormal Chromosomal Screening: Will My Baby Have Down Syndrome?

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With so many technological breakthroughs recently, the field of prenatal diagnosis has undergone major advances. Over the last 30 years, detection rates for Down syndrome and other chromosomal abnormalities (Trisomy 18 and 13) have increased from a mere 60% to well over 95%. Chromosomal abnormalities were once thought of as being an issue primarily for “older” women (pregnant women over the age of 35), but now with the ability to detect these problems so accurately, ACOG (American Congress of Obstetrics and Gynecology) now recommends that ALL pregnant women who present for prenatal care at less than 20 weeks be offered some form of prenatal screening for chromosome problems such as Down syndrome.

Discussing the topic of chromosome screening with patients can cause confusion and anxiety. Many patients wonder why this testing is needed, how testing is done, at what gestational age can testing be done, and of course, the big question: WHAT HAPPENS IF MY SCREENING TEST IS ABNORMAL? These are all great questions that are difficult to explain during one quick office visit. The following questions/answers will hopefully clear up any myths or rumors that you might be hearing about chromosomal screening.

What is aneuploidy?

Aneuploidy means abnormal chromosome number (either missing or extra chromosomes). Aneuploidy results from a problem very early in pregnancy when chromosomes fail to separate properly and therefore an “extra” chromosome is obtained.  Most commonly this occurs on chromosome numbers 21 (Down syndrome), 18 (Edwards syndrome), and 13 (Patau syndrome). When a fetus has an extra chromosome at one of these positions, the outcome can have varying degrees of abnormalities. These range from learning difficulties, short stature, or distinct facial features to even more serious problems such as structural birth defects (heart, kidney, GI tract) or a baby who will be unlikely to survive after birth.

What is a screening test?

A screening test is a test that is performed to give information about a patient’s risk of having a baby with certain birth defects/chromosomal problems. It DOES NOT have the ability to diagnose a chromosomal problem. Instead, it simply indicates that a patient is at higher risk and needs more invasive testing to confirm the screening test results. The higher the detection rate, the better its ability to pick up the abnormality, and therefore the better the screening test.  Unfortunately, screening tests cannot detect 100% of all abnormalities and rarely even give false positive results.

How is a chromosomal screening test performed?

Levels of certain hormones/proteins are often abnormally high or low with certain chromosomal problems. These levels can be measured by simply analyzing a mother’s blood during specific times in pregnancy.

What specific tests are involved with chromosomal screening?

There are many different tests available to screen for aneuploidy. It’s more important that testing IS BEING DONE rather than WHICH test is being performed. With that said, different tests have different detection rates and which test you receive will depend on your doctor’s office’s resources and laboratory. At MacArthur OBGYN, you will have your blood tested on two separate occasions and an ultrasound to evaluate the neck of your baby (nuchal translucency) as babies with thicker neck measurements on ultrasound are at higher risk for having chromosome problems.

When will I be screened for chromosomal problems?

Typically, we at MacArthur OB/GYN use an “integrated” screening test. This involves combining the results of a test from 11-14 weeks with another test after 15 weeks. During your visit between 11 and 14 weeks, your blood will be drawn and an ultrasound will be done to measure the neck of your baby. These tests are combined with another blood test after 15 weeks to calculate a combined risk. The result of the test does not come back until after the second blood test is performed after 15 weeks. The combination of both of these tests (as opposed to only one test) leads to a higher detection rate and more accurate results. If for some reason a pregnant woman misses her first screening test from 11-14 weeks, but is still less than 23 weeks, a single blood test called the Penta screen can be performed to determine her risk. The Penta screen has a lower detection rate than traditional integrated screening but is still effective.

How accurate are chromosomal screening tests?

The detection rate of the integrated screening test is approximately 94-96%, while the Penta screen (the testing that occurs only in the second trimester after 15 weeks) has a detection rate of approximately 85%.

What happens if I have a positive screening test result?

If you have a positive screening test, first of all, DO NOT PANIC. You simply are deemed higher risk. It DOES NOT mean that your baby has a chromosome defect. A positive screening test will typically be followed by a referral to a Maternal-Fetal Medicine specialist (high risk pregnancy doctor), where he or she will offer the following:

  1. A targeted ultrasound to look closely at the other parts of the baby (heart, stomach, face, spine, kidneys) to see if there are any obvious birth defects that suggest chromosomal problems or other genetic syndromes.
  2. A confirmatory test to diagnose what type, if any, chromosome abnormality is present.

Confirmation of aneuploidy can be done in several different ways depending on the doctor.  Some will offer you an amniocentesis. This is a procedure in which amniotic fluid (which has fetal cells) is drawn from within the amniotic sac and sent for chromosomal analysis. Others will offer a chorionic villus sampling (CVS), in which a small sample of cells from the placenta is tested. Other testing that can be done are maternal blood tests such as the Panorama, Harmony, or Materni21 tests, which detect cell free fetal DNA in the maternal circulation. This testing involves new technology and is indicated for pregnant women over 35 years old or for women who have an abnormal standard screening test or ultrasound findings suggestive of aneuploidy. These tests are not confirmatory tests but do have detection rates up to 99% and are therefore very helpful to patients who either decline amniocentesis or where amniocentesis is not feasible.

With new technologies we now know even more about the health of babies before they are born. Improved ultrasound quality and more accurate blood testing has given us more insight into a baby’s genetic makeup, specific syndromes, or any structural problems that he or she may have. Chromosomal screening is an integral part of prenatal care and hopefully the information above has helped make it a less intimidating and confusing topic.

Folic Acid: What’s the Big Deal?

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As an obstetrician, an important part of my job is preconceptional counseling. Making sure that hopeful mothers are healthy, eating right, and avoiding harmful behaviors and substances in preparation for pregnancy is a very important duty to me as their OB doctor. Counseling women before pregnancy has even occurred is always challenging though. It’s hard for people to keep themselves healthy for something that hasn’t even happened yet. However, certain topics are so beneficial and universal to all women that they cannot be ignored. Folic acid supplementation and the prevention of neural tube defects is one such topic. So, what is folic acid and why is it so important?

Folic acid is a B vitamin that is essential for numerous bodily functions. Folic acid is crucial for production of DNA, which is the genetic code for all cells in your body. Therefore, it is important for rapid cell division and times of growth such as during infancy or pregnancy. It also plays a vital role in the formation of red blood cells which carry oxygen throughout your body and therefore prevents you from becoming anemic (low red blood cell count). Unfortunately, folic acid is not a vitamin that your own body produces so you must get it from your diet.

So, how is folic acid helpful to pregnant women specifically? Overwhelming evidence has shown that folic acid reduces your baby’s risk of neural tube defects (NTDs). What are neural tube defects? They are defects (openings) in the baby’s spine or brain that cause varying degrees of disability or even death. Normally the neural tube closes very early at approximately the fourth week of gestation. When it does not close completely or at all, a neural tube defect occurs. Because of this it is very important for women to have adequate folic acid intake prior to and during early pregnancy. In fact, taking adequate amounts of folic acid reduces the chance of NTDs by up to 70%!

Here are some common questions I often get asked by patients regarding folic acid:

How can I get enough folic acid?

There are two ways to get folic acid in your body:

  1. Take a vitamin that has folic acid in it. This is easy. Just ask your doctor to write a prescription for prenatal vitamins for you. You can also get them over the counter in grocery stores, pharmacies, and even discount stores. They are inexpensive and can be purchased without a prescription. Most bottles with 100 vitamins only cost ~$5, which is only 5 cents per vitamin! You buy them just as you would any other grocery item. Just be sure that the label says 100% of the daily value of folic acid which is 400 mcg – the recommended daily dose.
  2. Eat foods that have folic acid in them. The most common and convenient food is breakfast cereal although other foods are now fortified with folic acid as well. Fortification of cereals with folic acid occurred in 1996 and was done primarily to prevent NTDs. One bowl of cereal each morning usually provides sufficient amounts of folic acid, although with foods, you can never be completely sure that you are getting the recommended amounts because it all depends on how much you take in.

How much folic acid should I be taking?  When should I start?

With vitamins, it’s always hard to remember the recommended doses and timing because they all differ depending on who you ask. Luckily, when it comes to folic acid, all recommendations are essentially the same. You should be taking 400 mcg (micrograms) of folic acid every day starting at least 1 month prior to pregnancy and continuing it at least through the first trimester. Waiting to start folic acid until you find out you are pregnant is too late. Most women will not even know they are pregnant until 8-10 weeks after conception which is 1-2 months after the neural tube has already formed and thus too late to prevent these birth defects. In fact, almost half of all pregnancies are unplanned! For these two reasons, it is important for every woman of childbearing age to be on folic acid even if not planning to become pregnant.

Should I ever be on a higher dose of folic acid?

With all rules there are exceptions, and folic acid is no different. There are two main instances where a higher dose of folic acid is necessary. If you, your partner, or your child has had a neural tube defect you should be on a much higher dose. The recommended dose is 4 mg (milligrams) or 4000 mcg (10 times the normal dose discussed above). You will need a special prescription for this from your doctor. Taking multiple doses of prenatal or multivitamins may lead to dangerously high amounts of other vitamins in your body. Similarly, if you have a history of seizures and are on anti-epileptic medications, you should be on 4 mg of folic acid as some seizure medications can lead to an increased risk of NTDs. Again, this increased dose should be started at least 1 month prior to conception and continued at least through the first trimester.

What other foods have folic acid in them?

Lots of foods now have folic acid in them since food fortification has been in place for almost 20 years now. These include breakfast cereals, breads, rice, pasta, and other grain products. The best natural sources of folic acid are green leafy vegetables like spinach, turnip greens, and collard greens. Other foods rich in folic acid include other vegetables (broccoli, asparagus, carrots, squash), citrus fruits, seeds, nuts, peas, and beans. By eating these foods, a woman can be confident that she is getting folic acid in her everyday diet. This however should not be a replacement but rather a supplement to your daily vitamin.

What if I have trouble remembering to take a vitamin each day?

Women are busy these days, no doubt about it! Between kids, jobs, groceries, and errands, it’s hard to set aside time each day to take a vitamin. We just sometimes flat out forget as well. But just as regular exercise, adequate sleep, and healthy eating are important to your health, taking folic acid is too. Try and coordinate taking a vitamin each day with your daily routine activities (i.e. brushing your teeth, showering, putting on your makeup). Or try coordinating with someone else like your child or spouse who is also taking a daily vitamin so you can keep each other in check. Keep the bottle in sight next to your bathroom sink or on the kitchen counter so that you will be frequently reminded of it. Also, with smartphones these days, it’s easy to set a daily alarm or reminder. These are just a few ways to help you remember. Do whatever is most comfortable and convenient for you.

What if I can’t swallow pills?

Nowadays, multivitamins with folic acid come in various shapes and sizes. Many pills are chewable or in liquid form. Some even have fruity or chocolate flavors to make them more tolerable to those who have trouble with a pill’s bad taste.

Neural tube defects are the second most common class of birth defects second only to congenital heart defects in babies. However, NTDs are one of the only birth defects in which primary prevention is possible. Therefore, it is vital to make sure that all women are aware of this simple measure to prevent a birth defect that could negatively impact your baby’s life.

Female Pelvic Medicine and Reconstructive Surgery

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In the field of Obstetrics and Gynecology, there are currently 3 recognized, (board-certified), sub-specialties. These are: Maternal-Fetal Medicine, Reproductive Endocrinology and Infertility, and Gynecologic Oncology.  This year however, the American Board of Obstetrics and Gynecology (ABOG), together with the American Board of Urology (ABU) are recognizing through a board certification process those physicians who devote the majority of their practice to the treatment of women with pelvic disorders.

In the past, physicians have divided the female pelvis loosely into three areas. The front part with the bladder was the urologist’s territory, the middle with the vagina and uterus was for the gynecologist and the back was for the gastroenterologists and colo-rectal surgeons. Sometimes you would have a gynecologist who also treated urinary incontinence, or a urologist who treated pelvic organ prolapse (ie, fallen bladder) and we would call these hybrid doctors “Urogynecologists”.

Fortunately, there has been recognition that there is quite a bit of inter-relation between all of these organ systems, plus the muscles that support them, the nerves and blood vessels that supply them and most importantly, the patient who is attached to all of these and is having an issue with one or more. For example, I see patient’s who have to strain or push down on the vagina to have a bowel movement because there is a weakness in the wall between the rectum and the vagina. Or a patient who has frequent bladder infections due to incomplete emptying caused a fallen bladder. Or, a patient who has bowel and bladder issues due to neurologic condition such as MS, or a stroke.

So where does Female Pelvic Medicine and Reconstructive Surgery (FPM/RS) come in?  For some physicians, they have completed a residency in either obgyn or urology and then had training in a fellowship, most commonly urogynecology.  For others, like myself, I completed my obgyn residency back in 1997. The few urogynecology fellowships that were available were not, “approved” that is, recognized by the American Board of Medical Specialties. I spent as much of my residency as I could with the urologists at the hospital learning about treating incontinence and other urinary/bladder conditions in women, so off I went into private obgyn practice. I was very fortunate to spend the next 13 years working with Dr. J. David Wollenman who was a great friend and mentor to me until his passing in 2011. He and I both shared an interest in treating female incontinence, pelvic organ prolapse and other conditions like Interstitial Cystitis. And over the years, we were able to grow our practice and spend more time helping patients with those issues. In 2011, I was again blessed to merge my practice with MacArthur OB/GYN and work with an equally stellar group of physicians and nurses who have supported me and encouraged me to continue my focus on treating women with pelvic disorders.

In September of 2012, ABOG and AUA announced that the first subspecialty exam in FPM/RS would be offered in June of 2013. There would initially be two categories, FPM/RS and FPM/RS-Senior. The first category would be for those who entered their fellowship program within the last 3 years. The latter category would be for those who completed their fellowship, or on the basis of their clinical experience and dedication of the majority of their practice to the field of FPM/RS, i.e., what I have been able to do over the last 15 years.

People have asked me why I am taking the exam and what will it mean for my practice? I think that it is an opportunity for me to validate what I have trying to do for my patients over the years as well as a chance to measure myself against my peers in the same field. Everyone in medicine has a story about why they chose the specialty they are in. For me, part of it was my exposure to urogynecology cases in both my obgyn and urology rotations in medical school. I found the surgeries to be interesting and challenging, and I appreciated how grateful many of the patients were when they got a good result. This interest and appreciation continued for me during my residency and into private practice. Most people probably don’t think much about how multi-functional their pelvis, and the organs within it are. As I type this, I’m sitting on mine. It also functions as an area of storage and elimination of solid and liquid waste. It is intimately involved in sexual intimacy and reproduction. And it provides something to hold up our pants. No one gives any of this a second thought, until something doesn’t work the way it is supposed to.  Unfortunately, as our population ages, the incidence of disorders affecting these normal bodily functions is increasing. So the creation of a sub-specialty called Female Pelvic Medicine and Reconstructive Surgery allows patients to seek out physicians with knowledge, training and interest in treating the many varied and interrelated conditions that may affect women and their bowel, bladder and reproductive organs. This can be done through various therapies such as behavior modification, biofeedback, physical therapy, medication, and surgery.

Urinary Incontinence Is Common But Never Normal

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I Laughed So Hard, Tears Ran Down My Leg

That was a quote from a sign I saw on vacation last summer. While we read it and laugh, we all know what it means. “How’s your bladder working? ” is a common question that I ask patients in the office. Read more