Tuesday, December 27, 2011

Getting Healthy for Your Unborn Baby

Tips to ensure a healthy lifestyle before pregnancy...


By Tracy Fritz, MS, RN, FNP-BC, APNP
Nurse Practitioner


Sometimes, pregnancy doesn’t give much warning before it’s already here. SURPRISE! Therefore, it’s important to recognize that a healthy lifestyle is not only important when you are thinking of becoming pregnant, but also for daily living.

Being healthy before a pregnancy, or “preconception health,” is very important in helping to give baby the best shot at a healthy start. It can also affect the health of the mother during and following pregnancy.

However, preconception health also applies to the partner, too. Issues like smoking, food choices, immunizations, drugs, and stress are just as important for the partner as the mother. These are all things that can affect a healthy pregnancy and can affect the child’s health after he or she is born. All of these things can and should be discussed with your provider before you are considering a pregnancy.

What are some things that can be done to plan for a healthy pregnancy?

1.  Make sure your weight is stable and healthy for your height. Now is the time if you are going to start a weight loss program, consider becoming a vegetarian or do anything that will improve your health but may stress out your body—because after you are actually pregnant, it is not recommended to dramatically change your eating or exercise habits.

2.  Get 0.8mg (or 800mcg) of Folic Acid for at least 3 months before a pregnancy. This can easily be obtained through a good prenatal vitamin (either over-the-counter or by prescription). Please check the label prior to purchase or consult your Women’s Care Provider. This can prevent neural tube defects in the first trimester of pregnancy.

3.  STOP unhealthy practices. This includes, but is not limited to, smoking, alcohol, and illicit drug use. If there is ever a time in your life that you have more motivation to quit, the time is now. It has never been shown in any literature that any amount of tobacco, drug or alcohol use is safe in pregnancy. In fact, the risk to the baby and your health during pregnancy are greatly affected, and this can lead to maternal and fetal complications and possibly death. There are also prescription medications that can be damaging to a developing fetus and should be discussed with your Women’s Care Provider prior to pregnancy.

4.  Avoid environmental teratogens. A teratogen is any agent that can disturb the development of an embryo or fetus. These harmful agents can be found in the home or at work, and include, but are not limited to, solvents, fumes, heavy metals (mercury or lead), and pesticides. Again, no recommended amount of exposure is okay during pregnancy and should be avoided. It is also noted that environmental exposures can also affect your body’s ability to get pregnant.

5.  Check for medical conditions and STDs. If you have any pre-existing medical conditions including diabetes, heart disease, high cholesterol, thyroid disease, etc, it is recommended to speak with your Women’s Care Provider prior to a pregnancy as well as your primary medical provider. It is also recommended to have sexually transmitted disease screening for you and your partner, and to get treatment if needed prior to a pregnancy. Some STDs can affect your body’s ability to become pregnant even if the symptoms were not noticeable during the infection.

6.  Get a genetic screening. Any genetic screening for Cystic Fibrosis, Tay Sachs, Sickle Cell Anemia, Thalessemia, etc, that can affect a pregnancy is also encouraged prior to getting pregnant, to ensure the best possible outcomes for you and your baby.

7.  Get up to date on vaccines. Please get your vaccines updated before considering a pregnancy, as there are some that can NOT be given during your pregnancy. It is always recommended to obtain an influenza vaccine before or during your pregnancy to avoid life-threatening complications of influenza and prevent your baby from infection. Babies are not able to get a flu shot until they reach at least 6 months of age. So to protect you and your family, get vaccinated. This goes for everyone in the household and those who will be taking care of your baby after he or she is born.

8.  Discuss concerns with your provider. If you had problems with past pregnancies, it is recommended to discuss these concerns with your Women’s Care Provider prior to attempting another pregnancy. Also, if you have had any lower abdominal surgeries or procedures that may have affected the uterus or cervix, those would also be important to discuss as well.
*(ACOG, 2011) (NIH, 2011) (NICHD, 2011)

Considering a pregnancy can be the most exciting and scary time of your life and you are NEVER going to be 100% prepared for that little bundle of joy—but as they say, “An ounce of prevention is worth a pound of cure,” and a healthy lifestyle paves the way for a healthy baby. The providers at Women’s Care are here for you to help you with all your questions about your health, your partner’s health and your unborn baby’s health. Happy planning!

Tracy Fritz is a Nurse Practitioner at the Oshkosh location of Women’s Care of Wisconsin. Contact her at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/.

* ACOG, 2011.  FAQ Good Health Before Pregnancy: Preconception Care. Internet search on December 7, 2011 at http://www.acog.org/~/media/For%20Patients/faq056.ashx

National Institutes of Health (NIH), 2011.  Preconception Care: MedlinePlus. Internet search on December 7, 2011 at http://www.acog.org/~/media/For%20Patients/faq056.ashx

National Institute of Child Health And Development (NICHD), 2011.  Preconception Care. Internet search on December 7, 2011 at http://www.acog.org/~/media/For%20Patients/faq056.ashx

Friday, November 18, 2011

Preterm Labor – What You Need to Know

Risk factors and what to look for to determine if an early delivery may occur...


By Kristin L. Clark, MD
Obstetrician/Gynecologist
View Kristin's Video


Patients often ask me, “How will I know when I go into labor?” If they have had a healthy pregnancy and are of a term gestation, I usually tell them not to worry; that signs and symptoms of labor aren’t subtle. Preterm labor, however, can be a little bit harder to detect. Fortunately, it’s not a common complication, but when it happens, early recognition and treatment are key in a successful outcome.

Risk Factors
There are some risk factors for preterm labor, the biggest of which is a prior history of preterm labor and delivery. Other risk factors include:
• previous cervical surgery
• multiple first or second trimester D&Cs (procedure to empty the uterus after a miscarriage)
• previous second trimester loss
• uterine infection
• premature rupture of membranes

Causes of Preterm Labor
Ultimately, we don’t really know what causes preterm labor. As I mentioned, the symptoms can be more subtle than labor at term. Some people will notice:
• an increase in pelvic pressure and spotting
• rhythmic tenable tightening
• cramping
• significant pain

It can also be very normal to have Braxton Hicks contractions during your second and third trimesters, so if you are having any of these symptoms, I would advise that you discuss them with your doctor so that he or she can help you sort through what’s normal and what needs to be addressed.

If your doctor is concerned that you might be in early labor, he or she will likely perform a cervical exam. Other tools that can be utilized include an ultrasound measurement of your cervical length and a fetal fibronectin swab. If this swab is negative, it gives us a 95% reassurance that you will not deliver in the next two weeks and a 99% reassurance that you will not deliver in the next week. If it’s positive, it doesn’t mean you are going to deliver, it just means that we need to watch you closer.

At times, I place my patients in the hospital for observation to see whether or not they are contracting regularly and to observe them for any change in cervical dilation. There are both oral and IV medications that can be used to treat preterm labor, and I use both differently in my practice.

Further, if your doctor feels that you are at risk for preterm delivery, he or she may advise two injections of a steroid called Betamethasone, 24 hours apart. This will help enhance your baby’s lung maturity so that if the baby did deliver before 34 weeks gestation, he or she has an easier time transitioning to breathing outside of the womb.

Ultimately, most people will not have to worry about preterm labor and delivery, but if it happens to you, we are lucky that we live in a day and age where we can treat it aggressively, and frequently help keep you pregnant until a term gestation.

I always tell my patients, “It’s your job to worry and it’s my job to make you feel better.” So keep this information in mind. If you have concerns, be sure to address them with your physician.

Dr. Kristin L. Clark is an Obstetrician/Gynecologist at the Neenah location of Women’s Care of Wisconsin. Contact Dr. Clark at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/.

Monday, October 24, 2011

Briefcase or Diaper Bag: Decisions, Decisions

Understanding the risks of delaying childbirth: what every woman should know...

By J. Elaine Larmon, MD
Perinatologist, Perinatal Consulting Group


Many women are faced with this difficult decision: have a baby, or focus on their career. There are many factors that contribute to their decision on what time is the best time to have a baby.

In the past 25 years, older women in the United States have accounted for an increasing proportion of total births (14%). The mean age at the birth of a woman’s first child (around 25) has increased by 4 years since 1970.

The increased occurrence of births at an older maternal age is due to several factors including:
   • Number of women aged 35-45
   • The availability of reliable contraception
   • Wider opportunities for further education and career advancement for women

Maternal education is one of the strongest predictors for the use of contraception, timing of childbearing and total number of children. College-educated women tend to have higher first birthrates in the thirties, illustrating the trend of delayed child-bearing being related to educational achievement and career opportunities.

The Risks
Although many older couples tend to be more mature and financially stable, women who delay childbearing are at increased risk of infertility and pregnancy complications. Facts that women should know when planning the timing of their childbearing include:
   • The probability of achieving pregnancy begins to decline significantly at the age of 32
   • The incidence of coexisting medical disease and pregnancy complications also increase with advancing maternal age
   • Pregnancy complications that are increased include chromosomal abnormalities, some congenital anomalies, placenta previa, gestational diabetes, preeclampsia, cesarean delivery, ectopic pregnancy, miscarriages and stillbirths

Fertility
Advancing age is also associated with prolongation in the average time for achieving pregnancy. The probability of achieving a pregnancy in one menstrual cycle (fecundability) begins to decline significantly at about the age 32 with a more rapid decline around the age of 37. Sub-fertility is primarily related to the poor quality of aging eggs, decreased ovarian reserve (fewer eggs), and an altered hormonal environment resulting in ovulatory dysfunction.

Older women also have had more time to acquire medical and surgical conditions such as endometriosis, pelvic infection, endometrial polyps and fibroids, which can impair fertility. Lifestyle factors may also play a role. Older women may have a decreased frequency of sexual intercourse and are more likely to be obese.

Pregnancy Complications

1. Pregnancy Loss
    a. Miscarriage: Older women experience an increased rate of spontaneous miscarriage. These losses are both chromosomally abnormal and normal and primarily result from a decline in egg quality. Changes in the uterine environment and hormonal function may also play at role.

In a large series of studies from Scandinavia, the overall rate of miscarriages treated in hospitals was 11%. Assuming that only 80% of women with miscarriages were treated in the hospital setting, the risk for miscarriage in various age groups was calculated. The risk of miscarriage in women less 30 years was 12%, between 30-34 years it was 15%, between 35-39 years it was 25%, between 40-44 years it was 51% and at ages 45 and greater it was 93%.

    b. Ectopic Pregnancy: A maternal age of 35 or older is associated with a 4- to 8-fold increase in ectopic pregnancies. This is likely due to an accumulation of risk factors over time, such as multiple sexual partners, pelvic infection and tubal pathology.

    c. Stillbirths: Women 35 years old and older have a higher risk for stillbirths compared to younger women. The risk of stillbirth also increases with advancing gestational age and is most notable after 37 weeks. The increase in mortality is largely unexplained. The absolute risk of stillbirths in developed countries such as the United States is still small.

2. Co-existing Medical Conditions: The prevalence of medical and surgical illnesses such as cancer, hypertension, diabetes, renal disease, and autoimmune disease increase with advancing age.
    a. Hypertension: This is the most common medical problem encountered in pregnancy and is more prevalent in older women. The incidence of chronic hypertension is 4-fold higher in women 35 years old and older than in women 30-34 years of age. The incidence of preeclampsia in the general population is 3-4%, which increases to 5-15% in women greater than 40, and to 35% in women older than 50.

    b. Diabetes: Prevalence of this condition also increases with age. The incidence of both pre-existing and gestational diabetes increases 3- to 6-fold in women older than 40, compared to those 20-29 years old. Gestational diabetes occurs in the general population at rate of 3%, rising to 7-12% in women greater than 40 years of age and to 20% in women over 50. Pre-existing diabetes is associated with increased risks of structural birth defects and pregnancy loss.

3. Fetal Abnormalities
    a. Chromosomal Abnormalities: Analysis from spontaneous miscarriages, terminations, genetic amniocentesis, stillborn and live born infants show a steady increase in the risk of chromosomal abnormalities as a woman ages.

    b. Congenital Birth Defects: The risk of having a child with a congenital malformation may increase with age. Several but not all reports suggest that as a woman ages, the risk of non-chromosomal anomalies increases. In particular, heart defects seem to increase with advancing maternal age.

4.  Placental Problems: The prevalence of placental abruption and placenta previa is higher among older women.

5.  Multiple Gestation: Advancing age is associated with an increased prevalence of twin pregnancy which is due to a higher incidence of naturally conceived twins along with a higher use of artificial reproductive technology in older women.

In summary, women who delay childbearing are at increased risk of infertility and certain pregnancy complications. Knowledge of these obstetrical risks associated with advanced maternal age can help a woman make an informed decision about timing of childbearing. These risks should be balanced against career and personal issues that might favor delaying childbearing.

Dr. J. Elaine Larmon, MD is a Perinatologist at Perinatal Consulting Group, 3913 W. Prospect Avenue, Suite 102, Appleton, WI 54914. Contact Dr. Larmon at 920-729-7121 or meet her here.

About the Perinatal Consulting GroupThe caring team at the Perinatal Consulting Group provides specialty care to women with delicate pregnancies. We are focused on diagnosing, treating and caring for women and unborn babies who are at risk for complications or illness during pregnancy or who have been diagnosed with a disease or other medical problem. We work with your doctor to provide you and your baby with the special care you need. We are strictly a consultative practice, which means we do not perform primary care services. Patients receive a formal referral from their primary care provider and we work in conjunction with that provider (obstetrician, family practicioner or midwife) to ensure that you and your unborn baby get the best care possible. Learn more at www.perinatalconsultinggroup.com.

Monday, September 26, 2011

An Overview of HPV - Human Papilloma Virus

What everyone needs to know about HPV...



By Hassan Shahbandar, MD
Gynecologist
View Dr. Shahbandar's Video Bio



What is HPV?
HPV is a virus that is responsible for cervical cancer, genital warts and other cancers, such as throat and penile cancers. There are over 120 different types of this virus. About 30 of these types are transmitted through human contact and most of these types are sexually transmitted.

How many people have HPV?
It is most common in teenagers who harbor it:
• 24% of 15 year olds
• 38% of 16 year olds
• 51% of 17 year olds
• 62% of 18 year olds

What is the difference between low-risk and high-risk types of HPV?
Of the over 120 different types of HPV, there are low-risk types that infect people without producing symptoms or with producing minor symptoms (skin warts), while the high-risk viruses are associated with potential causes of cancers.

How do women get HPV?
The virus is transmitted through skin-to-skin contact. It is not transmitted through ingesting contaminated food nor through breathing contaminated air.

Should I get the HPV vaccine?
Any female over the age of 10, who is not infected by HPV, is a candidate for the vaccine. If infected, then the vaccine is worthless. Insurance companies do not cover the cost for females over age 26 and do not approve the vaccine for males.

How do I know if I have an HPV infection?
Because most people who are exposed do not have symptoms, it is important to be tested by your health care provider, doing a pap smear, which shows if the virus has caused abnormality in the cells. If so, then a specific test to check for the virus is done. So far, the FDA does not recommend testing for the virus without a pap smear.

Do I still need a pap test if I got the HPV vaccine?
Yes, because the vaccine does not protect against 100% of the HPV types. It protects against the most common types: types 16 and 18 (causes of cervical cancer) and types 6 and 11 (genital warts). In all, the vaccine protects against 70% of cervical cancer but not 100%. It also prevents 90% of genital warts, but not all.

How often should I get a pap smear?
A pap test is used to detect the effect of HPV on the cervical cells and should be performed yearly between ages 21 and 30. After age 30, then it can be done every 2-3 years if you have had 3 previous normal pap tests without any abnormal ones, and if you do not practice risky sex. There is no need to test men, women who have had a hysterectomy for non-cancerous causes, or women after age 65 who are monogamous and have never had cancer or an abnormal pap in their past.

What happens if I have an abnormal pap?
You will need further testing called colposcopy, which allows your doctor to look at your cervix and vagina with a magnifying tool (colposcope) and perform a probable biopsy. Most of the time, the changes in your pap are not cancerous.

Could I have HPV even if my pap was normal?
Yes. If your immune system is good, then the virus fails to harm you, and usually you are not infectious.

Can HPV be cured?
Yes. Most people who do not develop cancer from HPV are cured by themselves without any use of medicine, but there is not an antibiotic available for HPV. The best cure is to prevent the spread of this virus by getting vaccinated and also avoiding risky sexual behavior.

Dr. Hassan Shahbandar is a Gynecologist at the Appleton and Waupaca locations of Women’s Care of Wisconsin. Contact Dr. Shahbandar at 920-729-7105 or meet him here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/.

Wednesday, September 14, 2011

“Sitting Up Straight” Can Help You Feel Better!

Awareness of your posture can lead to increased musculoskeletal health and less chronic pain


By Michelle Landsverk, DPT
View Michelle's Video Bio Here!



Do you remember the words…“Sit up straight… pull your shoulders back… and for crying out loud, DON’T SLOUCH!”

Imagine your mother watching you doing any one of the following: Sitting in front of a computer monitor. Snuggling up with a favorite book. Playing video games. Sitting on the floor, in a chair, on bleachers, at church, or in a theatre. Standing in place. Waiting in line. Watching TV. Fishing. Driving a car.  Or…doing anything during your normal day that requires you to be in one place for a period of time.

Worse yet, imagine me watching you doing these things!

As a physical therapist, I talk about the importance of good posture as a way of maintaining good musculoskeletal health. This blog entry is to educate you on the relationship between good posture and good musculoskeletal health (I didn’t make this up; they are honestly interrelated). For, everything in our bodies is connected somehow, and at least philosophically speaking, one thing can have an effect on everything else.

To specifically address YOUR posture, is as individual as your day, but I can address global concepts here that are good for every woman to keep in mind. Words like: balance, tension, and harmony all come into play. Let’s take a look at them one at a time.

Balance – Think about your daily activities and habits. Are they “balanced”?  In other words, do you spend a measured amount of time standing in one place? Ask yourself these questions:

• Do you spend time standing at a checkout counter or standing in one position at an assembly line?
• Do you spend any time strolling or walking?
• Do you spend a measured amount of time in an office chair?
• How much time do you spend driving or riding in a car?

Furthermore, when you think about these daily activities and habits, does one in particular outweigh the others? If the answer is “Yes”, is there a way that you can find or make more balance between them?

You see, our bodies are not meant to be in one place for a lengthy period of time and our bodies were certainly not designed to be in one place or position for the majority of the day. Sometimes, it’s challenging to look for and find balance for our body positions during the day, but if you can achieve it, it’s well worth it!

Tension – Now let’s take our balance concept one step further. If you are balanced, then you are changing your position frequently throughout the day. If you are not changing your position at least once every 50 minutes, then you are NOT balanced, and therefore you are probably under some physical tension. Musculoskeletal tension to be exact; involving not only our muscles, bones and joints, but our connective tissues: like tendons, ligaments and fascias, and our nerves – right down to the cellular level.

This amounts to lots of layers of tension. This tension builds over time; hours upon hours, and sooner or later your body will retaliate. Usually that retaliation comes in the form of pain.

Some common types of pain that comes from chronic tension include:
• Headaches
• Neck pain
• Lower back aches
• Upper back pain
• TMJ pain
• Pinched nerves
• Intervertebral disc herniation
• There are also numerous medical conditions that are exacerbated by chronic musculoskeletal tension.

Harmony – How can we take our concepts of balance and tension in order to create harmony? We can actively work our bodies thru our awareness of what we are doing, and how we are doing them. In other words, if I am standing in line for an hour, I can be aware of my legs. Am I standing with all of my weight on one foot, or am I shifting my weight every few minutes? Am I locking my knees, or am I using my strong leg muscles to support me? Is my pelvis tilted way forward so that my butt sticks out, or am I using my powerful hip muscles to line up my spine with my pelvis? Where are my shoulders in relation to my head? Are they forward and rounded? Or are they comfortably lined up with my ears? Is my head forward in relation to my body? Or is it lined up, too?

You see, we can use our body awareness in order to create harmony and balanced tension in order to achieve the best posture for the current situation.  By doing so, we can reduce or completely eliminate pain resulting from chronic musculoskeletal tension.

Through this effort of creating harmony through balance and awareness of tension, we can optimize our posture, and therefore our musculoskeletal health, on a daily basis. Theoretically, this will lead to a reduction in any chronic pain we have as a result of the poor postures we used to maintain during the day. For everything in our body is connected, in some way.

Michelle Landsverk is a Doctor of Physical Therapy at Women’s Care of Wisconsin/PT Center for Women, 3913 W. Prospect Avenue, Suite LL2, Appleton, WI 54914. Contact Michelle at 920-729-2982 or meet her here.

About the PT Center for Women
At PT Center for Women, our focus is on helping women incorporate lifestyle changes that will improve the quality of their lives. This includes gentle therapeutic exercise to both improve and maintain muscle tone, to rehabilitative exercise designed to get you back to your previous level of function and activities. From managing crippling abdominal and pelvic pain, to teaching proper sleeping postures and body mechanics at home and at work, we’re here for women. Learn more at www.ptcenterforwomen.com.

Monday, August 22, 2011

Is Hormone Therapy an Option in 2011?

Women need to know the risks and benefits of post-menopausal therapy

By Chris Danz, APNP
Nurse Practitioner


Despite the “information age” in which we live, confusion about post-menopausal hormone therapy persists. This is due to several factors.

In more than 60 years of research in menopausal medicine, studies have found both good and bad regarding hormone replacement therapy. The primary reasons for confusion regarding hormone therapy to treat the symptoms of menopause include:

• Menopause study results, which are fairly frequently changing, have not always been clearly communicated in an up-to-date manner
• Misrepresentation of study data by the media has at times resulted in further misinformation
• Outspoken celebrities, while making women aware of choices available to them, have provided information out of context at times, therefore contributing to misunderstanding of the risks and benefits of hormone therapy

In 2011, knowledge based on scientifically obtained information leads many menopausal experts to agree that hormone therapy for menopausal women can have a place in the management of symptoms of menopause.

Though not the only option, hormones are undoubtedly the most effective way to treat symptoms including:
• Hot flashes
• Night sweats
• Mood swings
• Cognitive changes (memory/focus)

Additionally, hormones are generally effective for treatment of vaginal dryness that results in pain with intercourse. Estrogen can also benefit fatigue, muscle and joint pain, and bone density. Although it continues to be debated, many physicians feel that if given early in menopause, estrogen can help minimize heart disease.

What about cancer risk with hormones?

In women who have a uterus, progesterone must be used in combination with estrogen to protect the lining of the uterus from becoming a cancer-prone environment.

Because estrogen and progestin used together appears to be the link between hormones and breast cancer, this is obviously of concern. However, newer ways of administering hormones using the lowest possible dose and cycling the progestin to limit exposure may decrease that probability.

Recent research has also found that numbers of years of use increases the risk most notably. Therefore, short-term use of hormones (less than 5 years) is generally recommended. Other risk factors such as age, weight and family history also indicate risk and need to be considered.

For every woman, both possible risks as well as potential benefits of hormone therapy need to be evaluated. Each woman has a unique health history and each patient’s symptoms, personal and family history, and long-term health goals need to be considered when making a decision to use or avoid hormone therapy.

If you do choose hormone therapy, here are some helpful hints to ensure you get the most benefit out of your menopause treatment plan:

• Work with your health care provider to individualize your menopause plan.
• Be comfortable with your health care provider and the information they are providing you.
• Request the lowest possible dose which allows you to be comfortable, and for the shortest duration of time, to get the greatest benefit while minimizing the risks.
• Request discussion about the safest possible way to deliver the hormones to your body.
• Follow up regularly with your hormone prescriber to be made aware of any changes in research or recommendations for hormone replacement. 
• Be aware that information in the media may be incorrectly represented. Find out the facts from your health care provider.

Stay tuned for more topics about menopause to be covered in upcoming blog posts!

Chris Danz is a Nurse Practitioner at the Appleton and Neenah locations of Women’s Care of Wisconsin. Contact Chris at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/.

Monday, August 15, 2011

Menopausal Symptoms & Stages

What you can expect during the stages of menopause

By Chris Danz, APNP
Nurse Practitioner
View Chris' Video Bio!


Although every woman experiences menopause uniquely and with variable intensity, most women will experience some symptoms. This is because most of the body’s organs have estrogen receptors, which are affected in one way or another by the circulating hormones. As the hormone levels decline, the resulting estrogen deficiency results in symptoms.

Menopausal symptoms can be divided into three (3) time frames:
• Early menopausal changes
• Intermediate menopause
• Perimenopause (“late” menopause)

The “early” menopausal changes often overlap with the perimenopause time. In other words, some of the early symptoms are a continuation of those noted as hormonal changes of the late 30’s and 40’s.

The most common early menopause symptoms, one or more of which 85% of all women will experience, are:
• Changes in energy level (fatigue)
• Joint or muscle pain
• Sleep disturbance
• Hot flashes
• Night sweats

Other early symptoms can be vaginal changes, breast tenderness, decrease in sexual desire, weight gain and increased abdominal bloating. Many women will also notice cognitive changes, which include change in mental alertness, memory and ability to stay focused.

Altogether, these symptoms often result in a general decrease in well-being, which can further fuel or cause depression.

Some early symptoms do resolve after a time as the body adapts to lower hormone levels.  However, many persist and progress to the intermediate and late menopausal time, when the longer time of hormone deficiency results in further issues.

Intermediate menopausal symptoms can include:
• Vaginal dryness
• Pelvic tissue changes that often result in painful intercourse
• Further decline in sexual responsiveness
• Bladder changes

Late menopause symptoms can include:
• Bone density loss that can result in osteoporosis
• Changes in the heart that make women at greater risk for heart disease
• In general, more issues of aging are noted

As you work with your health care provider to identify a plan of care for your menopause, it can be most helpful to provide him or her with a list of symptoms you are experiencing, along with a “rating” of those which you are most affected by. It is also helpful to share possible long-term issues which are most worrisome to you. In this way, each of you will be able to focus on those options which will result in optimal improvement in your health and well-being.

Stay tuned for more topics about menopause to be covered in upcoming blog posts!

Chris Danz is a Nurse Practitioner at the Appleton and Neenah locations of Women’s Care of Wisconsin. Contact Chris at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/.

Tuesday, August 2, 2011

Puberty in Reverse -- Know Your Menopause

What to know and expect when entering the stages of menopause

By Chris Danz, APNP
Nurse Practitioner




Menopause is a time in a woman’s life where her body goes through many physical and physiologic changes, due to hormone changes. Providers specializing in menopausal medicine help women during this stage of life by educating them and advising them on treatment options for conditions that may arise.

What is menopause?
Menopause is generally considered the end of a woman’s reproductive life. The ovaries stop producing eggs and the hormones that bring about ovulation and the ability to get pregnant. The average age of menopause in the United States is about 51 years, though some women experience this change at 40, and almost all women will be menopausal by age 60. The average woman can anticipate spending one-third of her lifetime in menopause.

Estrogen is the most commonly discussed hormone of menopause. In fact, many of the changes which occur are directly related to estrogen decline. However, progesterone changes also contribute to the end of menstruation, and testosterone changes also occur, though generally more gradually.

How does menopause begin?
The first and most obvious change for a woman entering menopause is that menstrual cycles change and eventually, stop. By definition, a woman is considered menopausal if she has not had a period in one year.

Every woman will experience the hormone changes of menopause uniquely. For some, the onset may be very abrupt, quite intense, and difficult. For others, symptoms may be more subtle (or even absent). Most women will notice some symptoms, but these will vary from one woman to the next as to which ones are most bothersome to her.

What women need to know
However, whether symptomatic or not, women should understand the transition their bodies are undergoing, make choices and lifestyle changes to accommodate those changes, and embrace this new era in their female life-cycle.

Menopause is a relatively new phenomenon, as prior to 1900 many women did not live long enough to experience menopause. Because of this, the field of menopausal medicine is relatively new. There has been notable new knowledge and information in very recent years that affects choices available to women at this time in their life.

Despite the increase in available information, or perhaps because of it, many women are confused about menopause and treatment options they may have. Educating yourself is the first and most important step in managing your menopause. This blog will cover some of the issues related to menopause in the coming months. Topics will include:
* Symptoms of hormone decline
* Are hormones an option in 2011?
* Let’s talk about “bio-identical” hormones
* Non-prescription choices to manage symptoms
* Choosing a health care provider who will help meet your menopause treatment goals
* What about heart disease and menopause?
* Osteoporosis: am I at risk?
* Managing dryness - inside and out
* Menopausal weight gain
* Changes in sexuality
* Why am I not sleeping any more?

Stay tuned for these topics about menopause to be covered in upcoming blog posts!
Chris Danz is a Nurse Practitioner at the Appleton and Neenah locations of Women’s Care of Wisconsin. Contact Chris at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/.

Thursday, July 14, 2011

Irritable Bowel Syndrome: What Women Need to Know

Physical therapy and other lifestyle changes may improve the symptoms of IBS


By Connie Strey, Physical Therapist, PT, BCIA-PMDB
View Connie's Video Bio!




What is IBS?
Irritable Bowel Syndrome, or IBS, is defined as a non-inflammatory condition of the bowels that may cause cramping, diarrhea and/or constipation. Bowel control problems affect at least 1 million people in the United States. IBS mainly affects women and is most common between the ages of 30 and 50 years.

What Causes IBS?
It is not always clear what causes Irritable Bowel Syndrome, but experts feel that it may be caused by one or more of the following:
• Hypersensitivity with abnormal movement of the gut
• Disturbances in the gastrointestinal sensor and motor system
• Problems in the pathway of the central nervous system
• More sensitive colons than usual
• Visceral sensitivity (diffused pain in the low abdominal region)

What are the Symptoms of IBS?
IBS is usually very painful, is chronic, and is usually associated with flare-ups of both constipation and/or diarrhea. This gastrointestinal condition may present itself in three ways: diarrhea dominant, constipation dominant and/or both constipation and diarrhea.

Symptoms may include the following:
• Cramps / Abdominal Pain
• Gas
• Bloating
• Fatigue
• Changes in bowel habits—constipation, diarrhea or both
• An urge to have a bowel movement that does not happen
• Stools that have mucus in them

The symptoms can come and go over time. For some people, it is only mildly annoying. For others, it can be serious.

What Triggers IBS?
Triggers that result in the symptoms of IBS to flare up vary from individual to individual. Many patients report symptoms caused by:
• Psychological factors and stress
• Eating large meals
• Travel
• Certain foods
• Certain medications
• Women may have more symptoms during their menstrual periods

How Do You Treat IBS?
Irritable Bowel Syndrome cannot be cured, but it can be managed to reduce the symptoms.

Some options include:

Diet:
Keeping a record of foods you eat and symptoms you have. This can help you pinpoint which foods cause problems. Your doctor can suggest changes in your diet to help manage IBS. Eating frequent small meals, rather than two or three large meals a day can help. In some cases, adding fiber to your diet may help.

Exercise:
Exercise helps to increase bowel motility and reduce overall stress and anxiety.

Physical Therapy:
Physical therapy is an effective, non-surgical treatment choice for IBS. PT treatment such as progressive relaxation and diaphragmatic breathing are also beneficial. Light pressure techniques and visceral work have been known to help relieve pain.
The patient is always evaluated for pelvic floor dysfunction because of the tightening of the rectal region in order to decrease the urgency that may be present. Many times, tightness of the muscles in the pelvic floor and decreased sensation of the pelvic floor can be related to constipation. Soft tissue work will help resolve tightness of the hip and pelvis. Biofeedback is also used to decrease overall muscular tension.

Your physician also may suggest medications or lifestyle changes to relieve the symptoms.

IBS is not an easy condition to diagnose or treat, but with guidance from your doctor and/or physical therapist, you can identify some options that will help you find relief.

Connie Strey is a licensed Physical Therapist at Women’s Care of Wisconsin/PT Center for Women, 3913 W. Prospect Ave., Suite LL2, Appleton, WI 54914. Contact Connie at 920-729-2982 or meet her here.

About the PT Center for Women
At PT Center for Women, our focus is on helping women incorporate lifestyle changes that will improve the quality of their lives. This includes gentle therapeutic exercise to both improve and maintain muscle tone, to rehabilitative exercise designed to get you back to your previous level of function and activities. From managing crippling abdominal and pelvic pain, to teaching proper sleeping postures and body mechanics at home and at work, we’re here for women.

Tuesday, June 28, 2011

The Mystery About Annual Exams Revealed

Critical reasons that women of all ages should schedule an annual gynecological exam


By Becky Thyssen, MSN, CNM, APNP
Nurse Practitioner



It’s that time again—time to schedule your annual gynecological exam. But then you stop dialing and you think, “Do I really need to have an annual exam?” Or, you may be the mom of a teenage daughter and you think, “Should I schedule one for her too?”

Annual gynecological exams are visits designed to screen a woman for certain conditions and give you and your provider the opportunity to discuss ways to help you prevent these conditions and lead a healthier life.

During your life span, you may be at more risk for certain conditions than at other times. For example, in your 20s, you may be more at risk for unwanted pregnancy; while in your 50s, you would be more at risk for breast cancer. Therefore, as you change, so does your annual exam and recommended screening tests.

TEENS:
If you are a teenager or a mom of a teenager, there is no set time to start seeing a provider for an annual gynecological screening. Sometimes your first visit is just sitting down and talking about your health and teaching you ways to be healthier.

Beyond establishing a regular health screening, teenagers should also be seen if:
• You are thinking about or already are sexually active
• You have a menstrual cycle that is irregular, heavy, or painful to the point that it interferes with your day-to-day activities
• You need the Gardasil vaccine, which is a vaccine that can help prevent cervical cancer
• You have vaginal discharge that causes an irritation or odor or any pelvic pain

20-39 YEARS:
Pap tests are recommended to start at 21 years of age. Therefore, if you are 21 and you have not had your pap test you should schedule yourself for a yearly gynecological exam. This is one screening tool that we use to make sure you continue to be healthy. In addition, clinical breast exams and pelvic exams are done at your annual exam. These two exams screen for breast lumps, ovarian masses or cysts, or any abnormalities of the uterus.

Young women should also be seen if:
• You are sexually active: for screening for sexually transmitted infections
• You are trying to prevent a pregnancy: for birth control options
• You are planning your first pregnancy: for preconception counseling

40-65 YEARS:
At age 40, your annual exam will include your first mammogram. Depending on your individual and family history you will need one every other year until age 50 when it is recommended yearly.

In addition, women over 40 should schedule exams for:
• Cholesterol, diabetic, or thyroid screening: this is done every 5 years if normal
• When you turn 50 years old, we recommend your first colon cancer screening
• When you begin menopause, we recommend screening for osteoporosis every 2-3 years

In summary, this is just a brief overview of what occurs at the annual gynecological exams over your lifespan. You can see the importance of getting expert gynecological care for you and your loved ones. By scheduling preventative annual exams, many conditions can be found and treated before they cause serious health concerns.

Becky Thyssen is a Nurse Practitioner at the Appleton and Neenah locations of Women’s Care of Wisconsin. Contact Becky at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/.

Tuesday, June 14, 2011

Gynecologic Surgery: Woman Versus Machine


Compare the realities of laparoscopic surgery vs. robotic surgery


By Rami Kaldas, MD
Obstetrician/Gynecologist


Laparoscopic surgery, also known as minimally invasive surgery, has been around for a long time. However, it was only in the late 1980’s that someone connected a camera to the laparoscope. In gynecologic surgery, this is usually placed through the belly button through a 5-10 mm incision and usually there are anywhere between 1 and 3 other incisions depending on the surgery. That is very small! Therefore, major surgery can be done and the patient frequently will be going home feeling well the same day.

As of late, robotic surgery has been all the rage. Robotic surgery is simply laparoscopic surgery with a “robot,” or a computer/machine, helping in the surgery. Many of us see advertisements for it and think this is the ultimate in surgical intervention and that complication rates should be lower and recovery faster. Well, before jumping to conclusions, compare both types of surgery and decide for yourself.


Robotic Surgery vs. Laparoscopic Surgery:
Robotic Surgery
Laparoscopic Surgery
Surgery Set Up Times
The time to perform robotic surgery simply by virtue of turning on and setting up the robot/machine is much longer; sometimes hours.
With no machine to turn on and “warm up”, the set up time to perform surgery simply in the hands of a skilled laparoscopic surgeon is much shorter.
Incision Size
Two of the incisions are 1cm each and two or three more incisions are 8mm each.
Depending on the surgery, usually 1-3 incisions total and the incision size is anywhere from 5-10mm.
Surgeons at Bedside
Not necessarily; the surgeon could be elsewhere in the room or elsewhere in the world. The surgery is performed by the surgeon moving the hydraulic arms while sitting at the console away from the operating table. The surgery assistants are at the bedside.
Yes, both the surgeon and the assistants are at the bedside.
Cosmetic Results
With robotic surgery, the hydraulic arms are powerful and can sometimes pull on the skin, especially since once the robot is connected, the patient cannot be moved.
In the hands of an experienced laparoscopic surgeon, the cosmetic result can be more attractive due to the delicacy of movements.


That is not to say that robotic surgery does not have a role. The technology is getting ever better and it is enabling surgeons who would otherwise not have the skill to do minimally-invasive surgery to do it. Ultimately, the surgeon must know how to operate very well in whichever modality they are offering the patient to avoid serious complications.

At Women’s Care of Wisconsin, we have an exceptional collection of skilled laparoscopic surgeons. We have revolutionized surgery for women in Northeast Wisconsin. We insist that each surgeon who comes to us as a new associate becomes learned in advanced operative laparoscopy until they, too, are amongst the few exceptional laparoscopic surgeons in the country. We rarely have to leave longer incision scars, even though more than two-thirds of hysterectomies in this country still leave women with a big vertical incision or horizontal incision on their bellies.

Before you decide on a surgery option, consider all the facts about a laparoscopic surgery vs. a robotic surgery and talk to your physician about the best option for your situation.

Dr. Rami Kaldas is an Obstetrician/Gynecologist at the Neenah and New London locations of Women’s Care of Wisconsin. Contact Dr. Kaldas at 920-729-7105 or meet him here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/.

Monday, May 23, 2011

To Worry or Not to Worry?

What to expect and what to be concerned about during the first few weeks of pregnancy.

By Sreedevi Sreenarasimhaiah, MD
Obstetrician/Gynecologist



Congratulations! You’re pregnant. This is the start of a wonderful journey. However, your body is going through many changes and it may be hard to know what is to be expected and what are reasons for concern.





Nausea & Breast Tenderness
Nausea and breast tenderness are one of the first symptoms that women experience. This is because of the rise in hormone levels in the body.

Human chorionic gonadotropin, also known as HCG, is the pregnancy hormone responsible for the nauseated feeling. Some women are more sensitive to the hormone than others. Some women will have vomiting. Vomiting is not dangerous to the baby and does not mean that anything is wrong with the pregnancy. Sometimes, women can be miserable if it is severe.

There are many conservative remedies to help with nausea, but if your condition is severe, call or see your healthcare provider to discuss measures you can take. A warning sign for the need for medical attention is the inability to keep even liquids down, like water or juice. Dehydration can occur if it is not controlled quickly.

Typically, nausea and vomiting typically improves by the completion of the 3rd month of the pregnancy.

Vaginal Bleeding
Another symptom that is important to discuss with your doctor is any vaginal bleeding that may occur. Vaginal bleeding can vary from as much as some spotting or old brown discharge to bleeding that requires a pad or sanitary napkin. Your doctor will want to make sure that bleeding is not because of a threatened miscarriage and may need to do a pelvic exam.

Not all bleeding is bad and does not mean the pregnancy is at risk. Sometimes bleeding can be seen with implantation of the pregnancy or with sexual activity as the surface of the cervix is easily irritated in pregnant women. In such cases, the bleeding is usually very minimal. Bleeding of any amount, however, should be discussed with your doctor.

Vaginal Discharge
Women may notice changes in vaginal secretions during this time. A mucous-type discharge or white discharge may be present. This is normal as the body develops a natural barrier for protection of the cervix during pregnancy. However, signs of a discharge that is not normal is that which itches, has a foul odor, or may have a curd-like appearance. You are encouraged to report such discharge to your healthcare provider.

Fatigue
A feeling of fatigue is very common during the first few weeks. The need for more sleep is also common and normal. This again is hormone mediated and will improve as the pregnancy progresses.

Aches & Pains
Finally, some general aches and pains, specifically on both sides of the groin area, are to be expected. This is called “round ligament pain.” These are the ligaments that support the uterus that are being stretched as the uterus grows. This pain may be crampy, but should not be severe or constant.

If you have pain that is severe or is associated with any fevers or bleeding, this is not round ligament pain and could be something else that requires immediate attention. Notify your doctor.

Baby Movement
During the first few months, you will not be able to feel the baby move. Movement of the baby may not be felt until the fifth month. This is normal. Until then, reassurance can be provided by hearing the baby’s heart beat on monthly visits by a doppler exam.

The first few weeks are full of changes, but it is the road to an amazing journey! If you are being seen by a Women’s Care provider, we encourage you to make an appointment and be seen in our office between 8 and 10 weeks of pregnancy.

Dr. Sreedevi Sreenarasimhaiah (“Dr. Sree”) is an Obstetrician/Gynecologist at the Appleton and Neenah locations of Women’s Care of Wisconsin. Contact Dr. Sree at
920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/.

Monday, May 2, 2011

Vulvovaginal Health: What Every Woman Needs to Know

The facts about women’s most private parts and tips on how to keep them healthy.


By Tatyana Shereshevsky, MD
Obstetrician/Gynecologist



Vulvovaginal health is an important area of women’s health, yet is often overlooked or disregarded. Knowledge about and comfort with your body, including the genitalia, is vital to maintaining good health.




Introduction to female vulvar anatomy or the 3 V’s: vulva, vestibule and vagina.

1. The Vulva.

The vulva is outside the body. It includes all the outer genitalia you can see between your legs. The vulva protects the women’s sexual organs, urinary opening, vestibule and vagina.

The vulva begins at the top with the mons, made mainly of a fat pad and covered with pubic hair. All together, it provides a cushion during sexual intercourse. The mons leads down on each side to the labia majora, that are also covered with pubic hair. The labia contain a fair amount of fat to act as a cushion for sexual intercourse as well.

The outer lips, or labia majora, surround two smaller, thin flaps of skin without hair, the labia minora. These are part of the protective covering for the vestibule, urethra and vagina. The inner lips of the labia minora might be visible or not. Either appearance is normal anatomy. In cases of significant enlargement, it can cause sexual discomfort, hygiene problems and pain with physical activities. If so, it might require medical attention.

The main function of the labia minora is sexual. At the top, labia minora meet under the clitoris and above the clitoris to form a hood.

2. The Vestibule.

The area between the labia minora is the vestibule. The name fits. Like the lobby, the vestibule is the site of two doorways: the urinary opening (urethra) and vaginal opening (introitus) lower. There are a few sets of glands that open into the vestibule. The major ones are Bartholin’s glands, which reside on the either sides of the vaginal opening. Their role is to assist in lubrication.

The thin membrane with one or more tiny openings in the middle of it that surrounds the vaginal opening is called the hymen. The hymen is a membrane of tissue at the opening of the vagina. It covers the opening of the vagina from birth until it is ruptured vaginal penetration, delivery, a pelvic examination, injury or sports. It has no known biological function.

3. The Vagina.

The vagina is truly inside the body. The vagina is a tube-like passage from the vulva to the cervix, which is the portion of the uterus that projects into the vagina. It is through a tiny hole in the cervix that sperm make their way toward the internal reproductive organs. The vagina is usually six to seven inches in length, and its walls are lined with mucus membrane and numerous tiny glands that make vaginal secretions.

The stretch of skin between the vagina and anus is called the perineum. Its skin covers a muscle called the perineal body. Providing resistance, it plays an important role in delivering babies.

Everyday Habits to Maintain Good Vulvovaginal Health.

1. It is so worth repeating: eat well, get adequate sleep, and exercise 2-3 times a week. Good general health is the best defense against infection and diseases.

2. Have smart sex. That means have one partner and use a condom.

3. Douching might destroy the normal bacteria in the vagina.

4. Avoid scented deodorant tampons or pads and spraying perfumes in the vaginal area.

5. Use tampons wisely. Choose the right absorbency tampon and change it regularly every 2-6 hours. A menstrual period usually produces around 4 to 12 teaspoons of menstrual fluid, about 20-60 gm.

6. Rethink powders. Corn starch is safer than talcum.

7. Loosen up. Thongs, bodysuits or tight spandex garments can trap sweat and feel abrasive.

8. Bathe right. Limit your time in hot showers or baths to 3 minutes. Mild soaps such as Dove, Basic, or Neutrogena are advisable. Never scrub the vulva. Occasional soaks in not-too-hot bubbles are fine. Lavender, rosemary, and clove oils should be diluted.

9. Wash diaphragms, cervical caps, spermicidal applicators and sex toys periodically.

10. Do not wear a pad or panty liner every day. It can be abrasive and irritating.

By educating yourself and being proactive about your feminine health, you can avoid discomfort, infections and diseases and ensure that you and your body are happy and healthy.
  
Dr. Tatyana Shereshevsky is an Obstetrician/Gynecologist at the Neenah and Oshkosh locations of Women’s Care of Wisconsin. Contact Dr. Shereshevsky at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/.

Thursday, April 14, 2011

Sexually Transmitted Infections: More Common Than You Think

What you need to know about bacterial and viral STDs

By Kirsten Wengeler MS, APNP
Nurse Practitioner

Sexually transmitted infections (referred to as STIs or STDs), are a group of infections that are transmitted through sexual contact. This sexual contact can be vaginal, oral, or anal and in some cases through intimate skin to skin contact. A person with an STI can pass it to others by contact with the skin, the genitals, the mouth, the rectum or through body fluids. In many cases this person may not even be aware that they have one of these infections and could pass it along.

Some quick facts on STIs include:

• STIs affect people in all age groups, races, and backgrounds
• Centers for Disease Control (CDC) estimates that there are approximately 19 million new STI infections each year
• They cost the U.S. healthcare system $16.4 billion annually
• They cost individuals even more in terms of acute and long-term health consequences

STIs can be broken down into two categories, bacterial and viral.

Bacterial STIs:
• Often has no symptoms, especially in early phases
• Can be treated and cured with antibiotic therapy
• If not found and treated early enough their consequences can be permanent, including infertility
• Examples of bacterial STIs are chlamydia, gonorrhea and syphilis

Viral STIs:
• Often has no symptoms, especially in early phases
• There is presently no cure
• Can cause life-long symptoms and in some cases even death
• Examples of viral STIs include herpes, HPV (Human Papilloma Virus), HIV (Human Immunodeficiency Virus) and Hepatitis B

Limiting Your Risk

There is really no way to have a sexual relationship with another person that does not put you at risk for STIs, unless you are both tested prior to being intimate. However, limiting the number of sexual partners you have in your lifetime reduces your risk of acquiring an STI, and the correct and consistent use of condoms has been shown to decrease one’s risk of acquiring an STI (but does not entirely prevent the transmission of STIs).

The only sure way to protect yourself from an STI is abstinence. This is avoidance of all types of sexual activity. Someone who practices sexual abstinence does not run any risk of contracting an STI or having an unwanted pregnancy.

Ideally you should wait to have sex until you are ready for a long-term relationship with just one person. This person should be equally committed to this relationship and to only having sex with you. Even in this situation, there is a risk of STDs if you or your partner has had other sexual relationships prior to this relationship.

If you are or have been sexually active it is important that you see your healthcare provider for STI testing. Your healthcare provider will also be able to help you assess your risk and provide you with information to reduce your likelihood of acquiring an STI.

Kirsten Wengeler is a Nurse Practitioner at the Neenah location of Women’s Care of Wisconsin. Contact Kirsten at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin: The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at http://www.womenscareofwi.com/.

Monday, April 4, 2011

I Want My Body Back!

Reliable, safe exercise tips for after baby is born

By Michelle Landsverk, DPT

So congratulations! You’ve had your baby, and now you’re excited to get back into those favorite clothes that you haven’t worn in quite awhile. You feel like they should fit, because after all, your baby is five weeks old already. But, your jeans are still two sizes too small.

So, what do you do? You promptly jump onto the treadmill, turn up the incline, and start jogging. Fast. For like, two minutes. And then something happens. You notice that you’re wet. Not wet with sweat, just wet. In the saddle region, and at that moment you realize that your body is not quite like it used to be prior to that beautiful baby you now have. The very next thing you do is call your girlfriend, mom, sister, or all three and shout, “DID THIS HAPPEN TO YOU!?” 

It’s true, and it happens all the time. Women have a baby, and then they want to pick up their life where it left off prior to pregnancy. The little story I just told you about is only one of several potential hiccups that new moms experience when they are ready to resume their pre-pregnancy workouts, or simply start exercising altogether.

So, let’s take a step back together and figure out a safe, effective, and successful way to get back into a healthy and active lifestyle once your baby is born. After all, a “simple” thing like going for a jog may not be all that simple. 

The first thing you need to do is take into account exactly how the delivery of your baby went:
• Did you have him or her vaginally, or via c-section?
• If you had the baby vaginally, did you push forever and a day, or was the delivery very fast?
• Did your perineum tear, or did you have an episiotomy?
• If you had a c-section, did your incision heal properly in a timely manner?

These factors may influence how quickly you will feel ready to start a post-pregnancy exercise program.

You also need to think about what exercises you have available to you. For example, many women will begin a running program either because they own a treadmill, or running is easy because all you need to do is step outside. Problem is, when running, each time your foot strikes the ground, there is considerable force on your pelvic floor, like, seven-times your body weight. Think about that for a second. A 150-lb woman running strikes the ground with 1,050 lbs of force with each stride! In my opinion, that’s way too much for any woman until she’s closer to twelve weeks post-partum (I know there are plenty of moms out there who disagree with me, but for the vast majority of American women, twelve weeks is a better guideline).

Many women go to the library and check out exercise DVD’s of various sorts. Often times the most popular DVD’s are those that correspond with the latest exercise fad, or reality TV show. The latest exercise class crazes are definitely zumba and kettlebells, and Jillian Michaels is the most popular exercise guru right now, bar none. Interestingly her video, “30 Day Shred” is one of the most sought after DVD’s for those people interested in weight loss. Now, I don’t want to pick on Jillian too much, after all, she has been and continues to be an incredible vehicle for change. However, one of her promises is “killer exercises.”

Well, I’m here to tell you, as a physical therapist, the number one reason for a failed exercise program is burnout or injury from choosing exercises that are simply too tough for a de-conditioned body. I do in fact see plenty of patients in the clinic who have injured themselves doing a new exercise program. So please, if you do choose to do a DVD work-out, avoid any exercise that doesn’t feel right, or stop doing any exercise that hurts to do.   

Finally, I do need to make one point about working out those abdominal muscles. Oh, our poor abs! First we stretch them beyond recognition, and then we expect them to bounce back with vigor. Second, there’s exercising abdominal muscles in order to get them stronger or more toned…which is the more correct mindset for exercising them. And there’s exercising the abs in order to shed excess fat around the waistline, which is a less healthy to approach exercising them.

Let me explain why: despite the claims of popular infomercials, you cannot spot-train any particular area of the body, especially the middle! In other words, you cannot achieve a smaller waist by simply exercising your abdominals. There are other factors involved. You need to increase your aerobic (cardio aerobic) exercise, AND decrease your caloric intake in order to decrease the size of your midline. This is a very hard concept to grasp for a lot of frustrated women out there, but once you embrace it, you will find that your clothes fit better and you will feel better about your body!

There are some wonderful exercise options out there for women. If you have access to a full-service gym, you can get your cardio aerobic exercise by swimming, and by using various pieces of exercise equipment like the elliptical trainer, recumbent or upright bikes, and rowing machines. Treadmills are excellent, but again, I recommend only walking for the first 12 weeks after your baby is born.

If you don’t have access to the gym, and the weather is agreeable, taking your baby for a walk in the stroller is wonderful for you and him or her. Fresh air is great for the two of you, and the resistance of the stroller will help increase your heart rate for the cardio aerobic workout your body needs.

Resistance exercise, or weight training, is also great. Although I do recommend that you use weights for toning and light strengthening, versus heavy resistance training. Working out with heavy weights, particularly if you are doing standing-type exercises, is not good for your pelvic floor muscles for the first 12 weeks after the baby is born.

And finally, exercise classes, like zumba and yoga will help you with balance, coordination, flexiblity and strength. Plus, exercise classes give you the camaraderie that you might need to draw upon on those days that it is hard to motivate yourself to get going.

My point is really this: there are healthy ways to view exercise, and I’m here to help you pick out good, safe options to lose that baby weight. The healthiest way is to set realistic goals for yourself, and to stick with the basics of diet (i.e. portion control) and exercise. Please realize that your weight wasn’t put on in a few short weeks, and it will not come off in a few short weeks. Eat right, and get your sleep, and pick some exercises that feel right to do. In addition, check out these online resources for post pregnancy exercise tips:

• Post Pregnancy Exercise: Getting Back in Shape
Post Pregnancy Fitness

Michelle Landsverk is a Doctor of Physical Therapy at Women’s Care of Wisconsin/PT Center for Women, 3913 W Prospect Ave, Suite LL2, Appleton, WI 54914. Contact Michelle at 920-729-2982 or meet her here.

About the PT Center for WomenAt PT Center for Women, our focus is on helping women incorporate lifestyle changes that will improve the quality of their lives. This includes gentle therapeutic exercise to both improve and maintain muscle tone, to rehabilitative exercise designed to get you back to your previous level of function and activities. From managing crippling abdominal and pelvic pain, to teaching proper sleeping postures and body mechanics at home and at work, we’re here for women. Learn more at www.ptcenterforwomen.com.