The Women's Group Newsletter
- REDUX and PHEN-FEN....What’s the
Story?
- Breastfeeding Intelligence. How to
Tell That Your Baby Is Getting Enough Milk
- Heart Murmurs
- Nancy's Nook
- Nurse Midwife to
Join With The Women's Group
- Pregnancy Gingivitis
- Colorado Open Access Law
Dr. Elizabeth Aparicio
Many women have trouble with weight loss particularly after pregnancy or as they age.
Redux and Phen-fen are new medications available to assist with weight loss. There has
been much recent advertising of these drugs that alludes to complete safety and ease of
acquisition and use. However, this is not entirely true. I wish to give you “the rest
of the story”.
Redux and Phen-fen are prescription drugs obtainable only through a physician. They act
on a particular area of the brain to suppress one’s appetite. They are most effective
in combination with a low fat, low calorie diet and exercise. In fact, one should not
begin one of them unless diet and exercise have been started.
These medications are only recommended for people who are either 30% or more over their
ideal body weight or for people with diabetes, high blood pressure, high cholesterol, or
other conditions affected by excess weight who are 20% or more over their ideal body
weight. Ideal body weight is estimated as 100 lb. for 5 feet, then an additional 5 lb. per
inch.
The reason for the strict guidelines has to do with the potential risk of developing a
life threatening condition called primary pulmonary hypertension (PPH). This is a
condition in which blood vessels in the lungs are permanently damaged. Half of all people
who develop PPH will die within 5 years of onset. The risk of developing PPH in the
general population is 1 per 1 million people. This risk increases to 23-46 per 1
million people with the use of Redux or Phen-fen (obviously small but still quite
significant).
Early symptoms include shortness of breath, chest pain, decreasing exercise tolerance,
fainting, and swollen ankles. PPH is difficult to diagnose and there is no good treatment
for it.
Compared to the risk of PPH, people who are quite overweight may actually be at greater
risk of developing health problems as a result of their obesity. These are the people who
may benefit from diet medications. However, even for these people, a few important facts
are necessary to know.
First, the studies of these drugs are limited to one year. Their safety and efficacy
beyond one year is unknown. Secondly, rebound weight gain commonly happens after cessation
of the drugs unless major lifestyle changes have occurred and will continue (low fat, low
calorie diet and daily exercise).
Thus, the bottom line is that diet medications may be beneficial for people who are
significantly overweight. The risk of developing PPH is too great to recommend their use
in people who only need to lose a small amount of weight.
By Dr. Lois McLauchlan
For many good reasons, the majority of mothers are now breastfeeding their children.
This is the first in a series of articles on maximizing and prolonging the success of this
artful practice.
Once you have begun to breastfeed, one of the most important things you’ll want to
determine is whether the baby is getting enough milk. Luckily, there are many good clues.
These guidelines pertain to the healthy normal baby born at term.
The first few days of life, the baby is given lots of time at the breast to practice
nursing and to receive the nutrient and immunity rich colostrum. Expect the milk to
“come in” the 2nd to 4th day after delivery. The breasts then become full and
firm before a feeding and softer afterward. The breast that is not being nursed may drip
milk at feedings. Baby should be latching on correctly, sucking vigorously, and swallowing
regularly. There should be eight to fourteen feedings every twenty four hours, each
typically hlasting at least ten minutes per breast. It may occasionally be necessary to
awaken the baby to nurse if there has been more than three hours since the beginning of
the last feeding (one four or five hour stretch through the night may be permitted).
Contact a lactation consultant or other qualified caregiver for more information or
suggestions if you have concerns about how these things are going.
Within a day or two, the newborn goes from wetting a couple of diapers a day with dark
or possibly rust colored urine to six to eight dilute, colorless voids per twenty four
hours. The stools should turn from a greenish brown to four or more a day of a loose,
yellow, seedy type (like a mix of cottage cheese and mustard). Ideally, the baby then
begins to gain an ounce a day. If these changes have not occurred by the fifth day, notify
the baby’s doctor as it becomes important to get the baby weighed.
It is important to nurse as frequently as the baby gives signals of being ready such as
arousal from sleep, increased alertness, bending the arms and legs, bringing the hand to
the mouth or sucking on the hand, making tongue and mouth movements. Anticipate times of
increased demand as the baby undergoes appetite spurts. Some infants prefer to cluster
their feedings rather than space them out evenly over the day. As the richest portion of
the milk comes at the end, let the baby finish completely on one breast before offering
the other. Alternate the breast you begin feedings with. The baby should seem satisfied
after nursing and indeed may fall asleep at the second breast. When the breasts are
particularly full (such as during the first week or with a prolonged time between
feedings) it’s very important to completely empty the breast as continued pressure in
the breast may greatly slow down milk production. This may require arental grade electric
pump.
By two weeks, the baby should be back up to it’s birthweight. Most women begin to
notice the feelings of the milk let-down reflex such as tingling, pins and needles or
tightening sensations as milk begins to flow. The surest way to determine your baby is
getting enough nutrition is to regularly check his or her weight. A gain of an ounce a day
from the time the milk is in through two months of age is expected. Tender, cracked, or
bleeding nipples or yellowness of the baby’s skin may be indirect signs the baby
isn’t getting enough milk. If there could be a problem with your supply or with the
baby’s nursing habits, the earlier recognized and treated, the better.
by Dr. Gretchen Frey
You’re in for your annual checkup. Your doctor listens to your lungs, then your
heart. She gets a little frown of concentration and listens in several spots. Then she
says, "Has anyone ever mentioned hearing a heart murmur on your exam?"
Many people panic at this question. We all know how prevalent heart disease is, and a
"murmur" can sound like a sinister condition. What does it mean? How worried
should you be? If you already know, congratulate yourself on being well educated. If not,
read on.
A heart murmur is an extra heart sound heard on exam. There are normally two sounds
heard (the "lub-dub" we are all familiar with). A murmur sounds like a swishing
or sometimes a groaning sound. You need a stethoscope to amplify the noise enough to hear
it. It simply represents the sound of blood flowing through the valves and chambers of the
heart. Whenever flow is increased, a murmur is more likely to by heard, as in pregnancy or
after exercise. Most of us will exhibit a murmur under certain conditions, if a sensitive
enough pair of ears is listening. Even if a murmur is heard consistently (on several
occasions, that is) the majority will turn out to be benign, with the heart found to be
completely normal.
The best test to evaluate most murmurs is the echocardiogram, or ultrasound of the
heart. This is painless and fairly quick, usually performed at one of the hospitals, and
is read by a cardiologist. Your doctor may order one if she hears a new heart murmur, or
if you have any symptoms of heart disease, such as chest pain with exertion or extreme
shortness of breath.
Even if your heart function is normal, there is one more important issue to settle. A
few murmurs will be due to abnormally shaped heart valves that do not close normally,
allowing some blood to leak through. If the closure is very poor, there are always
symptoms such as those mentioned above. If the valve only leaks a little, you will be
perfectly healthy, but there is sometimes enough turbulence generated by the backflow that
the bacteria carried in the blood may settle on the leaky valve and infect it. Such an
infection (luckily rare) is very hard to treat.
The only time most of us have any bacteria in our bloodstream is during major surgery
or following a dental procedure (including cleaning). There are lots of bacteria in the
mouth, and the gums are fragile enough that the skin can get broken during the procedure.
(by the way, blood on your dental floss isn’t considered enough trauma to let in a
significant number of bacteria). The body clears these bacteria rapidly, and they
don’t ordinarily make us ill. However, for those few people with turbulent blood flow
in the chambers of the heart due to an abnormal valve, it is felt wise to give antibiotics
whenever there is dental work or a major surgery. This prevents the bacteria from
colonizing the valve.
So, you’ve just heard a very long-winded reason why your doctor may be interested
in whether you’ve ever been told you have a heart murmur, and many want to
investigate a new one. But I hope you’ll agree there’s no cause for panic.
By Dr. Nancy Rudd-McCoy
Back to Basics
The best time to do a PAP is midcycle, that is around the 14th day after your last
menstrual period begins.
Douching and the use of vaginal creams will impair the adequacy of the PAP. Sex will
not. The use of vaginal creams will prevent a microscopic exam of secretions - a very
important test in diagnosing vaginitis.
DHEA Sulfate
This hormone is a product of the adrenal gland and ovary in women. It is an androgen- a
male hormone. In fat tissue it gets converted to estrogen. Studies of this hormone in lab
animals is intriguing. However there are not, as yet, enough well-designed studies in
humans to state that it had any benefits (or side effects). As a natural substance, the
FDA cannot control DHEA sulfates’ marketing. It can only prevent unsubstantiated
claims on the label.
PAPs After Hysterectomy
Two very large and well-designed epidemiologic (population) studies have recently shown
PAP smears after a hysterectomy for benign indications to be essentially useless. If a
hysterectomy was done for cervical dysplasia (a precancerous condition) or cervical or
uterine cancer, an annual PAP should still be
done.
Our feeling is that a history of HPV (human papillma virus) or genital warts is an
indication for annual PAPs throughout life.
Does this mean a woman is “off the hook” in regards to pelvic exams after a
hysterectomy? `No such luck! Besides doing a breast exam, the annual gyn exam screens for
ovarian cancer, vulvovaginitis, and hormone status.
Seen in Traffic...
A bumper sticker stating “Dole for Pineapple”. Yes, we’re simple.
So where’s Marta?
Much to our dismay, we’ve had tremendous turnover in our back office staff. We
think we’ve got the best team ever now, so we’d like to introduce two of them...
Kimberly Ann Pfeifer, RN, BSN
Our Pracice Administrator graduated summa cum laude from Thomas Jefferson University in
Philadelphia, PA. She recently moved here from Erie. PA where she worked as an office
nurse for an Infertility specialist. Prior to this, she worked as a neonatal intensive
care nurse at Hamot Hospital.
Kim has a strong interest in Women’s health issues, both administrative and
clinical. She lives in Highlands Ranch with her husband, Dr. William Pfeifer, a trauma
surgeon, and her two daughters Karen and Anna. She enjoys gormet cooking, tennis, reading
medical mystery novels, and a little peace of mind now and again.
Joanie Dunning, RN
Our Nurse Coordinator is currently living in Littleton. She moved here from New Jersey
approximately five months ago with her husband Jeff and two sons, Nicholas 11 and Michael
9. She previously worked in Hackensack University Medical Center in Labor and delivery for
the past 5 years. Prior to that, she worked in post partum and 4 years in Med-Surg. She
received her RN from Felecian College in Lodi, NJ. She enjoys reading, cooking, and most
of all being with her family. She is currently expecting a new baby in October.
We are very pleased to announce our new association with Felicity A. Thompson, ANC, MS,
Certified Nurse Midwife.
She will begin practice at The Women’s Group this summer. Low risk obstetric
patients will have the choice of being followed and delivered by Ms. Thompson with The
Women’s Group doctors as back up, or to be followed by the physicians directly.
Midwives have the reputation and tradition of needing fewer interventions such as
episiotomy, cesarean section or forceps for delivery and their style may be more conducive
for those who wish a natural labor.
Ms. Thompson also handles annual exams, infection checks, and contraceptive counseling.
Her training includes a Bachelor of Science in Nursing as well as a Masters of
Science with focus on Nurse Midwifery from the University of Colorado Health Sciences
Center. Her experience is varied and includes work as a high risk perinatal nurse and a
labor and delivery nurse at Rose Medical Center, midwifery at the Indian Health Service,
and clinical work at Planned Parenthood.
She is married to husband Richard, has three sons (ages 12, 10, and 5), and enjoys
gardening, biking, and community involvement.
submitted by Scott R. Burkhart, D.D.S.
Kay Burkhart, R.D.H.
Changes in the hormonal balances during pregnancy can result in an exaggerated response
of gum tissue to local irritants and plaque. When your mouth is in good health and your
oral hygiene is adequate the changes may be small or may not occur at all.
Pregnancy is not the cause of gingivitis, but the hormonal changes tend to aggravate
the inflammatory response to plaque bacteria. The result of this response will be painful,
red, swollen gum tissues that bleed easily.
The first step toward reversing the inflammation is to get on a routine of good oral
care. This would include brushing twice a day with a soft toothbrush and gentle flossing
once a day. It is important that you continue with your regular dental check-ups.
Left untreated, gingivitiscan progress into periodontal disease, which involves an
irreversible loss of bone and can lead to tooth loss. This is probably where the wives
tale of losing a tooth for every child originated.
You do not have to suffer with this painful disease. If you are not able to control the
redness and bleeding with improved home care, please call your dentist or dental hygienist
immediately for treatment.
The State passed a law which went into effect early 1997 making it easier to obtain
medical care from your obstetrician gynecologist. In the past, many HMOs required referral
from a primary care physician in order for a visit to the OBGYN to be paid by the
insurance plan. It is now no longer necessary to obtain such a referral from the primary
care doctor to be seen by a participating OBGYN for routine exams or for any obstetric or
gynecologic related problems such as irregular periods, abnormal PAP smears, infertility,
vaginitis, pregnancy, pelvic pain, menopause counseling, PMS, contraceptive advice and
administration, breast lumps, sexually transmitted diseases, etc., etc.
This new law does not, however, alter which services are specifically covered under
your plan, nor does it allow for unreasonable overuse or duplication of services. It
simply means you no longer must seek approval by a “gatekeeping” physician ( and
potentially be denied that permission) to be seen by an OBGYN group for these types of
concerns.
If you have any questions about this new regulation or feel it has not been applied
fairly to you, please notify the Insurance Comissioner:
Mr. Jack Ehnes
560 Broadway #850
Denver, CO 80202
(303) 894-7490.
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