December 2006
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December 2006
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Women's Group Newsletter December 2006
The Women’s Group is offering the new Gardasil vaccination to our patients. HPV, or human papilloma virus, is a sexually transmitted virus with many different strains. Some strains cause genital warts, and others cause changes in your pap smear, which can ultimately lead to cancer of the cervix. Both the American College of Obstetricians and Gynecologists and the American Board of Pediatrics are recommending this vaccination. Gardasil protects against the four most common strains to cause problems, and is given in three separate shots. The second is given 2 months after the first, and the third is given 6 months after the first dose. The recommended target population is: · Women, age 9-26 years old · Sexually active women · Women with previous abnormal pap smears It is ideal to vaccinate girls before they ever become sexually active, and the vaccine is available your pediatrician’s. If you are pregnant, it is best to wait until after you deliver your baby to start the vaccination series. You should always continue to get your regular pap smear, and your normal office visit is a perfect time to discuss the vaccination with your provider. Ask us about it! Dr. Anne Coury
Fall and winter usher in the beginning of the cold and flu season as people begin to cluster together indoors. These illnesses have many common symptoms, but are very different. Influenza, or “flu” is a very specific illness caused by one of several Influenza viruses. Its onset is abrupt, with severe muscle aches, prominent headache, a non-productive cough and fevers in the range of 102-103 degrees Fahrenheit. The illness is usually self-limited and subsides within a few days. In some susceptible individuals influenza can progress to pneumonia. Each year the Center for Disease Control studies the patterns of influenza spread worldwide and creates a vaccine to prevent what they believe will be the three most common types. Patients who are high-risk for influenza should be vaccinated in October or November. Vaccinations are still offered through the end of Flu season in February or March. Pregnant women, and families with children under the age of 6 months are included. At age six months, children may receive their own dose of the vaccine. Treatment of influenza involves primarily supportive measures, which will be detailed below. Cases of severe influenza or pneumonia can be treated with antiviral medication. Rarely, antibiotics are prescribed for secondary infections. The Common Cold is a viral infection of the upper respiratory tract. Most commonly it is caused by Rhinovirus, but can be caused by many other viruses as well. The common cold is the leading upper respiratory tract infection in both adults and children, with the incidence rising in the fall, peaking in winter, and declining significantly in the early to late spring. Adults average two to four colds per year. Cold viruses enter the body through the nose after transmission by hand contact with infected individuals. Symptoms usually develop within two days of exposure. Cold Symptoms Runny or stuffy nose. Itchy or sore throat .Cough. Congestion. Slight body aches or a mild headache. Sneezing. Watery Eyes. Low Fever–less than 102 degrees Fahrenheit. Mild Fatigue. The usual course involves includes a watery nasal discharge that becomes thick and yellow after several days. Symptoms peak by the second or third day and subside within seven days. Cough may persist for days to weeks after the initial resolution of symptoms–particularly in smokers. Supportive Treatment Treatment does not target the virus itself, as there is no cure for viruses. Instead treatment is targeted at symptom relief. Stay at home and rest, especially if you have a fever. Stop smoking and avoid secondhand smoke. Drink plenty of fluids like water and chicken soup. Don’t drink alcohol. Gargle with warm salt water to relieve sore throat. Use saline nasal spray to loosen mucus and moisten skin in the nose. Medication Medications do not shorten the duration of a cold, in fact, they can prolong its course. They fall into several broad categories: · Analgesics–these relieve aches and pains and can reduce fever. Examples include aspirin, ibuprofen, acetaminophen, ketoprofen, naproxen. · Antitussives–these tell your brain to stop coughing. Examples include dextromethorphan. · Antihistamines–these dry nasal secretions. Examples include diphenhydramine, cetirazine, loratidine, phenolpropanolamine, fexofenadine. · Expectorants–help thin mucus so it can be coughed up more easily. Example: guaifenesin · Decongestants–shrink nasal passages and reduce congestion. Examples include pseudoephedrine, phenylephrine Because of the new laws restricting the sale of pseudoephedrine-containing products several brands have changed their contents. Sudafed is no longer pseudoephedrine. Please inspect the labels carefully to ensure that you are taking the medicine you intend. Over-the-Counter Medications Safe in Pregnancy · Acetaminophen 650-1000mg every 4-6 hours · Diphenhydramine 25-50mg every 4-6 hours · Pseudoephedrine 60mg every 6 hours or 120mg every 12 hours · Guaifenesin 100-400mg every 4 hours Do not take combinations of medications without consulting a physician. For instance, plain Robitussin is usually guaifenesin, which is safe in pregnancy. Robitussin DM is not safe, because it also contains dextromethorphan, which is not recommended. Check labels carefully.
When to call a Doctor Only complicated cases need to be managed by a physician. Reasons to call include: · Fever above 102 F ! Colds that last more than 10 days ! · Trouble breathing or shortness of breath ! · Pain or pressure in the chest ! Fainting, or feeling like you are about to faint ! · Confusion or disorientation ! · Severe or persistent vomiting ! · Severe pain in your face or forehead ! · Hoarseness, sore throat or cough that won’t go away ! · Antibiotics are rarely necessary for colds ! Prevention General good habits to avoid colds include frequent hand-washing, keeping common areas clean when someone in the home or workplace has a cold, using tissues for coughing and sneezing, not sharing drinking glasses and utensils and avoiding sick individuals. Moderate doses of Vitamin C and Zinc at the beginning of a cold may shorten the duration. Gina Campbell, M.D.
Good health before pregnancy may lower the risk that either you or your baby will be exposed to things that could be harmful. It may also help to have a healthy pregnancy. Some special concerns include use of medications for current medical conditions. If you are considering pregnancy you may need to speak to your care provider about the safety of medications and pregnancy. Sometimes alternative products may be offered. This is a good time to make sure you are current on all your Immunizations such as; Tetanus-Diptheria booster (every 10 years) · Measles, mumps, rubella (once if not immune) · Chickenpox (once if not immune) · Hepatitis A vaccine · Hepatitis B vaccine · Influenza vaccine Family health history is important. Certain disorders can be inherited and some of these can be tested for. Sometimes genetic counseling can be beneficial before attempting pregnancy to help couples understand the risks of these disorders. A few of the disorders that can be tested for are: cystic fibrosis, Canavan disease, Sickle cell disease Tay-Sachs disease and Fragile X (a cause of mental retardation. Diet and nutrition are important to consider. Before you become pregnant you should try to reach a healthy weight. Try to eat a balanced diet. Women planning pregnancy should be getting at least 400 micrograms of folic acid a day. This is to help prevent neural tube defects. Neural tube defect is a defect that results from improper development of the brain, spinal cord or their coverings. Now is a good time to try to get on that exercise plan. A regular fitness routine before your pregnancy and improve your chances of having a comfortable and active pregnancy. Alcohol, tobacco and illegal drugs can harm both you and your fetus. No amounts have been found to be safe in pregnancy. Alcohol and illegal drugs have been linked to mental retardation and birth defects. Cigarette smoking can cause premature birth, low birth weight, premature rupture of membranes and problems with the placenta. Help is available to stop these substances if needed. Some jobs can expose women to harmful or toxic substances. At times women have to discuss risks with their employer. This may also be the time that you check into your employer’s maternity policies. Adjustments to schedules may have to be taken. Insurance coverage is different in many cases. Now is a good time to determine what your coverage is and make plans for the differences for expected payments. With some planning and a few changes now you can feel you have done the most you can to prepare for a normal pregnancy and a healthy baby. Barbara Ferris, RNC,NP,MS
One Day and Years of Heavy Periods Are Done!For most women, menstrual periods are a simple fact of life. But if you suffer with heavy menstrual bleeding, there may not be anything simple about it. The medical term for heavy menstrual bleeding is "menorrhagia" (men-or-ah-jah). If you find yourself rearranging your schedule around your period, or limiting participation in favorite activities, or coping with the pain and fatigue that heavy periods can sometimes cause, you are probably suffering from menorrhagia. If this sounds like your life, you are not alone. More than 1 woman in 5 share this common condition. The good news is that safe and effective treatments for heavy periods are available... and now you have better choices! Laparoscopic Supracervical Hysterectomy (LSH) is a minimally invasive treatment developed to eliminate heavy menstrual bleeding in an outpatient setting with an overnight stay in the hospital. Unlike a traditional hysterectomy, LSH is accomplished with small incisions resulting in minimal tissue injury, which means, recovery is fast - many women return to their normal activities in 7-14 days. The procedure uses a thin, lighted telescope-like instrument called a laparoscope, which acts like a video camera, along with small, "high-tech" surgical instruments that are all inserted through four tiny incisions in the abdomen. Three of the incisions are 5 mm and one is 15 mm in size. Using the instruments, the surgeon carefully separates the uterus from the cervix and removes it through one of the openings. The cervix, the bottom part of the uterus, is left intact. Because this type of surgery does not require the surgeon to make a large abdominal incision, you will not have the same kind of visible scar typical as with most traditional, "open" surgeries. LSH causes less stress to the body than the traditional "open" hysterectomy. It was developed to reduce pain, minimize scarring, and shorten recovery time. The procedure can be done on an outpatient basis, which means a woman can be home resting comfortably within 24 hours and back to her normal activities in less than two weeks. As with all surgery, hysterectomy involves risk, including potential blood loss, infection and damage to other internal organs. What is "excessive" menstrual bleeding, and what are the symptoms? Every woman is unique, and so are her periods. When it comes to periods - how long they last, how heavy they are - there is a wide range of normal. But usually, the average period lasts 5-7 days, and the average amount of blood lost is only one to two ounces per cycle. On the other hand, if you suffer from heavy periods you may bleed as much as 10 to 25 times that amount each month (Source: National Women's Health Resource Center). And if you do, you probably know what it's like to experience one or more of these difficult and disruptive symptoms: · Menstrual flow that interferes with your regular activities or lifestyle and causes anxiety about embarrassing accidents · Periods that last longer than seven days · Menstrual flow that soaks through one or more tampons or napkins every hour for several consecutive hours · Menstrual flow that includes large blood clots · Fatigue or shortness of breath (which are symptoms of anemia caused by blood loss) If you are experiencing heavy, prolonged menstrual periods, take a few minutes to answer the following questions. Your answers to these questions can help your doctor determine if you have menorrhagia and, if so, what may be causing the condition.
1) Do tampons or sanitary napkins quickly become
soaked, causing a frequent need to change them? Yes No If you have answered yes to even a few of these questions, be sure to talk to your doctor.
Heavy Periods Self-Quiz
Results
0: Although your bleeding may be heavy at times,
it does not seem that you suffer from abnormally heavy bleeding. Jonathan Franco, MD
Soon there will be another option available for long-term reversible birth control. A single rod insert using a progesterone substance has been approved for use in the United States. Training programs will begin after the first of the year for clinicians. The procedure will be simple and the implant will be effective for 3 years. There have also been changes in birth control pills. Now available are two brands with 24 active pills out of 28. Women should experience a shorter menstrual period with this schedule. At this time there are 2 kinds of extended cycle pills. These are packaged with 3 months of active pills. This will decrease periods to 4 times a year instead of each month. Currently in the U.S. there are two devices for intrauterine placement. One device contains a small amount of hormone, progestin. The other has copper. Both are T shaped and must be inserted and removed by physician or nurse practitioner. The copper IUD may stay in place 10 years and the hormonal IUD is effective for 5 years. Easily available methods are barrier methods such as condoms, spermicides and back on the shelves the “Sponge”. These are all at your local pharmacy or grocery store. Another barrier method is the diaphragm. This must be fitted by a trained clinician and is prescribed and purchased at a pharmacy. Soon to be available “over the counter” Plan B is emergency contraception. This is to be used after unprotected sex or if there is a contraceptive failure. If it is taken within 72 hours of the incident, the risk of unintended pregnancy is reduced by 89%. The sooner it is taken the more effective. Plan B should be used in emergencies not to be relied on as primary birth control. Plan B cannot protect from the other risks of unprotected intercourse such AIDS and other sexually transmitted infections. Plan B is used to prevent pregnancy; it is not effective if you are already pregnant. It will not affect an existing pregnancy or harm a developing pregnancy. Please schedule an appointment to discuss any contraception concerns you may have. With all the available options, working together we should be able help you find an acceptable method and appropriate timing for your family Barbara Ferris RN, BSN, MS
Preventative Health Screening Recommendations for Women over Age 45: · Cervical Cancer Screening (Pap Test): Every two or three years after three consecutive tests or as recommended by your health care provider. · Pelvic exam: Annually to check the health of your reproductive organs. · Breast Exam: Annually by your health care provider to detect lumps or masses of concern; monthly by you · Mammogram: Every 1-2 years in your forties, every year beginning at age 50 to check for breast cancer · Lipid profile ( cholesterol): Every three to five years if normal. · Blood pressure: Annually to check for high blood pressure ( 130/90 or higher). · Bone Density test: Recommended for all women ages 65 and older; may be recommended for younger women with one or more risk factors for osteoporosis. · Colon cancer screening: Regular screening beginning at age 50. (Fecal occult blood test annually, or flexible sigmoidoscopy every five years, or double contrast barium enema every five years, or colonoscopy every 10 years). · Fasting Glucose test: Every three years. · Thyroid-stimulating hormone screening: Every five years beginning at age 50 to check for thyroid problems. · Immunizations: Annual influenzas vaccine beginning at age 50: tetanus-diptheria every 10 years. Barbara Ferris RN, BSN, MS
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