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April 27, 2016

Dr. Haley pic

What Sets FPMRS Apart and What is ALCAT Testing?
– An Interview with Dr. Haley

How has being a FPMRS (Female Pelvic Medicine and Reconstructive Surgery) specialist changed how you practice medicine?
In order to become board certified, and have that distinction, you have to do a tremendous amount of studying. In a sense, the certification forces you to become an expert. Generally speaking, OB-GYNs are trained in pelvic floor complications, but not nearly to the extent that’s required for FPMRS certification. Going through the sub-specialty training makes you realize what you didn’t know. It really advances not just your knowledge, but also makes you a much better surgeon in regards to your approach and your ability to take care of even the most difficult situations.

Having three of us as FPMRS specialists distinguishes us as the go-to for women who need pelvic surgery.

When you offer patients pelvic repair procedures such as Vaginal Rejuvenation, how does that compare to ThermiVa, which is a less invasive?
ThermiVa is a non-surgical procedure for vaginal tightening, performed in the office. I think of ThermiVa as an option for women that may have issues with vaginal dryness or sexual dysfunction, some leakage, or some loss of support. However, when comparing the ThermiVa procedure to some aspects of vaginal reconstruction, they are not the same. If a patient’s issues aren’t too bad, ThermiVa can be a good option. The worse the problem, however, the more extensive surgical reconstruction the patient may require.

Is there a trend in GYN Surgery?
Over the next few years, it looks like reconstructive pelvic surgeries will no longer be performed by general OB-GYNs, either because they don’t want to or because they won’t be qualified. Instead, they’ll refer their patients to a specialist who has earned this board distinction. This trend has already happened in a number of fields, with the sub-specialty of FPMRS being one of the most recent ones.

Additionally, as the population ages, we’re seeing pelvic floor problems more and more. The number one reason for issues with prolapse is delivering babies vaginally and having them come out through the birth canal. These aren’t necessarily births that have complications, but it’s just fallout from regular deliveries where babies come through and stretch–and often damage–the muscles and tissue.

In addition to childbirth, there are other things that contribute to loss of pelvic floor support, including jobs that involve lots of lifting and/or heavy straining. Other people who have experienced the loss of pelvic floor support include long-term smokers, people who are overweight and even athletes who compete extensively in high-performance activities.

Recently, you have gotten interested in ALCAT [food sensitivity] testing. What is it, and what drew you to learning more about ALCAT?
The ALCAT test (antigen leukocyte antibody test) measures negative reactions to the food we put in our bodies. I got interested because I was seeing patients having health issues, and no amount of regular testing was showing any kind of helpful results. Becoming a subspecialist in Female Pelvic Medicine has factually pushed me to a new level of knowledge for my patients –surgically, and in other areas as well.

Is there a correlation between food sensitivity picked up from an ALCAT test and gynecological issues?
A lot of “hormonal” issues can actually be related to food sensitivities.

I hear patients discuss things like hormone imbalances, weight gain and depression all the time. Sometimes there’s a gynecological cause. But sometimes, there’s an interplay of other things. And what I’ve come to realize is it’s often the combination of underlying issues that’s the source of the problem.

Dr. Haley with patient picAs an OB-GYN, I see women every day who tell me the problems they’re experiencing, and yet sometimes there hasn’t been this simple, easy resolution. This is especially the case with patients who use their OB-GYN as their primary care provider and don’t see an additional doctor. A woman will come in for her yearly exam and mention she’s just not able to lose weight, or that nothing she’s tried is working. If we check standard things and find nothing is working, what’s missing? Then I know it’s time to move onto something else.

An ALCAT test is the only reliable test that can discover these types of things in the blood. They are used worldwide, and a lot of athletes use ALCAT tests to try to give themselves an edge in performance.

What exactly is a food sensitivity?
Here’s a little backstory:
Our bodies react when they come in contact with toxins in our food, such as chemicals, dyes, or pesticides. When you talk about our immune system, there are two parts: one is when our bodies come into contact with a particular food; there can be an immediate allergic reaction that many people are familiar with. (For example, peanuts, shellfish, etc.) But the second part, called the Innate Immune System, is when we come into contact with foods that create a delayed response. This response can occur within a day, several days, or even a week. We don’t realize the connection, and sometimes we don’t even notice.

So, if we’re putting things into our body, and the body recognizes it as an “intruder,” our bodies send out an “attack” response to this particular type of food or substance. Food responses are responsible for numerous related health issues.

Some of the biggest health issues have been linked to these types of responses, including heart disease, diabetes, complications with weight and obesity, chronic fatigue, bowel issues, depression, ADHD, and it just goes on and on. The commonality behind a lot of those diseases is inflammation. The body mounts an inflammatory response when it comes into contact with something it doesn’t recognize, and over time, that causes issues in the body.

Years ago, we thought our bowel was responsible for only 20 percent of the immune function. Now they realize 80 percent of our immune system is related to the bowel. So now, the bowel is the primary immune function. Given that change in percentage, a lot of problems can be connected to that.

How does the ALCAT test work?
A patient can choose by picking up a number of panels what they want to be tested for. The panel gets sent off and they get a very detailed result indicating what foods are okay to eat, what foods are triggering a mild reaction, and what foods are triggering a severe response and should be avoided. The company that administers the ALCAT test will also help the patient with a rotation diet to help their body recover from the inflammatory-triggering foods.

Are there any references you recommend to patients if they’re interested in learning more about it?
Patients can visit the ALCAT website. It’s pretty helpful. I actually created my own brochure about ALCAT testing so that when patients ask about it, they can read the information and get a much better understanding of what the test involves and what might be a result of what they’re experiencing. If a patient shows interest in the test, I’m happy to sit down with them and send them home with additional information.

“Down Time”
You’re a big participant in marathons, and even a few triathlons. What else do you enjoy doing in your spare time?
I like traveling and spending time with my family. I also enjoy golfing and hiking.



April 12, 2016

Stay fit during pregnancy.

Regular fitness is one of the best ways for women to stay healthy during pregnancy. Staying active during pregnancy can improve mood, reduce pregnancy pains, and boost overall health. If you’re training for a marathon, you’d better leave it for your baby’s first birthday. Otherwise, it’s time to get active!

Benefits of Exercise During Pregnancy:

  • Staying active keeps both mom and baby healthy and strong.

Regular fitness during pregnancy:

  • Decreases the risk of gestational diabetes and long-term obesity
  • Reduces backaches, bloating, and swelling
  • Contributes to faster postpartum recovery
  • Improves energy levels
  • Increases endurance, strength, and muscle tone
  • Improves posture

How to Stay Active While Pregnant
Whether you’re a CrossFit champion or a full-on couch potato, it’s important to find the right level of fitness for your pregnancy. The American Congress of Obstetricians and Gynecologists recommends moms-to-be exercise for at least 30 minutes most days. For fitness newbies, this can work just as well broken into three 10-minute sessions throughout the day. Try a brisk walk after each meal (don’t forget to give yourself time to digest). Other safe pregnancy workouts include:

Dr. Crigler tries to keep fit no matter what!
Water makes your body feel lighter, so it’s easier for pregnant moms to get moving. Bonus: swimming can help reduce nausea, swollen joints, and sciatic pain.

Hardcore runners don’t have to go from 60 to 0 when they get pregnant. Speak to your obstetrician about adjusting your training during pregnancy. But pay close attention to what your body tells you; pregnancy loosens joints, increasing risk of injury.

Low impact aerobics
Don’t be afraid to sign up for that dance fitness class. Just don’t ignore your body when it says, “Ok, enough is enough!”

Indoor cycling
A good workout that’s easy on the joints, indoor cycling adds stability during a time when a growing stomach makes balance a daily struggle.

Weight training
Choose lighter weights and increase your reps to weight lift safely with a baby on board. To protect yourself from injury, consider using a weight machine, which limits your range of motion.

Pilates and prenatal yoga
Both exercises improve flexibility and strength while promoting relaxation. They also improve posture, which relieves back tension from a burgeoning belly. As you grow, ask the instructor to modify moves and make certain poses safe for you. And whatever you do, avoid Bikram yoga (commonly known as hot yoga).

It’s important that pregnant women listen to their bodies when finding the right pregnancy fitness routine. Use common sense – if the exercise makes you feel energized, it’s likely healthy. If the activity results in discomfort, it’s more likely unhealthy!

If you have further questions about the right kind of exercise during your pregnancy, call Cherokee Women’s Health and schedule your appointment to discuss with one of our board-certified OB-GYN’s.

March 31, 2016

Cherokee Women's Health works to achieve and maintain national ultrasound accrediation.The Ultrasound Practice Accreditation Council of the American Institute of Ultrasound in Medicine is pleased to announce that Cherokee Women’s Health Services has been awarded ultrasound practice accreditation.

Cherokee Women’s achieved this recognition by meeting rigorous voluntary guidelines set by the diagnostic ultrasound profession. All facets of the practice were assessed, including the training and qualifications of physicians and sonographers; ultrasound equipment maintenance; documentation; storage, and record-keeping practices; policies and procedures to protect patients and staff; quality assurance methods; and the thoroughness, technical quality and interpretation of the sonograms the practice performs.

Dr. Michael Litrel FACOG, FPMRS of Cherokee Women’s Health said “our guiding mission is to maintain the best standards in health care to help our patients achieve the best possible outcomes. Meeting AIUM standards may seem like a ‘nice-to-have’ feature, but for our practice, it is a must have. Our patients deserve the very best from us whenever they step through our doors.”

March 24, 2016

Endometriosis is a condition where tissue from the lining of the uterus, called the endometrium, forms and grows in places outside the uterus. These growths may lead to pain and infertility. Up to 50% of women who have endometriosis may experience infertility.

If you had painful periods as a teenager, it is very likely you have endometriosis. This problem often goes undiagnosed because women “get used to” the pain.

Symptoms of Endometriosis

In endometriosis, displaced endometrial tissue continues to act as it normally would — it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — abnormal tissue that binds organs together.

Endometriosis can cause pain — sometimes severe — especially during your period. Fertility problems also may develop. Fortunately, effective treatments are available.

Causes of Endometriosis
The exact cause of endometriosis is not known. However, possible causes include the following:

  • Your immune system may not be getting rid of endometrial cells outside of the uterus like it should.
  • Heavy bleeding or an abnormal structure of the uterus, cervix, or vagina causes too many endometrial cells to go up through the fallopian tubes and then into the belly. (This is called retrograde menstruation).
  • Blood or lymph fluid may carry endometrial cells to other parts of the body. Or the cells may be moved during a surgery, such as an episiotomy or a cesarean delivery.
  • Cells in the belly and pelvis may change into endometrial cells.
  • Endometrial cells may have formed outside the uterus when you were a fetus.
  • It may be passed down through families.

When to Call Your Doctor
If you develop sudden, severe pelvic pain, call your doctor immediately. Call a doctor to schedule an appointment if:

  • Your periods have changed from relatively pain-free to painful.
  • Pain interferes with your daily activities.
  • You begin to have pain during intercourse.
  • You have painful urination, blood in your urine, or an inability to control the flow of urine.
  • You have blood in your stool, you develop pain, or you have a significant, unexplained change in your bowel movements.
  • You are not able to become pregnant after trying for 12 months.
  • If you plan to become pregnant and have painful periods or painful sex

Treatment Options
There is no cure for endometriosis, but treatment can help with pain and infertility. Treatment depends on how severe your symptoms are and whether you want to get pregnant. If you have pain only, hormone therapy to lower your body’s estrogen levels will shrink the implants and may reduce pain. If you want to become pregnant, having surgery, infertility treatment, or both may help.

Not all women with endometriosis have pain. And endometriosis doesn’t always get worse over time. During pregnancy, it usually improves, as it does after menopause. If you have mild pain, have no plans for a future pregnancy, or are near menopause (around age 50), you may not feel a need for treatment. The decision is up to you.

If you have pain or bleeding but aren’t planning to get pregnant soon, birth control hormones (patch, pills, or ring) or anti-inflammatories (NSAIDs) may be all that you need to control pain. Birth control hormones are likely to keep endometriosis from getting worse. If you have severe symptoms or if birth control hormones and NSAIDs don’t work, you might try a stronger hormone therapy. Besides medicine, you can try other things at home to help with the pain. For example, you can apply heat to your belly, or you can exercise regularly.

If hormone therapy doesn’t work or if growths are affecting other organs, surgery is the next step. It removes endometrial growths and scar tissue. This can usually be done through one or more small incisions, using laparoscopy. Laparoscopy can improve pain and your chance for pregnancy.

In severe cases, removing the uterus and ovaries (hysterectomy and oophorectomy) is an option. This surgery causes early menopause. It is only used when you have no pregnancy plans and have had little relief from other treatments.

As OB-GYNs, we specialize in protecting your fertility and providing treatment to relieve physical suffering. Our three board certified specialists in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) provide an exceptional level of expertise you won’t find in any other OB-GYN practice in the Southeast.

Please contact us today to schedule your appointment by calling 770.720.7733.

March 23, 2016
Susan Griggs, APRN, CNM photo

Susan Griggs, APRN, CNM

As Cherokee Women’s First Nurse Midwife, a Pioneer at Northside Hospital Cherokee

When Certified Nurse Midwife Susan Griggs joined the practice nine years ago, she was the lone midwife in the practice, as well as the only midwife delivering at Northside Hospital Cherokee, period.

What was it like being the only midwife delivering babies at Northside Hospital Cherokee?
Being first brought positives and – challenges! The Labor and Delivery nurses were very supportive; many had worked with midwives at other hospitals. But I had to educate about my skill set and which patients I can care for, 37-40 weeks – pre-term patients are cared for by MD’s.

And being first also meant pushing through some red tape! A typical hurdle I had to jump as the first midwife at Cherokee Women’s Health was getting prescriptive authority. This is something available for Advanced Practice Nurses – the ability to write for patient medications. I enlisted the help of the other Advanced Practice Nurses in the office, Women’s Health Nurse Practitioners; the State Board of Medicine approved the application. So now any nurse-midwife or nurse practitioner in the practice can write prescriptions for routine meds – this is very helpful for our patients and makes things in the office run smoother every day!

On the positive side, being the first midwife delivering at Northside Cherokee – One thing I’m proud of is that I’ve inspired several nurses to go back to school to get advanced degrees in nursing. Advance Practice Nurses approach patient care from a unique perspective – and that opportunity to set an example has meant a lot to me.

You’ve been a Clinical Preceptor for nursing students pursuing their Master’s at more than one university – including Emory, Frontier Nursing University, University of Alabama and Kennesaw State University. How have you ended up training students in so many programs?
A lot of people don’t realize that Emory University has the only Masters degree training for nurse-midwifery in the state. Also, there’s a shortage of clinical rotations available for students in general, so I try to do my part. For example, this month I got a call from the program at Georgetown University, asking if we could please place a student. I’m eager to have them starting in the fall.

Every program is a little different. A midwifery student at Emory, for example, needs to complete 40 deliveries by the time she or he graduates. Midwifery students attend births here and at other clinical sites, so sometimes by the time they arrive, they already know a good bit. But depending on the program, another student might need a lot of one-on-one mentoring. Students in Family Nurse Practitioner Programs need to learn about OB along with their clinical rotations in pediatrics and adult medicine.

Students learn three basic actions in their clinical rotation with me: 1. How to do an OB exam. They learn the protocols for OB management. 2. How to complete charting. They gain experience using electronic medical records. 3. Finally, they have an opportunity to use their teaching skills with the patients.

Some of the teaching I share with the students is just common sense advice you might not expect. For example: Even if your hands are squeaky clean, go ahead and wash your hands in front of the patient. It’s reassuring to them.
With nursing students, they’ve already had nursing experience, so they have a good sense of the patient clinical experience, unlike a young medical student.

What kind of perspective do you have on patient care? Concerns?
I’ve been taking care of new OB’s for 30 years. At every age there is a different set of concerns.

With an 18 year old, we look at things like nutrition. They need education. A mother of 2-3 children will be more concerned about weight gain. And an older patient will have genetic concerns – there will be testing we’ll need to offer them.

But I always start with the patient. There’s no set formula. If you listen to the mother, you’ll know what they need.

First off, I try to address their concerns. Some may have come from a practice where they had a negative birth experience. Typical things I might hear are:
“My epidural wore off and I felt everything.”
“The doctor cut an episiotomy and I didn’t want that.”
“I wanted to be active in labor but I was restricted to the bed.”

susan-griggs with patients and babies

Many times we can do something about those concerns the second time around!
If they have had a previous Cesarean delivery, they may be able to have a trial of labor and possible vaginal delivery. When the physician reviews the operative record, they can determine whether a ”trial of labor” is possible [natural childbirth].

What is the most important thing you want to give the patients?
The thing I think about is giving each mother the best Birth Story she can have. Every birth is special!

Just last night I had a wonderful experience. [This interview occurred on March 18.] I was on call and asleep in the call room when I got called to Labor and Delivery for a WONDERFUL birth – As a matter of fact, it was a St. Paddy’s Day baby delivered by an Irish midwife!!

The mother had wanted a natural birth after having had an epidural with her other children. Her labor went quickly, and it ended up we were able to give her a natural delivery. It was the Birth Story she wanted – she’ll remember it with happiness the rest of her life.

And I think she actually gave her baby an Irish name.

Okay, I have to ask the Irish midwife, what was your maiden name?



March 22, 2016

If your pregnancy pains incite panic, you’re not alone. Moms are hardwired to protect their babies, and it’s easy to jump to the worst case scenario when experiencing unexpected pregnancy pains. But pregnancy means your body is stretching to accommodate new life, and sometimes those internal gymnastics result in some less than pleasant feelings. It’s not always fun to be a human trampoline! So when is pregnancy pain something to get concerned about?

Common Pregnancy Pains
Pregnancy pains are nothing new. Between the uterus expanding and infant elbows jutting into your internal organs, pregnant mothers undergo a lot. The most common causes of sharp pain during pregnancy are uterine cramping, gas and bloating, constipation, and second trimester round ligament pain. Home remedies will typically alleviate these discomforts. Try:

  • Pregnancy safe stretches
  • Walking or light exercise
  • Breathing exercise
  • Experimenting with sleeping positions and sitting positions

When to Call Your Obstetrician
While many pregnancy pains are nothing to worry about, they can be a warning from your body that something isn’t right. Contact your obstetrician immediately if:

  • You experience bleeding, chills, fever, or you are leaking fluid
  • Pain lasts longer than several minutes or fails to abate after resting or adjusting
  • The pain makes it difficult to move, breathe, or speak
  • Sharp pain is localized on one side of the abdomen or uterus
  • The pain comes and goes in cyclical fashion and increases in intensity

Your midwife or obstetrician is with you for every step of your pregnancy. If you have concerns about pregnancy pain you’re experiencing, contact your physician or call Cherokee Women’s Health.

March 16, 2016

smiling womanThermiVa is performed without the use of lasers, offering patients no recovery time or delay in sexual activity. The procedure only takes 15-30 minutes and requires no preparation time, so it offers flexibility for patients looking to receive treatment without hassle.

How Does ThermiVa Treat Mild Urinary Incontinence
Pregnancy, childbirth and menopause are all contributing factors to urinary incontinence in women. ThermiVa is best for mild stress urinary incontinence, which includes leakage with certain activities, including coughing, sneezing, laughing and during exercise. For these factors, ThermiVa can be an excellent treatment option. Benefits of the ThermiVa include:

  • Reduction in leaking during everyday activities
  • Reduction in the “gotta-go” feeling, or sense of urgency
  • Improvement of muscular coordination and strength of squeeze

ThermiVa and Vaginal Dryness
Another common issue that many women face, particularly after menopause, is vaginal dryness. Vaginal dryness occurs during menopause as a result of the body’s decrease in the production of estrogen. ThermiVa treatments promote internal and external vaginal moisture by encouraging new collagen growth and circulation of the blood. Thus, this treatment is useful for menopausal patients who do not want or are unable to use estrogen replacement. ThermiVa can also offer relief for women who are on estrogen-reducing prescriptions such as Tamoxifen, which can cause vaginal dryness.

Are You a Good Candidate?
If you’re interested in receiving the ThermiVa procedure, consider these questions:

  • Are you currently menstruating?
  • Do you have signs of vaginal or bladder infection or severe vaginal pain or pelvic pain?
  • Are you pregnant or could you become pregnant?
  • Do you experience difficulty with tampons staying in, vaginal flatulence, or have you noticed a difference in penetration during intercourse or foreplay?

All physicians at Cherokee Women’s Health are trained and qualified to administer ThermiVa treatments. Our practice also offers patients three physicians (Dr. Litrel, Dr. Gandhi and Dr. Haley) who are board certified in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). This certification allows them to provide exceptional care in regards to complications related to pelvic floor disorders.

radiant life magazine coverLearn more about our FPMRS physicians and ThermiVa in Radiant You Magazine. Ask for your own copy at our office.

To schedule an appointment to speak to one of our physicians about ThermiVa, contact our office at 770.721.6060.

March 10, 2016

by Michael Litrel, MD, FACOG, FPMRS

Dr. Litrel April Fools article graphicThe year my sons were seven and ten, I asked for my wife Ann’s help playing an April Fools’ joke on them.

Sunrise on the big day found me crawling like a Ninja across the floor of my eldest son Tyler’s bedroom. With barely a sound, I rolled on to my back and shifted my body directly beneath his bed. I took a deep breath, and then, using all my strength, began shaking the entire bed frame.

Ann’s timing was perfect. She burst into the bedroom. “Tyler!” she shouted. “Get up! It’s an earthquake – it’s an earthquake! Go downstairs – HURRY!”

Tyler hardly moved. “It’s okay, Mom,” he mumbled, still half asleep. “It’s just Dad under my bed.”

I was demoralized, with only bruised knees and a scraped back from my efforts. But it was not going to be for nothing. Nursing my wounded pride, I hushed Ann and went to the next room. “Let’s try it on Joseph.”

But by the time I had crawled under Joseph’s bed, Ann reported that Joseph was smiling, his eyes closed, pretending to sleep.

Luckily, I had prepared a backup trick the night before. I’d slid a rubber band around the kitchen sink nozzle so it would spray as soon as the water came on. It pointed up to the exact spot for dousing whichever of my beloved offspring washed his hands first.

Tyler came downstairs still half asleep.

“Would you please wash your hands before you eat,” I reminded him. It was hard to hide the eagerness in my voice. I watched Tyler as he came to the sink and reached for the soap. He stopped, looked at the faucet, and yawned.

“You know, Dad,” he said with a trace of patronization, “if you use scotch tape, it won’t show as much.”

I wasn’t in the mood for advice. “Just be quiet, and let’s wait for Joseph,” I replied testily.

“AAUGHH!” screeched Ann. Oops. While I was distracted, Annie had turned on the water. Her pajamas were soaked. I apologized profusely, but Ann was not amused.

Well, at least I’d gotten someone.

But my real quarry was Tyler. He was just too cocky for his own good. I spent the day mulling it over, playing a few jokes to pass the day. Pregnant patients made the easiest targets.

“Gosh, I hope you have two girls’ names picked out.”

Or, “Wow, we haven’t had triplets in the practice in four or five years.”

Back at home that evening, Tyler wouldn’t fall for anything. I found myself growing amateurish in my desperation.

“There’s a spider on your shoulder!”

“Your teacher just called. You’re in trouble!”

Tyler just rolled his eyes. April Fools was obviously beneath him. Indeed, he hadn’t played a single joke on me all day. I finally gave up and trudged upstairs to bed. Just as Ann and I climbed between the sheets, we were met with an impediment.

Tyler had short-sheeted our bed.

Ann was dead tired. She began to complain and laugh simultaneously as she stripped the bedcovers to remake the bed. I tried to shush her so Tyler wouldn’t have the satisfaction of knowing his trick had succeeded.

Dr. Litrel photoBut it was too late. I could hear him snickering outside our bedroom door.

My mind was unsettled. Although I was tired, I lay awake in bed for a while, unable to sleep. Finally, after some honest introspection, I came to a resolution which allowed me to drift off at last.

Just wait ‘til next year.


Excerpted from Dr. Litrel and his wife Ann’s book of “he-said, she-said” stories about love and family.  A MisMatch Made In Heaven: Surviving True Love, Children, and Other Blessings In Disguise is available in the office, and online at www.createspace.com/4229812

February 18, 2016

Dr. Michael Litrel volunteers in Honduras photo
by Michael Litrel, MD, FACOG, FPMRS

When my son Tyler was fifteen, I brought him with me on a church mission trip to Honduras. It seemed an inspired idea: I was seized with a vision of him forsaking his Xbox for a transformative week of caring for poor people in a third world country.

Twenty of us boarded the plane headed for rural Central America. Our physical task was to repair homes. Our spiritual task was to learn and teach about God’s love.

Tyler was shocked by the poverty. Forty people lived in the remote village in mud and stick huts. They had no running water or electricity. Wandering the village were dogs so emaciated you could count each rib.

Over the days that followed, Tyler took me to the side several times to sort through his feelings. How could we have so much at home when others in the world have so little?

I was proud of him, growing up, asking the right questions… But as it turned out, he was still an obtuse adolescent. On the last day, we faced a grueling three-mile hike through the steaming jungle to the work site. Tyler assured me he had filled all our water bottles. But when we arrived, I discovered only three of the eight bottles were full. Tyler had gotten lazy and just hadn’t bothered.

I was livid. We had an entire afternoon of physical labor ahead. Don’t you realize we have four THOUSAND pounds of cement to mix? How can we work without water? Blah, blah, blah…

I’m sorry, DAD!!! I GET it! Tyler threw up his hands in exasperation.

I could tell Tyler was more angry than sorry. But I stopped and sulked away, muttering dark thoughts under my breath. I had been proud that Tyler had chosen to come – the youngest in the group by five years. Heaven knows it was gratifying to see his hands finally off the game controller and wielding a shovel full of dirt.

But I didn’t want to hear any adolescent fibs about filling water bottles.

Our project was a hut with a dirt floor, to be replaced with cement. Twenty bags of mix had already been carried to the site. The choice of tasks were these: carry buckets of water from the stream, mix the cement on the ground, carry the wet cement into the hut, or lay down the floor. There were eight of us. It was back-breaking work.

Holding water in cupped hands photoThree hours later, we lay exhausted under the hot equatorial sun. A feeling of discouragement began to creep over us. The floor was only a third done, and we were running out of both cement and energy.

I slumped on a stool. A small village girl named Amalia crept quietly next to me. Her dress was worn, her face dirty, but her smile was glowing. She was one of eight children who lived in this tiny hut. A cement floor would keep her young body off the ground at night.

Tyler rested motionless, his back against a tree. His work efforts had been listless at best. But I kept my criticism to myself. At least he was here.

Just when the job seemed hopeless, a few neighboring villagers arrived to help. Recharged, we resumed mixing cement, carrying bucket after bucket into the hut. Somehow, we now had so much that we could not only cover the entire dirt floor but even make a front porch.

Remarkably, too, our water bottles never ran out. Tyler and I had enough to last all afternoon.

It was a strange and wonderful day in Honduras. Tyler and I had partaken in a kind of miracle: plenty of cement, a floor for Amalia, and even enough water.

For me, it was a spiritual reminder that we are always given enough – an ironic lesson to learn while helping a family whose belongings could fit in the trunk of my car.

It was only later, as I was falling asleep, that I figured out – Tyler had left all the water for me.

Dr. Michael Litrel photo

Excerpted from Dr. Litrel and his wife Ann’s book of “he-said, she-said” stories about love and family.  A MisMatch Made In Heaven: Surviving True Love, Children, and Other Blessings In Disguise is available in the office, and online at www.createspace.com/4229812


February 17, 2016

pelvic pain photoMarch 1st marks the beginning of Endometriosis Awareness Month, a month dedicated to shining a light on the symptoms and treatment of endometriosis, a condition that affects over six million women and teens in the United States, and millions of other women worldwide.

If you have a history of painful periods, pain with sex, or general pelvic pain, there is a good chance you have endometriosis.

Cause and Symptoms of Endometriosis
While the definite causes of endometriosis aren’t 100% clear, possible causes include:

  • Retrograde menstruation
  • Embryonic cell growth
  • Surgical scar implantation
  • Endometrial cells transport
  • Immune systems disorder

Symptoms can be varied, with some women experiencing little to no pain and others experiencing moderate to heavy amounts of pain during periods, sexual intercourse or with bowel movements. Other symptoms include:

  • Fatigue
  • Diarrhea
  • Constipation
  • Bloating
  • Nausea
  • Excessive bleeding
  • Infertility

Treatment Strategies for Endometriosis
While there is not a cure for endometriosis, certain treatment options can help with pain and infertility. Treatment will vary depending on your symptoms, your age, and whether or not you have future plans of becoming pregnant.

Medication – Over-the-counter pain relievers may include aspirin and acetaminophen, as well medicines that inhibit prostaglandin (the hormone that controls processes such as inflammation, blood flow, and the formation of blood clots and the induction of labor). These include ibuprofen and naproxen sodium. If pain is very severe, prescription drugs may be required.

Hormonal Therapy – Hormonal treatment aims to stop ovulation for as long as possible and may include: oral contraceptives, progesterone drugs, a testosterone derivative (danazol), and GnRH agonists (gonadotropin releasing hormone drugs). Side effects may be a problem for some women.

Surgery – If your doctor has determined that surgery is the best treatment option, a board certified FPMRS (Female Pelvic Medicine and Reconstructive Surgeon) can determine what surgical method works best for your needs. FPMRS surgeons are highly skilled in the diagnosis, evaluation and both surgical and non-surgical treatment of pelvic floor disorders such as endometriosis.

Types of Surgery For Endometriosis
A more conservative surgery option consists of using a laparoscope to find and remove any growths to remove pain and increase the possibility of pregnancy. In some cases, hormonal therapy may be prescribed in conjunction with conservative surgery.

In more severe cases, your surgeon may recommend a hysterectomy, removal of all growths, and removal of ovaries (also called oophorectomy). These types of surgeries are considered only when other treatment options have offered little relief, as the surgery causes early menopause. Additionally, it is only considered when you have no future plans to become pregnant.

The OB-GYNs at Cherokee Women’s have a deep understanding of women’s anatomy and the types of concerns that women struggling with endometriosis may be facing. Our board certified FPMRS staff members can address concerns related to scar tissue, internal trauma after childbirth, excessive bleeding and infertility. If you have questions or concerns regarding symptoms or treatment for endometriosis, don’t hesitate to contact our office to schedule your appointment.

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“Dr. Litrel was a fantastic doctor. I had my first exam with him, although at first I was skeptical about a male doctor for my GYN. But after I met him I’m glad I kept an open mind, and I couldn’t have dreamed up a better doctor. He cares about you as a person and not just a patient. The front desk ladies and nurses were very friendly and it’s a great office, very clean and not intimidating. I highly recommend Cherokee Women’s Health.”
– Vicki