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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.

Medicines
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.

Surgery
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?
Flanagan!

 

 

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.

But 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.

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.

Dr. Gandhi delivering babyWhat are some of your favorite parts about your job?
I really enjoy talking to my patients and caring for women. Especially as a woman. I feel like I can relate to a lot of the same worries and concerns they have.

Also, the spontaneity. This specialty incorporates surgical skills as well as quick-thinking on your feet. It is a moment-to-moment kind of thing, especially when it comes to delivering babies. I always feel totally humbled because when I get to work, my schedule may say one thing, but when I get done, I could have done a C-section at lunchtime or an emergency surgery that afternoon. All in the same day.

Dr. Gandhi graduation photoHave your studies and sub-specializing in FPMRS changed the way you think about patients or how you approach their problems?

The pelvis is such an interesting cavity, containing organs that play a crucial role in muscle support, reproduction and sexual function. After becoming board certified in this subspecialty, I realize that I play a unique role in helping women resolve issues of pelvic organ prolapse, leakage and sexual dysfunction. In fact, I realize how much women think about these embarrassing topics, especially the sexual dysfunction symptoms, and how much their needs change as they get older.

For both menopausal patients and younger patients, it’s becoming a lot more acceptable to talk about sexual dysfunction. There’s a cultural shift going on that is allowing and encouraging women to feel more comfortable talking to their doctors about it. I’ve learned how to talk to patients better about sex, too. And why they’re not enjoying it, and how to improve it. We even do ThermiVa in the office which is a procedure that helps tighten the vaginal canal and improves lubrication. This is cutting-edge technology that provides patients non-surgical options without having to even take hormones.

Another unique piece is the degree in which doctors are challenged to restore the anatomy without using synthetic materials (such as mesh). Patients are looking for surgical options that give them a quick recovery and yet, are successful. Surgical management of prolapse is more tailored to each patient, rather than using synthetic products to augment repair. I think I’m a better surgeon because of it.

What has been your biggest challenge?
I’m very sensitive. I really have to displace myself from taking things to heart. I worry about my patients all the time. How they’re doing; how I can help them. But it can be emotionally draining. I’m trying not to be such a worrywart all the time, and trying to be more objective.

What is your biggest success up until now?
Building up a medical practice that I am proud of – I can think of no other success than being a trusted provider. I think most of my referrals come from other patients. It’s been a slow process for me, but I see the difference in the number of patients after joining Cherokee Women’s eight years ago. I continue to grow and try to improve the care I deliver.

Patients have said to me, “I want to see you because I know you’ll take care of me.” It’s so flattering, it’s such a high. I can’t believe somebody would feel that way about me, especially if they don’t even know me. That’s what I wanted, when I was in medical school and residency, to have a situation where the patient could tell that their doctor loves what they do.

When you were young, how did you picture being a doctor? How is your work the same as that, and how is it different?Dr. Gandhi with mom photo
When you’re young, you don’t live in reality. You live in this foggy, idealistic world. I had a really good mentor, though. I went to high school in a very small town called Amanda, Ohio. Everybody kind of knew each other. My parents owned a grocery store, and we lived on top of the grocery store. I knew I wanted to go to medical school, and I surrounded myself with other people who believed in me and thought I could do it. I always pictured myself looking old (around 30 or so, because when you’re 15, 30 seems so old!), and saying, “Man, I knew I could do it.”

I realize now how naïve I was. The practice of medicine is on-going and fluid. One can never master it. But every great doctor aims high. This is what benefits patients in the long-run, a physician who never stops learning and is never “done.”

What words of wisdom would you give your younger self?

I think I would’ve told myself to have more fun. Trying to get everything done is an accomplishment, but sometimes it can compromise your ability to really grow as a person. If I could tell my fifteen-year-old self anything, I would say take moments to spend time with your family and friends. Every summer, all I did was study or go on some internship or work. And this is the first time in private practice that I’ve actually started taking vacations and making myself a priority.

My dad passed away in November and it’s really impacted my life and how I will live it in the future.

Dr. Gandhi with dad photoWho is one person who has had a tremendous impact on your life, personally or professionally? Why and how did this person impact your life?

Honestly, there is never just one person. My father obviously was my biggest supporter. He never doubted my ability and was so insistent that I could achieve ANYTHING as long as I worked hard. He and my mother and brother have been so crucial in getting me to this point. The sacrifices they made for me through the years, I could never repay. But I strive to make my father proud, every day. I miss talking to him during my lunch breaks. But I know he is with me. I am so lucky to have had HIM as my father, mentor and spiritual role model.

You’ve mentioned that you like Shakti Gawain’s quote, “Our bodies communicate to us clearly and specifically, if we are willing to listen to them.” What are some ways patients can be more in tune with their bodies? What kinds of things should they pay attention to?

I think one thing is to not ignore symptoms. Day to day, you want to think about what you’re putting into your body, and what your body is saying in return. If it’s time for an oil change in your car, and the little light in your dashboard comes on, you’ll probably get your oil changed. Symptoms are the dashboard warning lights. Our bodies communicate to us using these sometimes subtle signs or symptoms. We just have to make sure we heed the warning.

On the flip side, as a doctor, you’ve gotta pay attention too. The answers are there when the patient walks through the door. But they may not have the answers to explain what the patient is feeling. Most of the time, patients don’t want to complain about their symptoms. I ask them if they have any concerns or if they’re having any pain, and sometimes I get, “Not really.” Not really? Who knows what “not really” means in medicine? You have to really explore further.

Ideally, if patients are able to listen to their bodies, they shouldn’t prolong seeking care. A delay in getting care, whether financial, or for some other reason, can lead to disease or other issues that ultimately either require invasive intervention or make an issue untreatable.

February 16, 2016

 

pregnant-woman-saying-no-to-alcohol picThe Centers for Disease Control made headlines this week when they announced that sexually active women of childbearing age should never drink alcohol unless they’re on birth control. The recommendation met with both support and backlash: many women agree that it’s not worth the risk, while others argue that telling 3.3 million women not to drink isn’t feasible. What do you think?

Are You Expecting?
You probably know that consuming alcohol during pregnancy can negatively impact a baby’s mental, physical, and behavioral development. What you may not know is whether or not you’re expecting. Some moms-to-be take 4 to 6 weeks to realize they’re pregnant. And as many moms of lovable broods know, about half the pregnancies in the United States are unplanned. Even women actively trying to get pregnant might continue drinking. According to the CDC, only 1 in 4 women stops drinking alcohol when they go off birth control. Exposure to even minimal alcohol during pregnancy may affect the baby’s health. So is the risk worth it?

The Effect of Alcohol on Developing Babies
Whether you’re happily expecting or simply trying, we know your baby’s health is your #1 consideration. But you may not realize just how much damage drinking during pregnancy can cause. Even small amounts of alcohol can cause:

  • Miscarriage
  • Stillbirth
  • Prematurity
  • Fetal Alcohol Spectrum Disorders (FASDs)
  • Sudden Infant Death Syndrome (SIDS)

FASDs can affect a child’s development both before and after birth. Symptoms can include anything from abnormal facial features and underdeveloped growth to poor memory, attention or hyperactivity disorders, learning disabilities, speech and language problems, and low IQ. Many people suffering from FASDs also have impaired hearing or vision and problems with their hearts, kidneys, or bones.

Make the Healthy Choice
At Cherokee Women’s Health, we advocate for the health of mothers and their babies. According to the CDC recommendation, all expectant mothers should refrain from drinking alcohol during pregnancy. If you’re trying to get pregnant, we recommend that you stop drinking alcohol until you go back on birth control. If you discover you’re pregnant unexpectedly, stop drinking immediately.

Cherokee Women’s Health has an experienced team of obstetricians, dedicated nurse-midwives, and board certified FPMRS surgeons on staff. We specialize in normal and high risk pregnancies, with expert care providers trained in both natural and standard births. To learn more about how to ensure a healthy pregnancy, call today to make an appointment with one of our providers.

patient talking to doctors picWhen you’re diagnosed with Pelvic Organ Prolapse, you’re faced with a challenging and emotionally painful question: Should I continue adding children to my family?  Whether you’ve always wanted a big family, or just two children, you know that your health is in a precarious and delicate state. You’re afraid of worsening your prolapse, but even more afraid that you will regret not choosing to become pregnant again.

Talking with a Urogynecologist who specializes in Female Pelvic Medicine and Reconstructive Surgery may help to make this decision easier for you to make. Since there are surgical and non-surgical treatment options for any stage of prolapse, your doctor can offer insight that may alleviate your fears and concerns. Once you’ve settled on an additional pregnancy, it is important to take care of yourself physically in order to optimize a birth and post-partum period that will accommodate your body and your prolapse. Pelvic Organ Prolapse doesn’t have to rule your decisions. Don’t let your limitations hold you back from living the life you want!

During and After Pregnancy Prolapse Care:

Pelvic Floor Physical Therapy- The exercises and touch therapy included in PT can help to keep your symptoms to a minimum throughout your pregnancy. Ask your Urogynecologist or OB/GYN for a referral to a Physical Therapist who specializes in Women’s Health. After you deliver, check with your Urogynecologist and OB/GYN to be cleared to begin the healing process of post-partum physical therapy.

Prenatal and Post-Partum Support- When worn correctly, a maternity belt can ease pressure on the pelvic floor and lower back, allowing you to move easier and prevent straining. Different from a waist-trainer or girdle, effective post-partum support can be therapeutic for a healing pelvic floor. Run these products by your doctor to see if they will work for you and your limitations.

Conscientious Movement- Remember that you are growing a baby, as well as nursing your prolapse. Move with purpose, and don’t push yourself to the point of pain. Lifting should be kept to a minimum, as well as bending over. When you do have to make larger movements, engage your Transverse abdominus and Kegel muscles. Keeping theses muscles strong will help support your pelvic floor, and help prevent any stress urinary incontinence. When recovering from birth, give yourself time to heal. Move slowly, and deliberately, and “baby” your pelvic floor. Ask your doctor how soon you can resume any pelvic floor exercises, and start slowly, working yourself up to your pre-pregnancy status. Simple life adjustments can have a big impact on a successful pregnancy and post-partum period.

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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