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February 4, 2016

Dr. Sara Bolden picDr. Sara Bolden is a Women’s Health Physical Therapist, board certified Women’s Health Clinical Specialist, owner of Women First Rehabilitation in Woodstock, GA, and author of What a Girl Wants: The Good Girl’s Guide to Great Sex.

Adopting a Higher Quality Obstetrical Care Model for Women in the United States

If you’ve ever had a baby, witnessed one being delivered or heard of someone’s detailed labor and delivery story, one thing’s for sure, there was pain involved. We’re not talking about a little discomfort here, folks. We’re talking about deep, intense, I-could-kill-the-man-that-did-this-to-me pain. Quite honestly, we’ve come to expect extreme bodily pain during a situation like this. It would be absolutely crazy to think otherwise. I mean, we’re talking about a small melon exiting out of an opening the size of a child’s sock. Yes, the sock will stretch, the melon will emerge, but not without some repercussions…sometimes big repercussions. Often, these consequences can be serious and have lasting musculoskeletal effects. So what’s a girl to do?

Physical Therapists are NOT Massage Therapists
Many would say, childbirth trauma is inevitable so proverbially “push” through the pain and try to get over it quickly. Unfortunately, this is frequently the default response to childbirth in the United States. There is little to no preparation of the pelvic floor muscles, the low back, the abdomen, nor education for proper breathing, delivery positioning, energy conservation or anything, for that matter, that adequately prepares the body’s musculoskeletal system for the delivery of a small human being. However, for many years now, international countries, such as England, Germany, Australia, Brazil and South Africa (to name a few), have taken proactive measures to assist women with labor and delivery and thus lower the risk of long-term musculoskeletal injuries or urogenital dysfunctions. One way they have elevated the standard of obstetrical care is to include physical therapists throughout pregnancy, during labor/delivery and for post-partum recovery. You might be saying to yourself, “Physical Therapists? Don’t they just give massages?” Brace yourselves…wait for it…no, they don’t. Physical therapists are not massage therapists. They are, however, musculoskeletal experts that have unique knowledge of the evaluation, assessment, treatment, disease/injury prevention and general wellness of the human body.

The Difference a Women’s Health Physical Therapist Makes
In other countries, the physical therapists that assist with prenatal and post-partum women are called obstetrical physiotherapists and have advanced skill and training in women’s health. In the United States, we call them women’s health physical therapists. I know, ingenious. They, too, have advanced knowledge and extensive training in women’s health; however in the U.S., their services have only been considered for the prenatal patient with abnormal or life-altering pain or for the complicated post-partum patient with pain and/or pelvic floor dysfunction (i.e. urinary incontinence, organ prolapse or pain with intercourse).

Higher Standards of Obstetrical Care
If the U.S. adopted a more comprehensive standard of obstetrical care, every pregnant women would be evaluated by a women’s health physical therapist. During the prenatal phase, she would get education and training on pelvic floor stabilization, core strengthening, body mechanics, birthing positions, perineal massage, breathing, relaxation and proper Valsalva for effective pushing, etc. Then, a women’s health physical therapist would be included in the delivery room to help with pain management, assist with birthing positions that open the pelvis and decrease risk of vaginal tearing, perform perineal massage to allow adequate room for the decent of baby, provide biomechanical support and coach the patient on the when’s and how’s of proper pushing…just like obstetrical physiotherapists are doing right now in other countries!

After the birth of the baby, post-partum women would follow up with their women’s health physical therapist to assess healing of vaginal and/or abdominal tissues, be educated on scar management and facilitated tissue recovery, learn mechanics for lifting baby as well as for breastfeeding and restoring pelvic strength. Of equal importance, women’s health physical therapists would help new moms get their bodies back in shape, set realistic goals and expectations of motherhood and restore her vibrant, sexual health. Yes, I said “vibrant!” Who wouldn’t want that?!

Good news! You belong to a cutting-edge OB-GYN practice and are hearing about women’s health physical therapists! I invite you to do a little research and see for yourself how effective this type of physical therapy is for pregnancy, labor, delivery and post-partum. Don’t be shy: ask your doctor to include physical therapy as part of your prenatal and post-partum experience.

Company bio:
Women First Rehabilitation is an elite healthcare practice devoted exclusively to treating individuals with pelvic pain, urogynecologic disorders and pelvic floor dysfunction in all phases of life. All of our practitioners are licensed women’s health physical therapists with advanced knowledge and training in women’s health. For more information, visit www.WomenFirstRehab.com.

February 3, 2016

Dr. Litrel photoFor ten years, without fail, Ann and I kept our razors side by side in the shower. Then I switched to the Mach 3 triple blade razor, and suddenly the ever-present disposable pink lady razor disappeared. I didn’t give it much thought at the time. I figured such a sissy razor was an embarrassment beside my macho marvel of modern technology.

The truth was more horrific. One morning I walked into the bathroom while Ann was in the shower, and I discovered that my Mach 3 triple blade marvel was being used to shave her legs. It didn’t take much to surmise that it might be getting some time under her arms, too.

I kept my mouth shut until our morning coffee.

“Doesn’t it repulse you,” I said calmly, “to know that the razor you’re using under your arms is the same one that I’m using on my face?”

Ann laughed, and then quickly reached for my hand. “Sometimes…” she replied with a serious voice. “But love is a strange and wonderful thing.” She gave me an angelic smile.

All was forgiven.

Disagreement between a husband and wife occurs in the best of marriages.  Sometimes this manifests as open argument.  Other times, marital conflict can be more subtle, an unspoken tension permeating the relationship for years, like an uncomfortable humidity.

When I met Ann at that fraternity costume party, she was supposedly dressed as a Greek goddess, in a skimpy toga no father would have permitted his daughter to wear in public.

I fell in love.

After our three years apart, there was nothing I looked forward to more than marriage and spending my life with Ann. My attraction to her was more than just her physical beauty; I admired her talent, kindness, intelligence and discipline.

I still admire her. But after twenty-five years of marriage, the intelligence and discipline thing sometimes gets on my nerves.

Ann has tendencies towards frugality that do honor to her Scottish heritage. She also endeavors to be environmentally aware. These two qualities are evidenced in the temperature settings Ann prefers for the household thermostat. During the hot Georgia summer the air conditioning is set at 80. During the cold of winter the heat is set at 65. In January when I am cold, Ann tells me to put on a sweater. In July when I am hot, Ann tells me to take my sweater off.

thermostatLast year it was another hot, humid summer. So one day when Ann wasn’t looking, I sneaked to the thermostat and deftly dropped the temperature five degrees.

It didn’t take Ann long to notice. “Who turned the air conditioning so low, Michael?”

“Those kids,” I responded, shaking my head disapprovingly. I was not lying. I was simply making a declarative statement designed to misdirect.

“The boys say they didn’t touch the thermostat, Michael.”

“Those kids,” I repeated, shaking my head disapprovingly.

Ann laughed and moved the thermostat back to “where it belongs.” I didn’t argue. I could understand her perspective: why burn fossil fuels to lower the temperature of my house just so I could be a tad bit more comfortable?

But sometimes it was annoying. It was like I was married to Al Gore, and every time I touched the temperature control I was sinking an axe into the trunk of the last giant redwood.

Over the years, Ann had successfully colored our “thermostat decision” in spiritual terms. With artful language she conveyed to me sophisticated thoughts about the needs of the body versus the needs of the soul. Essentially, her argument boiled down to this:
Jesus didn’t have air conditioning, so why don’t you spend more time praying for strength, and less time whining about the heat?

One summer Ann left town to visit her sister for a week. It was like Dorothy’s house had plopped down in Oz, and ding dong, you-know-who was dead!

I ran to the thermostat like an unsupervised teenager and lowered it not five degrees, but ten. I was going to get all the air conditioning that compressor could muster. That night my house was so cold I needed another blanket from the closet. Immobilized by comforters, I slept like it was the dead of winter.

Condensation covered all my windows when I awoke. I shivered when I sat down to my morning coffee. Now this was what July in Georgia should feel like!  I thought about getting out that dang sweater. Maybe I should light a fire too?

But after an hour of reflection, I simply turned the air conditioning off.

I missed Ann. Morning coffee was more fun with her. It’s far better to have a home that is too hot in the summer and too cold in the winter than to suffer again through the fires and chills of a long distance relationship.
A prescription for tolerance is an occasional few days apart. In our human struggles, we can sometimes fixate on small problems.

Absence gives God a chance to direct our focus on the big picture –
Love.

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

Dr. Crigler photo

An Interview with Britton Crigler, MD, FACOG 

What made you want to become a vegan? 

My wife and I made the decision together. She was a vegetarian in the past, and studied nutrition in college, so she has an understanding of how meat is processed and the affects it has on the environment and our health. I grew up in a southern cooking meat and potatoes family so if I can make the change, anyone can!

Our path toward a plant-based diet started on a medical mission trip to Ecuador while I was in medical school.  I volunteered at a women’s health hospital while Lauren volunteered in the physical therapy department of a military hospital.  We lived with a family for a month and were fed a mostly plant-based diet.  In Ecuador, a typical meal consists of vegetable soup, a cooked whole grain, one or two cooked vegetable dishes and maybe a small (3 ounces or so) side of meat. They had very limited access to fast food chains and processed foods. Their small portions of meat may have stemmed from lower economic means, but they were eating healthier meals than most Americans! That’s when the idea of limiting our meat and dairy intake first began. During my residency in Tampa, we decided to switch to a completely plant-based diet.

Dr. Crigler photo

What’s the key to making dietary changes such as switching to a vegan diet work? (Especially in a family with two small children?)

One key step is to recruit people around you to help you make the change:

It’s important to include the whole family. My kids eat everything we eat: carrots, broccoli, spinach, hummus, whole grains and legumes. We expose them to everything we eat, so they eat different types of cuisine including Indian, Thai, Vietnamese, South American and African. (I am also lucky that I have a wife who cooks really well and tries new dishes!) We eat a larger variety of food now than we did before we switched to a plant-based diet.  That exposure to different foods in childhood is important, although I think my 3-year-old son would be a fruitatarian if he were given the choice. My oldest son is five and in kindergarten so we pack his lunch.  It takes my wife about five minutes each morning, which we consider to be a small investment in our child’s health. We’re also not really strict if they attend a birthday party and eat cake or something like that.

Another key is: don’t keep unhealthy food in the house.

Eating a whole food plant-based diet is relatively easy for our family because healthy food is the only option we have.  There’s no processed food in our house, so we don’t have an opportunity to eat it!

My other advice is to make changes that are sustainable to your budget.

We focus on buying food we know we’ll eat, and we tend to waste very little food. Choosing things like dried beans, legumes and whole grains will last much longer in your pantry and are a lot cheaper than buying meat every week.

Dr. Crigler's children photo

February is American Heart Month. What are some of the easiest ways women can take better care of themselves with a focus on their hearts?

Lowering cholesterol has a huge positive impact on heart health, and anyone can decrease their cholesterol by avoiding or eating less animal products. Also, cardiovascular exercise at least 3-5 times a week for at least 30 minutes can really improve heart health. The key is to choose an activity that you enjoy so you’ll want to continue. The added usage of technology like Fitbits and pedometers can help encourage you to move more and make small changes every day.

What’s the best way to go about choosing a physical activity?

You need to choose an exercise type and intensity level that’s right for you (if you’re arthritic, for instance, long distance running may not be the best option). Whether it’s biking, running, swimming, or something else, making attainable goals can help to improve your motivation. Then update your goals as your reach them. Also, having somebody to hold you accountable is helpful. It can be a friend, spouse, workout partner or personal trainer. My brother-in-law is a real inspiration to me. He has run at least a mile every single day for the last eight years, rain or shine. His dedication is a reminder to me to always stay active, no matter what. (Fun fact: My brother-in-law is a track coach and was inspired by my wife to begin his running streak.  She beat him in a 5K and he started his streak the very next day!)

Dr. Crigler and wife photoYou and your wife Lauren are big fans of running to keep physically fit. Do you have any marathons or other events you’re planning on participating in this year?

We did the Atlanta half marathon for the past two years and will continue this tradition for as long as we can. We also really enjoy supporting local 5Ks so I’m sure we’ll be running with our jogging strollers through a few of those.

What is the best way anyone could compliment you about your work? 

I want my patients to feel comfortable and cared for like a member of my family.  Our patients often share some of the most significant events of their lives with us.  So, to have them tell me that they felt cared for means the world to me.  Also, when they send their family members and friends to me, it’s a huge compliment.

What was the most unusual job you ever had? 

I was a nanny for a six-month old through his second birthday right after college, in between college and medical school (it helped pay my rent). I was also a lifeguard and waited tables. Waiting tables was a skill that turned out to be helpful as far as being able to multitask and keep track of all the patients we have in one day. (We’re sensing a theme here – Dr. Litrel said the same thing about his time waiting tables!)

If you won the lottery and never had to work again, how would you spend your time?

Traveling. I’d love to visit Australia, South America, and Europe; pretty much everywhere.

JUST FOR FUN:

Would you rather skydive or hang glide? 

My wife would never let me skydive, haha. I think I would prefer hang gliding anyway. I think I’d like the sensation of flying as opposed to just falling. Hang gliding also lasts longer and you’d get to see more stuff.

What category on a quiz show would you select at the best chance of winning?

After medical facts and cool baby names, probably anything related to cars. Either “Name That Car” or “Random Facts About Sports Cars.” (I drive an electric car because I’m a bit of an environmentalist, but a guy can dream!)

January 21, 2016

Your feedback is very important to us. The doctors and staff at Cherokee Women’s Health care about what you want from your doctor visits, which is why we regularly survey our patients. Your feedback tells us that you want doctors who listen, spend time with you and have a great bedside manner. And of course, you want an educated physician who can clearly explain your symptoms and treatment options.

Dr. Litrel wants every patient of Cherokee Women’s Health to feel seen, heard and compassionately cared for so he has hand-picked an amazing team of caring, compassionate and highly educated doctors. All our providers pride themselves on engaging with their patients while making sure the patient feels accepted and heard while discussing symptoms or treatment.

Following are a few testimonials from our patients:

Dr Litrel is always very caring and considerate. He listens to your symptoms without making you feel like he’s in a hurry to move on to the next patient. He has offered alternative help with my Sjogren’s Syn. Disorder. He treats you with respect.” Sue H.

“Dr. Gandhi serviced my prenatal appointments, and I thoroughly appreciated how she listened to me and my body. Nothing unnatural was forced, which I believe helped in a very smooth delivery. She was always very upbeat and her excitement bubbled over. By the end of each visit, I was always smiling. Susan delivered my baby, and she did a wonderful job. She was very comforting and soothing. Again, I appreciate how she let my body naturally deliver the baby it its own time. This was a wonderful pregnancy and birthing experience.””Billi R.

“Doctors actually listen to me and do what’s best for me. They care more than another other doctor I’ve been to.” Emilee Z.

“In June of 2011, I was rushed to Northside Hospital in Canton in severe pain only to find I had a ruptured tubal pregnancy. My family and I were so devastated. Dr. Litrel came to my bedside and prayed with us, and then I was rushed to the operating room for surgery. He was so wonderful, kind and had the best bedside manner. It’s February of 2012, and we are expecting again. Everyone in the office is so kind and respectful. I wouldn’t have any other group of doctors take care of me in our situation, and couldn’t imagine any other doctor bringing our miracle baby into this world.” Kimberly L.

“Dr. Gandhi is an extremely professional and caring doctor. She always makes sure that I am completely informed of what is going on with me. She also explains everything in a manner that is easily understood. I am so thankful for her hard work, dedication, and concern for my well-being. I cannot imagine trusting anyone else with my health than Dr. Gandhi and Cherokee Women’s.” Lyn B.

Cherokee Women’s Health wants to be your OB/GYN healthcare provider. With a diverse group of five doctors – male and female – a seasoned midwife and a nurse practitioner, we believe you will find the care, compassion and excellent care that you are seeking. Please call 770-720-7733 or visit cherokeewomenshealth.com to schedule an appointment today at our Canton or Woodstock locations.

December 17, 2015

pregnant-woman photoYou just had a baby, but something feels “off “down there. You’re not quite sure what to expect because you’re new to the whole postpartum process, but you’re certain that a bulge in your vagina is not normal. When the vaginal pressure does not ease up, you decide to check in with your doctor, only to find out that you have a type of Pelvic Organ Prolapse called Uterine Prolapse.

As scary as this diagnosis may sound to you, there are options available to relieve symptoms, or repair the prolapse.


Uterine Prolapse: Causes and Treatments

You wonder how this prolapse happened. One day your uterus is snugly in place, and the next, you are suffering the unpleasant symptoms of pain, pressure and an aching lower back. A prolapsed uterus is a common occurrence after a vaginal birth, but even women who have never given birth can also develop a prolapse. When damage to the fascia, ligaments and muscles of the pelvic floor occurs, it can cause the uterus to sag into the vaginal canal – leading to incontinence, and a feeling that something is “stuck” or “falling out.” These problems may worsen with age, as decreased estrogen causes the pelvic floor to relax even more.

Fortunately, you don’t have to deal with these meddling symptoms. There are options, depending on the severity of your symptoms.

Relax – not every uterine prolapse will require surgical repair. You and your doctor can work together to decide the best course of action to fit your lifestyle and diagnosis. Many women with mild symptoms find that pelvic floor physical therapy is helpful in reducing symptoms. Those with more moderate symptoms might find reprieve by wearing a device known as a pessary, which is fitted to your vagina, and worn internally. A pessary can help to lift the uterus out of the vagina, and relieve many of the distressing symptoms. If your symptoms are more severe, Pelvic Reconstructive Surgery may be the best option to ensure that you are not living with the troublesome effects of uterine prolapse.

You are not alone! Many other women are dealing with the inconvenience and pain of a prolapsed uterus, and you don’t have to suffer in silence. Make a list of questions and concerns and contact your doctor today. A prolapsed uterus doesn’t have to rule your life.

Specialists in Female Pelvic Anatomy
Physicians who are board certified in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) understand complex female anatomy, and are able to offer a range of effective treatment options when problems occur. In fact, Cherokee Women’s is the only OB/GYN practice in the southeast with multiple OB’s who are also board certified in FPMRS.

You’re in good hands – during your pregnancy and after. Talk to your FPMRS physician about your options to find relief for your symptoms – and help that “bulge” disappear.

Many women spend weeks, months, or even years reaching the decision to have vaginal surgery. Each woman has her own reasons for the choice: discomfort, pain, embarrassment, or decreased sexual pleasure, to name a few. But once surgery day arrives, this transformative life experience becomes a waiting game. Even the most knowledgeable patient can succumb to fears while healing from a vaginoplasty. That’s why Cherokee Women’s Health gives you top care, expert follow-up, and direct access to your surgeon when you need it most.

Is My Post – Vaginoplasty Healing Process Normal?

  • How long does it take to recover after vaginoplasty surgery? Because every woman’s body is different, each patient recovers at a slightly different rate. Many patients can start to move around as soon as the anesthesia wears off. Ice the incision area in the 24-48 hours after surgery. Most patients can return to a normal behaviors (such as non-strenuous work) after 48-72 hours, but a full 6-8 week recovery period is necessary before engaging in sexual activity. Optimize your healing process by carefully following the post-op instructions of your physician. 
  • pelvic painI still feel vaginal pain a week post-op. Is that normal? Many women experience pain as the skin and muscles of their most sensitive areas knit back together. Vaginal pain is still expected one week after surgery. If you’re experiencing post-op pain, take your prescribed painkillers or ice the area as recommended by your doctor.
  • I’m not happy with my results. Can I schedule another surgery? A patient cannot appreciate the results of a vaginoplasty before she’s fully healed. Tenderness, swelling, and myriad other factors may influence a woman’s perspective of her post-op results. We recommend waiting 6 months to 1 year after surgery to allow the site to fully heal and the vaginal muscles to settle into their new permanent state. If you’re still not happy with the results of your vaginoplasty, ask your surgeon about a follow-up procedure or labiaplasty.

Do you want to learn more about vaginal rejuvenation and recovery? Schedule a consultation with one of our GYN surgeons board certified in FPMRS (Female Pelvic Medicine and Reconstructive Surgery).

December 16, 2015

dr-hale-sunburst-pngTalking Veggies with Dr. Hale
We recently sat down with Dr. Hale to chat with her about her nutrition journey. Always a proponent of healthy eating, Dr. Hale began eating a plant-based diet last fall. She was enthusiastic about the positive results from her new eating habits, and shared the surprising connections between diet and “classic” female health issues, ranging from polycystic ovaries to adult acne, and even heavy, painful periods.

Pegan Dish PhotoThe Unhealthy Vegan – Go “Pegan”
Specifically, Dr. Hale’s diet can be referred to as a whole food, plant-based diet with an emphasis on whole grains, fruits, vegetables and legumes. “This is an important clarification,” she said, “because it is often confused with a vegan diet.” Her diet is not vegan; as vegan diets can still consist of a lot of processed, unhealthy foods.

A “pegan” diet is low glycemic, still high in vegetables and fruits, but allows for a small amount of high quality organic meats or low mercury, low toxin fish. Here, meat is used more as a condiment rather than the main feature. This is Dr. Hale’s second choice as an ideal diet. Her preference is still a completely plant based diet.

What advice would you give to others for transitioning to a plant-based diet?
The big thing is to consider food as medicine. (There’s lots of emerging evidence on this topic.) So if health is a priority, you need to be more attentive to what you’re putting into your body. If you try to have a more plant-forward diet (having more of your meals and more of your plate consist of vegetables), you are likelier to get a healthy dose of antioxidants and other things that help your body naturally detox.

Pegan Dish PhotoWhen I’m counseling patients about making a lifestyle change, I get them to look at lifestyle changes that will improve their health in the long-term.

When I was younger I had very heavy, painful periods. One of my main goals for transitioning to a plant based diet was to improve my periods as well as my overall health.

What are the benefits for women who choose to eat a plant-based diet?
While not everyone is guaranteed to have the same results, women with endometriosis can benefit from avoiding red meat and dairy as a means to reduce inflammation in their body. Many women with PCOS (polycystic ovarian syndrome) can improve their hormone balance through a low glycemic, plant based diet. A plant based diet is also a great strategy for achieving and maintaining a healthy weight. It also can reduce their risk for heart disease, which is the leading cause of death for women in the United States.

Are there any downsides to not eating meat?
I personally don’t think so. Contrary to what many people think, pregnant women can be completely meat-free and get sufficient protein to support a healthy pregnancy. They should, however, supplement with B12 and DHEA since these nutrients are harder to get naturally on a completely plant based diet.

dr-hale-running-picWhat are the first things you noticed happening to your body/mind after you changed your diet?
An increase in energy was the most noticeable change. Excess sugar sucks my mental clarity. Also, my menstrual flow wasn’t as heavy with hardly any cramps. As an added bonus I
also lost about 20-25 pounds.

How soon did you notice a difference after you switched up your diet?
In terms of my cycle, I noticed changes within a few months. A lot of people do notice that their skin clears up because you’re removing those inflammatory foods. That aspect for me has been a slower process since I’m working through multiple food sensitivities which I’ve learned also affects acne in adults.

How do you view your role for patients looking to make a dietary change?
I see my role as trying to help patients attain and maintain long-term health. Improving your nutrition is a way to be proactive about your health and do more than just depending on pills. I encourage patients to focus on the things they can add to make positive lifestyle changes rather than focusing on what they can’t have or do. Making small changes over time can help produce more sustainable change in the long term. This also helps fight an all-too-common diet “crash-and-burn.”

Do you have any suggestions on how to make the changes easier?

Having a buddy makes it easier. I have a certificate in Plant Based Nutrition through the T. Colin Campbell Center of Nutrition Studies that I feel equips me to support patients wanting to make positive changes in their diet. Dr. Crigler has many years of experience with a plant based diet so is also a good resource. There are also numerous resources available including websites, books, movies and more. While the New Year is a common time to make lifestyle changes, there is never a bad time to improve your health.

Below are a handful of resources that Dr. Hale recommends:

21daykickstart.org – free meal plans by the Physician Committee for Responsible Medicine in addition to numerous informative articles
Yum Universe – the blog that got Dr. Hale started with tasty plant based recipes
T. Colin Campbell Center for Nutrition Studies – articles, inspirational stories and recipes
The China Study – a book based on a landmark study in nutrition and disease.
Happy Herbivore encouraging blog and low-cost meal plans
Forks Over Knives – inspirational film, app and meal plans
Food Matters TV – hungry for change movie
Mark Hyman, MD – a proponent of the pegan diet
Plant Pure Nation – movie released earlier this year. You can join a “pod” in your area for support for your healthy lifestyle.

Dr. Hale on Vacation! Staying Healthy – Mind, Body and Soul
With all that hiking and fresh air, it’s clear to see that Dr. Hale not only talks the talk, she walks the walk!

Dr. Hale Vacation Photos

 

 

December 4, 2015

Essure photoEssure is a permanent birth control method that is over 99% effective preventing pregnancy. Approximately 750,000 women and their doctors have chosen Essure for permanent, non-hormonal birth control without surgery.

Recently, the safety of Essure has come into question, and the FDA has received thousands of complaints about the device from women and doctors. The FDA held a committee hearing on September 24th to review Essure’s safety and efficiency, but no recommendations have yet been made to the agency.

According to the FDA’s website about Essure, they are currently reviewing information from the September 24th meeting, the public docket, and additional medical literature and adverse event reports which have been published or received since the panel meeting.

They anticipate communicating the next steps publicly at the end of February 2016.

The Essure Procedure
Essure is an in-office procedure in which a qualified physician inserts a soft, flexible coil into your fallopian tubes. The inserts work with your body to form a natural barrier that keeps sperm from reaching the eggs, preventing pregnancy. Once the Essure inserts are in place, you must continue to use another form of birth control until you have your Essure Confirmation Test, which is usually performed three months following the procedure.

Essure is only to be used as a method for birth control and does not protect against HIV or other sexually transmitted diseases.

What are the Risks of Essure? 
As with any procedure or other birth control method that alters a woman’s fertility, there are risks involved with the Essure procedure. Talk to your doctor about any questions or concerns you may have before starting any birth control method.

Short-term risks for Essure include:

– Mild to moderate pain during the procedure
– Your body may absorb a large amount of the salt water solution used during the procedure
– Mild to moderate pain and/or cramping, vaginal bleeding, and pelvic or back discomfort for a few days following the procedure. Some women experience nausea and/or vomiting or fainting, so you should arrange for transportation after the procedure.

Long-term risks for Essure include:

– Essure is made of materials that include a nick-titanium alloy. Once placed inside the body, small amounts of nickel are released from the inserts. Patients with a nickel allergy may have an allergic reaction to the inserts.
– Some reports of chronic pelvic pain related to the Essure procedure have been documented.
– Having the NovaSure procedure after the Essure procedure may affect the blockage in your tubes, and a risk of pregnancy may increase.

Putting It In Perspective

For patients who are considering forms of birth control, we asked Dr. Litrel to comment on the Essure controversy. “Pregnancy is a natural process, but it’s important for people to remember that unplanned pregnancy may be riskier than contraception. It’s important to discuss your specific health goals with your doctor.”

Schedule an Appointment

If you’re finished adding to your family and are looking for birth control solutions, schedule an appointment at 770.720.7733 to speak with your doctor to determine a good option for you.

December 3, 2015

dr-litrel-round-pic
An Interview With Michael Litrel, MD, FACOG, FPMRS

What was your first job?
I was a waiter at Kennedy Airport, at the international arrivals building. I was seventeen years old, and had to wear a bow tie. It was great preparation for being a doctor. I met people from around the world, served people with their basic needs, and I had to utilize my time efficiently. I shuttled between tables just like I do between exam rooms – and I tried not to drop anything.

What is your legacy? How do you want to be remembered?
As the longest living person alive? (He laughs.)

I want to have always done my best, and to have always been honest, and to accomplish what God had put me on the planet for.

What book has influenced you most?
In 1984 I read The Road Less Traveled by Scott Peck – that really influenced me a lot. I also really like Richard Bach’s book, Illusions.

Other books include Mere Christianity, by C S. Lewis, and The Prophet, by Kahlil Gibran, which has influenced me a lot again this year. One of my all-time favorites that I’ve re-read for several years is The Holy Man, by Susan Trott. It’s short, funny, and quite profound.

A book that’s influenced me this year is The Life-Changing Magic of Tidying Up by Marie Kondo. I especially recommend it to young mothers.

Dr. Litrel study photoWhat words of wisdom would you pass on to your childhood self?
I think believe in yourself and know that the dreams in your heart are gifts from God to pursue. And I would say that I think there’s so much bad stuff – and it’s so easy to believe the bad stuff – but what’s most important is to believe the good stuff, and to then pursue. Never give up. Keep endeavoring despite the pain and the sadness.

If you could master one skill right now, what would it be?
Surgery. That’s the skill I’m most endeavoring to master. You don’t cut into the human body willy-nilly. During each and every individual operation, I try to master the surgery.

I think the pursuit of mastery is the purpose of life. You have to seek mastery. You can master the ability the walk at two years old, but that doesn’t mean you don’t trip sometimes. When performing surgery, I think that I serve, not that I’ve mastered. In every surgery, my goal is to serve each patient and God at the same time.

Okay, a question just for fun – If you could only eat one meal for the rest of your life, what would it be?Dr. Litrel Santa hat photo

Chinese food. I really like Szechuan beef, but now I’m a vegetarian. I’m an aspiring vegan, following in the footsteps of Dr. Hale and Dr. Crigler, so I’ve given up a lot of my favorite foods.

Cookies, a personal favorite, are sadly not on the list.

FUN FACTS

chris-and-dr-litrel-twin-pic2Unexpected Twin
Dr. Litrel is an identical twin. Born before the technology of ultrasound, he was unexpected until the very day he and his brother Chris were delivered. His first birth certificate named him “Baby B”

Chinese-Italian Culinary Mutt
Dr. Litrel grew up eating custom ravioli from his Italian father’s pasta shop on Long Island, and authentic Chinese dishes homemade by his Chinese grandmother in the Bronx

Healer With a Black BeltDr. Litrel Karate photo
Dr. Litrel is a lifelong martial arts student. He has studied karate, chi gong, bando, tai chi, and has a black belt in tae kwon do. He has also studied the Japanese healing art of Reiki.

POP QUIZ:  How well do you know Dr. Litrel?

Which of these jobs has Dr. Litrel NOT had?

A. EMT (Emergency Medical Technician) on ambulance
B. High School Chemistry Teacher
C. Forensic Intern (assist with autopsies)
D. Waiter

ANSWER:
Sorry – trick question! Dr. Litrel has worked in ALL these jobs.

November 10, 2015

By Kathryn A. Hale, MD, MPH, FACOG

Dr. Hale photoI was blessed to have a unique training opportunity as a medical student at St. George’s University School of Medicine: I was given the option to complete certain clinical training blocks in the United Kingdom (UK).

In the UK at that time, labor and delivery was largely run by nurse midwives. I chose to complete my rotation in Obstetrics & Gynecology at Poole General Hospital in the south of England. The OB/GYN only became involved if there was a medical complication, fetal distress or the rare major perineal laceration. This meant that I spent the majority of my time working with and under the supervision of midwives, even though I was training to become a medical doctor.

Learning To Support a Natural Process
Midwifery approaches pregnancy and birth as a natural process. There is a focus on empowering the mother to harness her own strength to achieve the beauty of birth, and a shift away from medical interventions. In my training at Poole, patients were assigned one midwife who followed that patient throughout her entire shift. I was often assigned to a patient who may not have had a doula or family member present. I became her support. I spend much of my time listening to and encouraging the patient, and less time examining her.

When the time for delivery came, there was no sterile draping or gowns as if preparing for a surgical procedure. We simply donned a simple plastic apron and gloves. The bed wasn’t broken down. We just supported the mom in whichever position felt right to her body for birthing her child.

Healthy and Holistic Pregnancy Options
That experience helped lay the foundation of my transition to a more holistic approach to OB/GYN in general. It gave me a more compassionate and patient approach to coaching women through their pregnancy and birth, and strengthened my belief in supporting the mother in doing what she was made to do. This includes being attentive to a patient’s unique emotional needs and desires – so that she feels empowered rather than helpless during this critical period.

The midwifery experience during my training opened me up to patients who desire more natural options as they approach pregnancy and birth. I’ve also felt led to pursue more education in the application of options such as chiropractic care, herbal medicine and essential oils in pregnancy.

In our practice, my colleagues and I are fortunate to have the skills and experience of our Certified Nurse Midwife Susan Griggs as part of our OB team. Empowering our patients with knowledge and healthy options is what makes caring for women the amazing experience that it is, every day.

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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