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December 1, 2016

Polycystic ovarian syndrome (PCOS) is a syndrome suffered by 1 in 20 women of childbearing age. It is the leading cause of infertility in women. At Cherokee Women’s Health Specialists, our highly qualified staff of OB-GYNs and fully accredited Female Pelvic Medicine and Reconstructive Surgeons (FPMRS) is qualified to recognize, diagnose and treat this problem. We offer our patients decades of combined expertise and, in collaboration with Northside Hospital Cherokee, have access to the most recent cutting edge technology known to modern medicine.

What is Polycystic Ovarian Syndrome?
PCOS, simply put, is a condition that wreaks havoc on a woman’s hormonal system, causing an imbalance of progesterone and estrogen, the sex hormones. This imbalance can cause the body to produce ovarian cysts, which are benign masses frequently found on the ovaries. PCOS can disrupt a woman’s menstrual cycle which may adversely affect her ability to conceive. It can also pose serious health risks, and may have an effect on physical appearance and cardiac function. Currently, over 5 million women in the United States alone are affected by this condition.

What Causes Polycystic Ovarian Syndrome?
While no one knows for certain what causes it, following may be some reasons:

Genetics – It’s speculated that genetics play a role. If a family member has PCOS, there is a likelihood that you may develop it as well.

Androgen – Another factor that may cause PCOS is overproduction of the male hormone, androgen. The female body produces this hormone naturally but women with PCOS have higher than normal levels. Excess androgen can have an undesirable impact on the development of the egg and its release during ovulation.

Insulin resistance – Insulin resistance is a condition where the body’s cells do not respond to the effects of insulin and may also contribute to high androgen levels.

What Are the Symptoms of PCOS?
Symptoms usually begin with the onset of menstruation and are characterized by:

  • Irregular, absent (amenorrhea), sparse, unpredictable, frequent, infrequent or heavy periods
  • A change or deepening in voice
  • Thinner hair
  • Acne
  • Decreased breast size
  • Pelvic pain
  • Weight gain or obesity
  • Anxiety and depression
  • Infertility
  • Darkened, thick downy skin patches (acanthosis nigricans)
  • Oily skin
  • Excess hair on toes, thumbs, stomach, upper thighs, chest and face (hirsutism)
  • Small multiple ovarian cysts.

Though not PCOS symptoms, many women who have polycystic ovarian syndrome are also prone to suffer from hypertension, diabetes and high cholesterol conditions that may be attributable to excessive weight gain often occurring with PCOS.

Is Polycystic Ovarian Syndrome Dangerous?
If not treated or controlled, PCOS may lead to serious complications such as:

  • High blood pressure (hypertension)
  • Periodic cessation of breathing while sleeping (sleep apnea)
  • Anxiety and depression
  • High cholesterol
  • Diabetes
  • Heart attack
  • Endometrial cancer
  • Breast cancer.

Furthermore, should you become pregnant, PCOS can place you in a high risk category, as women with this syndrome have a greater chance of developing gestational diabetes. There is also a much higher possibility of miscarriage and premature delivery. More vigilant monitoring may be necessary to help insure a safe pregnancy, labor and delivery.

How Do I know if I Have PCOS?
There are currently no definitive tests for this syndrome. In order to diagnose PCOS, we begin by taking a complete medical and family history, along with various tests to rule out any other conditions. Physical and pelvic examinations must be performed to look for such indications, such as a swollen clitoris or enlarged ovaries. To conclusively determine if you have PCOS, any or all of the following tests may be performed:

  • Fasting glucose tests to measure blood sugar levels
  • Thyroid function tests
  • Lipid tests to check cholesterol levels
  • A vaginal ultrasound to study your reproductive organs
  • A pelvic laparoscopy to detect any possible ovarian growths
  • A tissue biopsy if these growths are found.

What is the Treatment?
If, in fact, we diagnose you as suffering from polycystic ovarian syndrome, treatment consists of controlling and managing the symptoms to insure no complications develop. There is no actual cure, and since symptoms vary from woman to woman, any of the following may help to alleviate your condition, providing you with a better quality of life:

  • Birth control pills to adjust menstrual cycles, acne, and to reduce male hormone levels
  • Regular exercise and dietary changes to control or lose weight
  • Fertility drugs to aid with ovulation
  • Anti-androgen drugs to reduce acne and male hormone characteristics, such as excessive body hair and other masculine traits
  • Diabetes medication to lower male testosterone levels and blood glucose
  • Surgery, such as ovarian drilling, which uses electrical current to reduce male hormone levels and destroy a small section of ovary to promote ovulation.

Is There Anything I Can Do?
Yes. The following lifestyle changes can greatly diminish many of the negative symptoms of PCOS and any future impact they may have on your health:

  • Lose weight if you are obese or overweight
  • Exercise regularly
  • Don’t smoke
  • Eat a healthy balanced diet low in sugar and fat.

The earlier polycystic ovarian syndrome is diagnosed and treated, the sooner we can help prevent the serious complications that can occur as a result of this disorder. To schedule an appointment with one of our providers, please call 770.720.7733.

In vitro fertilization has become a wonderful option for many women who suffer from fertility issues. At Cherokee Women’s Health Specialists, our OB-GYNs and Female Pelvic Medicine Specialists are not only qualified to diagnose and treat these issues, but have the accreditations and combined decades of experience to effectively change lives child-free lives with their accumulated wisdom, experience, and access to the most cutting edge, up-to-date medical technology.

What is In Vitro Fertilization?
In vitro fertilization (IVF) is the most successful of several fertility treatments known as assisted reproductive technology (ART). Both the female egg and sperm are fertilized outside of the body, processed, and then reintroduced into a woman’s uterus to achieve conception.

Is In Vitro Fertilization My Only Recourse If I Suffer From Infertility?
There are several assisted reproductive technologies. In vitro fertilization may be necessary if other methods cannot help you achieve conception. Our OB-GYNs and FPMRS specialists are skilled in all aspects of Women’s Health, including fertility issues. We examine, diagnose and treat each patient with the same intense scrutiny and care we would a member of our own family. You will be assessed on an individual basis. We will recommend the best options based on your unique case, providing you with any available resources and referrals that meet your specific requirements.

Am I a Good Candidate for In Vitro Fertilization?
When other options have failed, or if we consider IVF the best course of action based on our expertise and knowledge, then this procedure will be recommended, if you:

  • Have been trying unsuccessfully to conceive through unprotected sex for more than six to twelve months.
  • Have ineffectively tried other forms of assisted reproductive technology.
  • Are 35 years or older (natural egg production decreases as women enter their late thirties).
  • Have blocked, scarred, missing or damaged fallopian tubes.
  • Suffer from endometriosis as endometrial scarring may prevent conception.
  • Have been diagnosed with polycystic ovarian syndrome (PCOS), a condition where excessive androgen (male) hormones may inhibit or cause irregular ovulation.
  • Produce too much prolactin in the blood (hyperprolactinemia).
  • Have incurred damage from pelvic inflammatory disease or another STD.
  • Have a partner with male fertility issues, such as a low sperm count.

in-vitro-photoHow Does In Vitro Fertilization Work?
In vitro fertilization is done in stages beginning with hormonal treatments to stimulate the growth of multiple eggs needed in the event that one or more may not develop or fertilize during the later process. These eggs are subsequently retrieved through a simple surgical procedure, and inseminated with the prepared, furnished sperm. Eggs are then monitored carefully to insure that fertilization and cell division are occurring. If success is achieved, the egg officially becomes an embryo and is ready for transfer into the uterus, where implantation will hopefully take place. The entire process from retrieval to implantation takes approximately a week. Close monitoring is done at every stage of this process to insure optimal results.

What if My Eggs or My Partner’s Sperm Are Deemed Weak or Unhealthy, or if There Are Dangerous Genetic Factors in My Family Tree?
From the moment of your first appointment, we will study and assess any problems that may be preventing you from conceiving, after which we will outline your best options. In the case of a low sperm count, intracytoplasmic injection can be used to infuse a single strong and healthy sperm directly into the egg. If healthy sperm cannot be provided by your partner, if your own eggs are not viable for this procedure, or if you are a female in a same sex relationship, you may opt to use donor sperm or eggs.

If genetic abnormalities are a concern, we will thoroughly study your family history, along with your own medical information. After careful analysis and testing, if we concur that your child may be at risk for inheriting a genetic or infectious disease, the above mentioned donor option is, again, available to you. Today’s technology also allows us to screen an IVF embryo for certain diseases or conditions before implantation.

What About Multiple Births?
During the in vitro fertilization process, several fertilized eggs are reintroduced into your uterus to insure a better chance of successful pregnancy. However, if you prefer not to have more than one baby and wish to avoid a multiple birth, today’s technology makes it possible to limit the number of fertilized eggs implanted to one in order to insure a single birth.

What Happens to Perfectly Good Eggs, Sperm or Embryos That Are Not Used?
Both fertilized and unfertilized eggs and sperm can be frozen (cryopreservation) for use at a later date. If you no longer wish to have another baby, you are free to donate them for use by someone else.

Freezing for later use is an excellent option if, for some reason, it is inconvenient to become pregnant immediately due to health or other concerns such as cancer treatment, a medical condition that can compromise fertility, etc.

How Successful is In Vitro Fertilization and How Can I Improve My Chances of Getting Pregnant?
As with every assisted reproductive technology, there is never a 100% guarantee, but IVF is one of the most effective methods to insure pregnancy. You can help guarantee even better results with the following lifestyle changes:

  • Eat a nutritious, balance diet.
  • Don’t smoke.
  • Take precautions to avoid contracting sexually transmitted diseases.
  • Maintain a healthy weight.
  • Schedule regular medical and gynecological checkups.
  • Limit alcohol intake.
  • Don’t use recreational drugs.
  • Try to keep a day job (studies shows that night or evening shifts can disrupt natural hormonal balance).
  • Exercise moderately (too much vigorous exercise can inhibit progesterone production).
  • Avoid exposure to toxins.
  • Limit caffeine consumption.
  • Practice pelvic exercises.

Today’s technology gives more women than ever the opportunity to conceive in cases where there was little hope only a few decades ago. For a consult with one of our OB-GYNs, book an appointment by calling 770.720.7733.

Dr. Litrel Explains Cosmetic and GYN Glossary Terms in Plain English

dr-litrel photoVaginoplasty: Tightening of the entire vaginal canal from the opening to the cervix (or the apex of the vagina, if hysterectomy was performed).

Hymenoplasty: Restoration of the hymen to create virginal anatomic state, which can be done at the time of vaginoplasty, if patient desires.

Cosmetic Surgery on the External Genitalia

Labiaplasty: Reshaping the labia minora or inner lips for improvement in appearance and to diminish labial irritation with clothing and during sex.

Clitoral Hoodectomy: Removal of excess skin covering the clitoris to create a better appearance and to help with clitoral orgasm.

Perineoplasty: Reshaping the external opening to the vagina for a smaller, more youthful appearance. This is performed during vaginoplasty or can be done without vaginoplasty, if vaginal tightening is not desired.

Labia Majora Reduction: Reshaping the labia majora or outer lips for a better appearance.

Female Reconstructive And Reparative Surgery (Usually Covered By Medical Insurance)

Anterior Repair: Repair of cystocele or bulging of bladder using natural tissue or biological graft or synthetic material.

Posterior Repair: Repair of rectocele or bulging of rectum using natural tissue or biological graft.

Enterocele Repair: Repair of enterocele or the sagging of the top of the vagina using natural tissue or biological graft or synthetic material.

Incontinence Repair: Repair of leakage of urine using native tissue, biological graft or synthetic material.

Endometrial Ablation: Outpatient or in-office procedure to diminish or eliminate menstrual bleeding without changing hormone status.

Hysterectomy: Removal of uterus to stop periods and pelvic pain associated with menses and sexual intercourse (pelvic pain with thrusting motions). Or, to remove tumors or pathology once childbearing is complete. During this procedure, removal of fallopian tubes (or salpingectomy) is strongly recommended to decrease the risk of future cancer.

Oophorectomy: Removal of ovary or ovaries for pelvic pain associated with sex or menses or is chronic or for cyst or mass. These are the organs that secrete hormones so removal of both will result in surgical menopause. Removal of one ovary will not affect hormones. Removal of one ovary is recommended once a woman is in menopause if hysterectomy is performed to decrease risk of cancer. If a woman has significant chronic pain on one side of her pelvis during her cycles or sex or chronic, removal of that ovary is considered.

Enterolysis: Minimally invasive (laparascopic or robotic) removal of internal adhesions of bowel to pelvic organs that cause pelvic pain with sex, menses, bowel movements or is chronic in nature.

Removal/Fulgurtion of Endometriosis: Minimally invasive (laparoscopic or robotic) removal and destruction of endometriosis lesions that cause painful menses or pain with sex or is chronic.

Salpingectomy: Removal of tubes for sterilization. Note: Tubal ligation without removal of tubes is not recommended because tubal removal will decrease future cancer risks but tubal ligation will not.

November 29, 2016

woman with low sex drive photoEvery week women ask me why their sex drive is so low. “Fix me so I can enjoy sex more and want it more often,” they say. Then they ask me to check their hormones and to give them a physical examination.

This is a popular topic among women and it’s everywhere in the media. Patients ask me about the latest fads they’d seen touted as the latest, greatest best thing. They ask about bioidentical hormones. Vaginal rejuvenation. Sexual vitamins. Gspot enhancement. clitoral hood reduction. The list goes on. Treatments of all sorts are advertised to women of all ages to solve a low sex drive. And it’s true that some solutions, when chosen for the right person, can transform a woman’s sexual responsiveness.

However, most of the time treatment is unnecessary or unhelpful.

Sometimes a woman’s sex drive is low for a good reason. But something that’s not broken can’t be fixed. Other times there is something that can be done. Asking the right questions is the key to understanding how to help them.

Five Key Questions for Women With a Low Sex Drive

1) Has your sex drive dropped or has it stayed more or less the same?
Many women are convinced they have a low sex drive because they compare their desire for sexual contact with their male partner’s. However, men and women typically have vastly different desires for sexual intercourse. The typical woman’s sexual desire usually ranges from once or twice a week to once or twice a month. The typical man’s is once or twice a day. This discrepancy accounts for the feeling many women have that there is something wrong with them.

That said, if a woman’s sex drive has suddenly dropped, a woman should consult with her doctor to determine the reason. If it’s always been low, then chances are that’s the way you are.

2) What is your childbearing history?
There is a myth that women reach their sexual peak in their forties. This is the idea that women in this age range finally becoming sexually liberated from natural inhibitions. The idea is that the forty year old woman now has a sexual desire and ability to orgasm that has reached new heights. There are specific circumstances in which this occurs but it is the exception rather than the rule.

Women in their forties who have not yet had children can have a very high sex drive. But oftentimes, there’s a reason for this. Women who have small children will often see their sex drive plummet. When toddlers and grade school children require constant mothering, there is often little left for the woman’s partner.

And women who are breastfeeding often have the lowest sex drive of all women. After all, she has a baby feeding off her body all day long and when she puts her head on her pillow at night, the last thing she wants is for more physical contact. Men will often say, “You used to want to have sex, I think there is something wrong with you.” It’s at this point that she’ll seek my help. Or, her partner will send her in to see me.

3) Does sex hurt or do you have pain with your cycles?
There are two main reasons why sex hurts. One has to do with vaginal dryness. This is pain with entry, which commonly occurs with menopause. The ovaries stop producing estrogen which leads to thinning of the vaginal lining, which exposes nerves and decreases lubrication. There is more pain and less pleasure and a reduced desire for sex. This can be treated with topical estrogen cream or even more advanced office procedures such as ThermiVa.

Other women commonly hurt with sex because they experience pelvic pain with their cycles. This is painful sex from the actual thrusting motion. If a woman missed school during her adolescence because of discomfort during her cycle or if her mother needed a hysterectomy for pelvic pain, it’s very likely she has endometriosis or internal scarring of her internal reproductive anatomy. This patient needs a gynecological evaluation, particularly if she has not had children, is experiencing infertility or if she experiences pain more than a couple of days a month.
Women with back pain during their cycles often have a tilted uterus that can be corrected by an experienced surgeon during an outpatient laparoscopy.

4) How is your general health?
In the same way that a person’s appetite for food drops when they’re not feeling well so does their appetite for sex. When you are in bed with the flu you don’t want to eat and you don’t want to be sexually active. But if you are chronically unhealthy, your desire for sex will be low as well.

The most common reason for poor health in America is lifestyle. As a society, we are sedentary and we eat addictive, poorly nutritious food. Patients with cancer and heart disease don’t come to my office complaining of low sex drives. But overweight patients who munch on pizza and don’t exercise often complain of a lack of sexual desire. Exercise and nutritious plant based diets raise testosterone levels and other important hormones responsible for not only sex drive but also an overall sense of youth and vigor.

5) Do you have orgasms?
Many women cannot have orgasms with sexual intercourse. Clitoral stimulation is the main way for a woman to achieve sexual climax. Unlike a man’s sex drive that ends with ejaculation, many women don’t focus on the biological climax but rather the emotional and physical intimacy. But a woman who does not orgasm can see her sex drive eventually plummet. It’s important to understand your body and to know how you achieve physical gratification from sexual activity.

Many women need vibrators applied directly to their clitoral region to achieve climax. The first step is masturbation alone when you can discover for yourself what gets you there. This can then be incorporated into sexual activity with your partner. Good communication is necessary to have a healthy sexual life. Some husbands will be uncomfortable with this kind of change. I tell my patients who indicate this to me to blame me (their doctor). “My doctor told me I have to do this so I can continue to be sexually active because having children and getting older has changed my body.” Hey, if it means a woman will have more intimacy and a better sex life, I’ll take one for the team!

Woman Healing From SurgeryThe length of time it takes to recover from surgery is different for everyone. In the same way that one person can run three miles and another has trouble walking up a flight of stairs, our bodies can heal at vastly different rates. But no matter who you are there are things you can do to increase your recovery time.

1) Adequate Rest – Most women are sleep deprived even without surgery because they typically take care of everyone around them. 12 to 14 hours of sleep each day is recommended the first week after surgery. For the next three weeks, an extra two hours of sleep a day is recommended.

2) Adequate Calories – After surgery is not the time for weight loss. Your body needs good nutrition to allow for healing of injured tissue. 15 to 20 calories per pound of current body weight is a good guideline.

3) Adequate Protein – Healing from surgery requires increased protein intake. Protein is required for your tissue to rebuild and for antibodies and white blood cells to fight off infection. This is sometimes difficult to do in the first week after surgery when you are more sedentary and may not be as hungry. But target one half to one gram of protein per pound of body weight a day. A hundred grams of protein a day is an excellent target. Consider supplementing your diet with protein shakes or protein bars.

4) Adequate Iron – If you had any blood loss during surgery, then you should take 15 to 30mg of iron a day for the first month after surgery. There are iron supplements available over the counter. These can cause constipation, particularly when taken with narcotics for pain relief. Iron rich foods include spinach, beans, whole grain oats, greens, lentils, shell fish like clams or oysters. Dietary iron is better than supplements if you can get enough this way. Eat a spinach salad with beans and drink a green smoothie to build up your iron and get rich healing nutrients every single day.

5) Water and Fluids – Water is necessary for carrying nutrients to your cells and to flush bacteria and waste from your body. The classic recommendation for water intake is eight 8 oz. glasses of water a day or about one half gallon. This is a fine target for most people. You want to drink about one half to one ounce of fluid per pound of body weight. Gatorade or a drink with electrolytes can help replace lost salts and minerals and help you get additional calories. You can tell you are getting enough fluids if you must urinate frequently.

6) Decreased Activity – After surgery everyone decreases their activity because of the pain. People have different abilities to tolerate physical discomfort so some increase activity faster than others. A good rule of thumb after a major surgery is to minimize your activity for at least two weeks. It’s fine to walk to the mailbox when you feel up to it but don’t go shopping or clean or vacuum. I took my wife to the movies four days after her c-section because she absolutely insisted, but I parked in the handicapped spot. After two weeks of relative inactivity, try increasing your activity to about 25% of your activity before surgery. After four weeks increase to 50%. After six weeks, 75%. Expect to get to 100 percent after 8 weeks. This will vary of course based upon the surgery and the individual. Bottom line: Get adequate rest and allow your body to heal.

7) Fresh Air and Sunshine – It is well known that sunlight helps with the synthesis of Vitamin D. This is certainly necessary for healing. But many holistic doctors also promote sunshine as necessary for the healing process in general. There are different theories about this but nothing definitive. From my experience as a clinician and at times in my life as a patient, I have noticed that people heal faster when they get sunshine and fresh air on a daily basis. This doesn’t mean you should lay out in the sun but an open window or sitting on the porch each day for twenty minutes or longer is a good idea. I suspect so much of the poor health that we see in the developed world is that too many of us are cooped up inside all day.

8) Inner Peace – We all weaken and become ill at times and this can be very frightening. As you heal from surgery, it’s important to focus on whatever it is that brings you peace and comfort. For some, it’s prayer. For others, it may be meditation. But at the core of these things, it’s the ability to feel gratitude for all the blessings we’ve been given. It’s a blessing to be able to walk around pain-free, to have plenty to eat and drink, to have a warm bed, to have people to love and laugh with – and yes, even to be able to go to work.

So while it’s easy to get down while your body heals, it helps to focus on the big picture and be grateful for all you have, including the surgery you just had. After all, there was a time not so long ago when that surgery may not have even been available.

November 10, 2016

A recent study has concluded that certain types of hormonal birth control can lead to depression. More than one million women were studied over a 13-year span and those who took combined progestin and estrogen pills had a 23% likelihood of developing depression. Those who were taking a progestin-only pill were 34% more likely to be diagnosed as depressed. For adolescents between the ages of 15-19 who used birth control pills, the instances of depression jumped to 80%.

Does taking birth control cause depression?There may be outside factors involved in the diagnosis of depression, especially considering that women in the adolescent stage may be predisposed to depression due to other issues they encounter such as hormonal changes, or depression from a triggered immune system.

With depression associated as a symptom of some types of hormonal birth control, it is important for women to discuss all birth control options with their doctor as well as disclose any and all side effects, including depressive symptoms.

If a patient is prone to depression or has relatives who suffer from depression, it is worth mentioning to the doctor. However, these risks should not scare women away from birth control, in fact, an unplanned pregnancy can cause depression, too. There are many options available today. If one on method does not fit with a patient’s lifestyle, there are others to try. Being open with health care providers is key. Knowing a patient’s health history makes it possible for doctors to prescribe medications that will get the best results.

Do you experience side effects from your birth control? Tell us about it, we might be able to help!

November 4, 2016

ultrasound photo with brenda

Accredited ultrasound services require a highly educated and skilled expert to operate the ultrasound machine and perform diagnostic examinations. Ultrasound is used both for pregnancy and also for the diagnosis of GYN issues.  A physician interprets the resulting images. Based on one or multiple factors, he or she affirms that the anatomy is normal, or if an abnormality is suspected, recommends further testing or treatment.

How Ultrasound Changed Pregnancy

When the technology of ultrasound first emerged, pregnant women were excited to see their developing babies. A patient would lie on a cold table, bladder filled with the large quantity of water she was required to drink to yield a clear picture. The technician lubricated her stomach with cold gel, and proceeded to rub a transducer probe across her belly while the anxious future mom and dad looked on.

The pictures were often disappointing – blurred and grainy. Without the sonographer patiently tracing the image with a finger on the monitor, prospective pareents didn’t know if they were admiring their baby’s face or the uterus it was inside. As for gender, well, that was still a hit and miss thing – basically no different from the baby shower tradition of swinging a ring on a rope, and guessing the baby’s sex based on whether the ring twirled or swung like a pendulum.

Back then, only the sonographer’s experienced eye could differentiate the important information from the blips and blotches on the monitor to insure that all was well. But since then, the quality of ultrasound – and the training of technicians – have evolved a hundredfold.

Briefly, How Does Ultrasound Work?

The ultrasonographer sends harmless high frequency sounds, undetected by human ears, toward a ‘target,’ in this case, your growing baby. Those sound waves are directed via a probe called a transducer. The sound waves bounce back, creating an ‘echo’ when they encounter the bone or tissue of the baby. That echo creates an image on a monitor—a picture of your baby complete with all its parts, including internal bones, tissue, organs and even blood flow. You may recognize only larger parts of your baby, like face, limbs, heart, etc., but the technician knows what all the little pieces of the fetus are. He or she is trained to decipher and measure every part to verify due date, gender, and to detect if anything is out of the ordinary.

Does Our Practice Offer Ultrasound Services?

Yes, we offer ultrasound services at our practice and are accredited at both our Canton and Woodstock locations. Headed up by our chief ultrasonographer, Brenda Peters, our practice has earned a place on a limited list of practices fully accredited by the American Institute of Ultrasound in medicine for obstetric and gynecologic ultrasound. Brenda’s training includes a Bachelor of Science degree from the diagnostic medical sonography program of the Rochester Institute of Technology, where she graduated with high honors in 2000. She is also a registered OB-GYN Ultrasonographer by the American Registry for Diagnostic Medical Sonography, and is certified in nuchal translucency, a specific screening to determine the presence of Down syndrome.

What Does Ultrasound Accreditation Involve?

The ultrasonographers in our accredited offices update their skills and stay current by attending the obligatory programs available. Additionally, our physicians take ongoing ultrasound classes and pass a test every three years to meet AIUM guidelines for reading ultrasound studies.

What Skills Does a Registered Ultrasonographer Have?

  • They are required to have basic knowledge of pathophysiology (knowledge of disorders and syndromes), anatomy, and physiology (knowledge of the function of living matter such as cells, tissues and organs)
  • They must be able to differentiate between normal and abnormal sonographic findings, recognizing particular conditions and diseases.
  • They must be able to recognize ultrasound patterns and imaging.
  • Sonographers do not simply diagnose findings, but must also know how to efficiently operate the equipment to acquire all the necessary data for diagnosis.
  • They must possess excellent clinical and communication skills
  • They must be able to assess and care for their patients, be adept at problem solving, and apply unbiased, logical, critical thinking to all findings.
  • They must adhere to all sanitary guidelines to prevent infection, and be mindful of all safety and health issues.
  • They are required to have knowledge of ultrasound physics
  • They keep image copies, accurate records, precise charts and detailed information, sharing their diagnosis with their medical colleagues in order to insure optimum patient care.
  • They often communicate findings to patients in real time, taking however long is necessary to explain all procedures, thus instilling trust, confidence and calmness in the person under their care.
  • They need strong verbal and written skills, in both medical and layman terminology to be able to communicate their findings to their colleagues.
  • In many cases, they may be required to move patients and be able to stand for long hours, requiring them to be in peak physical condition.Ultrasound Registry takes years of study, dedication and experience to achieve.
  • Reaccreditation is done every three years for our office.

Our staff of professionals in this field are available to care for you, the patient, with their knowledge and expertise at all times.

For more information, visit Northside Hospital Cherokee.For an appointment, call our office at 770.720.7733.

November 1, 2016

woman-choosing-food

It’s common knowledge that smoking, drinking or misusing drugs can be harmful to a growing fetus. It’s also becoming widely known that a proper prenatal diet is vitally important to a baby’s health and development.

We consider diet such an important factor in pre-pregnancy planning and prenatal care that we offer the options of both regular and holistic plant based prenatal nutrition information to all our patients. Our providers can help advise you on a regimen that works for you, based on your specific needs and preferences, even allowing for any budgetary limitations you may have. This service is available before, during, and after pregnancy.

Two of our physicians, Dr. Britton Crigler (MD, FACOG), and Dr. Kathryn Hale (MD, MPH, FACOG), are practicing vegans and pegans, respectively. Their expertise and input into prenatal holistic nutrition can prove invaluable should you choose to follow a plant based diet while pregnant.

What is Holistic Nutrition?

Holistic nutrition is eating foods that are as close to nature as possible. None of us would dream of walking into a lab, grabbing random test tubes, and drinking the contents. Yet, in essence, we do something similar to this every day by ingesting foods saturated in chemicals, additives and preservatives. Grocery store shelves bulge with genetically altered meat, produce, dry goods and beverages that make them look, sound, or taste more appealing.

The list of ingredients on most packaging has become so long that one almost needs a microscope to read the fine print. Even someone with 20/20 vision needs a PhD to decipher the multisyllabic contents on a box of crackers.

Your baby is completely dependent on you to provide her with the nourishment she needs to grow healthy and strong while she develops inside your body. Her bones, muscles, tissue and organs are sensitive to every bite you eat and every drop you drink, so if you opt for holistic nutrition, your baby also benefits from the purity of unprocessed, unrefined and organic food.

What’s the Difference Between a Vegetarian, Vegan and Pegan Diet?

A strict vegetarian diet consists of grains, seeds, nuts, vegetables and fruits, with no fish, meat, poultry, game or shellfish. In some cases, vegetarians will eat occasional dairy products and eggs, but emphasis in this diet is on the exclusion of all slaughtered animals. Less strict plant-based diets may include fish, dairy products, eggs and poultry. Most vegetarians exclude meat, but some include it infrequently.

A vegan diet is entirely plant based with no animal products. Emphasis is on seeds, nuts, fruits, grains and vegetables.

A pegan (paleo-vegan) low-glycemic diet consists of fruit, vegetables, meat, fish, and eggs. It omits dairy products, processed foods, grains, sugars and legumes.

Although these sound like contradictions of each other, they’re not. All three place importance on a natural plant based diet, and all are beneficial to good health, prenatal and otherwise. Though the pegan diet includes meat, it is in extremely limited quantities.

How Can Any of These Diets Help Me and My Baby?

Dr. Hale’s and Dr. Crigler’s diet regimens vary somewhat, but both stress the benefits of natural plant based nutrition to you and your baby. As a vegan, Dr. Crigler avoids meat completely and encourages eliminating it. He states:

“… A plant based diet has multiple benefits for women’s health…Even for our pregnant patients, a vegan or plant based diet free of dairy and meat can be very healthy for both baby and mother.”

As a pegan, Dr. Hale, who holds a plant based nutrition certificate, is not opposed to a scant quantity of organic meat or low toxin fish, but only considers inclusion of it as a second choice. Meatless pegan is her first. She also affirms:

“…Contrary to what many people think, pregnant women can be completely meat-free and get sufficient protein to support a healthy pregnancy…”

Both also agree that protein can be derived from other holistic sources.

Dr. Hale recommends taking B12 and DHEA if you opt for pegan. Dr. Crigler prescribes B12 and Vitamin D if you prefer vegan. These supplements round out a healthy regimen, supplying the body with everything it needs to maintain optimum prenatal performance.

Both are also in total agreement that vegan and paleo-vegan nutrition help prenatal and postnatal women in the following ways by:

    • Decreasing preeclampsia risk
    • Providing antioxidants
    • Producing more beneficial, purer breast milk
    • Preventing breast, colon and ovarian cancer
    • Minimizing incidents of allergies to your baby
    • Lowering exposure to additional or harmful hormones.

Holistic nutrition can also alleviate the symptoms of chronic conditions and diseases such as:

    • Endometriosis
    • Lupus
    • Acne
    • Irritable bowel syndrome
    • Heart disease
    • Type 2 diabetes
    • Constipation
    • Systemic inflammation
    • Polycystic ovarian syndrome
    • Heavy menstrual periods
    • Menstrual cramps.

Additionally, holistic nutrition has been known to enhance mental clarity, improve energy and help with weight loss.

Isn’t it Dangerous to Suddenly Change My Diet While Pregnant? Am I Not Eating for Two Now?

Pregnancy is one of the best times to address the subject of nutrition. In a sense, you are eating for two, but this doesn’t mean double the amount. It means that you have to fuel two growing bodies with the vitamins, minerals and nutrients they both need to remain healthy.

A developing fetus can not only sap your energy by absorbing all the ‘goodness’ it needs from the food you ingest, it can deprive you of what you need to remain strong and fit enough to handle all the physical, emotional, and hormonal changes that are going to happen during the next few months.

Proper nutrition replaces what the fetus depletes, preparing the two of you for the intensity of labor and delivery. Holistic nutrition counseling can help make the choices that are right for you.

For more information on high risk pregnancy, visit Northside Hospital Cherokee.

To schedule an appointment to discuss your needs, call 770.720.7733.

October 26, 2016

Bring your birth control questions to the providers at Cherokee Women's Health.The responsibility of Family Planning has never been easier with all of the options available to meet a patient’s health and lifestyle needs.  While the choices may seem overwhelming, a doctor can help to find the right contraception method to meet each patient’s needs. Below are some things to consider before scheduling an appointment with a care provider:

  • Disclose Complete Health History- It is especially important to be honest and thorough when disclosing health history because of any risks associated with contraception methods. This is a critical step in finding a birth control that will work for any health conditions a patient may have. Furthermore, there are certain birth control types that are contraindicated for those with genetic conditions or predispositions such as breast, uterine, or ovarian cancers.
  • Ask about options-it is best to make an informed decision about birth control, so start by asking what types are available. Choices range from pills, implants, and injections to more permanent options such as sterilization for women or men. While considering all of the options, it is important to plan for the future. For patients looking for long-term or permanent birth control, it is advantageous to ask about the reversibility of the method. Plans change, and patients should know if their birth control can be easily reversed.
  • Inquire about the Efficacy of Birth Control-Different methods hold different rates of effectiveness and a doctor can help compare methods that will work best for each patient’s needs. Find out what types of back-up or emergency birth control can be used to bolster effectiveness, prevent failure, and protect against sexually transmitted diseases. Additionally, ask if any supplements or antibiotics will interfere with the effectiveness of birth control and if there are back-up birth control options that should be used.
  • Evaluate the Cost-Some birth controls will cost more out-of-pocket than other types. Doctors can assist in finding a solution that fits into the budget. Contacting insurance is another suggestion to see what options are covered under a patient’s health plan.
  • Compare the Side-Effects and Benefits-Ask for a run-down on the types of side effects that can occur on birth control. Some patients may want to adjust their method based on their level of comfort with the side effects they experience. A doctor can answer any questions about switching methods or reducing symptoms or side effects.
  • Lifestyle Considerations-Depending on a patient’s lifestyle and individual menstrual cycle, there are contraceptive methods that may be the most optimal choice. For patients who travel often, they may find that they need a method that does not require weekly updating, or monthly prescription renewals. Those with irregular periods may want to consider something that regulates their cycle, such as birth control pills. Doctors can help pinpoint a method that accommodates lifestyle needs.

More than Protection– Proven benefits of taking contraceptives include regulating periods, reducing heavy bleeding, and clearing up skin conditions such as acne. Endometriosis is another condition that can be helped with the right birth control method, eliminating pain associated with the disorder. Women suffering from PMS, or PMDD should ask their doctor about a birth control method that can also help eliminate or lessen these irritable symptoms. Mention any symptoms experienced prior or during a menstrual cycle such as:

  • Mood changes or Anxiety and Depression
  • Severe pain
  • Sleepiness or Insomnia
  • Social Dysfunction
  • Weight gain and water retention

Birth control is not a one-size-fits-all method. If a particular type of birth control does not meet a patient’s needs, they should discuss any issues with their doctor and find other suitable options. Cherokee Women’s Health want to help take the guess work out of choosing a birth control. The first step in finding a contraception method is making an appointment with one of our health professionals, today!

October 19, 2016

Routine prenatal care is not a luxury or indulgence. It’s something both you and your baby deserve, and it’s a service that we excel at and are happy to provide.

Just as a gardener waters, nurtures, and cares for the seeds that he planted in rich, fertile soil, your baby, who is even smaller at conception than those seeds, needs the same dedication and attention to insure its prenatal growth and development in the womb. We help make that happen.

Whether this is your first pregnancy, or you’re already familiar with the whole process of giving birth, the importance of prenatal care can’t be emphasized enough. No matter how typical your pregnancy is, or how little risk your baby is exposed to health-wise and genetically, proper vigilance from conception to safe delivery is vital.

routine prenatal care exam photoOur specialists are trained in every facet of women’s health. We excel in the fields of fertility, obstetrics, gynecology and pelvic surgery. Not only do we offer optimum prenatal care, but we treat you, the patient, the same way we would treat our own mothers, sisters, daughters and all other females in our lives. Having successfully delivered over 10,000 babies, our priority is to safeguard not only your continuing well-being, but that of your baby. We offer every advantage currently known to women’s medicine, all with a compassionate and dedicated approach.

What Can You Expect From Us?
From your very first prenatal care visit, we treat you with the utmost care and respect, beginning with the initial pleasant greeting you receive the moment you walk through our doors. We’re professionals, but first and foremost, we’re human, just like you. We want you to feel as comfortable as possible so that you can establish a trusting relationship with your physician, and with his or her assisting staff.

How Can You Prepare For Your First Visit?
Bring your medical history and background. They’re important. That information gives us an idea of how closely we need to scrutinize your progress. It can help us decide what tests we should run during your first few prenatal care appointments. Your information and subsequent test results, if merited, determine whether your pregnancy should be considered high risk, moderate risk or risk free. No matter what the results, we are qualified to treat all levels.

What Happens During Routine Prenatal Care Appointments?
Our standard examinations during each visit include the following:

  • Blood tests
  • Blood pressure monitoring
  • Listening to your baby’s heartbeat
  • Urinalysis
  • Abdominal measurement to verify normal fetal growth
  • Pelvic examinations when necessary
  • Addressing any patient concerns.

When you’re ready for your first ultrasound, our prenatal care physicians are among the few who are fully accredited in the use of the most modern up-to-date 4D ultrasound. This procedure allows you to see your growing baby in full detail. It also lets our trained specialists evaluate your baby’s progress, detecting any potential problems that might occur as it matures from embryo to fetus, and finally to the infant you’ll cradle in your arms.

What Other Routine Prenatal Care Services Are Available?
We check for gestational diabetes, anemia and any genetic abnormalities. By conscientiously monitoring both your baby’s development along with your own, we want to relieve you of any stress or worry. When you leave after an appointment with us, we want you to do so with complete peace of mind.
We also offer the following prenatal care services:

    • Nutrition and diet: Our experts will help you maintain a healthy weight throughout your pregnancy, insuring a less complicated delivery. We provide information on regular, vegetarian, gluten free, vegan, and holistic nutrition. We take every precaution to insure that you and your baby receive the proper nourishment you need to sustain a trouble-free pregnancy.
    • Physical therapy: On-staff professionals will guide you in preparing your body for labor. Their recommended prenatal exercises and fitness regimens will minimize any possible trauma your body might experience during delivery, such as perineum damage, pelvic organ prolapse, or urinary incontinence. Their expertise has been proven invaluable, reducing previously unavoidable pelvic injury while giving birth.
    • Midwifery: You may be more comfortable with a nurse-midwife to assist you during delivery. We will partner you with a highly skilled nurse midwife, who has decades of experience. As long as your pregnancy is uncomplicated and progressing within normal guidelines, this practitioner is available to you.
    • Counsel and advice: No topic or concern you wish to broach regarding your pregnancy is trivial to us. We’re happy to address any subject, including such topics as breastfeeding, natural childbirth, having participants in the delivery room, umbilical cord blood banking, signs of postpartum depression, or circumcision if you are having a boy. You might be strongly opposed to routine afterbirth procedures, like a nurse washing your baby instead of leaving that first bath to you, or allowing it to have a pacifier in your absence. If it’s important to you, it’s important to us. We’ll answer your questions, dispense guidance as you need it and accommodate you to the best of our ability.

Getting you through your pregnancy with as little stress and complication as possible is our primary focus. We accomplish this goal successfully during every routine prenatal exam by treating you as the important and unique individual you are.

To schedule an appointment, please call us at 770.720.7733. For more information on prenatal care, visit Northside Hospital Cherokee.

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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