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Category: Health

September 6, 2017

by James Haley, MD, FACOG, FPMRS

Dr. Haley photo

Dr. Haley

As many as 86 million people in the United States have prediabetes, yet 90% of them don’t even know it. Prediabetes is the condition that exists when you have higher than normal blood sugar levels, but not high enough to classify as diabetes. Someone with prediabetes has a higher risk of developing Type 2 diabetes and other serious health issues, including stroke and heart disease.

Since this condition has no symptoms, it can easily go undiagnosed. However, there are risk factors to look for, and certainly ways you can decrease your risk of becoming a Type 2 diabetic. Type 2 diabetes is a major public health issue, and more people need to know they are at risk.

Know the Risk Factors for Prediabetes

The American Diabetes Association (ADA) has guidelines that list a total of 11 specific risk factors that determine if you should be screened for prediabetes. They include:

  • High Blood Pressure
  • High Cholesterol
  • Body Mass Index (BMI) over 25
  • History of Heart Disease
  • Physical Inactivity
  • 1st Degree Relative with Diabetes
  • Over 45 years old
  • Had Diabetes in Pregnancy (gestational diabetes)
  • African-American race
  • Latino ethnicity
  • Asian-American race

bmi-photo

If you’re over 45 and have any of the other risk factors, you should see your doctor. A simple blood test can let you know if you are prediabetic. Unfortunately, most Americans these days have a body mass index (BMI) over 25, not realizing the risks associated with it. If you have a calculator, you can easily figure your BMI. Below is the standard formula. If you are in good shape and have extra muscle, it may be a little off. Nevertheless, it is still a good method and will give you a close estimate.

How to Calculate Your BMI

  1. Figure out how many inches tall you are. (Example: if you are 5’4″ you are 64 inches).
  2. Multiply the number by itself. (Example: 64 x 64 = 4096)
  3. Write the total down and clear your calculator.
  4. Now, punch in your weight in pounds and divide by that saved 4-digit number (For a 125 woman, 125 divided by 4096 = .03051758)
  5. Multiply your result by 703. (.03051758 x 703=21.4538)
  6. Here, 21.45 is the BMI

If the result you get is less than 18.5, you are considered underweight. If your BMI is between 18.5-24.9, you are normal weight. But if your BMI is 25-29 you are considered overweight, and over 29 is considered obese.

No matter how undesirable you find your calculations, don’t despair. Make today the first day of positive changes. It’s never too late to start a sensible diet and exercise plan. Change begins with that first step. Get committed!! Get going!

For guidelines on nutrition and weight loss, discuss your concerns with your doctor at your next annual exam.

by James Haley, MD FACOG, FPMRS

Dr. Haley photo

Dr. Haley

As a physician and fitness enthusiast, I’ve read a plethora of articles, books, and journals on weight loss. My patients continually tell me their struggles with dieting, lamenting that the weight always returns, usually along with a few extra pounds. Personally, I can relate. It’s not a dilemma exclusive to women. Men struggle, too. As you age, you just can’t eat like you used to – even if you exercise regularly.

After reading numerous books and trying different diets myself, I finally discovered an author who not only pinpoints the problem of obesity, but also the answer to those last ten pounds.

In his book, ‘The Obesity Code’, Dr. Jason Fung, a nephrologist, states that the real culprit of weight gain isn’t overeating. It’s excessive insulin. He is emphatic that many of his patients would need less medical intervention if they lost weight. Since most of his patients are Type 2 Diabetics, a disease associated with too much insulin, he has been able to determine the common link – SNACKING.

In the past few decades, the number of times we eat daily has increased. People have gone from eating three meals a day to about six, counting snacks. Go on, admit it. It’s what you do – what I’ve done. it’s a cycle, and it makes sense once you understand the reason why. Every time you eat, you stimulate insulin, keeping it at a constant high level. This fools the body into thinking it’s always hungry. Your body is constantly thinking you are hungry because your insulin stays in a high range.

woman weighing on scaleObesity is a hormonal disease. Insulin, a hormone, tells you how much to eat and how much to burn. The body behaves as if the weight is set on a thermostat. So, obesity is not about caloric imbalance. Thus, it makes sense that the idea of cutting calories is totally wrong.

You may not be obese. Maybe you have a few obstinate pounds that won’t melt – a jiggle around the middle resistant to diet and exercise. ‘Fat’, ‘plump’, ‘chubby’ – whatever you call it, a surplus of insulin is causing it. The longer you have higher amounts of it, the more resistant your body becomes, which produces even more and causes that crazy, never-ending cycle.

So what’s the solution?

  • Avoid insulin-stimulating foods like sugar and refined grains. These are the enemy.
  • Eliminate between-meal snacks.
  • Designate mealtimes.

Meal timing and insulin levels work together to regulate our weight. We need periods of time when we aren’t eating, so insulin can go down, leaving our bodies in energy burning mode. If we leave more time between meals…. we burn energy.

And when we burn energy, we lose weight.

To learn more about the other secret to regulating insulin for weight loss, read here.

 

September 5, 2017
Dr. Haley photo

Dr. Haley

by James Haley, MD, FACOG, FPMRS

I have always had a personal interest in nutrition and fitness, and more so after I became a doctor and needed that knowledge to benefit my patients. After reading volumes of research on these subjects and hearing my patients’ struggles with weight gain, I came across nephrologist Dr. Jason Fung’s book, ‘The Obesity Code’.

Most of Dr. Fung’s patients are Type 2 diabetics, and he explains clearly how obesity is a problem due not to caloric intake, but to constant high levels of insulin in the body retained through frequent eating.

In short, Dr. Fung states that the more often you eat, refueling with snacks between meals, the longer your insulin levels remain elevated. Since insulin is a hormone that tells your body how much to eat and how much to burn, high insulin levels fool the body into thinking you are always hungry. Those messages cause you to eat more, and of course, gain weight.

How do you overcome this vicious circle?

1. Stop Snacking

This is the first step. Avoid especially the sugary and refined, processed foods which make your insulin levels spike and fall all day, perpetuating the cycle of hunger and sluggishness, making you think you’re hungry.

2. Stay Hydrated and Eat Well  

Drink plenty of water and eat healthy foods like vegetables, nuts, salads, fruit and protein-rich chicken and fish, which keep your insulin levels steady.

woman fasting fruit photo3. Fast

Fasting! The word may make you shudder. I’m not talking about a three-week, Gandhi-type fast. Dr. Fung suggests a “mini- fast”: going without breakfast. And yes, this goes against everything you’ve ever been told, that breakfast is the most important meal of the day. You don’t need to do it daily, but skipping breakfast gives your body about 14 hours of fasting from the night before. We need periods of time when we aren’t eating, when insulin can go down, leaving our bodies in energy burning mode. This one step will dramatically lower your insulin, which in turn acts to lower the body’s set weight. You’ll start to feel better, have more energy – and you may just get rid of that last, lingering ten pounds.

4. Consult Your Doctor

Fasting is never recommended for pregnant women, breastfeeding mothers, or people with certain diseases.

If you simply need a jump start to weight loss, try the mini-fasting route and let your body’s insulin levels drop to burn energy. You will be surprised at how much better you feel. Once you change your mindset about food, regulate your insulin, and time your meals, you will see many positive results. Whether you need to lose weight or not, you will definitely have more energy, and hopefully live a longer, healthier life.

To learn more about the other secret to regulating insulin for weight loss, read here.

June 22, 2017

cwhs officePatients travel from across the country to Canton, GA, in north metro Atlanta to have surgery with Dr. Michael Litrel at Cherokee Women’s Health Specialists.

We are committed to ensuring your experience with us is safe, comfortable and convenient so we have provided the following information to assist out of town patients with transportation, accommodation and what you can expect before and after your surgery. And because you may have some downtime between your pre-op appointment and your surgery, we’ve also included links to stores and activities in the Canton area.

Please follow the instructions to prepare for your surgery with Dr. Litrel if you live outside the Canton/Atlanta area.

Contact Our Office
The first step for out of town patients is to contact our office to schedule a phone consultation with Dr. Litrel. If you have photos to provide for the consultation, you’ll be given a secure designated e-mail address to send the photos so that Dr. Litrel can review and understand your surgical needs.

Following your consultation, you’ll be contacted by our scheduling team to set up a preoperative examination appointment and your surgical date. 

Traveling to Canton
If you are flying to Atlanta, we recommend that you fly into Hartsfield Jackson International Airport, located about one hour from our Canton office. Once you arrive, you may choose from several transportation options. We have provided helpful links for you below.

Car Rental
Shuttle / Limo Services
Uber / Lyft

hampton-inn-and-holiday-inn-photosYour Accommodations
While staying in Canton, we recommend Hampton Inn or the Holiday Express Inn, where you will receive a reduced rate on your room during your stay, as a patient of Cherokee Women’s Health. It’s conveniently located off I-575 and within just three miles of our office, Northside Hospital Cherokee, several restaurants, shopping areas and more.

Hampton Inn
710 Transit Avenue
Canton, GA 30114
770-345-7400

Holiday Inn Express
713 Transit Ave
Canton, GA 30114
770-479-7300

Your Pre-Op Appointment
Your pre-op appointment will typically take place the day before your surgery. During this appointment, Dr. Litrel will examine you, explain again what to expect during your surgery, discuss what your recovery will be like, and answer any questions you may have. Rest assured, you will be able to contact Dr. Litrel with any issues or questions before you arrive – and after you depart.

Checking Into Your Hotel After Your Pre-Op Appointment
The check-in time at both Hampton Inn and Holiday Inn Express is 3 pm. However, as a patient of Cherokee Women’s, they may be able to accommodate an earlier check-in. If desired, please give them a call.

When checking in, be sure to tell them that you are a patient of Cherokee Women’s and that you will be receiving surgery at either our office or at Northside Hospital Cherokee to ensure you receive the reduced rate.

If you’re unable to check-in immediately after your pre-op appointment, we’ve provided several links to restaurants, shopping and other nearby activities below.

After Your Surgery
We want you to be as comfortable as possible so after your surgery, you will return to your room where you can rest in private. If you have arrived for your surgery alone, a Medical Assistant will provide transport from our office to the hotel. That evening, our nurse will come by to check on you. The following morning, Dr. Litrel and his medical assistant will do a post-op visit to ensure everything is going well and answer any additional questions or concerns you might have.

Canton Restaurants, Shops and Activities
You may want to get out and explore during your downtime so we’ve provided the following list for your convenience.

Restaurants
A wide range of restaurants are located within a mile or two of your hotel. For upscale dining, Downtown Woodstock is just ten minutes away, featuring award winning restaurants such as Century House, Vingenzo’s and Salt Factory Pub. If you prefer to stay even closer to your home away from home, Cracker Barrel is a one-minute walk from the hotel.

outlet-shoppes at atlanta photoShopping – Target, Kohl’s, Belk and Publix are just a few of the stores that are minutes away from Hampton Inn. The Outlet Shoppes at Atlanta is a short 10-minute drive south on I-575, and Downtown Woodstock just beyond offers a pedestrian-friendly downtown district. There you’ll find unique galleries and shops nestled among outstanding restaurants, bars and eateries.

Parks and Attractions
Greenprints Trail in downtown Woodstock begins in Woodstock’s Sculpture Garden at Elm Street and takes you through tree-lined green space through “Woofstock” Dog Park and beyond to the scenic local Noonday Creek. Elm Street Cultural Arts Village offers award-winning musicals, concerts and local improv talent.

Heritage Park has beautiful, open walking trails and is located just past our office, next to the YMCA.

Tanglewood Farm is a 10-acre petting zoo with more than 150 rare, miniature and heritage breed farm animals in a Wild West Town setting.

Gibbs Garden is 220 acres of beautifully landscaped gardens surrounded by forest, ponds, streams, waterfalls and bridge crossings. It is located about 30 minutes from Hampton Inn in nearby Ball Ground.gibbs-gardens photo

For more activities and information about Canton and the surrounding areas, visit Georgia Tourism and Travel.

Thank you again for choosing Cherokee Women’s Health Specialists. Please call us at 770.720.7733 to let us know if there is anything further that we can assist you with.

woman eating healthy before getting pregnantYou’re considering getting pregnant! Mentally, you’re beginning to commit to the idea, so one of the first few questions you might ask yourself is, “What can I do before getting pregnant? How can I be sure my baby will be healthy? Is there anything I can do ahead of time to make sure everything goes right?”

While the physical part of creating new life is pretty simple to comprehend, but many women don’t actually consider that there are ways to prepare their bodies for reproduction well ahead of time. Even if you’re not ready to conceive right away, there’s lots you can do before getting pregnant, and most of it is pretty basic.

When you leased your very first apartment, you wanted everything to be just right. Before you even moved in, you eagerly imagined how you would decorate it. You carefully selected the best furniture and matching accessories you could afford. You thought of where you would put your bed and bought food for the refrigerator and pantry. Everything was positioned just right for the new home you were to live in.

When you get pregnant, your body is going to be your baby’s ’apartment’ for approximately the next 280 days. Your womb (uterus) will be its bedroom, the amniotic sac will be its bed and the umbilical cord will be its fridge and pantry. Why not prepare your body to give your child the best possible home until its first ‘lease’ is up? There are steps you can take to make that happen.

Long before the actual union of sperm with egg, there are numerous measures you can take to optimally prepare your body. You can make gradual, positive lifestyle changes in the months preceding pregnancy. Some of these include:

Diet: If you haven’t done so yet, begin incorporating more fruits, fiber, and vegetables into your daily meals. Cut out excess fat, sugar, and caffeine. Eat junk food in moderation. Eliminate as many additives and preservatives as possible from your food by carefully reading labels and avoiding those with a long list of ingredients that you need a Hubble telescope to read or a scientific dictionary to translate.

• Exercise: Getting into the habit of walking even a block or two regularly can strengthen bone, muscle, circulation, tissue, blood and organ function, benefiting not only your own overall health but that of your future baby as well.

• Lose weight: If you are overweight, slowly shedding those extra pounds and achieving your ideal weight during the months before conceiving ensures a much better chance of becoming pregnant and carrying full term. The same holds true if you are underweight and need to bulk up a little. A healthier weight will also allow for an easier labor and delivery.

• Eliminate toxins: It’s no secret that smoking is dangerous to both you and those around you, so it stands to reason that it can be disastrous to the fetus growing inside you as well, Smoking while pregnant can deprive the fetus of oxygen, compromise heart rate, and result in premature birth or low birth weight. It can also increase the chances of miscarriage, birth defects, and stillbirth. Studies show there is a higher risk of Sudden Infant Death Syndrome (SIDS) in babies whose mothers smoked. Even exposure to secondhand smoke can have an adverse effect on your baby. Quitting before conception should be one of your top priorities. This also applies to excessive alcohol intake and any recreational drug use. Prescribed or over the counter medications should be discussed with our doctors before you become pregnant.

• Birth control: Ovulation can be calculated easier when you have had at least one normal menstrual cycle before getting pregnant. Though it’s not absolutely necessary to stop taking birth control months before you plan to get pregnant, this is something that should be discussed at your preconception counseling session with us, especially if you are currently using a long-lasting form of birth control, such as progestin, which may inhibit fertility for several months.

• Preconception counseling: Preconception counseling can evaluate, test for, diagnose, and determine any problems that may be a setback to a full, healthy and safe pregnancy for both mother and child. Your preconception counseling session with us will delve into a much more thorough list of steps you can take to make your future pregnancy as safe, smooth and healthy as possible. Ideally, it is best to book an appointment with us to discuss your plans approximately three months before you wish to conceive. At Cherokee Women’s Health Specialists, we are committed to giving you the best possible preconception care available to women today in order to ensure the optimum health of both you and the baby you are planning to have.

These are only several of the many things you can do before you decide to get pregnant. Our comprehensive staff includes Female Pelvic Medicine and Reconstructive Surgeons (FPMRS), urologists, nutritionists, OB-GYNs, physical therapists and midwives. Their combined decades of experience and expertise can guide you through the preconception process, pinpointing any problems that may inhibit or be detrimental to your pregnancy. They can correct any physical abnormalities that may be hindering the process as well. Your reproductive health and the wellness of your future baby is our primary concern. No question is too trivial or embarrassing, and you will be treated with the utmost respect and confidentiality.

To book an appointment, please call our clinic at 770.720.7733.

June 12, 2017

Genital herpes is an STI that can be contracted by any sexually active person. Herpes is very common throughout the United States. In fact, nearly 1 in 6 people ranging in age from 14-49 have genital herpes.

It can be passed from one partner to another through oral, vaginal, or anal sex. You, or your partner, may not even be aware that the herpes strain is being transmitted.

Although both men and women are at risk for STI, women are at a much higher risk. This is because the virus is more easily sexually transmitted from men to women than women to men.

There are two types of herpes; HSV1 (Herpes Simplex Virus Type 1) and HSV2 (Herpes Simplex Virus Type 2). Each spreads through skin to skin contact, however, only HSV1 known to cause cold sores or fever blisters as well.

Herpes is highly contagious and can be transferred to one partner from another through the fluids excreted from a blister or sore. Even if you are not showing signs of an outbreak, herpes can still be passed from partner to partner through the skin.

Genital Herpes Symptoms

Most people don’t know they have genital herpes. Symptoms can be minor or even non-existent if you have herpes.

The most commonly known symptoms or genital herpes include painful blisters or sores around the genitals or anus. The can appear as a single sore or be clustered together.

Often, genital herpes goes undetected. Many people mistake HSV2 for other minor skin conditions such as a pimple or ingrown hair.

While there are not always clear signs that you may have herpes, there are symptoms associated with genital herpes that you should be aware of besides outbreaks. Take a look at some of these lesser-known signs that you could have herpes.

  • Flu-like symptoms (especially during the first outbreak)
  • Smelly discharge
  • Genital dryness or itchiness
  • Burning when urinating
  • Bleeding in between periods

If you or your partner have any of the above symptoms, you should consider making an appointment with your healthcare provider.

Diagnosing Genital Herpes

Often, your healthcare provider will be able to diagnose you just by looking at the affected area. Once you are suspected of having genital herpes, your doctor will take a sample and test fluid from a sore.

Blood tests can also be performed to determine if you have genital herpes and are showing no signs. If you suspect you or your partner have contracted the herpes virus, ask your doctor to test you as soon as possible to prevent further spreading.

Treatment for Genital Herpes

There is no cure for genital herpes. However, there are ways to manage the virus. If you are diagnosed with genital herpes, your doctor may provide you with daily medication. This medication can help prevent and shorten outbreaks.

In the early stages of herpes, you may have up to 4 or 5 outbreaks a year. Generally, you’ll experience more outbreaks early on. Even though herpes is something you will need to deal with your whole life, outbreaks should become less often over time.

Prevent Getting Genital Herpes

While genital herpes does not usually cause serious health problems, it is still important to take proper safety precautions when having oral, vaginal, or anal intercourse.

Herpes can be passed from person to person without even knowing it, which is why it’s especially important to take precautions against possible transmission.

So, what can you do?

  1. Abstain from sex. Abstaining from sexual contact is one of the best ways to prevent contracting genital herpes and other STIs.
  2. Commit to a monogamous relationship. Because genital herpes can go undetected, you may want to consider scheduling a doctor’s visit for both you and your partner.
  3. Use condoms correctly. Although, not 100% effective, condoms can prevent spreading of genital herpes in some cases. Be aware, genital herpes can still be transmitted through skin-to-skin contact while having intercourse.

Prevent Transmitting Genital Herpes

If you or your partner have genital herpes, you should talk to your doctor about preventive measures to ensure you do not infect your partner.

Because genital herpes is so contagious, you should avoid touching sores or blisters. Otherwise, you may run the risk of infecting other parts of your body. Always, wash hands thoroughly if you come in contact with a sore.

For those who have multiple outbreaks a year, your doctor may prescribe a medication called ‘daily suppressive therapy’ which can lower the risk of your partner getting genital herpes.

It’s always important to maintain open communication with your sexual partner(s) about any STIs that you may have and agree on options moving forward.

Final Thoughts

Knowing your body is the first step in preventing or transmitting genital herpes. If you or your partner notice any symptoms such as unusual sores, you should both schedule an appointment with your doctor.

Getting tested regularly along with being open and honest with your healthcare provider is essential to maintaining a healthy sexual lifestyle

Don’t hesitate to give us a call with any concerns regarding genital herpes or other STIs. We’d be happy to confidentially answer any questions you may have or schedule an appointment with your doctor.

May 9, 2017

postoperative careThe physicians at Cherokee Women’s Health Specialists are committed to ensuring that your experience after surgery is as comfortable as possible. The following information will help answer frequently asked questions and will help you understand some of the common experiences that may occur after your surgery. Please do not hesitate to call the office with any additional questions about your recovery.

  • Call the office to schedule a post-operative appointment two to four weeks after your surgery.
  • If an ER visit is necessary post-operatively, go to Northside Hospital Cherokee if possible, but if you are an out of town patient or live in another state, then your closest hospital is appropriate.

Call the office at 770-720-7733 right away if you experience:

  • Fever higher than 100.4 degrees
  • Shortness of breath
  • Dizziness
  • Heavy vaginal bleeding
  • Severe pain not relieved with your pain medication
  • Persistent nausea or vomiting
  • Increased pain, redness, or swelling at the incision

IF THE SYMPTOMS ARE SEVERE, GO TO THE EMERGENCY ROOM OR CALL 911 FOR AN AMBULANCE IF NECESSARY.

How Much Activity Can I Do After Surgery?

General – There are no standard limitations with regards to activity after gynecological surgery except for driving and sexual activity (see below). If you stayed in the hospital overnight, you should plan to rest with minimal activity for at least a week. If you were sent home the same day you should plan to rest with minimal activity for three days. If you had a procedure with no incisions (such as a D and C or endometrial ablation) then you probably only need to rest for a day. Use common sense and listen to your body. Every patient is different, and different patients will have differing degrees of recovery. Gradually advance your activity. If the activity you are doing increases your discomfort, then STOP. If you are feeling well during increased activity but have increased pain the next day you need to decrease your activity.

Adequate rest and nutrition is required to heal from surgery. LISTEN TO YOUR BODY.

Stairs – Apprehension about stairs or weakness in mobility may require help when climbing up and down stairs. You are allowed to use the stairs if you feel you are able. It’s a good idea to put both feet on each step to not lessen the strain on your body for a week or longer after surgery.

Exercise – If you had incisions on your body wait until you get clearance from your surgeon. Use common sense when starting an exercise routine after surgery. Start out slowly and gradually increase time, distance and speed. Once you are cleared to exercise a general recommendation is to start out at 25% of what you were doing before surgery for a week or two and increase by 25% at each one or two week interval.

Driving – Driving should only begin only after you have stopped taking narcotics, and if you feel strong enough to be able to stop the vehicle in an emergency. At this point you should be able to walk up and down stairs comfortably and sit down and stand up without experiencing discomfort. Have someone drive you if you are still experiencing discomfort.

What Should I Eat After Surgery?

After surgery, your body needs enough calories and nutrients to fully recover from the procedure. Eating the right foods after surgery can decrease risk of infection, speed healing of the incision and increase strength and energy. The best post-surgery foods to eat are packed full of vitamins and minerals.

Here are some foods and nutrients you should focus on in your post-surgery diet:

Fiber – A common complaint after surgery is constipation. To avoid this uncomfortable post-surgery complication, eat plenty of fiber. Some high-fiber foods include fresh fruit and vegetables. Whole grain breads and oatmeal are other great sources of fiber. To prevent constipation, avoid foods like dried or dehydrated foods, processed foods, cheese and dairy products, red meats and sweets.

Protein – The amino acids in protein help with wound healing and tissue regeneration. Protein can also help with strength and energy following surgery. Lean meats such as chicken, turkey, pork and seafood are excellent sources of protein. You can also get protein from eggs, nuts, beans and tofu. Dairy also contains protein, but if you’re struggling with constipation, go for the other sources of protein instead of dairy options. If you have trouble getting enough protein in your diet after surgery, try adding protein powder to drinks or smoothies. Several Physicians at Cherokee Women’s recommend a Vegan diet which is absence of animal products including meat, dairy and eggs. Eat to Live by Joel Furman MD gives excellent recipes and recommendations for those inclined.

Carbohydrates – Fatigue is common following any surgical procedure, but eating the right kinds of carbs can help restore your energy levels. Get carbs from high-fiber foods like whole grains, fruits and veggies, and beans and legumes. These foods will boost energy levels without causing constipation.

Fat – Healthy fats from olive oil, avocados, coconut oil, nuts and seeds will improve immune response and aid the body’s absorption of vitamins. Fat will also help increase energy levels after surgery.

Vitamins and Minerals – Perhaps the most important nutrients in your post-surgery diet are vitamins and minerals. Vitamin A (found in orange and dark green veggies like carrots, sweet potatoes, kale and spinach) and vitamin C (found in citrus fruits, berries, potatoes, tomatoes, melons, and sweet bell peppers) help with wound healing. Vitamin D (found in milk, fish, eggs, and fortified cereals) promotes bone health. Vitamin E (found in vegetable oils, nuts, beef liver, milk and eggs) protects the body from free radicals. Vitamin K (found in green leafy veggies, fish, liver and vegetable oils) is necessary for blood clotting.

Zinc – (found in meat, seafood, dairy and beans) and Iron (found in meat and poultry, beans, apricots, eggs, whole grains and iron-fortified cereals) are also helpful for wound healing and energy following surgery.

Water – In addition to eating foods that are rich in fiber, protein, healthy fats, carbohydrates, vitamins and minerals, you must stay hydrated after surgery. Proper hydration isn’t only necessary for healing, but may also be necessary to help your body absorb medications following surgery. Be sure to drink at least eight glasses of water every day after surgery to stay hydrated.

The foods you should and shouldn’t eat can vary depending on the type of surgery and any medications you may be on so speak with your surgeon about your specific post-surgery dietary questions.

When Can I Take a Shower?

You may take a shower the day after surgery. Baths are typically fine the day after surgery if you desire. Make sure you have someone around to help you should you need assistance. If you are experiencing discomfort a sponge bath is a fine substitute.

How Should I Care For My Incisions?

Keep your abdominal incisions clean and dry. No special creams or ointments are needed. Your incisions are closed with a suture underneath your skin, which will dissolve on its own. It is then covered with a surgical-grade liquid band-aid. This protects the incision and will stay in place for up to two weeks or longer. The glue can be removed after two weeks by applying some Vaseline to the glue for several minutes and then using soap and water and gentle scrubbing with a washcloth after two weeks. A small amount of bleeding at the incision sites is not uncommon. If it persists, call your doctor. Once the glue is removed it is OK to apply Neosporin to the incisions if they are red or inflamed. If you notice sutures poking through the skin you can trim them with nail clippers and/or see your surgeon.

How Long Will I Have Bleeding After Surgery?

Vaginal spotting may last for several weeks after gynecological surgery. Call the office if you have heavy bleeding, increasing bleeding, a foul odor, or if you have urinary or rectal bleeding. Removal of ovarian cysts or other gynecological procedures may cause your period to come within a few days after surgery.

I Have Large Bruise Near My Incision, Is That Normal?

Some patients will develop bruises at the incision sites. The incision sites are made by “trocars”, a plastic sleeve that is used for access during the surgery for the camera and for instruments. Sometimes these trocars cut tiny vessels just beneath the skin that cause limited bleeding. Even under the best of circumstances, it is sometimes impossible to see these small vessels. A bruise will develop that will resolve. Those patients with very large masses or fibroids may also develop bleeding at the incisions that can be more extensive due to longer manipulation of the trocar sites. Rarely, this bleeding can be very extensive, leading to a large bruise that tracts to the groin area. Please note that this type of bleeding almost always resolves. Pain or warmth may develop from the blood under the skin. Use Motrin 600 mg every six hours or 800 mg every eight hours to relieve the pain.

How Much Pain Will I Have After Surgery?

Incision – Pain around the incision sites is not uncommon, and will resolve over several days. Most patients describe pain as minimal or moderate, and will improve daily.

Pelvic and Rectal – Some patients describe pressure and pain with urination or with bowel movements. These symptoms resolve and are due to irritation to the rectum and bladder from the surgical procedure, and will resolve with time.

Chest and Shoulder – If you had laparoscopic surgery, the carbon dioxide gas used to insufflate the abdomen during the procedure (so the surgeon can see) will irritate the phrenic nerve in some patients, leading to mild to severe pain. This nerve tracks pain impulses from the lining of the chest cavity. The pain can occur during deep breaths. This resolves within two to three days, and is not worrisome. If the pain is extreme or does not resolve, a visit to the local ER is important to rule out other causes of chest pain, such as heart or lung issues.

Sore Throat – Some patients will have a sore throat from the tube that is placed during anesthesia. Throat lozenges or warm tea will help soothe the discomfort, and this will resolve within a few days.

General – Pain should resolve over time, and will get better every day. If pain persists or becomes worse, a visit to the ER at the hospital where the procedure was performed is recommended.

How Should I Manage My Pain After Surgery?

You will be given a prescription for Motrin and a narcotic (Percocet, Norco or Dilaudid) at the hospital prior to your discharge. To be effective, Motrin should be used in doses of 600 mg every six hours, or 800 mg every eight hours. Narcotics should be used sparingly since they will cause constipation. The first several days following surgery, most patients use mainly Motrin during the day, with use of a narcotic sometimes at night to help with sleep. Using a heating pad on the lower abdomen is safe. Coughing can be uncomfortable initially because of abdominal discomfort. Placing a pillow on the abdomen to support your abdomen while coughing can be helpful.

Is It Normal to Have Swelling?

Abdominal – Some degree of abdominal distension (swelling) is to be expected after surgery. This is due to distension of the intestines, and resolves over time. It is usually mild to moderate only.

Extremities – Swelling of the legs and sometimes arms is not uncommon after surgery. This is due to increased fluid given during the procedure. This will resolve over several days. If you notice persistent or increasing swelling, tenderness to the calf or calf pain, please call the office immediately. If one leg is more swollen and red than the other you should be evaluated by your surgeon or in the emergency room because of the risk of a blood clot in your leg (DVT) that can be life threatening.

I Have Constipation, What Should I Do?

Constipation is common after surgery and usually resolves with time and/or treatment. Constipation means that you do not have a bowel movement regularly or that stools are hard or difficult to pass. Constipation can be made worse by narcotic pain medications or decreased activity or decreased fluid intake.

If you are having vomiting in addition to constipation, or if your surgery involved the stomach or intestines, call your surgeon before using medications to treat constipation.

A common approach to constipation after surgery is to take a laxative (eg, magnesium hydroxide [milk of magnesia]) or fiber supplement (eg, psyllium [Metamucil, Hydrocil] or methylcellulose [Citrucel]); this can be taken with a stool softener (eg, docusate [Colace]).

If the initial treatment does not produce a bowel movement within 24 to 48 hours, the next step is to take a stimulant laxative that contains senna (e.g,, Black Draught, Ex-lax, Fletcher’s Castoria, Senokot) or bisacodyl (e.g,, Correctol, Doxidan, Dulcolax). Read the directions and precautions on the package before using these treatments.

If these treatments do not produce a bowel movement within 24 hours, you should call your healthcare provider for further advice.

Once the bowels begin to move, you may want to continue using a stool softener (e.g., docusate (Colace) or a non-stimulant laxative (e.g., MiraLAX/GlycoLax) on a daily basis to keep the stools soft. This treatment may be taken for as long as needed.

I Have Diarrhea, What Should I Do?

Diarrhea sometimes is caused by antibiotics and will resolve once the antibiotics are stopped. A probiotic such as lactobacillus can help with this process. Rarely, severe diarrhea can develop. Call your doctor if you have severe diarrhea, bloody diarrhea, or if your diarrhea is accompanied by fever or worsening pain.

I’m Nauseated, What Can I Do?

Anesthesia is the main cause for nausea immediately after surgery. After the first 24 hours, nausea is more likely caused by either your narcotic pain medication or your antibiotics. You will be sent home with nausea medication such as Phenergan or Zofran. If you are experiencing severe nausea, please call your doctor.

Will I Have Problems With My Bladder?

Is it normal if it hurts when I urinate? — If you have had vaginal surgery, you may feel a pulling sensation during urination or you may feel sore if the urine falls on vaginal stitches. It can be normal to urinate frequently after surgery. Call your surgeon if you have any of the following:

  • Burning with urination
  • Needing to urinate frequently or urgently and then urinating only a few drops
  • Temperature greater than 101ºF or 38ºC (measure with a thermometer)
  • Pain on one side of your upper back that continues for more than one hour or keeps coming back
  • Blood in your urine (you can check to see if this is just vaginal blood falling into the toilet by holding toilet tissue over your vagina)

What Should I Do if it is Difficult to Urinate?

Most women urinate at least every four to six hours, and sometimes more frequently. If you have not urinated for six or more hours (while you are awake) or if you feel the need to urinate and it will not come out, you should call your healthcare provider. Urinary retention is the inability to pass urine through the bladder.

A very small number of patients will develop this problem due to the anesthetic used for the surgery or if they had incontinence surgery. If you are sent home and are not able to pass urine, please go to a local emergency room. A catheter may be placed to allow the bladder to “rest” after the surgery, and will be removed several days later in the office. It is important to have this catheter placed to avoid injury to the bladder. If you have a self cath kit and instructions how to use it, you may do this instead of seeking medical care. (You can look at a video by Bard on Youtube called “Female Self-Cath Instructional video (animated) Magic3” or watch other available videos on cherokeewomenshealth.com or on YouTube.)

When Can I Resume Sex?

Intercourse should be avoided until cleared by your surgeon. If your surgery did not involve the vagina or cervix, intercourse can typically resume in two to three weeks. If you had a hysterectomy or surgery in the vagina, you should avoid intercourse for a minimum of eight weeks to allow the top of the vagina to fully heal. Make sure you are examined by your surgeon and cleared. Avoid deep penetration initially until you are completely comfortable. Clitoral orgasm (stimulating the clitoris without vaginal penetration) is typically fine after gynecological surgery if you desire unless you had surgery on your labia minora or majora (in which case you need to get clearance from your surgeon.)

April 3, 2017

It is critical that women receive various health checks at different age ranges as recommended by your doctor. When you break down health screening by age, it can help you to stay on track and take preventative measures.

There are many key reasons to receive regular health check-ups, and by screening for medical issues or assessing your risk for future medical problems, you can maintain a healthy lifestyle at every age.

Women Ages 18-21

  • Physical Examination: At this stage of your life, you should have full physical examinations. A physical exam includes blood pressure testing and an assessment of height, weight, and BMI to help determine your need for early diabetes screenings.

    The purpose of these screenings is to evaluate risk for future health issues. You will be able to discuss lifestyle habits with your OB/GYN and keep vaccinations up-to-date.

Women Ages 21-35

  • Pelvic Examination and Pap Smear: Women should receive a pelvic examination every year and Pap smear every 3 years. A Pap test combined with a screening for HPV will help you and your doctor determine your risk of cervical cancer.

    If you are sexually active, you should ask to be screened for chlamydia and gonorrhea to help prevent the spreading to partners. You will also discuss how to take preventive measures against sexually transmitted infections and plan regular testing depending on your lifestyle.

  • Cholesterol Screening: Depending on your weight and lifestyle, starting between the ages of 20 to 40, women should receive cholesterol screenings. If you have normal levels, you only need to be tested every 5 years. By treating high/low cholesterol, you can significantly reduce your risk for heart disease.
  • Clinical Breast Examination (CBE): A breast cancer screening done by your healthcare provider trained in CBE, will strongly aid in early detection. A CBE should be done every 3 years for the average woman, and more frequently for women over the age of 40.

Women Ages 35-50

  • Mammogram: Starting at the age of 40, women should plan to receive mammograms every year to two years. This is an x-ray of the breast, and the results will help your doctor determine if further testing is needed to screen for cancer.
  • Diabetes Screening: Within this age range, women should begin getting screened for diabetes. These screenings help to prevent or treat diabetes which is a disorder of the metabolism.

    Women are evaluated with a blood glucose test to measure the amount of sugar in the blood. If you are overweight or at a greater risk for diabetes, your screenings may be more often, but typically they are done every 3 years.

Women Ages 50 and older

  • Thyroid Testing: If you are at early risk for thyroid issues, you may have already discussed screenings with your doctor. However, if not, you should receive screenings at this age since women over the age of 60 are more likely to have hypothyroidism.

    Hypothyroidism is a condition in which your thyroid does not produce the right quantity of certain critical hormones. Early and regular screenings for an under or  overactive thyroid can help to prevent serious conditions that may be caused if left undetected.

  • Colon Cancer Screening: At age 50, doctors highly recommended that women begin to receive a colonoscopy every 10 years or more often if at risk due to family history or other factors. Colonoscopies with other tests frequently done, will help you identify early signs of colon cancer so you can remove precancerous polyps.

Final Thoughts

By using these guidelines listed above for health screenings by age in combination with what your doctor recommends can help resolve and even prevent serious health issues.

If you have not received certain tests as outlined for your age group, call for an appointment to consult with your OB-GYN about setting up additional health screenings.

March 23, 2017

When used correctly and consistently, condoms can be an effective method of birth control and provide protection from STIs.

If you or your partner has a latex allergy or sensitivity to latex, rest assured that there are easily available alternatives to latex condoms. Many are equally useful in the prevention of pregnancy and sexually transmitted infections.

What is a Latex Allergy?

Latex is a natural rubber that comes from trees.Latex is natural rubber, a product made primarily from the rubber tree. Some people have a reaction to the rubber in latex, which can cause moderate, severe, or even life-threatening reactions.

Allergy to latex is an increasing health problem. In some cases, repeated contact with products containing latex can increase your sensitivity and, with continued use, develop into an allergy.

Symptoms of Latex Allergy

The following are the most common identifiers that you may be sensitive to latex. You’ll find that latex can affect both your skin as well as cause internal respiratory problems.

Below is a list of the most common skin reactions when it comes to latex allergies. These reactions most commonly occur on or near areas that come into direct contact with latex.

  • Hives
  • Burning, itchy rash
  • Contact dermatitis (inflamed or irritated skin)

You may have a latex allergy if you are experiencing any of the following respiratory issues during or after using a latex based condom.

  • Mild to moderate: sneezing, coughing, runny nose, watery eyes.
  • Severe: shortness of breath, swelling of the throat, severe wheezing, loss of blood pressure, tightening of airways.
  • Life-threatening: anaphylaxis.

If you notice one or more of these symptoms after coming in close contact with latex, contact your doctor to get tested for a latex allergy. Furthermore, if you experience severe or life-threatening symptoms, seek immediate medical attention.

Alternatives to Latex Condoms

Condoms are one of the most common types of birth control and STI protection on the market.

A condom is a thin sheath that fits over the erect penis. There are currently three types of male condoms available other than the latex variety.

Let’s take a closer look at some of your options to help you determine which will work best for you. Each has advantages and drawbacks. Ultimately, it’s up to you and your partner to make the right choice for your lifestyle.

Polyurethane Condoms

Polyurethane is a plastic based product that contains no latex.

  • Statistically effective method of birth control when used correctly.
  • Effective in preventing STIs, including HIV, when used correctly.
  • Thinner and sometimes stronger that latex condoms.

Polyisoprene Condoms

Polyisoprene is a newer product made of a non-latex material.

  • Statistically effective method of birth control when used correctly.
  • Statistically effective in preventing STIs, including HIV.
  • Combine the strength of latex with the sensitivity of a thinner condom.

Natural Condoms

Made from the oldest material on the market—the intestinal membrane of a lamb, sometimes known as a lambskin condom.

  • Statistically effective method of birth control when used correctly.
  • NOT effective protection against STIs or HIV, due to tiny pores in the membrane. The pores are small enough to block passage of sperm but will not block transference of STIs or HIV.
  • May not be the right choice for those with animal rights convictions. Not vegan-friendly.
  • May have an odor that some find offensive.

Female condoms are not as popular of choice as traditional condoms. However, you may find that they suit your needs better.

A female condom is a thin plastic pouch that lines the vagina. It is held in place by a closed inner ring, or rim, at the cervix and an outer ring at the opening of the vagina.

  • Statistically effective method of birth control.
  • Some studies suggest that a female condom will work as well as a male condom in preventing STIs, including HIV.
  • May provide some protection of the genital area around the opening of the vagina during intercourse. May reduce the risk of getting and transmitting diseases such as genital herpes or genital warts.
  • Can be inserted up to 8 hours before intercourse.
  • Can be a good option for both partners.

Final Thoughts

There are numerous alternatives to latex condoms. All of the varieties we’ve mentioned require no prescription and can be purchased in pharmacies, stores or vending machines.

Many family planning clinics, school nurses, or university health centers will provide condoms, including non-latex condoms, free of charge.

For the best protection against unplanned pregnancy and STIs, use a condom even when using another method of birth control, such as pills or an IUD. Always use a condom when participating in vaginal, oral, or anal intercourse.

If you have a latex allergy or sensitivity to latex, make an appointment to discuss your options with your OB/GYN.

March 3, 2017

Menopause is a turning point in a woman’s life that can have a significant impact on her health and overall well-being.

Natural menopause is a gradual process that can bring about physical upheaval from hot flashes, night sweats, sleep issues and other symptoms.

Let’s take a look at the different phases of menopause and the signs and symptoms to help determine if you are entering menopause. It will be much less stressful if you are informed and know what to expect.

Perimenopause: An Overview

The transition to menopause is known as perimenopause. It can range 4-7 years prior to actual menopause. The average woman experiences perimenopause at approximately 46 years of age.

During this phase, a woman’s ovaries are beginning to produce less estrogen. Estrogen is the hormone that helps control the menstrual cycle. You will notice a difference in your periods which will vary from woman to woman.

Although periods may become unpredictable, ovulation can still occur, so it is still possible to get pregnant.

In fact, many of the signs and symptoms of perimenopause are similar to pregnancy or PMS including the following.

  • Hot flashes or night sweats
  • Decreased libido
  • Weight gain
  • Vaginal dryness
  • Mood swings

Perimenopausal women will notice these symptoms appear at any time throughout their cycle instead of only 1-2 weeks before menstruation.

Determining whether you’re experiencing perimenopause or may be pregnant can be confusing so consult with your OB-GYN right away if you think you might be pregnant.

Menopause: An Overview

Menopause is the permanent end of menstruation. It is the natural end of a woman’s potential childbearing years. At this point, the ovaries no longer function, menstrual periods have stopped, and it is not possible to become pregnant.

According to the National Institute on Aging, on average, women are 51 years of age at natural menopause. However, a woman is considered to have reached menopause after she has missed her menstrual cycle for 12 consecutive months.

There is no reliable way to predict menopause age. Women have been known to start menopause as young as 40 and as late as 60 years old. Women who smoke tend to begin menopause a few years sooner than non-smokers.

Menopause can be induced, at any age, by certain surgeries and medical treatments. Chemotherapy, pelvic radiation therapy and surgical removal of the ovaries can lead to the sudden onset of menopause.

What To Expect As Your Body Changes

Beginning in your 30s and 40s, the amount of estrogen produced by the ovaries starts to fluctuate. It’s likely you will notice a change in your menstrual cycles. You may begin to skip periods. Flow may be heavier or lighter. Cycles may be shorter or longer in duration. You may have periods less often or more frequently.

Menopause affects each woman differently. Some women reach natural menopause with little or no trouble. Others have severe symptoms that drastically affect their health and lifestyle. The length of time from perimenopause until menopause will also vary from woman to woman.

When menopause begins suddenly as a result of radiation, chemotherapy or surgical removal of the ovaries, the symptoms and adjustments can be more extreme than with naturally occurring menopause.

Signs and Symptoms of Menopause

Numerous signs and symptoms will help you, and your doctor determine if you are entering menopause. Remember, every woman is different. You may experience none, some, or all of these symptoms during perimenopause and menopause.

Hot Flashes and Night Sweats

A hot flash is a sudden feeling of heat that rushes to the face and upper body. Some women have hot flashes several times a day while others only several times a week. A hot flash can last a few seconds or several minutes or longer.

Hot flashes occurring at night are known as night sweats. They may wake you up or make sleep difficult causing you to feel tired and ill-rested the next day. A hot flash can cause temporary red blotches on the chest, back and arms. Both sweating and chills are possible.

Sleep Issues

Menopause can affect your body’s chemistry in other ways as well. Besides having problems associated with night sweats your normal sleep patterns may be disrupted.

Because of the many changes your body is experiencing, you may have trouble falling asleep and staying asleep. You may wake up long before your usual time.

Vaginal and Urinary Tract Changes

The lining of the vagina may become thinner, dry, and less elastic as estrogen levels decrease. Vaginal dryness can make intercourse uncomfortable or painful. Vaginal infections may occur more frequently.

The urethra can become dry, inflamed, or irritated causing more frequent urination and an increased risk of urinary tract infections.

Changes In Libido Function

During perimenopause and menopause, the libido may also change, for better or worse. But remember that many factors besides menopause can affect sex drive.

Stress, medications, depression, poor sleep, and relationship problems can all have an immediate impact on your libido.

Menopause Health Risks

Along with menopause comes a greater chance of heart disease (the No. 1 cause of death for U.S. women) and osteoporosis (thinning of the bones). These are areas to be aware of even after other symptoms of menopause have subsided.

Heart health and strong bones are important throughout life, but menopause is the time to get serious about it. Consult your doctor about any lifestyle changes that should be made during menopausal years to maintain a healthy heart.

How Your Doctor Can Help

Your doctor will help you monitor your transition through perimenopause into menopause and beyond. Some women experience only minor changes or discomfort. Others find the menopause years to be quite challenging both physically and mentally.

It is possible that your symptoms will require appropriate treatment to help you navigate your way through menopause more comfortably. Your doctor will work closely with you to find a treatment that will see you through this normal phase of life.

What To Tell Your Doctor About

You know your body better than anyone. If you are experiencing any of the following symptoms or have any concerns about your health, contact your doctor right away.

  • Much heavier than normal bleeding during or between menstrual cycles.
  • Periods that occur very close together.
  • Painful urination or frequent urination.
  • Vaginal pain, irritation, itching, or unusual discharge.
  • Uncomfortable or painful sexual intercourse.
  • Sleep problems that interfere with your ability to function and lead a healthy lifestyle.
  • If you think you may be pregnant.

Final Thoughts

If you are entering menopause, it is important to see your doctor on a regularly scheduled basis, according to their recommendations. Between regular appointments, if you have questions, concerns or experience severe symptoms, contact your doctor as soon as possible.

Menopause is a new beginning. Use this time to redefine yourself with positive thoughts. Dedicate yourself to a healthier lifestyle and enjoy life. You’ve earned it.

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