Author name: Diane

More than one million women in the United States alone suffer from pelvic inflammatory disease each year. Females under twenty years old are affected more often than women in a higher age bracket. Left untreated, it can cause infertility, ectopic pregnancy, subsequent scar tissue (adhesions), chronic pelvic pain, complications to an unborn baby if you are pregnant, cancer and many other serious, even life threatening problems. If ignored, more than 25% of women affected suffer some or all of these long-term effects, some of which may lead to the need for a complete hysterectomy. However, it is also one of the most preventable diseases if diagnosed and treated in time. What is Pelvic Inflammatory Disease and What Causes It? Pelvic inflammatory disease, or PID, is a serious complication that usually arises from exposure to a sexually transmitted disease or infection (STD, STI). Your cervix, located just above your vagina, usually protects bacteria from attacking your reproductive organs, which include the fallopian tubes, uterus, and ovaries. However, if you’ve contracted a sexually transmitted infection such as gonorrhea, syphilis or chlamydia, and it was allowed to go untreated, complications could arise. Infection could travel past the cervix and wreak havoc on your reproductive system, often causing irreversible damage. Although the cervix is usually shut tightly, and thus serves as a kind of protective barrier to the reproductive organs, it opens during childbirth or when menstruating to allow blood flow. Though regular sex does not penetrate the cervix, semen carrying an STD can linger outside of it. Then, much like a plunger forces blockage in a toilet or sink to push through pipes, any means by which the cervix is opened or penetrated can allow that STD or other bacteria to ascend to the reproductive system. Therefore, though the highest percentage of pelvic inflammatory disease incidents are caused by sexually transmitted diseases during unprotected vaginal, anal and oral sex. Other Ways You May Get Pelvic Inflammatory Disease: • Having an abortion• Engaging in sex with multiple partners• Having sex under the age of 25• Undergoing a pelvic examination• Having an intrauterine device (IUD) inserted• Undergoing other surgical procedures such as a D & C or endometrial biopsy• Using douches• Using tampons• Inserting foreign objects into the vagina• Undergoing surgical procedures to the uterus• The migration of normal human bacteria that has travelled to and past the cervix• Having a previous history of pelvic inflammatory disease. Symptoms of Pelvic Inflammatory Disease Often, there aren’t any symptoms until it has spread, particularly if the infection is caused by chlamydia. This makes PID hard to diagnose, especially in its early stages. You should consult your doctor if you experience any of the following: • Lower abdominal pain• Fever of 101° F or more• Chills• Uncomfortable or painful intercourse• Upper abdominal pain• Fatigue• Irregular bleeding or spotting• Discharge accompanied by foul smell• Nausea and vomiting• Chronic pelvic pain• Fainting• Difficulty or pain when urinating• Pain when walking (PID shuffle)• Symptoms of dehydration• Sharp abdominal pain worsening over a period of several days that mimics appendicitis. If symptoms are unbearably severe, this may indicate that infection may have spread into the blood stream. You should seek immediate medical attention, as the situation may become life threatening. How is Pelvic Inflammatory Disease Diagnosed? A series of tests may be necessary to isolate a positive diagnosis of pelvic inflammatory disease. Your doctor will want to perform some or all of the following: • A complete and thorough examination of genital organs and abdomen which may include taking cervical cultures.• Manual probing of the vagina to feel for inflammation or ovarian tenderness.• Blood tests and cultures to check blood counts and to determine if you might be pregnant.• A urine test to look for traces of blood, cancer or other diseases.• Tests to check for the existence of any sexually transmitted diseases such as syphilis, hepatitis, HIV, chlamydia, gonorrhea, herpes, genital warts, etc. Testing for a Positive PID Diagnosis • An ultrasound, especially if the ovaries are too painfully sensitive for a manual probe. Sound waves can create an image of your reproductive organs for assessment.• An endometrial biopsy to examine a sample of the lining of the uterus.• A laparoscopy to pinpoint a more accurate, positive diagnosis. Treatment for PID If you are positively diagnosed with pelvic inflammatory disease, the treatment is usually an antibiotic shot or course of antibiotics. Sometimes both are required. In the event the actual bacteria causing the infection cannot be determined, additional medication may be recommended. Your doctor will discuss all options with you. Depending on the severity of your case, you may be required to be hospitalized on an inpatient basis, especially if there are more advanced complications such as ovarian abscesses. Sometimes, even surgery may be necessary. If your doctor has ascertained that your pelvic inflammatory disease is caused by an STI, your partner will also need to be treated in order to stop any continuing transmission. Of course, all sexual activity will need to be discontinued until you are confirmed infection-free. What Can I Do to Avoid Getting Pelvic Inflammatory Disease? There are many precautions you can take to avoid getting this disease. Most are simply safe practices such as: Finally, statistics show that teenagers are having sex more often and at an earlier age than ever. Because the incidence of pelvic inflammatory disease is highest in girls under 20, it’s important to educate our youth, both male and female, in the practices of safe sex. Though discussion regarding intimacy is still a delicate one for many parents, an open and frank dialogue can help future prevent issues. Our Doctors are Pelvic Health Experts At Cherokee Women’ Health Specialists, our physicians have decades of combined experience that enable us to diagnose, treat, correct, and answer any questions regarding not just pelvic inflammatory disease, but also the many other different disorders that can affect a woman’s genital health and reproductive system. Our staff includes Female Pelvic Medicine Reconstructive Surgeons (FPMRS). These specialists

Almost every woman knows annual gynecological checkups and regular pap smears are important to maintaining good pelvic health. Sometimes, though, things go wrong down below and we begin to hear about tests and procedures that not only sound intimidating, but are hard to pronounce. One of those procedures may be urethrocystoscopy, a multisyllabic word that sounds as complicated as it is to spell. Based on symptoms you’ve mentioned having to your doctor, he or she may have recommended urethrocystoscopy to further investigate and diagnose your problem. What is Urethrocystoscopy? Simply put, urethrocystoscopy or cystoscopy is an examination of the bladder and urinary tract. An instrument is inserted into the urethra, the tube or duct that empties urine from your bladder and out of your body. This instrument is called a cystoscope and assesses any damage, disorder, disease or irregularity. What is a Cystoscope and How Does it Work? A cystoscope is a long tube with a light and camera on one end. The other end is equipped with lenses just like a microscope or telescope. As the doctor slowly probes the area to be examined, the camera will project pictures onto a screen to study. Some cystoscopes also have flexible glass called optic fibers that can generate an image from the probe end to the examiner’s viewing lens. Depending on your particular case, your doctor may opt to use a cystoscope that is either hard and rigid or soft and flexible. He may also use one equipped with an extra tube in order to perform surgical procedures or immediately correct other problematic urinary issues. For biopsy purposes, or for surgical procedures, the rigid cystoscope is used, but if your doctor is simply investigating the area to look for whatever might be ailing you, the flexible tool is used. Sometimes, a ureteroscope, which is similar to a cystoscope, but of a thinner caliber, is better suited for the procedure if it’s necessary to remove stones or other blockages high in the urinary tract. This apparatus allows the physician to push a wire equipped with a basket through the ureteroscope’s extra tube to remove the stone. It also enables him to insert a laser fiber to break up larger ones that will later pass harmlessly during normal urination. That Sounds Terribly Painful. Is it? No. At worst, urethrocystoscopy can be uncomfortable and you may experience a burning sensation, along with the urge to urinate while the tube is being inserted. For a flexible cystoscopy, a local, often topical anesthetic is given before the procedure with plenty of time to take effect. If a rigid cystoscope is used, local anesthetic can be equally effective, but a general one can be used as well. Why Would I Need a Urethrocystoscopy? This procedure may be warranted if you’re experiencing or complaining of the following: • Repeated urinary tract infections• Kidney stones in the kidney ducts (ureters)• Blood in your urine (hematuria)• Pain or discomfort when urinating• Suspicious cells found in your urine sample• Suspicious polyps, tumors, growths or cancer in the ureter• A necessity for a bladder catheter• Urinary tract stones• Overactive bladder• Chronic pelvic pain• Incontinence• Interstitial cystitis• Any blockage that might be impeding your urinary flow, or causing a narrowing in your ureters. What Preparations are Necessary for a Urethrocystoscopy? Your doctor will discuss any preparations necessary. In some cases, with a weakened immune system, you may be prescribed an antibiotic prior to the examination. A urine sample may also be required. Make certain your physician is aware of any and all medications you may be taking. This includes vitamins and supplements. You may be asked to discontinue some of them to prevent excessive bleeding during the procedure. Unless you’ll be given a general anesthesia, you can probably eat and drink normally that day, but again, check with your doctor in case you may need to fast. What Can I Expect During the Urethrocystoscopy? First, you will be asked to change into a gown and empty your bladder. When you are finished, you will be led to a table, asked to lie down on your back, and possibly put your feet into stirrups. Depending on your case, you may be given an antibiotic to avoid getting a bladder infection. At this time, the area will be cleaned and sterilized and you will be given anesthesia. If it is general anesthesia, you won’t remember much after this point until you wake up. If your doctor has opted for a regional or local anesthetic, a sedative may be provided to calm you as you will feel some sensation during the examination. The area of the urethra will be treated with a numbing agent and checked to make sure that you are properly desensitized. The lubricated probe will now be gently inserted into your urethra. You may experience a burning sensation, coupled with a need to urinate. As the scope moves through your bladder, your doctor will be watching through the lens. He will then flood your bladder with a sterile solution, enabling him to assess the situation. Again, you may feel the need to urinate. The entire urethrocystoscopy with local anesthetic will take about 5 minutes, and perhaps 15 to 30 if using general anesthesia. Complete results may be immediate or they may take a few days. What Happens After? Urethrocystoscopy doesn’t usually have too many side effects, but you should take note of the following: • If general anesthesia was required, you may be somewhat groggy and should avoid driving or operating machinery. It would be wise to have someone stay with you for a few hours or even the rest of the day if possible.• You may need to urinate more often for a few days. Void as often as you need to and do not hold it in. Urinating whenever your body urges you to can prevent clots from forming in the bladder and creating possible blockages.• It’s normal to see a little blood in your urine, especially if you had

The risk of getting a urinary tract infection, or UTI, is high when you are a woman. Some experts say there is 50% chance to get it at least once in your life, with many women experiencing UTIs multiple times. Symptoms of Urinary Tract Infections First, it is important that you recognize the symptoms associated with the infection that can be located in different parts of the urinary tract. Symptoms of Lower UTIs Lower symptoms of UTIs are in the urethra or bladder, and include: Symptoms of Upper UTIs Upper UTIs are in the kidneys. These are vital to have immediately treated, due to the risk of having the bacteria moving from the kidney to the blood. This last condition is called sepsis and can cause low blood pressure, shock, and even death. Symptoms include: Diagnosis and Treatment for UTIs If you think you may have a urinary tract infection, get assessed by your OB/GYN. You will be asked to give a urine sample, which will be used to detect the bacteria that is causing the UTI. The treatment for lower UTI is oral antibiotics. Be sure to finish all the prescribed number of pills completely. Otherwise, you risk suffering the infection again with stronger bacteria. Upper UTIs may involve intravenous antibiotics. If your doctor suspects of an upper UTI, he may ask you for blood cultures and a complete blood count (CBC). This is to discard the possibility of having the infection moved to the blood. Some women have a bigger risk of being affected by a UTI. These factors contribute to a high-risk: If you have any of these conditions, it is especially important that you check with your OB/GYN right away when you experience the symptoms previously described. Recurrent UTIs Approximately 20% of women suffer a second urinary tract infection, and some undergo this continually. When this is the case, usually there is a different type of culprit or strain of bacteria. Some types can grow a community resistant to antibiotics and the body’s immune system. They travel out of the cells and re-attack. When the UTIs are recurrent, you should also check if there are any obstructions causing them. The tests used for this are: It is possible that during a cystoscopy, your doctor removes a small piece of bladder tissue to have a biopsy and rule out bladder cancer. Preventing Urinary Tract Infections You should also talk to your OB/GYN about how to prevent or minimize the urinary tract infections. The recommendations may include: Don’t Wait to Seek Help Don’t take too long to check with your doctor after recognizing the symptoms of a UTI. Kits designed for at-home tests can help detect a UTI but are not 100% accurate. You can observe the results, prevent complications and ensure a full recovery when you analyze the causes behind the UTI with your OB/GYN. If you suspect you have a UTI, call us today at 770.720.7733 or schedule an appointment online.

Since you were a teenager, or maybe even younger, you were probably aware that gynecologists existed. You knew that, as you matured, they were there for your basic women’s health issues, annual checkups, Pap smears and other feminine physical needs. It probably wasn’t until you began experiencing problems that you learned about different specialists and subspecialists. Words like ‘female pelvic medicine reconstructive surgeon’ (FPMRS), urogynecologist and urodynamic testing may have begun to litter your doctor’s vocabulary, and though they may sound daunting, they’re very simply explained. From the time you were potty trained, the exercise of urinating was something you did automatically. Your body told you when it was time to go and, depending on the intensity of the message your bladder was sending you, you either strolled, trotted, or ran to the bathroom to take care of business. However, as you age, you may have noticed some changes – unexpected involuntary leaks when you laugh or cough, sudden urges that leave you very little time to make it to the toilet, recurring infections, discomfort and maybe even the need to rush right back into the bathroom. When your quality of life becomes compromised, our experts are here to step in. Our FPMRS accredited specialists are intensely educated urogynecologists and experts in the field of women’s pelvic health issues. One of the many things we do is recommend and administer urodynamic testing to study, and subsequently, correct your urinary problems or disorders. What is Urodynamic Testing? Urodynamic testing is a series of tests that are run in order to evaluate exactly how well the bladder, sphincter and urethra are functioning in their job of storing and emptying the urine in your body. These tests can accurately pinpoint the reason for your particular problem. Why Might You Need Urodynamic Testing? You may need one or several different urodynamic tests if a routine pelvic examination does not reveal a visible reason for your problem. Your doctor may then recommend further testing if you have experienced any of the following: A pressing need to urinate without any flow Difficulty in starting urine flow Difficulty emptying your bladder completely Recurring urinary tract infections Burning or painful urination Unexpected and sudden urge to urinate Slow urine flow A need to urinate immediately after voiding Frequent urination (polyuria): You suddenly need to void more often than is normal for you, or find that you need to use the bathroom two times or more nightly (nocturia). Urge incontinence or overactive bladder (OAB): This is an uncontrollable leakage resulting from the inability to reach a restroom in time. Stress incontinence: You experience bladder leakage while lifting, exercising, laughing, coughing or sneezing. How Can You Prepare For These Tests? You will probably be asked to stop any bladder medications you are currently taking. Some tests may require that you arrive with a full bladder, while in other cases, you will be asked to arrive earlier and drinks at the testing site. Your doctor will give you this information. Complete testing should take approximately 2 to 3 hours, but again, this depends entirely on what tests are required for your particular issue. What Will Happen During the Test? The first part of urodynamic testing deals with emptying your full bladder, checking for any residual urine, and monitoring your urine flow. The second part examines how your bladder behaves as it fills up. Catheters are used for this and may cause some discomfort or pinching, but the experience is not intolerable. Leakage is common and expected, so there is absolutely no need to be embarrassed by this. It is an important part of the testing. Your input as you answer questions throughout the process is also important. You will be asked to shift positions, stand and cough. Again, your body’s reaction is important to your diagnosis and subsequent treatment. When testing is complete, you will be required to void again while the catheters are still attached, after which they will be removed and the testing will be complete. What Tests are Performed During Urodynamic Testing? There are several tests. Depending on your particular case, you may need one or more of the following: Video urodynamic test: While your bladder is filling and emptying, a technician will take pictures of the process, either through X-rays or via ultrasound. These are then studied, enabling your physician to make a diagnosis of your bladder function. Uroflowmetry: This test measure both how quickly you empty your bladder (free uroflowmetry) and the amount of pressure exerted (pressure uroflowmetry) while doing so. The purpose is to assess why there may be a problem voiding, and to check for any possible blockages or muscle weakness. Postvoid residual measurement: This measures any urine that is left in the bladder after you’ve finished urinating. Measurement can be obtained through either catheter tube drainage directly from the bladder or through an ultrasound scan. Depending on how much urine is extracted or scanned, anything over 100 milliliters may indicate inefficient bladder evacuation. Multichannel Cystometry: Under local anesthesia, two pressure catheters are placed in the rectum and the bladder to gauge bladder capacity, and to determine the amount of pressure buildup as the bladder fills with warm water. You will be required to indicate when the urge to urinate begins. This procedure can also determine if there are contractions while the bladder fills, or it can pinpoint the bladder muscle (detrusor) that may not be contracting as it should. Leak Point Pressure Measurement: During the cystometric test, while the bladder is filling, a sudden contraction may occur resulting in some of the water squirting out. This test, where one of the previously mentioned catheters is equipped with a pressure sensor called a manometer, measures the pressure at that leak point moment. You may also be asked to cough, or hold your nose and mouth while trying to exhale (Valsalva maneuver) at this time to check for any urine leakage that may indicate stress incontinence, and for any sphincter deficiency. Electromyography: This test

Uterine fibroids are a benign growth that appears on your uterus, uterine wall, or on the surface. These growths can be so small your doctor won’t notice them during an exam or significant enough to change the shape of your uterus, giving you severe discomfort. Statistics show that a whopping 25 percent of women suffer from uterine fibroids. As many as one-third of those women will experience pain or abnormal bleeding due to their fibroids. While uterine fibroids don’t cause pain in every woman, they have been known to create complications for some. Depending on the location of your fibroids, you may experience symptoms that can affect your daily life. You should consult your doctor about any symptoms you may be experiencing, especially if you have been trying to conceive. Symptoms Caused by Fibroids Uterine fibroids affect each woman differently. Women who suffer from uterine fibroids can have varying degrees of pain, especially during menstruation. Women who are at high risk for uterine fibroids are between the ages of 25-45. African-American women also are more likely to suffer from uterine fibroids. Research is still unclear as to why this may be. Women who are considerably overweight are 2-3 times more likely to get uterine fibroids. If you suffer from one or more of the following symptoms, you may have uterine fibroids. Changes in Menstruation – A typical menstrual cycle will last seven days. It should be heavier in the first several days and become lighter. Women who have fibroids can experience longer, more frequent or heavier periods. Bleeding or spotting at times other than your period are more likely to occur as well. Difficulty or Frequent Urinating – You may feel the need to use the restroom more often if you have uterine fibroids. Urinary leakage can be another side effect of having fibroids. Abdominal or Lower Back Pain – Generally, this pain will be a dull, heavy ache. However, you may experience a sharp pain as well. Pain or Pressure During Sex – Sex can be uncomfortable when you have fibroids, depending on the size and location of them. Infertility – Although there are many reasons you may be unable to conceive, your doctor will want to check to see if you have uterine fibroids. If you believe that you have uterine fibroids, you might want to consider speaking with your doctor about diagnosing them. Once diagnosed there are many treatment options available. Relieving Uterine Fibroid Symptoms There are several non-surgical options your doctor will suggest to help relieve the symptoms you may be feeling. If you are near menopause, your OB/GYN may recommend waiting out the fibroid symptoms if you can. Fibroids are linked to high estrogen levels, so they are likely to disappear with menopause. Use some of the following techniques to alleviate they symptoms of your uterine fibroids: Over-the-Counter Pain Medicine – If you suffer from painful, long lasting periods, drugs such as ibuprofen may help alleviate some of your pain. Birth Control – These pills can be prescribed to help control heavy bleeding during your period. Relax – Some research has determined a link between high-stress levels and your fibroids. Try relaxation techniques such as yoga, medication, and exercise to manage stress. Manage Your Blood Pressure – High blood pressure has been linked to fibroids. Talk to your doctor about lowering your blood pressure through diet, exercise or medication. Steer Clear of Smoking – Cigarette smoking can reduce the amount of oxygen that can reach your pelvic area and can worsen your menstrual pain. Be sure to contact your OB/GYN before taking any supplements or medicines that could affect your estrogen levels. We Can Help If you think you may have uterine fibroids, schedule an appointment today or call us at 770.720.7733 and ask your doctor about the various non-surgical treatment options available for uterine fibroids.

The length of time it takes to recover from surgery is different for everyone. Following are things you can do to lessen your recovery time after surgery. Things You Can Do to Shorten 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.