Author name: Diane

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Routine Prenatal Care

Routine prenatal care is not a luxury or indulgence. It’s something both you and your baby need. Just as a gardener waters, nurtures and cares for the seeds 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. The Importance of Prenatal Care 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. Our 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 thousands of 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 Cherokee Women’s Health? 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. We’re Here for You 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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Fertility Assistance

Our doctors have decades of combined experience and expertise in the field of women’s health and fertility assistance. We understand your frustration, sadness, and heartache over your efforts to conceive, and we want you to know that there is hope for your situation. Thanks to constant medical breakthroughs, that hope grows larger every day. Our priorities are twofold. The first is to treat every woman that walks into our clinic with the same counsel, focused care, and individual attention that we would treat a beloved member of our own family. The second priority, equally important to us, is to make sure that we are constantly abreast of the most up-to-the-minute technology and knowledge in all facets of women’s health. This includes reproductive assistance. Our technology is equally cutting edge, allowing us to correct many previously irreparable infertility issues. What Causes Infertility? Sometimes the causes are unknown, but the more common ones are: If My Cause is Unknown, Can Cherokee Women’s Reproductive Assistance Specialists Still Help Me? Yes. Even though your tests may come back completely normal, we can still help you. Though every reproductive system functions the same way, there are also differences. Just as you have a unique fingerprint, your body may have variations that can affect the process of fertilization. Simple lifestyle factors can affect your ability to conceive, and these can be as simple as: Our staff of reproductive assistance experts is persistent in finding the reason for your infertility, and once we do, we will recommended different modifications to help you through your dilemma. What Can You Do For Me? Not only do we offer the most in-depth testing to pinpoint your specific reason for infertility, our diet and nutrition experts can help adjust or change your diet, and recommend vitamins and supplements to help with any deficiencies that might be contributing to your difficulties with conception. If you are suffering from any weakness in your pelvic area that might be preventing you from carrying a baby full term, our doctors can customize an exercise regimen to strengthen those frailties.Our OB/GYNs and FPMRS surgeons (Female Pelvic Medicine and Reconstructive Surgery) hold the highest certifications and are qualified to perform the surgeries necessary to correct any physical impairment or disorder that may be interfering with your successful reproduction, including: What if I Still Can’t Get Pregnant? There are still reproductive assistance options available. Once we’ve looked at and corrected any possible physical, nutritional or lifestyle detriments that may be hampering your ability to conceive, there are still alternatives available. These include: There are almost as many solutions as there are reasons for infertility, and our women’s health specialists are here to help you with your situation. To make an appointment for fertility assistance, please call us at 770.720.7733 or schedule an appointment online.

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High-Risk Pregnancy: No Need To Panic

If your pregnancy has been defined as high-risk, there is no need to panic. The truth is, all pregnancies on some level are high-risk; to grow another human being inside your body is a significant event! A high-risk pregnancy status is a precautionary determination to make sure that any pre-existing risk factors you have, along with any you may develop during your pregnancy, are monitored closely to ensure both your baby’s safety and yours. Our obstetrics team has successfully delivered thousands of babies, many of those deemed high-risk. We’re trained to detect and evaluate situations hazardous throughout gestation, and equipped with the technology to do so. Most of all, our tenet is to treat every pregnant patient the way we would want our loved ones treated. What Is Considered a High-Risk Pregnancy? There are many factors that can designate a pregnancy as high-risk. Some medical, physical or genetic influences may predispose you to being susceptible to certain problems. These are: What Can You Do For Me If I Have Any of These High-Risk Pregnancy Markers? The first step is to establish a trusting relationship with you, taking the time to answer all your questions and concerns. In many cases, just a few lifestyle modifications can ensure a safe, healthy pregnancy. Some of these changes can be as simple as speaking to our diet and nutrition experts, who will counsel you on a food and supplement regimen appropriate for your specific needs. We may schedule more frequent prenatal visits so that we can carefully monitor your progress, taking immediate steps to treat whatever problems might occur. Your blood pressure will be watched closely. Blood and urine tests will be taken during every prenatal visit, along with any physical examinations or scans that may be indicated. Our high-risk obstetric specialists will evaluate any medications you might be taking, making adjustments as necessary to protect you and your child. If you suffer from pre-existing chronic conditions, we will work with you to minimize any arising difficulties. We may monitor your pregnancy more frequently with ultrasounds and fetal monitoring. Finally, we screen for genetic abnormalities, providing information, counsel, and advice if required. If My Pregnancy is Normal, With No Pre-Existing Conditions, Will it Stay That Way? Usually, but not always. This is why prenatal care appointments are so important for both you and your baby. You can develop complications at any time, placing you into a high-risk pregnancy category. Again, don’t become alarmed. Our specialists have combined decades of experience and training to deal with that if it happens, and the earlier we detect something, the better. Here are some of the things we look for: We Can Help Our hospital partner, Northside Hospital Cherokee offers a full range of services for our patients with high-risk pregnancies. Since 1993, Cherokee Women’s Health has delivered more babies at Northside Hospital Cherokee than all other OB practices combined. Whether yours is a routine or high-risk pregnancy, our highly qualified physicians and advanced practice providers pride themselves on giving you the best individual prenatal care necessary to ensure a safe and healthy pregnancy. For an appointment, call us at 770.720.7733 or simply schedule an appointment online.

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Maternity Care for High-Risk Pregnancies in Canton

A high-risk pregnancy requires special care and extra attention so that both mom and baby continue to thrive. At Cherokee Women’s Health, our highly-qualified doctors specialize in high-risk pregnancy and are dedicated to providing women with compassionate, caring, and competent obstetric care. Together, we partner with Northside Hospital Cherokee to focus on creating an individualized treatment plan to ensure the health of both mom and baby. Best in Class Maternity Care for High-Risk Pregnancies in Canton A high-risk pregnancy can be a scary diagnosis, but our doctors carefully guide women through pregnancy and delivery by being proactive with treatment to minimize complications. What Makes a Pregnancy High-Risk? Choosing a Provider for High-Risk Pregnancy A woman has many factors to consider when choosing a doctor, especially if her pregnancy has been labeled high-risk. The team of doctors at Cherokee Women’s Health collectively has more than 30 years of knowledge and expertise to diagnose, treat, and monitor high-risk pregnancies. Cherokee Women’s Health partners with Northside Hospital Cherokee to monitor high-risk pregnancies from conception to delivery. Both facilities utilize state-of-the art technology and offer skilled medical care. Northside Hospital offers a Center for Perinatal Medicine at their Cherokee location where specialists and doctors collaborate to offer a comprehensive care plan for women and babies in high-risk pregnancies. In addition, an award winning Level III NICU is prepared to give the highest level of medical attention to newborns who require intensive care. Care for High-Risk Pregnancy Patients do not have to endure long drives into Atlanta for state-of-the-art testing and care. Our doctors can perform some or all of these procedures during a high-risk pregnancy: Call us today at 770.720.7733 to schedule your consultation.

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The Pregnant Vegan

A healthy pregnancy requires that mothers-to-be eat foods rich in vitamins and minerals to help support their growing baby. One of the first prenatal appointments with an obstetrician will include a discussion about what foods to eat or avoid in order to provide optimal nutrition for fetal growth. The American Congress of Obstetricians and Gynecologists suggests that pregnant women eat a well-rounded diet which should consist of fruits and vegetables, whole grains, dairy, and meat. However, for those whose diets stray from the five food groups, such as vegans, or vegetarians, they simply need to find other foods or supplements that will provide adequate nutrition for themselves and their babies. Veganism is a dietary lifestyle which completely abstains from the consumption of animal products. A vegan’s diet eliminates: eggs, meat, dairy, honey, etc. It is not imperative for a vegan mother-to-be to include these food items in her diet because a 100% plant-based diet can include all the required nutrition a mom and baby need. A fundamental step is making sure to find alternative sources for the all-important vitamins and minerals needed to foster healthy development and less pregnancy complications. Important Vitamins Iodine No matter her dietary lifestyle, iodine is one of the essential minerals that a pregnant woman must consume. Iodine is important for proper thyroid function, and critical during pregnancy for fetal neurological development. The recommendation for pregnant women is 220 micrograms of iodine a day. Even a small deficiency can have a major impact on fetal development, which is why sources of iodine need to be included in consumption. Due to its use in the milking process, dairy can often be a main source of iodine intake for women. Instead of dairy, a vegan mother can add iodine to her diet by taking iodine supplements, eating fortified foods, or using iodized table salt. Iron Iron is a mineral often found in red meat. Iron deficiency anemia is a concern for pregnant vegans, unless they can find alternative sources for the mineral. The body requires at least 30 milligrams of iron daily during pregnancy to increase blood supply and foster a healthy fetus. In addition to possibly adding in iron supplements, pregnant vegans should be eating green leafy vegetables, whole grains, and dried beans daily to ensure necessary iron levels. Calcium For vegans, sufficient calcium intake will be more tedious to acquire than simply drinking milk. 1,000 mg. are needed during pregnancy to help build healthy fetal bones and teeth. Vegans can turn to kale as a large source of calcium to add to their diet. Other top vegan calcium sources include: almonds, bok choy, turnip greens, or fortified foods such as soy milk, cereal or orange juice. Vitamin B12 When it comes to vitamins, one vitamin vital to pregnancy is Vitamin B12. Vegans do not naturally consume as much B12, because they abstain from eating animal products which are rich sources of the vitamin. Plant products do not contain a considerable amount of B12, but foods such as cereal are often fortified with the vitamin. Pregnant women are recommended to take 2.6 mcg. of B12 a day, and even slightly more when breastfeeding. B12 deficiency is life-threatening, so pregnant and breastfeeding vegans need to ensure that their levels are appropriate for pregnancy. Vegan mothers should bring up any questions or concerns to their doctor when it comes to meeting the crucial vitamin and mineral intake during both pregnancy and breastfeeding. It is always recommended to not begin taking any additional vitamins or supplements without consulting a physician first. If a mom-to-be is struggling to reach these nutritional values, she may be put in touch with a nutritionist, who can assist in planning a suitable diet for the duration of pregnancy and breastfeeding. Having a baby changes everything; but moms don’t have to completely adjust their dietary lifestyles to keep themselves and their baby healthy.

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What is a Pap Smear?

A pap smear is a simple procedure which tests for abnormal cervical cells, which can lead to cervical cancer. The test is performed on an exam table and is generally a painless and quick procedure. The doctor uses a speculum to open the vagina so that a sampling brush can be guided in to gather cells from the cervix. This sampling brush is then sent to the lab for study and results will be communicated to the patient after the lab examination is complete. The 2 Types of Screening Options Along with the Pap test, an HPV test is also recommended. HPV (human papillomavirus) is a virus that can cause cervical cancer. These tests are both performed by taking cells from the cervix and tested. The Pap test looks for abnormal cells that may develop into cancerous cells over time. The HPV test looks for the strains of HPV that are most likely to cause cancer. How Often Should I Get a Pap Smear? HPV Test? It’s been determined that cervical cancer develops over many years, so the time between Pap exams has generally been expanded. However, it is still very important to visit their OB/GYN every year for an annual exam. It’s important to note though, that some women may require more screenings than the typical recommended guidelines due to their medical history, weakened immune system, etc. This will be determined by your provider. The Current Pap Smear and HPV Testing Guidelines Currently, ACOG (American College of Obstetricians and Gynecologists) recommends the following: Again, it’s important to remember that these are simply guidelines. Each woman’s medical history and health situations are different so your doctor may recommend more frequent testing. Annual Exams are Still Important and Recommended The routine visit to your OB/GYN is necessary for your overall health, and cervical cancer screening is just one small—but very important—part of that. Whether or not you are due for a Pap exam or HPV screening, you should still visit your OB/GYN at least once a year. Annual exams are a good time to share information with your doctor regarding any number of concerns, such as: Follow-Up Testing is Important If abnormal cervical cells are present, follow-up testing can reveal whether the abnormality is related to Human Papillomavirus (HPV) or cervical cancer. Cherokee Women’s Health will assist in diagnosing and treating cervical issues including dysplasia and cancer. With proper screening and prevention, cervical cancer diagnoses can continue to decrease. Prevention is Key in Cervical Cancer Screening Having a monogamous relationship, limiting the number of sexual partners, and using condoms are paramount to a woman’s health. Doctors advise that women receive the HPV vaccine, as well as pap tests, which will help to screen for any abnormalities and catch any precancerous cells (dysplasia) before they spread. Women who are found to have cervical dysplasia can receive treatment to prevent the cells from turning into cancer. Usually, this is removal of the abnormal cells. If cervical cancer is found to be invasive, surgery, radiation therapy and chemotherapy may be required to treat the cancer. Make an Appointment Today Pap smears and annual exams are a critical component of a well woman’s health exam. Schedule your appointment by calling us at 770.720.7733 or Schedule an appointment online. Pap Smear Education Articles

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What to Expect: The Third Trimester

The third trimester begins in the 28th week of pregnancy and ends when your baby officially becomes a newborn. This is a bulkier, less comfortable time, but will soon be over. At the end of this trimester, the fetus will be 17 to 23 inches long, fully formed, and weigh anywhere from 6 to 10 pounds. What Happens Now? Some new symptoms may appear, and familiar ones may intensify. They might include: Restless Leg Syndrome (RLS) and leg cramps: These can occur at any time. RLS is common in about 15% of pregnant women. Support hose, moderate exercise, less caffeine, and more fluids during the day may alleviate discomfort. Nasal congestion and snoring: Estrogen increases blood flow throughout the body, including nasal membranes. Nasal strips and saline drops often help. So can elevating the head during sleep. If snoring becomes intense, your obstetrician may want to rule out sleep apnea. Abdominal aches: The fetus is becoming more active. Growth is accelerating, widening the uterus so that it presses against your bladder, diaphragm and other organs. Discomfort is usually minimal. Fatigue: Finding a comfortable position in bed sometimes becomes difficult. It’s recommended that you not sleep on your back now, as the growing uterus can press on the main vein (vena cava) which pumps blood from your heart to the lower part of your body. Try sleeping on your left side, using pillows as props. Insomnia and/or bad dreams: Anxiety and overactive hormones may rob you of rest. Moderate exercise, a warm bath, massage, cutting caffeine and lowering the bedroom temperature helps enable sleep. Heartburn: Hormones and pressure from the uterus pushing the stomach upward can trigger indigestion. Consult your obstetrician before trying any remedies. Stretch marks: These may become itchy and more prominent. A good moisturizer can help. Varicose veins and hemorrhoids: Extra blood pumping through your body now can make these appear. Both usually diminish or disappear after birth. Clumsiness: Rapid body shape and size changes can make you misjudge distances and bump into surroundings. Try moving slower. This minimizes injury both to yourself and the fetus. Pregnancy fog and distraction: Forgetfulness and distraction are attributable to brain function changes during pregnancy. Research actually shows that women pregnant with females experience pregnancy fog more than those carrying males. This haziness disappears a month or two after birth. Until then, keep to-do lists on hand to jog your memory. Lack of bladder control/ frequent urination: Extra weight and pressure on the pelvic floor can result in leakage and constant bathroom visits. Do your Kegels and wear panty liners. Backache: A growing stomach pulls your center of gravity forward, triggering backache. Elevating your feet, a warm bath, and gentle massage can ease pain. If it’s intolerable, however, your doctor may want to rule out injuries like sciatica. Breast leakage: Your body is preparing for breastfeeding. Nursing Pads aid in preventing staining. Lightening: At about week 36, you might notice your shape changing. Your stomach will drop lower and you could start waddling. Your baby is changing position to prepare for birth. Your breathing will be easier, heartburn may diminish, but urination may become more frequent. Mucus plug: A clear gelatinous plug may detach from the uterus weeks or immediately before labor. This means the cervix is softening and preparing for delivery. Braxton Hicks: These irregular contractions are often mistaken for the real thing by first time moms. They can occur intermittently weeks before you actually go into labor. Bloody show: Pink or brown tinged mucous indicates that you are effacing and dilating. Labor is close at hand, but it can still be several days to a few hours away. Blood should not be bright red or excessive though. Call your doctor if it is. Water breaking: The amniotic sac has ruptured and labor is approaching. If steady contractions have not begun within 24 hours, labor might be induced to avoid infection. Contractions: These are regular and stronger than Braxton Hicks and will not diminish. Your doctor will advise you as to how long to wait before leaving for the hospital. What Precautions Can I Take During This Time? You can continue to do exactly what you’ve been doing all along- take care of yourself and your baby. Eat well but watch your weight. Rest when necessary, but avoid becoming inactive. Moderate exercise will make your labor and delivery easier. Avoid strenuous activity or heavy lifting. If you are uneasy about anything or notice radical symptoms that worry you, consult your doctor. How Important Are Fetal Kick Counts? (Very!) Dr. Litrel discusses the importance of counting fetal kicks during your pregnancy. Fetal Kick Counts Your baby’s movement may provide information that help us care for you during this pregnancy. During a convenient hour each day, after eating and emptying your bladder, please lie down (on your side is best) and concentrate on your baby’s movement. Note each movement. Smoking may interfere with the movements and should be avoided during pregnancy. Count the number of movements for thirty minutes. Your baby should move at least five times in that thirty minutes. If your baby moves less than five times during that thirty minutes call your physician or go to the hospital. Call your doctor if you experience:  Decreased fetal movement Rupture of membranes (water breaking) Contractions every 2-5 minutes (more than five per hour) Cramps in the lower abdomen with or without diarrhea Low, dull backache felt below the waistline Temperature over 100 degrees Vaginal spotting or bleeding. Helpful Hints: Be sure to drink at least 8-10 glasses of water every day (in addition to anything else you drink). Eat small frequent meals to avoid heartburn. Use Tylenol for minor aches and pains. You may take warm baths or showers, place a heating pad on your back using low heat setting and rest with your feet elevated. What Tests are Performed During the Third Trimester? By this time, most precautionary tests have been completed, and only these regular routine tests are done

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What to Expect: The Second Trimester

The second trimester takes place from the 14th to the 27th week of a woman’s pregnancy. This is usually the most comfortable and pleasant time. Mercurial Jekyll/Hyde moods begin to balance out. You no longer sob uncontrollably over a run in your hose, or laugh maniacally when someone passes gas. Morning sickness is becoming a distant memory, and you can now start showing off that baby bump in all those maternity tops you’ve carefully selected. Even that sex drive that may have waned somewhat during the nausea, exhaustion and general malaise of your first trimester may return. What Happens Next? The egg (zygote) evolved from being the size of a pinhead into a recognizable little human being, first called an embryo and, after 8 weeks of gestation, a full-fledged fetus. New symptoms may occur, but generally, they are more tolerable than the previous three months. These may include: Nightmares: Stress, hormonal change and anxiety can affect sleep, causing you to dream about outrageous, even horrible scenarios. Waking up in a cold sweat may happen more often. Abdominal discomfort: Aches and pains caused by a stretching uterus and ligaments is normal. Excruciating pain, however, is not. Call your doctor if you experience anything other than moderate discomfort. Quickening: This is the term given to feeling the fetus stir inside you. At about 16 to 20 weeks, you will feel a slight flutter. As the baby grows and takes up more room, movement is felt more distinctly. Blips: An odd bubbling sensation that turns into a stronger methodical twitch as pregnancy continues is simply the fetus experiencing hiccups. Don’t worry. He or she is not having seizures. Your dinner probably just didn’t agree with it. Breathlessness: The uterus can crowd the lungs as the fetus grows, disrupting smooth air flow. Unless you are gasping for air, some breathlessness is normal. Body shape changes: The waist thickens, hips expand, your derriere can widen, and even your face may produce an extra temporary chin if you gain too much weight too quickly. By the end of the second trimester, you will have probably gained 16 to 22 pounds. Only two can be attributed to the baby. The rest is placenta, uterus, amniotic fluid, body fluid and blood. Your body also stores about 7 pounds of fat throughout pregnancy to prepare you for breastfeeding. Stretch marks: Your tummy and thigh skin, elastic as it is, can only stretch so much at a rapid pace before the middle layer of skin (dermis) tears, exposing the deeper layers. Most of these marks diminish or disappear after birth. Bleeding gums: Many women experience sensitive, bleeding gums due to hormonal changes. Use floss gently and get a softer toothbrush, but don’t skimp on your dental hygiene habits. Heartburn, constipation and hemorrhoids: All are common. Smaller meals are recommended, along with more fiber and fluids. Try Sitz baths and speak to your doctor about an ointment or cream to relieve irritation. What Precautions Can I Take During This Time? Keep in shape with moderate, low impact exercise. Eat healthy and keep junk food to a minimum. The more weight you gain, the harder your labor can be, and losing excess pounds afterwards may be difficult. Avoid unnecessary medical procedures such as Botox injections, chemical peels etc. Even whitening your teeth or coloring your hair can be harmful. Take no medications without speaking to your obstetrician. Keep all your prenatal appointments. You will probably be seen once a month during this time, more often if problems are detected. It’s important to monitor your progress. What Tests Are Performed During the Second Trimester? Urine tests: These will be requested at every visit to monitor protein levels. Maternal serum alpha-fetoprotein (MSAFP) and multiple marker screening (MMS): One or the other are offered for genetic screening and are optional. They are used to measure specific fetal protein output to determine if there is a possibility of Down syndrome or spina bifida. If positive, an ultrasound or amniocentesis is done for confirmation. Sonogram: This non-invasive procedure can be done at any time during pregnancy, but is typically conducted at the end of the first trimester or during the second to confirm gender and due date. It can also reveal such conditions as placenta previa, cleft palate, and many other developmental or growth problems. Glucose screening: This checks blood sugar levels for gestational diabetes. If readings are elevated, a glucose tolerance test may be ordered. Fetal Doppler ultrasound: Sound waves determine if fetal blood flow is normal. How Big is My Baby Now? The fetus is about 14.5 inches long and weighs a little less than 2 pounds. It is about the size of a cantaloupe and is able to blink, sleep and wake up. The brain is very active and developing rapidly. Its maturing taste buds can now taste what you eat. Experts even believe dreaming is possible. Hearing is becoming more acute and sensitive eyes may react to light. Each trimester has its own unique milestones, and our doctors have the knowledge and expertise to make sure that your pregnancy is progressing safely and well. For more information, visit Northside Hospital Cherokee. For an appointment, call our clinic at 770.720.7733.

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What to Expect: The First Trimester

Congratulations, you’re pregnant! If you’re already a parent, you know what to expect, but if this is your first child, pregnancy can be a mysterious, sometimes almost frightening process. Today’s pregnancy tests are so precise, that they can detect the presence of human chorionic gonadotropin (Hcg) levels within days following fertilization. Immediately after a fertilized eggs attaches to the woman’s uterine wall, her body produces this hormone. A pregnancy strip can confirm conception has taken place by identifying Hcg presence in only a few drops of urine. What Happens Next? The average pregnancy lasts 280 days or 40 weeks, calculated from the first day of the woman’s last menstrual period. The first trimester covers week 1 to 12. As soon as the fertilized egg (zygote) latches on to the uterine wall, both the umbilical cord and placenta begin to form. Hormonal changes rapidly begin taking place in your body. Often, early symptoms of pregnancy are mistaken for PMS. These symptoms and others include: Spotting or bleeding Fatigue Dizziness (and possibly even fainting) Aversion to certain foods Queasiness or nausea Headache Cramps Bloating Moodiness Backache Breast tenderness More frequent urination (micturition). Can Anything be Done to Counteract These Symptoms? When the egg implants itself into the uterine wall, spotting may occur, but it’s always wise to report any bleeding to your doctor to rule out the possibility of miscarriage, ectopic pregnancy or infection. Additional progesterone can elevate blood pressure, dilate vessels, overheat the body, and force the heart to beat faster when sending blood to the uterus. All these changes can bring about fatigue, moodiness, dizziness and possible fainting. Progesterone can also slow some body functions down, including digestion which causes nausea, vomiting, constipation, and indigestion. The body reacts by trying to purge what is upsetting it, resulting in morning sickness. Higher Hcg in the body, especially in a multiple pregnancy, can also trigger nausea. It’s best to avoid foods that repel you during this stage. For intolerable nausea or vomiting, inquire about supplements or devices that can ease discomfort. If you experience dizziness, move slowly, especially when you get up from sitting or lying down. Should faintness occur, sit down with your head between your knees. Rest when possible. Moderate headaches may be relieved with acetaminophen, but never without consulting your physician. If symptoms are excessive, speak to your doctor. Cramps, bloating and backache can also be attributed to hormonal fluctuations. Frequent urination, even in this early stage, is usually the result of uterine growth and pressure against the bladder. Fluid intake should not be limited, as this is a normal occurrence. Breast tenderness is also hormonal. The breasts are preparing themselves for the baby’s upcoming nutritional needs. Investing in a good support bra may help. What precautions can I take during this time? Don’t smoke, and avoid exposure to second hand smoke. Don’t drink alcohol or use recreational drugs. Mention any prescription drugs you use to your doctor. Avoid caffeine Disclose any work hazards to your obstetrician, such as exposure to harmful chemicals, radiation, dangerous metals, toxic waste, etc. Do not eat or handle raw meat. Wash all fruits and vegetables thoroughly. Wear gloves while handling soil. If you own a cat, have someone else change the litter, and wash hands diligently after animal contact to avoid risk of toxoplasmosis which can harm your baby. Discuss your diet with your doctor and make necessary recommended changes. Take any vitamins, supplements and minerals your doctor prescribes regularly. Is it Safe to Engage in Sex During the First Trimester? Unless you have a specific medical condition of concern, it is safe to have sex. How Big is My Baby in the First Trimester? Between week four and twelve, your baby grows from the size of a tiny fig seed to roughly the length of that credit card you’re probably beginning to max out in happy anticipation. He or she is almost 3 inches long, weighing approximately one ounce and is about the size of a golf ball. Yet, by now, those tiny fingers have fingerprints. Organs are formed, functioning, and are visible through almost transparent skin. A heartbeat can be detected. The body is beginning to catch up with the head that still accounts for one third of body size. Reflexes are becoming sharper. The fetus can make sucking motions and respond to stimuli such as prodding. Eyes are close together on the face instead on either side of the head. Ears are forming and almost in position. The skeleton is made of cartilage that will gradually become bone. Gender is discernable. What Tests Are Performed During the First Trimester? Your blood will be will screened for type, count, RH factor, anemia, German measles (rubella), hepatitis B, HIV and other sexually transmitted diseases, along with exposure to diseases such as toxoplasmosis and varicella. Other test will look for genetic problems such as sickle cell anemia, Tay- Sachs disease, cystic fibrosis, etc. A combination blood/ultrasound nuchal translucency for Down syndrome and other chromosomal abnormalities may be offered during the latter part of this trimester. Glucose levels will be analyzed for signs of diabetes and urine checked for albumin which may indicate preeclampsia An ultrasound, usually near the end of the first trimester, will determine a due date, gender, and normal fetal progress. Although your baby develops throughout your entire pregnancy, extra precaution during the first trimester when fetus growth is so accelerated is vital. Our doctors can guide you in all the ways possible to ensure both your health and that of your child. For more information, visit Northside Hospital Cherokee. For an appointment, call our clinic at 770.720.7733.

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What is Vulvodynia and What Causes It?

Vulvodynia is persistent, inexplicable pain anywhere in the vulva. The discomfort associated with this condition can be so severe that any sexual activity may be impossible. Even sitting can become intolerable. Vestibulodynia (vulvar vestibulitis syndrome or vestibulitis) is another condition which is very similar to Vulvodynia except that pain is situated at the entryway just outside the vagina inside the labia (vestibule). Though it is not known exactly what causes Vulvodynia, doctors speculate that there may be several triggers: Vulvodynia has also been associated with several other chronic pain-related conditions, meaning that there is a higher likelihood of vulvodynia if a woman has any of the following: In most cases, however, there is no absolute known cause, and the reasons for Vulvodynia remain a mystery. Investigation of this disorder is still in its medicinal infancy because it was previously thought to be a purely psychological issue. What are the Symptoms? These symptoms can be sporadic or constant. They can last for weeks, months or even years. They may also appear suddenly, and disappear just as abruptly. This discomfort can be centralized in one area such as the vaginal opening, or spread throughout the entire vulvar zone. This area may appear swollen or irritated, but often looks completely normal. Vulvodynia can seriously impact a woman both physically and mentally. Inability to engage in sexual activity may jeopardize relationships. Chronic pain can also lead to irritability, anxiety, sleeping difficulties, social withdrawal, and low self-esteem. Vulvodynia, and the negative emotions that ripple from the condition, can disrupt quality of life and eventually activate full-blown depression. How Is Vulvodynia Diagnosed? There is no actual test for vulvodynia. Diagnosis is made by ruling out any other possible ailments that might mimic the symptoms of this disorder, such as: A medical history will need to be provided, especially past infections in the pelvic region. Any current drugs you are using, specifically hormonal replacement or contraception should be mentioned. You will be asked pertinent questions in order to determine the problem. A pelvic exam will be done, both internally and externally to see if there is a possibility of a present infection. Even if the genitals show no visual signs of any infection, a cell sample may be taken to rule out bacterial vaginosis or yeast infection. Finally, to check for vulvodynia, a swab that has been moistened will be used to gently dab at and probe the vulva and surrounding area to determine the exact locations of your pain. What Happens if I Have Vulvodynia? Can I Be Helped? Yes. There are several treatments that can minimize pain or discomfort: Is There Anything I Can Do At Home in the Way of Self-Help? There are some simple measures you can take to decrease some of the uncomfortable symptoms: It is important to note that vulvodynia is not a sexually transmitted disease. It is not contagious, and is in no way an indication of any kind of cancer. There is no cure for vulvodynia, but different remedies can ease the symptoms for different women. It may take time to find the combination that works best for you, but our doctors will work with you to help provide a comfortable, better quality of life. To schedule an appointment, call 770.720.7733 or schedule an appointment online.

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Low Libido in Women

Libido, very simply put, is sexual desire or sex drive. Just as there are multiple shades in a color spectrum, levels of libido are unique to each woman, and these levels can rise and fall monthly throughout a woman’s lifetime depending on many biological and psychological factors. What are the Different Levels of Sexual Desire? Intensity can vary. Sexual desire may range from heightened – where a woman may want sex one or more times a day (hypersexuality), to several times a week, once a month, once every few months or year, (hyposexuality) or not at all (asexuality). What is Considered ‘Normal Libido’? There are no standards for ‘normal’ libido, especially if a couple is sexually compatible and comfortable in their mutual need for intimacy. Often, however, this is not the case. Women frequently tend to have a lower libido than men. In fact, it is estimated that 1 in 10 women suffer from low sexual desire in the United States, meaning that 16 million women have what is referred to as hypoactive sexual desire disorder (HSDD). A female’s low libido can have a huge negative impact on a relationship. Once the brilliant shine of newly-found lustful love wears off, couples may find their physical needs are drastically different. The apathy of the less ardent woman may lead to conflict, suspicion, hurt, infidelity and even complete collapse of the relationship. The woman herself may also suffer feelings of inadequacy, self-doubt, and frustration, emotions that might send her into an emotional depression, worsening the situation. Mass media today slants sex to appear as if anything less than constant bedroom activity is abnormal, often convincing a woman with a perfectly healthy sexual appetite that she is some kind of freak if she doesn’t engage in a passionate encounter at every opportunity. For one who suffers from a lower sex drive, the impact may be even more devastating. The inner turmoil of a dwindling self-image and shattered self-esteem can compound the problems already complicated by sexual dysfunction. What are the Causes of Low or Waning Libido? There can be many causes for low sexual desire, and they can be either physical or psychological. Physical reasons for a low libido include: Psychological reasons for a low libido include: Is Help Available? YES!!!! There is no reason to go through life with lowered libido. Women can enjoy a satisfying sex life at any age, and with today’s resources and modern technology, we are usually able to effectively treat the problem. Diagnosis and Treatment In order to pinpoint the root of this dysfunction, frank honest discussion is necessary, as well as a list of any medications you are currently taking. Your doctor will ask pertinent questions to find out whether the problem is physical or emotional. After an examination of the genital area, blood tests may be required to determine hormonal levels. Once a diagnosis is made, your doctor will move forward to correct the problem. It may be as simple as a change or alteration in medication or a new prescription. If surgery is indicated, most physical corrections are minimally invasive, can be done in our clinic, and the recovery time is usually short. If the problem is psychological, our board-certified OB/GYNs can help. Call us today at 770.720.7733 or schedule an appointment online.

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Dr. Michael Litrel on Pelvic Reconstruction – Part 3

An Interview With Michael Litrel, MD, FACOG, FPMRS – Part 3 of a 3 Part Series Read Part 1 and Part 2 of Dr. Litrel’s interview. Guiding PrinciplesMy philosophy as a doctor is the mother principle—in that you treat all your patients the same, and always keep in mind how you would want your mother, wife or other loved one to be treated. If your mother is on that operating table, you’d want the surgeon operating on her to bring his A game. For me, an A game is not just about being in one place and doing well, it’s about availability, continuous improvement, compassion, learning the latest technology and methods, followup, etc., so I’m giving my patients the best possible care and aftercare. The Doctor/Patient RelationshipApart from the mother principle, the patient’s attitude tends to guide me. My principle is that I do my very best and I’m as honest as I can be. I try to do it in a way where people can be receptive. Sometimes it works very well and other times, well, not so much. Physician-patient compatibility is very important. For example, I recently had a patient with life-threatening blood pressure issues, and she really didn’t want to hear anything I had to say. She was being completely non-compliant by not taking her prescribed medication to combat dangerously high blood pressure readings. She became impatient, even angry with me, changing the subject to something else each time I tried to discuss the severity of her situation and the importance of following my recommendations. On the other hand, another patient reached out to me in desperation. She described how her son was heavily into drugs and how her father was seriously ill. The situation was causing devastation to her, both mentally and physically. Apart from understandable emotional turmoil, she was compensating for the difficulty in her life by overeating and was rapidly gaining weight. I listened to her because I truly sympathize and care about the struggles she’s going through. I gave her the best advice I possibly could. It was clear that she was receptive to everything I was telling her and would follow my advice. The non-compliant patient made me realize that our doctor/patient relationship was a mismatch and was going nowhere. I knew I would probably decide not to see her again, and I’m okay with that. My heart is telling me that she would be-or should be-better off with another doctor, and I’m okay with that too. However, the troubled mother was appreciative of the help I was trying to give her. I knew that, unlike my other patients, or those that I see over the years for just an annual exam, she would remain in the forefront of my thoughts. I would remember her son’s name, follow up with her regularly, stay in touch, and even pray for her because I’m genuinely concerned. I don’t doubt she truly wants my help. I can only help those people who want to accept my advice and, in turn, help themselves. Talking with Inhibited PatientsWith shyer patients who are more reluctant to discuss their problems, I simply confront the issue. I basically just tell my patients, “Look, I completely understand that it’s very embarrassing sometimes to talk about sexual or genital issues. It’s humiliating if you ‘poop’ or ‘pee’ on yourself, don’t know what an orgasm is, or if you’re ashamed of the way you look. Whatever it is, I know some of these things can be difficult to talk about. That said, I’ve heard and seen it all, so now I’m going to get the information I need from you. Sooner or later, I’m going to find everything out anyway, and we’re eventually going to have a trusting relationship so the more you tell me now, the more comfortable you’re going to be, and the more I can help you.” If I just acknowledge the fact that it’s an awkward or socially embarrassing subject, people tend to relax a little and speak more freely. Then, once I do an exam, my knowledge and experience guides me to ask more direct, delicate questions based on my visual findings—questions like, “Do you need to touch your vagina to defecate? Do you leak stool? Are you sexually active? Do you urinate when you cough, sneeze or jump? Do you have a sensation like your bottom is coming out? Does your back hurt a lot?” Because I’ve been practicing for so long, I can duplicate the anatomical findings with the physical symptoms. This makes them think, ‘Oh, he knows that, so maybe this is a normal thing!’ When that connection is made, we can discuss and build a trusting relationship. SurgeryMy philosophy is that, unless surgery is absolutely necessary, I discourage it. If you must have surgery, do it for the right reasons. I feel that patients seeking operations to improve their sexuality or the appearance of their genitals can be extremely vulnerable, impressionable and overly trusting of people who might want to take advantage of that vulnerability for their own profit. Since the internet has come into our lives, we’re often led to believe that there’s only one solution to all our problems. A place that sells widgets will try to convince you that widgets will solve everything that’s wrong with your life. Desperation causes people to believe that so they buy that widget only to find out it’s not a cure-all. It’s the same thing with surgery. It’s not always the answer to everything simply because it’s radical and is made to sound like the perfect answer to everything. I don’t subscribe to that way of thinking. Again, I rely on the ‘mother principle’, going on the premise that if this was my mother, wife, sister or daughter seeking help, I would recommend surgery only when surgery is indicated. I wouldn’t want my mother or my wife going somewhere and being talked into surgery simply because that’s how the provider makes money. There’s a

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