Diane, Author at Cherokee Women's Health

Hot flashes are one of the most common symptoms of perimenopause, the time in a woman’s life right before she experiences menopause, or permanent infertility. During perimenopause, your body’s production of estrogen and progesterone rise and fall, and many of the other symptoms are a result of decreasing estrogen. Other symptoms of perimenopause include menstrual irregularity, sleep problems such as night sweats, mood changes, vaginal and bladder problems, loss of bone density, changes in sexual function or desire, and changes in cholesterol levels. Treatment for Perimenopause If you’re experiencing any of the above symptoms, you can make an appointment with your doctor to discuss the various treatment options, the most popular of which is hormone therapy. Hormone therapy can help relieve the symptoms of menopause. For women who still have their uterus, estrogen is usually given in conjunction with progestin, a synthetic version of the hormone progesterone. This helps reduce the risk of cancer of the lining of the uterine that occurs when estrogen is used alone. Estrogen is used to treat hot flashes specifically, which is the main complaint of women experiencing perimenopause symptoms. Estrogen can also relieve vaginal dryness and can help to relieve some changes that can cause problems associated with urinary incontinence. It is recommended to maintain a healthy lifestyle by eating healthy, staying active and getting enough sleep during this time. Once you’ve gone through 12 consecutive months without a menstrual period, you’ve officially reached menopause, and the perimenopause period is over. We Can Help If you have questions about hormone therapy treatment for menopause or would like talk to one of our doctors about your perimenopause, don’t hesitate to schedule an appointment.

Ovarian Cancer Awareness

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Ovarian cancer will be diagnosed in approximately 1.5% — or 1 in 71 — women in her lifetime. Most women do not experience any symptoms of ovarian cancer, so it’s important to be in tune with your body and be comfortable talking to your doctor about any changes. Symptoms of Cancer of the Ovary While ovarian cancer is harder to detect than other cancers, there are some symptoms women can watch out for, especially if they persist for two weeks or longer: Bloating Pelvic or abdominal pain Back pain Enlargement or swelling of the abdomen Inability to eat normally Unexplained weight loss Urinary frequency or incontinence Constipation Feeling tired Indigestion. Diagnosing Ovarian Cancer A malignant cyst on the ovaries may be found during a routine yearly pelvic exam with your OB/GYN. Other diagnosis options are vaginal ultrasound, laparoscopy or blood tests. Vaginal Ultrasound – This procedure uses sound waves to create pictures of your internal organs that allow your doctor to view the images on a screen. The ultrasound will show shape, size, location and makeup of the cyst. Laparoscopy – In this type of surgery, a laparoscope is inserted into the abdomen to view the pelvic organs. Laparoscopy can also be used to treat cysts. Blood Tests – For women past menopause age, in addition to an ultrasound, your doctor may recommend a blood test that measures the amount of CA 125 in your blood. An increased CA 125 level may be a sign of ovarian cancer in women past menopause. Ovarian Cancer Treatment Treatment for ovarian cancer is based on the stage of the cancer and how much the cancer has spread outside the ovary. Epithelial ovarian cancer has four stages, ranging from the least to most advanced stage. Usually, surgery to remove the uterus and ovaries is performed, and sometimes the lymph nodes and tissue from the abdomen may be removed as well. Surgery may be followed by chemotherapy, depending on the stage of the cancer. It’s important for women treated for ovarian cancer to schedule routine checkups with their OB/GYN so he or she can monitor your body’s progress after treatment and make sure you stay as healthy as possible. Make an appointment today by calling 770.720.7733 or schedule an appointment online.

Nutrition and Weight Loss

Healthy Food Options for Vegetarians and Vegans

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Last week we received a great question from a potential patient about different types of protein alternatives for vegetarians and vegans. If you are looking for alternatives to animal-based proteins, whether it’s due to health reasons, personal beliefs or because you’re looking for alternatives due to pregnancy food aversions, never fear. There are plenty of great options to help keep your body healthy and strong. Here are a few of our favorites: Whole grains – Surprise! Certain whole grains can also be a good source of protein. These include whole wheat, brown rice, whole-grain cereals, wild and brown rice, barley, bulgar, millet, couscous and quinoa. Here’s a little tip about quinoa: it contains more than 8 grams of protein per cup, including all nine essential amino acids that the body needs. For an added protein punch, add wheat germ or rolled oats to your recipes when baking, Soy – Whether it comes in the form of soy milk, edamame (soybeans), or tofu, soy is an excellent source of protein. Foods made from soy contain some of the highest amounts of vegetarian protein. Legumes – Chock-full of protein legumes offer a variety of options in the form of split or green peas, soybeans, chickpeas, black beans, navy beans, kidney and pinto beans. Two cups of kidney beans, for example, contain about 26 grams of protein! And don’t forget the old standbys of peanuts and peanut butter. Seeds – Sunflower seeds, poppy seeds and sesame seeds all contain protein. Sunflower seeds contain the most at 7.3 grams per quarter cup. Try topping a salad with sunflower or sesame seeds, or adding poppy seeds to a vinaigrette. Whatever the reason for your diet preferences, the physicians at Cherokee Women’s Health are dedicated to help you find ways to get healthy and stay healthy. Don’t hesitate to let us know if you have questions about diet and healthy food options when you’re in our office for your next appointment.

GYN Problems, Laparoscopic Surgery Education

What to Know About Laparoscopic Surgery

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A laparoscopy is a surgical technique using a thin, lighted tube that’s threaded through a small incision in the belly to look at abdominal organs, and in many cases, female pelvic organs. Laparoscopy is used to detect problems such as uterine fibroids, cysts, adhesions (scar tissue), and infection. Other common procedures include hysterectomy, removal of abnormal tissue, tissue biopsy, and tubal ligation (commonly referred to as getting your tubes tied). Laparoscopic surgery has many benefits, including less pain after surgery, a lower risk of infection, a quicker recovery time, and generally, the procedure can be done as an outpatient surgery so you will be able to return home the same day. Additionally, because of the smaller incisions, your body heals faster and the scars will be smaller. Questions to Ask Your Doctor If you want to learn more about a laparoscopic procedure, first make an appointment with your doctor to discuss surgery options. During your pre-op visit with your OB/GYN, it’s important to ask as many questions as you need so that you can feel comfortable about the procedure. Questions to ask include: How long does the surgery typically take? What can I expect the aftercare to be like? What steps do I need to take to prepare for the surgery? What can I take for pain relief after the surgery? What to Expect After Laparoscopic Surgery In most cases, you will be able to return home the same day of your surgery. The doctor will want to keep you for 2 to 4 hours after the surgery to monitor you and prepare for your trip home. For the first 24-48 hours, you might experience some of the following symptoms: Pain at the site where the scope is passed through the wall of the abdomen. Mild nausea from the medicine Cramps similar to menstrual cramps Discharge like a light menstrual flow for up to 7 days Aching in your neck and shoulders from the gas put in your abdomen. Swelling in your abdomen for a few days. Bruising at the incision site. Fatigue or muscle aches for a day or two. If you can, try to enlist the help of a good friend or family member beforehand. You’ll want to make sure take it easy for a few days, so pre-schedule things like basic housecleaning, laundry, and a handful of easy-to-heat meals so that you’re off you’re feet as much as possible. We’re Here to Help For more information about laparoscopic surgery techniques, call us at 770.720.7733 or schedule an appointment online with one of our highly skilled OB/GYN surgeons.

Anterior and Posterior Repair Education, GYN Problems, Mesh Education

Cherokee Women’s Offers Treatment for Vaginal Mesh Complications

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Vaginal mesh is a piece of synthetic mesh that is inserted into the vagina to treat pelvic organ prolapse, a condition where a woman’s pelvic or reproductive organs fall into her vaginal opening, cystocele (anterior vaginal wall prolapse) and rectocele (posterior vaginal wall prolapse). Pelvic organ prolapse is often linked to strain during childbirth, when the muscles in a woman’s body can weaken or stretch out. If the muscles don’t recover, they are unable to support a woman’s pelvic organs. Women may also get pelvic organ prolapse after a hysterectomy, which can sometimes leave other organs in the pelvic area with little support. There are some misunderstandings surrounding vaginal mesh surgeries. For many years, vaginal mesh was used to treat the above conditions and was considered standard care. We want to take a deeper look at this procedure and quell any misunderstandings about vaginal mesh surgeries. Complications Associated with Vaginal Mesh The primary cause of complications associated with vaginal mesh is how the body reacts to it and how it is placed within the body during a surgical procedure. However, in the fall of 2008, an FDA notification that stated patients should be aware of the complications that do potentially exist in relation to the vaginal mesh surgeries urged people to ensure that their surgeon had the proper training and experience required to perform the procedures. Because of this notification, an increase in surgical technique and mesh technology have decreased complications associated with the procedure, but it’s important to note that it should be done by a surgeon with the proper training and experience in vaginal reconstruction. Cherokee Women’s Health’s Surgery Policy Here at Cherokee Women’s Health Specialists, our doctors’ approach to surgery is the following: This means no unnecessary surgeries, and looking for the best and easiest solutions to alleviate suffering for each and every patient. The Cherokee Women’s Health Specialists are experts at removing surgical mesh. Our pelvic and urogynecologic surgeons have the experience and education required to offer our patients a solution to their complications involving vaginal mesh. Schedule an appointment online or call us today at 770.720.7733 if you would like to discuss vaginal reconstructive surgery options.

Have a Healthy Pregnancy: Best Foods for Pregnant Women

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So you’ve just discovered that you’re pregnant! Congratulations from the team at Cherokee Women’s Health! One of the most important things you can do to get ready for your new baby is, well, eat! Best Foods for Pregnant Women If you’re already out of your first trimester and/or are fortunate enough to not have morning sickness as a symptom of your pregnancy, try to eat a healthy balance of the following food groups: Protein – If the idea of lean chicken or fish turns your stomach, try eggs, nuts, beans, or legumes, which are all great sources of protein during pregnancy. High-protein foods also contain amino acids, are the building blocks of every cell in your (and now your baby’s) body. Low-fat dairy – Calcium will help your bones grow strong during pregnancy, and will also help your baby’s growing bones. Try a creamy yogurt smoothie or a quick snack of string cheese to help get you through the day. Colorful fruits and veggies – Load up on any kind of green, yellow, orange, or red fruits and veggies you like (smoothies and juices count). Pinterest has a wealth of healthy food options for pregnant women, and there’s a recipe for just about everyone. Water – Ok, so water’s not a food, but it’s especially important to drink plenty of water during pregnancy because it provides benefits like building new cells, delivering nutrients, and flushing toxins. Fighting Food Aversion and Nausea If you’ve been relegated to crackers and ginger ale, don’t worry – here are a couple good options for your growing baby that are bland and easy to keep down. Lemons – Citrus fruits are packed with Vitamin C, an important nutrient during pregnancy. Try adding lemon juice to your water for an added punch. Other citrus fruits to try are oranges, tangerines and grapefruit. Pretzels – Had enough crackers? Pretzels are also a bland choice that add a little variety. Dry cereal Brown rice Applesauce (try to look for an organic option, if possible) Have a question about a food that’s a do or a don’t during pregnancy? Don’t hesitate to ask your doctor when you’re at one of our offices for your next prenatal appointment.

Well Woman

Get to Know Dr. Gandhi

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Dr. Peahen Gandhi discusses her passion for women’s healthcare and her expertise in obstetrics, gynecology and female pelvic medicine reconstructive surgery. Prefer to read about Dr. Gandhi’s passion for medicine and her expertise? See it here! Watch more GYN and Annual Exams videos below.

Dr. Litrel's Blog

A Holy Place

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Eight years ago my wife Ann was hospitalized for a life-threatening bleed in her brain. I sat in vigil at her bedside for many hours through the days and nights as she lay there in pain, unable to move, barely able to whisper. I was afraid that I would lose my wife – and my young boys their mother. But early one morning Ann spoke one sentence to me, and the heavy feeling of worry that had filled my chest suddenly evaporated. In its place was a wonderful certainty my wife would be okay. A shunt had been placed by the neurosurgeon to alleviate the pressure on Ann’s brain. The shunt slowly dripped out blood-tinged cerebral spinal fluid the entire week. I watched from my chair next to Ann’s bed as, drop by drop, the fluid fell into the collecting system. The fluid had a reddish color at first. As the days passed, the fluid gradually clarified to a pinkish tinge. Finally one morning the fluid had the healthy hue of fine champagne. Ann was still in such pain she could hardly open her eyes. She squeezed my hand as she woke up and whispered good morning. I tried to cheer her up. “Your cerebral spinal fluid looks so good this morning, I’m tempted to take a sip,” I said wryly. A few moments later Ann responded. “If you swallow….a mouthful,” she croaked, “it will raise your IQ…fifty points.” I was stunned. Immobilized in Intensive care for over a week, my wife had just made a joke. A funny one to boot! I knew then that Ann was going to be alright. Our son Tyler inherited his mother’s courage and sense of humor. Several years ago he was injured in a skiing accident. It was a two-hour ambulance ride to the nearest city hospital. With a fractured bone almost sticking through the skin, Tyler suffered the bumpy ride along the mountain road in agony. Just before Tyler’s surgery, his doctor told him he would need a strong narcotic for the pain. He recommended Vicodin. “Oh, that’s my favorite one,” my twelve-year-old offspring quipped. The surgeon looked shocked. “That’s the one that Dr. House takes.” Tyler grinned as he referenced a family TV favorite about an E.R. doc, “House.” Last week Tyler required another major reconstructive operation, casting a shadow of fear and worry over our household. As a surgeon, I find it far easier to be the one providing care than the one worrying about my loved one. Both roles come with moments of fear. But no matter on which side of the medical relationship I find myself, I know this to be true: The hospital is a holy place. Here in this holy place, we seek help when we or our loved ones are injured or ill. Here in this holy place, gathered together, are people who have dedicated their lives to helping strangers in need. Here in this holy place, Love manifests itself through us in the most concrete of ways – all of us helping one another when we are in desperate need. And here in this holy place, God grants healing and relief. Nevertheless, as a Dad sitting next to my son’s bed before major surgery, I was a bit anxious. Tyler grabbed my hand moments before he was to be wheeled back to the operating room. “Dad, I need you to remember something for me,” Tyler said in a low, intense voice. Unsettled, I leaned forward to listen. “971-32-2745-1994. Write it down.” I fumbled for a pen and wrote the number down, repeating it back to Tyler at his request. Confused, I waited. “If I die, you will be contacted. Give them that code number,” Tyler said. “Within a week, you will receive ten million dollars cash – in untraceable bills.” His face still wore the trace of a smirk as the nurses wheeled him back to surgery. Later, as I sat for hours in the waiting room during the operation, I found myself again worrying. Life can be frightening and painful. We suffer so much, and over the course of a long life, lose what matters to us most – our bodies, and our loved ones. It’s so easy to forget the truth: despite our being biologically mortal, we are spiritually eternal. I remembered Tyler’s last minute joke. It was going to be okay. And so it was. -Dr. Mike Litrel

Dr. Litrel's Blog

Cocaine or Prayer? How Best to Feel Better

Diane /

Sixteen years ago, when I first started my private practice, the complaints of some of my patients confused me. Despite normal exams and lab results, a number of women told me they just weren’t feeling well. They didn’t have energy and felt overwhelmed by life. I couldn’t figure out what was going on. The visiting pharmaceutical salesmen, however, came to the rescue. The diagnosis, I learned, was depression. The solution to my patients’ complaints was the pharmaceutical company’s product, taken once a day, every day — forever. In my first year of practice, I selectively began prescribing antidepressants. I was pleased to see that many patients experienced a lifting of their sadness. I continued prescribing depression medication judiciously. Still, the diagnosis and treatment troubled me. Early in my medical training, I had anticipated that psychiatry would be my specialty. The word “psychiatry,” literally translated from the Greek, means “treatment of the soul.” I had entertained the idea of a joint degree at Emory in both medicine and the ministry, so the idea of practicing in the field of medicine that handles the human soul called to me. But I soon learned that the reality of the practice of psychiatry was not what I had imagined. Psychiatric patients were placed on powerful medications with little real understanding of the diagnoses or the mechanism and side effects of the drugs. Now, twenty years later, my work hours and job duties can be demanding and emotionally draining. There are desperate moments in the dead of night when a life is at stake and I am rushing into the operating room. But no matter the hour, I find the cries of a healthy newborn baby a joyful reminder that God is always present in our lives. Obstetrics and Gynecology has proven to be the spiritual field of medicine I was seeking as a young man. I stopped prescribing antidepressants years ago, after a patient who had been on Zoloft came to my office in a desperate state. I found her curled up on the floor of the exam room. Having quit her medication three days earlier, she said she felt like she was going out of her mind. She quickly felt better after resuming the medication. But her withdrawal symptoms were too similar to those I’d seen experienced by addicts. People abuse drugs to be happier, to alleviate their suffering. Antidepressants affect the neurotransmitters in the brain with a mechanism similar to that of cocaine. We all experience sadness in our lives, a sense of confusion about what we are doing, and, at times, an overwhelming feeling of despair. These are normal human emotions that all too often have a spiritual purpose. Drugs supply relief; but are they the solution? Health is not just about vital signs, laboratory findings and medical diagnoses. Part of health is understanding our purpose in life and following that path in our daily actions. When we stray, we are designed to experience unhappiness. After all these years in practice, seeing thousands of patients, it’s been my observation that depression is not a true diagnosis of the body like cancer or pregnancy. It’s a spiritual discomfort to remind us to look deeper at our lives — and to make a change. -Dr. Mike Litrel

Well Woman

Cherokee Women’s on Faith and Health

Diane /

Dr. Litrel is known for making a priority out of praying with his patients before surgery. This is something that many patients appreciate and see as a way of connecting with their doctor on a more personal level. Cherokee Women’s Health on Faith and Health One of our patients had this to say about Dr. Litrel and his strong connection between faith and health: “Dr. Litrel, I am so grateful to have you as my doctor. I wanted to write you this thank you note to tell you how thankful I am that God brought me to you and your practice. I have prayed for a kind, caring, get-to-the-issue doctor for years and my prayer was finally answered. Not only have you made me feel comfortable you have shown and demonstrated to me the love of Christ. I never in a million years would have thought my doctor would pray with me before surgery. And when you did, I knew for a fact that God had His hand over me that day and it brought me complete peace. I could never say thank you enough. Praying that God blesses you, your family and your practice always. That He will continue to give you wisdom and favor in all you do. 1 Corinthians 1:4-9 In His Love.” – Allie S. We invite you to view more videos on our Youtube channel, and be sure to check back often for additions to the page. You can also follow along with us on Facebook, Twitter and Instagram as well.

Well Woman

Talking to Your Daughter About Her First Gyno Visit

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As young girls age and grow into teenagers, preparing them for their first gynecological exam can be a daunting task for parents. Your daughter may not understand why she has to go to the doctor when she feels perfectly fine, so communication is essential when it’s time to sit down and discuss the first visit. Here at Cherokee Women’s Health Specialists, we place a heavy importance on starting young women off on the right track in regards to their health. Timing is Everything It’s very important to listen to clues that will help you determine when your daughter should schedule her first gynecological exam. If your daughter is experiencing heavy or painful periods, is sexually active or has questions that you aren’t quite sure how to answer, scheduling an appointment will introduce her to the important role a gynecologist plays in a woman’s overall health. Communication is Key When you’ve broached the subject of scheduling an exam, communication is important to maintaining trust. Educating your daughter on what to expect during the visit can help calm nerves and ease her mind. Helping her prepare to answer questions the doctor might ask will take some of the fear of the unknown out of the appointment. Types of questions the doctor might ask are: When was your last period? Are you sexually active? If so, are you using birth control? Are you with one or multiple partners? Do you have any problems with your period such as pain or discharge? Is there any chance you could be pregnant? Encourage your daughter to answer honestly, as everything she shares with her doctor is personal and confidential, and her doctor will be able to give her the best care the more information he or she has. After the Appointment Once the appointment is over, talk with your daughter about it. It is important that your daughter feels she is in a safe, trusting environment. Once she’s had her first visit, help your daughter make annual appointments to keep her on a happy, healthy track. To contact us for an appointment at our Canton or Woodstock offices, please call 770.720.7733 or schedule an appointment online.

The Art of the Circumcision

Diane /

By Dr. Michael Litrel A Lousy Way to Start your Day A circumcision is a lousy way to start off life. For a newborn baby boy, the procedure’s only saving grace might be that five minutes of pain must pale in comparison to the agony of being born. Most mothers-to-be receive an epidural to alleviate the pain of labor. For the baby – no pain medication at all. Squeezed from the warm, dark comfort of his mother’s womb, he suffers through a ten-hour marathon of suffocating agony to land in the hands of yours truly. And the next day we meet again, so I can cut the foreskin off his penis. Moms generally like me pretty well. Newborns probably don’t. Making It Look Easy I was taught the art of the circumcision by Paul Taylor, a Physician Assistant at Grady Memorial Hospital in Atlanta. In his thirty-year career, Paul had probably performed more circumcisions than anyone else in the country. To date I have done only fifteen hundred, a mere ten percent of Paul’s total count. I still consider myself pretty good. But Paul was the best. A year ago, Paul was tragically killed in a bicycle accident. I think of him every time I do a circumcision. Sometimes I am saddened by his untimely passing. But then I focus on the five-minute task at hand, grateful for his lessons almost twenty years ago. When I watched Paul do that first circumcision, I naively commented that it looked pretty easy. “When Jack Nicklaus hits a golf ball 300 yards down the center of the fairway, he makes it looks easy, too,” Paul retorted. Paul was right. There are subtleties to the art of the circumcision that I have come to appreciate. But Paul’s technique has no doubt been responsible for my years of circumcisions unbroken by a single complication. “Give a man a fish, feed him for the day; teach him to fish and feed him for a lifetime.” Alleviating Pain There is, however, one thing I do differently from Paul. When my sons were newborns, it bothered me that they received no pain medication whatsoever. This was the traditional way to perform circumcisions: strap the baby down, cut the foreskin off his penis, and let him cry himself silly. I am proud that I have used pain medication for every circumcision I have ever done. I apply topical pain cream an hour beforehand and also use an injection at the time of the procedure. Yet even though I am diligent in this “alleviate suffering” matter, my babies still cry. So sometimes I resort to another trick Paul showed me. Sugar water on the pacifier works like a charm. The baby sucks happily and usually stops crying. Usually. The take-home message is this: life hurts, no matter what you do. The expectant mother with the epidural still cries when the baby is coming out, and the newborn on Dr. Litrel’s pain medicine cocktail still doesn’t like having his penis cut open. Life’s pain begins when it’s our time to be born. And Life’s suffering ends, just in time for our funeral. How we understand and handle that pain determines who we become. Do we take drugs, or alcohol, or sugar, to get through yet another day? Or do we build spiritual resilience, in understanding the purpose of our short time here on this earth? Those are the questions we answer all our lives. The less we need to take, the more we have to give.

Author name: Diane

Could it be Perimenopause?

Ovarian Cancer Awareness

Healthy Food Options for Vegetarians and Vegans

What to Know About Laparoscopic Surgery

Cherokee Women’s Offers Treatment for Vaginal Mesh Complications

Have a Healthy Pregnancy: Best Foods for Pregnant Women

Get to Know Dr. Gandhi

A Holy Place

Cocaine or Prayer? How Best to Feel Better

Cherokee Women’s on Faith and Health

Talking to Your Daughter About Her First Gyno Visit

The Art of the Circumcision

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WARNING: Mature Content