woodstock ob gyn Archives

Adrian came to my office this morning for a GYN visit. She is one of hundreds of women who visit our office every year looking for relief from pelvic pain. Adrian’s story is also common. “Period pain is a normal part of being a woman,” Adrian’s mother told her when she reached adolescence and the pain first began. Adrian believed it. “I experienced intense monthly pain around her pelvic area throughout my teens. When I entered my twenties, I missed work for a day or two every month because the pain was so bad. I didn’t make a big deal about it because I truly believed my pain was “normal.” – Adrian Pelvic Pain is Not “Normal” Adrian recently visited Cherokee Women’s Health after moving to the area. Like most women, she had formed a bond with her former OB, and the switch was hard. But not every GYN focuses on treating pelvic pain, and Adrian’s OB had been no exception. Pelvic pain is a complicated condition which can arise not just from the reproductive organs, but from the urinary tract or bowel as well. A woman might have more than one condition, each with a different cause. Causes of Pelvic Pain Include: Describing Your Pain is Key To Successful Treatment Part of successful treatment is answering questions, which helps your GYN understand your health history: A history of sexual abuse can also lead to symptoms of pelvic pain, whether from actual physical damage or the emotional trauma. Tools For Diagnosing Pelvic Pain Potential Treatments for Pelvic Pain In Adrian’s case, I diagnosed a longtime history of endometriosis. She seemed genuinely surprised at the range of treatment options available for her, and chose to try birth control pills as a first step. This week Adrian returned for follow-up, happy to report that the “normal” pain she had lived with all her life was gone! Don’t Suffer with “Normal” Pelvic Pain If you’re experiencing pelvic pain, help is available. Call our office at 770.720.7733 or schedule an appointment online today.

OB Patient Stories

Miscarriage: A Father’s Grief

Diane /

A father’s grief after a miscarriage is often overlooked. Miscarriage and subsequent pregnancies often center on the emotions of the mother only: the grieving and anxiety of losing a baby, and the nerve-racking experience of becoming pregnant again with a “Rainbow Baby”. A rainbow baby is a baby born after a miscarriage, thus becoming the “rainbow after the storm.” Sharing Grief With the Husband and Learning To Live With Grief and Joy Fathers often feel they have to be “strong for the mother,” so they may put their grief on the back burner, all while silently suffering alone. But solitary grieving can take a toll on a marriage, especially during stressful times, like losing a baby. “Rainbow Mom” Mariah Foster and her husband lost their unborn daughter, Raelynn, late in Mariah’s pregnancy, from a cord accident. She shares their experience and the words of advice from their doctor, who told her to pay attention to how the experience affected not only her, but also her husband and their relationship as a married couple. “After I lost my daughter, Dr. Litrel asked to see us so he could see how we were doing. His advice was not to try to cover up our grief with antidepressants. He told us to go ahead and scream, yell, even be mad at God – but especially to learn how each other grieves.” Mom Mariah shares how she coped with the devastation of miscarriage Miscarriage is Hard on Men Too Mariah said Dr. Litrel told them that the father’s grief is often overlooked, and that he had seen couples divorce after losing a baby because neither understood how the other grieves. “He told me to pay attention to my husband during this time of being sad. He said it’s hard for the man, too – and they grieve in a different way from the woman. “That conversation opened our eyes. And honestly, the grieving process built on our communication and compromise skills.” Mariah shares that Dr. Litrel also advised them to ‘talk about our daughter and use her name’, telling us to take time to enjoy each other, so we could accept the loss better and go on with the marriage. He didn’t want us to lose what we had. He also didn’t want us to try to have another, but just to ‘let it happen’, so he did not prescribe birth control for me. Smiling at the baby beside her in the stroller, Mariah says, “Eleven months later we ended up having our wonderful Rainbow Baby, Cayson Charles. Cayson means ‘Healer’ in Gaelic,” she explains. Getting Pregnant Again is Scary Mariah comments that becoming pregnant after a miscarriage is not the purely joyful experience everyone assumes it will be. “You know, everyone’s excited when you’re pregnant with a rainbow baby, but it’s a lot harder. I was nervous. When I hit nine months and said, “I need to be induced!” I finally ended up having a C-section — and the most beautiful rainbow baby. “During the pregnancy, Dr. Litrel had us on a strict schedule of seeing doctors and also the specialist. By 29-30 weeks, we were going to the doctor every week. “Pregnancy with a Rainbow Baby is nerve-racking. You want to feel him every second of the day. When he’s not moving, you’re panicking.” “The scariest time was at one point, when I slipped and fell at work. I thought at that point I was going to lose him. Dr. Litrel and really, all the medical staff, did everything for us. “They gave me a Doppler (a hand-held monitor) so I could check on Cayson, and seeing him on the screen helped me so much with my anxiety. “Pregnancy with a rainbow baby is nerve-racking. You want to feel him every second of the day. When he’s not moving, you’re panicking. You lay on your left side, you drink ice water, you try all the tricks the doctors tell you. There were times I went to Northside Hospital and just said, ‘Hey, I just need you to do an ultrasound. I can’t find my baby on the Doppler.’ They were great and really supportive during the entire pregnancy.” The Grieving Process “Losing Raelynn was hard for my husband, and sometimes it still is. He’ll take a picture of Cayson, which is his way of grieving. He’ll say, ‘I want to be with him so much, because sometimes he fills that void.’ When Cayson was crawling at six months, my husband was excited to see him, and he’d say, ‘Wow, Raelynn, look what your little brother is doing!’ Mariah wipes away a tear. “It’s hard to explain how it feels because the grieving never stops. “We actually planted a tree for my daughter, and we watch it grow, and talk about it all the time. We got a bird feeder and all the birds come so we can feed them. It’s really sweet. Getting Support “The grievance counselors at Northside are really great and so supportive. On Facebook, there’s a group called Rainbows of Atlanta. When you’re having a hard time — when that anniversary comes up and it’s the week you lost your baby — you can get on that group and post at 4 a.m., and you know someone is going to comment. Someone will be there. It’s so rewarding to see women back each other up. They give advice, and they’re just there.” Mariah smiles and gives her rainbow baby Cayson (aka the Healer), a kiss. Her eyes glisten, but there is happiness there, too. After Miscarriage – Stories of Hope Reading stories of hope from others who have experienced what you’re going through can help you feel not so alone. Here, we share stories from patients who suffered from miscarriage and how they got through it. Sheila suffered many miscarriages so we sat down with her to get her story and learn what she had to overcome to eventually have three Rainbow Babies. Jamie shares her story of

Bleeding Education, Menopause and Hormone Therapy

PMS Explained

Diane /

PMS (premenstrual syndrome) affects most women at one time or another. In fact, it’s estimated that three out of four women suffer from PMS regularly. What is PMS? Premenstrual syndrome refers to a cluster of physical and emotional changes a woman undergoes during the two weeks before bleeding actually occurs. This time frame is referred to as the ‘luteal cycle’. At the onset of her period, symptoms usually disappear. What Are the Symptoms of PMS? Symptoms of PMS are numerous and may include any or all of the following: What Causes PMS? The exact cause has not been pinpointed, but lowering levels of the sex hormones, estrogen and progesterone are believed to be key factors. Serotonin, a neurotransmitter responsible for feelings of well-being and happiness, also drops. Though this is a natural process, and necessary to prepare the body for reproduction, the monthly depletion can cause a hormonal imbalance, wreaking havoc on women physically and emotionally. If you are experiencing extreme discomfort and PMS is negatively affecting you physically and psychologically, do not hesitate to see your doctor. What is Dysphoric Menstrual Syndrome? Most women have mild to moderate cases of PMS which can be annoying, or at most, uncomfortable. These symptoms cause little or no disruption in their daily routines, and usually does not warrant medical help. However, about 5% of women with PMS suffer from what is categorised as dysphoric menstrual syndrome (PMDD), which is a far more severe and negatively impacts their lives. These women require more aggressive psychological or medicinal intervention. The criteria to meet the diagnosis of PMDD is that the patient has at least five of the emotional symptoms mentioned above during their luteal cycle. The presence of these symptoms is usually more exaggerated. These are a few that we look for: Approximately another 20% meet the definition of ‘subthreshold’ PMDD, meaning that they may be monitored diligently to avoid full-blown PMDD. This particular disorder is classified as ‘menstrually related mood disorder’ (MRMD) and may also need some medicinal or psychological treatment. Like PMS, hormone dissipation during the menstrual cycle may be the underlying cause. Are There Any Tests That Accurately Diagnose PMS? There are no specific lab tests to diagnose premenstrual syndrome. Instead, we’ll need to study your medical history to establish if you are suffering from it. It is very important to be completely truthful so that we can help you. We know that some of these symptoms may be frightening to you, and perhaps, at times, embarrassing to discuss, but getting the full picture allows us to give you the best and most effective advice and care. Keeping a diary of your symptoms for a few months helps. Three of the main things we look for are: Even jotting down specific odd thoughts and ideas, levels of fatigue, etc., can be helpful. This allows us to properly determine which hormonal imbalance is affecting you more and enable us to deal with the more troublesome symptoms accordingly. Remember to list the dates as these symptoms occurred, and exactly when menstruation itself began and ended. Can PMS be Treated? Mild to moderate PMS can be fairly easily managed with a few lifestyle changes and over-the-counter pain relievers. Heating pads or warm baths may help with pain, and ice packs with headaches. Topical rubs and ointments can reduce inflammation and joint pain. You may be advised to limit or completely eliminate salt, alcohol, caffeine, sugar and any artificial sweeteners as they contribute to many sleep and anxiety issues. Other recommendations to help alleviate PMS symptoms are: Some herbs and supplements may counteract PMS symptoms, although some have not been studied fully so it’s always best to get these from a healthy diet instead. Before taking them, it is recommended that you speak to your physician. Though they may help, the medications you already take may interact with them and cause adverse, sometimes dangerous interactions. Here is a list of the vitamins, herbs and supplements and the symptoms they may alleviate: For more severe PMS, your doctor may prescribe one or more of the following: How Can Cherokee Women’s Health Specialists Help Me? Because we deal with women’s health issues daily, we are aware of the debilitating effects of PMS. We would never minimize the detrimental influence it can have on you and yours. We are here to offer counsel, diagnosis, empathy, and treatment, using all our expertise and knowledge of the most up-to-date information medical science has to offer. Our staff includes three doubly accredited urogynecologists with the outstanding certification in OB/GYN and Female Pelvic Medicine and Reconstructive Surgery (FPMRS). This qualifies us to diagnose and treat all your female-related problems. Additionally, our staff includes specialists in other fields related to a women’s unique needs. To book an appointment to further discuss your PMS symptoms, call 770.720.7733.

Well Woman

Lesser Known Menopause Symptoms

Diane /

You always knew menopause would happen. You may have even looked forward to getting rid of those bulky pads, contraceptive devices, and tampons you’ve been using. You expected some hot flashes and maybe a few cranky days, but assumed those probably wouldn’t be much worse than getting through a long summer heat wave and then it would be all over. What you possibly didn’t know is that there are countless other symptoms that science is constantly learning about regarding the menopausal process. If you’re between the ages of 40 and 65 — and in some cases even a bit younger — you may be suffering with those very symptoms right now. Your body begins to change several years before menopause actually takes place, during the period known as perimenopause. This is the time when periods start to become irregular, along with some other unwelcome physical and emotional developments that you never anticipated. Lesser Known Menopause Symptoms Menopause comes with many minor and major changes. Some women manage to get through the process with only a little discomfort. Others may be slammed with multiple symptoms, many of which occur gradually over time so that they may not even notice that they’re happening, or that one may be linked to the other. Most menopausal changes are caused by the decline of three hormones; estrogen, progesterone, and testosterone. Progesterone and estrogen, produced by the ovaries, not only prepare a woman for reproduction during her childbearing years, but they impact the rest of her body’s health, both physically and emotionally. During menopause, the adrenal glands continue to produce testosterone, but those levels also decrease with age. Some of the most common symptoms of menopause are: The following menopausal symptoms are not as common, but are also usually caused by the same hormonal shifts: Serious conditions due to hormonal changes during menopause include: How Cherokee Women’s Health Specialists Help? Many menopausal symptoms are of little concern and often correct themselves given time. Others can be easily remedied through diet, exercise, hormone therapy and/or other medications. However, all unusual symptoms that arise should always be assessed by a physician to rule out other causes. Our broad-based practice consists of three board-certified, doubly-accredited urogynecologists who hold certification in OB/GYN and Female Pelvic Medicine and Reconstructive Surgery (FPMRS). Our staff also includes obstetricians, gynecologists and experts in holistic medicine and diet, and other specialists who, combined, have decades of accumulated expertise in the unique field of women’s health care. Call 770.720.7733 or schedule an appointment online today. Help is available.

Nutrition and Weight Loss

Is Snacking Feeding Your Insulin Levels and Leaving You With the Weight?

Diane /

by James Haley, MD FACOG, FPMRS As a physician and fitness enthusiast, I’ve read a plethora of articles, books, and journals on weight loss. My patients continually tell me their struggles with dieting, lamenting that the weight always returns, usually along with a few extra pounds. Personally, I can relate. It’s not a dilemma exclusive to women. Men struggle, too. As you age, you just can’t eat like you used to—ven if you exercise regularly. After reading numerous books and trying different diets myself, I finally discovered an author who not only pinpoints the problem of obesity, but also the answer to those last ten pounds. In his book, ‘The Obesity Code’, Dr. Jason Fung, a nephrologist, states that the real culprit of weight gain isn’t overeating. It’s excessive insulin. He is emphatic that many of his patients would need less medical intervention if they lost weight. Since most of his patients are Type 2 Diabetics, a disease associated with too much insulin, he has been able to determine the common link – SNACKING. In the past few decades, the number of times we eat daily has increased. People have gone from eating three meals a day to about six, counting snacks. Go on, admit it. It’s what you do—what I’ve done. it’s a cycle, and it makes sense once you understand the reason why. Every time you eat, you stimulate insulin, keeping it at a constant high level. This fools the body into thinking it’s always hungry. Your body is constantly thinking you are hungry because your insulin stays in a high range. Obesity is a hormonal disease. Insulin, a hormone, tells you how much to eat and how much to burn. The body behaves as if the weight is set on a thermostat. So, obesity is not about caloric imbalance. Thus, it makes sense that the idea of cutting calories is totally wrong. You may not be obese. Maybe you have a few obstinate pounds that won’t melt—a jiggle around the middle resistant to diet and exercise. ‘Fat’, ‘plump’, ‘chubby’—whatever you call it, a surplus of insulin is causing it. The longer you have higher amounts of it, the more resistant your body becomes, which produces even more and causes that crazy, never-ending cycle. So what’s the solution? Avoid insulin-stimulating foods like sugar and refined grains. These are the enemy. Eliminate between-meal snacks. Designate mealtimes. Meal timing and insulin levels work together to regulate our weight. We need periods of time when we aren’t eating, so insulin can go down, leaving our bodies in energy burning mode. If we leave more time between meals…. we burn energy. And when we burn energy, we lose weight. To learn more about the other secret to regulating insulin for weight loss, read here.

OB, Preconception Counseling Education

What to Do Before Getting Pregnant

Diane /

You’re considering getting pregnant! Mentally, you’re beginning to commit to the idea, so one of the first few questions you might ask yourself is, “What can I do before getting pregnant? How can I be sure my baby will be healthy? Is there anything I can do ahead of time to make sure everything goes right?” While the physical part of creating new life is pretty simple to comprehend, but many women don’t actually consider that there are ways to prepare their bodies for reproduction well ahead of time. Even if you’re not ready to conceive right away, there’s lots you can do before getting pregnant, and most of it is pretty basic. When you leased your very first apartment, you wanted everything to be just right. Before you even moved in, you eagerly imagined how you would decorate it. You carefully selected the best furniture and matching accessories you could afford. You thought of where you would put your bed and bought food for the refrigerator and pantry. Everything was positioned just right for the new home you were to live in. When you get pregnant, your body is going to be your baby’s ’apartment’ for approximately the next 280 days. Your womb (uterus) will be its bedroom, the amniotic sac will be its bed and the umbilical cord will be its fridge and pantry. Why not prepare your body to give your child the best possible home until its first ‘lease’ is up? There are steps you can take to make that happen. Long before the actual union of sperm with egg, there are numerous measures you can take to optimally prepare your body. You can make gradual, positive lifestyle changes in the months preceding pregnancy. 6 Things to Prepare Your Body for Pregnancy: At Cherokee Women’s Health Specialists, we are committed to giving you the best possible preconception care available to women today in order to ensure the optimum health of both you and the baby you are planning to have. These are only several of the many things you can do before you decide to get pregnant. Our comprehensive staff includes Female Pelvic Medicine and Reconstructive Surgeons (FPMRS), urologists, nutritionists, OB/GYNs, physical therapists and midwives. Their combined decades of experience and expertise can guide you through the preconception process, pinpointing any problems that may inhibit or be detrimental to your pregnancy. Our team of specialists can correct any physical abnormalities that may be hindering the process as well. Your reproductive health and the wellness of your future baby is our primary concern. No question is too trivial or embarrassing and you will be treated with the utmost respect and confidentiality. To book an appointment, please call us at 770.720.7733 or schedule an appointment online.

What to Expect: The Third Trimester

Diane /

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

What to Expect: The Second Trimester

Diane /

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.

What to Expect: The First Trimester

Diane /

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.

Fecal Incontinence Education, Sexual Health

Low Libido in Women

Diane /

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.

Anterior and Posterior Repair Education, Pelvic Organ Prolapse Education, Pelvic Reconstruction Education, Urogynecology

What is Pelvic Prolapse?

Diane /

Pelvic organ prolapse (POP) refers to the sagging or drooping of any pelvic organs due to damage, trauma, childbirth or injury. The pelvic floor consists of a group of cradle-shaped muscles that hold pelvic organs in place. The pelvic organs include the uterus, bladder, cervix, vagina, rectum and intestines. Like any other part of the body, these muscles, with their surrounding tissues (fascia), can develop problems. If you fill a small plastic bag with grocery items, say for instance, a box of cereal, a few cans of vegetables, some jars and a package of rice —the bag should hold the items with no problem. But if you hang that full bag on a wall hook and leave it suspended, you’ll start to notice the items in it begin to bulge against the membrane of the bag as it takes on the shape of its contents. After a while, depending on how heavy the items are, the corner of the cereal box or rim of a can may start to bulge and even poke through as the bag stretches, weakens and eventually tears from the weight of the items in it. The groceries may even begin to protrude and dangle outside of the bag as the tears get larger. Pelvic prolapse happens much the same way. As the muscles and tissues holding the pelvic organs weaken, degrade or tear, the pelvic organs slip or drop through, sometimes forming a small hanging internal bulge. At other times, depending on the damage, they may actually dangle externally from the vagina or anus, causing problems and inhibiting their function. This is called prolapse. Who is at Risk for Pelvic Organ Prolapse? One in three women suffer from POP. Any activity that puts undue pressure on the abdomen can cause pelvic floor disorders. Typically, labor and childbirth are the leading causes of prolapse, especially when a woman has had several children, a long, difficult labor, or has given birth to a larger child.Pelvic organ prolapse becomes more common with age, usually around menopause when tissues damaged during a woman’s childbearing years begin to lose strength. Other causes are: What are the Symptoms of Pelvic Organ Prolapse? It is entirely possible not to have any symptoms at all. Sometimes pelvic organ prolapse is only discovered during a routine gynecological examination. Minor symptoms are a feeling of annoying pressure of the uterus or other pelvic organs against the vaginal wall, minimal malfunction of those organs, and mild discomfort. Other symptoms are: Symptoms may be aggravated by jumping, lifting or standing. Relief is usually found after lying down for a while. When Should You See Your Doctor? If you have increased sensations of pelvic pressure or pulling which is exacerbated by lifting or straining, but relieved when you lie down. Diagnosis At times, pelvic organ prolapse may be hard to diagnose, especially if a patient does not complain of any symptoms. Patients might be aware there’s a problem but cannot actually pinpoint its location. After asking questions regarding symptoms, medical history, past pregnancies, and other health problems, your doctor will perform a physical examination. Then, if organ prolapse is suspected or discovered, the following additional tests may be ordered: The doctor will then use a classification system to decide the organ prolapse level so he can best decide treatment options. Often, only simple non-invasive treatments and lifestyle changes are recommended for minor prolapse. If surgery is warranted, the following may be suggested: What Can You Do? Pelvic prolapse often sounds worse than it is. For many women, there are hardly any symptoms. For those who do suffer, there is help available, whether it is a simple lifestyle change, surgical repair, or reconstruction. If you have questions about your gynecological health or would like to consult with one of our pelvic reconstructive surgeons, please call 770.720.7733 or schedule an appointment online.

Well Woman

First Gynecology Appointment

Diane /

At Cherokee Women’s Health, we understand the nerves a woman may experience when making a gynecology appointment, even for a routine annual examination. Our goal is to make patients feel as comfortable and assured as we can, beginning with their first appointment. To help prepare for an appointment, here are some expectations and answers to commonly asked questions about our practice and a routine gynecology examination. Health History Honesty is important when disclosing one’s health history. Doctors need to be aware of the past, so they can accurately care for a patient. Usual topics covered in a health history will include any medications currently being taken; sexual history; past pregnancies, surgeries, or treatments; and a familial history of cancer and other diseases. Come with Questions Don’t hesitate to bring up any concerns, no matter how trivial they may seem. It is best to be straightforward about symptoms, in the event that additional procedures need to be scheduled. Don’t leave our office with any questions unanswered! There is no need to be self-conscious about asking questions or discussing symptoms because our doctors have years of experience in their field. They discuss these topics daily with their patients. What to Expect A routine appointment lasts about an hour. Several exams take place during the appointment including a pelvic exam and a breast exam. Patients should also be prepared to provide a urine sample to test for pregnancy, and to catch any abnormalities in the sample that may indicate disorders or infections. A pelvic examination is performed to ensure that both external and internal areas of the vagina are normal, including a pap smear which is used to test for cervical cancer. At a patient’s request, a culture can be ordered to screen for any sexually transmitted diseases. The pelvic exam can make patients uncomfortable, but it is important to relax during the process. Reproductive health is important! A breast exam is completed to check for any lumps or irregularities in breast tissue. Based on family history of breast cancer, and your age, you may be referred for a mammogram which will screen for breast cancer. An opportunity to ask questions is part of the appointment. Be proactive and mention anything that is concerning. Honesty is essential to providing the best personalized care to our patients.

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What to Expect: The First Trimester

Low Libido in Women

What is Pelvic Prolapse?

First Gynecology Appointment

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