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Vaginal Health: Bacterial Vaginosis

Bacterial vaginosis (BV) is a common gynecologic infection that impacts 1 in 3 women. Also known as vaginal bacteriosis, BV is the most common cause of vaginal infection for women of childbearing age.

Although it frequently develops after sexual intercourse with a new partner, BV is not considered a sexually transmitted infection (STI). A woman who has never had sexual intercourse can have it because an imbalance in vaginal bacteria can lead to bacterial vaginosis.

What are the Symptoms of BV?

Most women with BV have no symptoms. If symptoms occur, they include vaginal discharge, burning, and itching.

Vaginal discharge may:

  • Be watery and thin
  • Be gray or white in color
  • Have a strong and unpleasant smell, often described as fishy

Less commonly, there may be:      

  • A burning sensation during urination
  • Itching around the outside of the vagina

What Causes BV?

BV is caused by an imbalance of naturally occurring bacterial flora, the usual bacteria found in a woman's vagina. It should not be confused with candidiasis, a yeast infection, or Trichomonas vaginalis (T. vaginalis), or trichomoniasis, also known as trich. These are not caused by bacteria.

The Centers for Disease Control and Prevention (CDC) estimate that 29.2 percent of American women aged 14-49 experience BV, but 84 percent of them report no symptoms. Doctors say treatment is not required if a woman has BV but no symptoms. Sometimes BV can appear and disappear for no apparent reason.

We know that bacterial vaginosis is linked to an imbalance in the bacteria that are normally found in a female's vagina, but why this imbalance occurs is unclear. All parts of the body have bacteria, but some are beneficial while others are harmful. When there are too many harmful bacteria, problems can arise.

The vagina contains mostly "good" bacteria and some harmful bacteria. BV occurs when the harmful bacteria outgrow the good bacteria. A female's vagina should contain bacteria called lactobacilli. These bacteria produce lactic acid, making the vagina slightly acidic. This prevents other bacteria from growing there.

Lower levels of lactobacilli may cause the vagina to become less acidic. If the vagina is not as acidic as it should be, this can give other bacteria the chance to grow and thrive. However, exactly how these harmful bacteria are linked with BV is not known.

Any woman can develop BV, but some behaviors or activities can increase the risk.

These include:

  • Douching, or using water or a medicated solution to clean the vagina
  • Having a bath with antiseptic liquids
  • Having a new sex partner
  • Having multiple sex partners
  • Using perfumed bubble baths, vaginal deodorants, and some scented soaps
  • Smoking
  • Washing underwear with strong detergents

BV cannot be caught from toilet seats, bedding, swimming pools, or touching objects.

How is BV Diagnosed and Treated?

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Any woman with an abnormal vaginal discharge should see their doctor as soon as possible. A doctor can diagnose BV and rule out other infections, such as gonorrhea or trich.

If you have any questions or concerns about vaginal health, don't hesitate to talk to any of our doctors about it. We are here to help!

 

Bone Up on Osteoporosis

As you get older, your doctor may talk to you about osteoporosis, a disease that occurs when the creation of new bone doesn’t keep up with the body’s removal of old bone, resulting in bones becoming fragile and brittle. Osteoporosis affects mostly older women, but prevention starts when you are younger.

No matter your age, you can take steps to build bone mass and prevent bone loss. One of the best ways to prevent weak bones is to work on building strong ones. Building strong bones during childhood and the teen years is important to help prevent osteoporosis later.

As you get older, your bones don't make new bone fast enough to keep up with the bone loss. After menopause, bone loss happens even more quickly, but you can take steps to slow the natural bone loss with aging and to prevent your bones from becoming weak and brittle.

  • Get enough calcium and vitamin D each day.
  • Get active. Choose weight-bearing physical activities like running or dancing to build and strengthen your bones.
  • Don't smoke. Smoking raises your risk for broken bones.
  • If you drink alcohol, drink in moderation (for women, this is one drink a day at most). Too much alcohol can harm your bones. Also, too much at one time or mixed with certain medicines can affect your balance and lead to falls.
  • Talk to your doctor about whether you need medicine to prevent bone loss.
  •  Most people with osteoporosis don’t experience any symptoms. Bones can deteriorate without any pain or weakness. Some people may only find out they have osteoporosis after they break a bone.

There are many good treatments now available to prevent the risk of fractures and even to help reverse osteoporosis. In addition to calcium and vitamin D, there are prescription medicines that can treat osteoporosis effectively. The most common class of medicines used to treat osteoporosis is called bisphosphonates. Your doctor will recommend the one that is best for you.

If you have any questions about what you should be doing to prevent or treat osteoporosis, ask any of our doctors at your next appointment. We have the information you need.

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Breast Cancer Awareness What do You Need to Know?

Most women may know the basics, but they may not know how to ensure they’re in good hands during screening or after diagnosis. The following facts can help you determine your risk factors and know what you can be doing to diminish your chance at a breast cancer diagnosis.

Are you at risk?

Breast cancer isn’t just one kind of cancer; it is many different types. Knowing that it is ductal or lobular carcinoma is no longer enough.

Within its cell structure are many specific features informing scientists that breast cancer is made up of hundreds of different types. This also helps scientists better understand why it has been so hard to cure and prevent.

Know your risk factors.

  • Family history of breast or ovarian cancer
  • Taking Hormone Replacement Therapy (HRT)
  • Drinking alcohol
  • Smoking
  • Obesity
  • Having atypical cells on a breast biopsy

Don’t have any risk factors? Well, being female is technically a risk factor, however 85% of women diagnosed don’t have the risk factors listed above. 1in 8 women will be diagnosed with breast cancer by the age of 85.

Know the geography of your breasts.

You should know your breasts better than anyone. Even though they may be lumpy and bumpy, those lumps and bumps are “your normal,” and you should be checking your breasts monthly, at the same time of the month, to see if there is any change.

Take an active role in reducing your risk.

Follow a healthy lifestyle with regular exercise, maintaining a normal weight, avoiding smoking, limiting alcohol, and adhering to a healthy, well-balanced diet that’s rich in green and orange veggies.

Facing a diagnosis.

An accurate diagnosis leads to the right treatment plan. Make sure the pathologist reading the breast biopsy specimen slides as well as the pathology slides from breast surgery specializes in breast cancer. If the pathology is wrong then the treatment will also be wrong.

Survival and beyond.

The goals of treatment today should no longer be limited to just survival. Women deserve to also have their life goals preserved—fertility preservation, staying on track for the next promotion, becoming a professional musician. If the treatment team doesn’t know what these life goals are, treatments given to the patient may cause her to forfeit these life goals. 

Women need to speak up, and make their doctors aware of what their life goals are. They should request that they be factored into the decision making about treatment options. Women should only give breast cancer the time it requires to get rid of it. It doesn’t deserve to take away her social time, personal time, work time, or family time.

There is some good news in all of this. More women with metastatic disease are living longer—even decades—thanks to improvements in treatments.

Talk to any of our expert doctors at WHASN about your risk factors and what screenings or tests are right for you. We are here for all of your gynecological and obstetric needs.

 

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Pickles and Ice Cream! What Causes Food Cravings During Pregnancy

Food cravings are a well-known and common companion of pregnancy. As a matter of fact, somewhere between 60 to 80% of moms-to-be say they have a distinct urge for certain foods while expecting. Why is this? What causes pregnant women to yearn for pickles and ice cream or be overcome by the immediate need for a tuna fish sandwich?

We don’t know exactly what causes food cravings during pregnancy. They may be related to all the hormones that are active in pregnancy. These hormones can make your sense of smell stronger, which can affect your sense of taste and make you want certain foods.

There haven't been many rigorous studies focusing on cravings, but some researchers have discovered interesting trends when it comes to pregnant women and food preferences. Nutrition scientists at the University of Connecticut found that, depending on the trimester of pregnancy, moms taste certain flavors more intensely and either prefer or dislike them.

In the first trimester, for example, moms in their study found bitter tastes especially potent and aversive. Evolution likely shaped a mom’s perception of bitter flavors this way, so that she would be leery of strong-tasting plants or spoiled foods, which are more likely to contain a toxin that could hurt the baby. Early on, this could be why some moms who formerly love such treats turn up their noses at coffee, alcohol, or spicy foods. As pregnancy progresses (and the baby’s critical organ formation completes), moms tend not to feel sick at the thought or smell of pungent foods anymore.

It’s usually okay to satisfy your food cravings, as long as what you eat is safe and you don’t eat too much of it. Eating too much of what you crave—especially sweet, spicy or salty foods—can cause problems, such as heartburn or gaining too much weight.  You only need 300 extra calories a day during pregnancy to support your baby’s growth, so grabbing fast food or snacking on chips every day to satisfy a craving may put you over the calorie count.

Here are some ways to help curb your food craving:

  • Work your cravings into your everyday eating. Add salsa or relish to your meal for a bit of spice. Add sweetness with citrus fruits, melon and juices.
  • Find healthier options. Instead of regular potato chips, try the reduced-fat kind. If you’re looking for something crunchy, go for carrots or a crisp apple. Try fresh fruit to satisfy your sweet tooth.
  • Don’t buy in bulk. When you can, buy single-servings of foods you crave. Don’t buy a whole bag of chocolate candy. Just buy one or two pieces.
  • Plan your snacks. Knowing what and when you’re going to eat between meals gives you something to look forward to.
  • Distract yourself. Do something to take your mind off your craving. Go for a walk. Call a friend.

Some pregnant women crave things that aren’t food. This kind of eating problem is called pica. Eating nonfoods during pregnancy can cause problems for you and your baby. If you’re filling up on nonfoods, they may not be safe, and they may make you feel full, which could keep you from eating healthier foods.

Nonfoods include:

  • Ice
  • Clay
  • Laundry starch
  • Wax
  • Coffee grounds
  • Dirt

If you crave nonfoods, tell your health care provider.

The bottom line is that, although we have some interesting ideas as to what might be causing the specific cravings of pregnancy, we still don’t really know.  More research is needed. If you have any questions or concerns about food cravings or aversions during your pregnancy, talk to your doctor about it at your next appointment or call us to schedule a conversation.

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Uterine Fibroids: Seek Treatment as Soon as Symptoms Begin

You may be surprised to learn that 8 in 10 women will develop uterine fibroids by the age of 50.  Uterine fibroids are common, non-cancerous growths of the uterine muscle consisting of smooth muscle cells and connective tissue. A woman may have one fibroid or groups of several fibroids, and they can range in size from less than 1 inch to more than 8 inches across. For some women, fibroids will go undetected and not cause any symptoms or trouble. But at least 25 percent of women with fibroids will experience a broad range of symptoms from mild to very severe, and will require treatment.

Here are key findings from a survey published in the American Journal of Obstetrics and Gynecology and the Journal of Women’s Health:

  • Women with fibroid symptoms often wait many years before seeking treatment or diagnosis from a health care provider.
  • African American women are disproportionately affected by fibroids, have more severe symptoms, wait even longer to seek a diagnosis, and have a greater need for information.
  • Most women reported fears associated with their fibroids, including being afraid that they will grow (79 percent), as well as fears regarding relationships, sexual function, body image, loss of control, and hopelessness.
  • Two-thirds (66 percent) of women were concerned about missed days from work due to their symptoms, and 24 percent of employed respondents felt that their symptoms prevented them from reaching their career potential.
  • Women strongly prefer treatment options that are not invasive and can protect fertility.

Women experiencing fibroid symptoms have many treatment options available to them. Speak to a health care provider as soon as possible about symptoms. Fibroid symptoms include:

  • heavy, prolonged or erratic menstrual bleeding
  • menstrual pain or cramping
  • passing blood clots
  • bloating
  • abdominal enlargement
  • constipation
  • urinary frequency or difficulty urinating
  • infertility
  • painful intercourse
  • chronic watery discharge
  • Fatigue

A delay in diagnosis can limit the effectiveness of treatment options available (due to unnecessary growth of fibroids, for example). The earlier one gets a diagnosis of fibroids, the more treatment options available, enabling one to choose a treatment based on health, lifestyle and professional needs, and family preferences.

Treatment options include:

  • Watchful waiting - recommended when fibroids are not currently causing any symptoms.
  • Hormonal therapy - involves the use of birth control pills or other hormones to shrink fibroids or control fibroid related bleeding.
  • Non-hormonal therapies - includes a class of drugs called “antifibrinolytics” recently adopted in the United States to decrease heavy bleeding.
  • Focused ultrasound - a newer, noninvasive, no-incision technology that uses waves of ultrasound energy to heat and destroy fibroid tissue.
  • Uterine fibroid embolization (UFE) - involves surgery to block the uterine artery with small particles to decrease blood supply to fibroids.
  • Myomectomy procedures – can be either hysteroscopic, laparoscopic, abdominal, or robotic – involve surgical removal of fibroids from the uterus.
  • Hysterectomy (including laparoscopic, vaginal, abdominal or robotic) involves removing the uterus entirely, eliminating any possibility of fibroid recurrence.

If you suspect you have fibroids, make an appointment with one of our doctors and begin learning about treatment options. The closer you are to the onset of your symptoms, the more likely it is that you will have a range of treatment options available to you for symptom relief and better quality of

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The Skinny on Eating for Two

Most women are aware that diet affects a baby's development in utero, but many pregnant women still make eating errors--mainly because they don't know any better. Even women who try to eat nutritious foods get caught up in the idea that pregnancy is the time for indulgence. After all, haven't we heard that moms-to-be are "eating for two" our whole lives? Unfortunately, this dangerous myth can not only make it harder to lose the excess weight after delivery, but it also puts one at increased risk for gestational diabetes and high blood pressure. The myth of “eating for two" endures partly because it kind of makes sense, but mainly because it is so appealing. Here's the truth:

  • During your first trimester, you don't need any additional calories.
  • In the second trimester, you need 340 more calories/day.
  • In the third, you need 450 more calories/day.
  • The U.S. Department of Agriculture recommends that pregnant women consume 71 grams of protein per day.
  • The number of extra calories you require is small compared with the amount of extra nutrients recommended, so get your additional calories from high-nutrient foods: fruits, vegetables, nuts, beans, legumes, low-fat dairy products, and lean meats. All of these give you lots of nutritional bang for your calorie buck.

While some women take in too many calories, others consume too few because they are terrified of gaining weight and scared it won't come off afterward, so they restrict their diets. This is a big mistake. For example, if you don't get 1,000 milligrams of calcium daily, the baby's skeleton will be built with calcium leached from your bones.

Don't deprive yourself of necessary nutrients during pregnancy, as your fetus will not get what it needs for healthy growth and development. If you are obese, consult a dietitian who specializes in pregnancy nutrition to determine the proper prenatal diet for you.

Here are some tips for maximizing nutrition during pregnancy:

  • Eat a variety of foods to meet your daily needs for protein, calories, carbohydrates, healthy fats, and key vitamins and minerals during pregnancy.
  • Try to minimize "extra" foods that have calories but few nutrients – sugary beverages, fried foods, foods with extra fat and sugar. Instead, choose meals and snacks that pack the most nutrition per calorie. Adding a few nutrition-packed snacks – like yogurt, nuts, a hard-boiled egg, some fresh fruits or vegetables – to your daily intake is a great way to get the healthy calories your baby needs.
  • Choose foods that are as close to their natural state as possible. Pick whole-grain bread or brown rice over refined white bread or white rice, and fresh fruits or frozen unsweetened fruit over canned fruits in sugar syrup, for example.
  • Eat fats, oils, and sweets sparingly. Be sure to choose healthy fats like those found in avocados, nuts, and olive oil.

If you have any diet or nutrition questions during your pregnancy, be sure to address them with your doctor at your next appointment. We are here to help!

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Exercising while Pregnant

Society often depicts pregnancy as a time of binge eating and unrestrained weight gain, but practicing healthy habits during these nine months is not only possible, but highly recommended. Of course, with a baby on board, your exercise regimen will change from what you are used to.

The American College of Obstetricians and Gynecologists and the National Institutes of Health (NIH) say almost all women can and should be physically active during pregnancy, recommending that pregnant women get about 30 minutes of moderate exercise most days of the week. The NIH reports that exercising during pregnancy helps reduce pregnancy discomfort, lowers the risks of gestational diabetes, improves sleep, improves mood, helps with an easier labor, and helps provide a faster recovery after delivery.

Here are some tips to keep in mind when it comes to exercising through pregnancy:

  • Research has shown that the mothers of infants who exercise generally have more desirable/healthy body composition. In other words, if you keep up an exercise routine throughout pregnancy, you will have an easier time going back to your pre-pregnancy weight once the baby arrives.
  • Stay well hydrated while exercising; stop exercising if you feel exhausted or overheated or if you feel dizzy.
  • Keep the weather in mind, and if it’s hot outside, avoid exercising in the heat, so you don’t become overheated.
  • For many active women, there is no reason to dramatically cut back on exercise during pregnancy. Most women can maintain the program and routine that they are accustomed to doing.
  • Listen to the body, and it will guide you. If you’ve never exercised, then you should take it easy on starting a plan, but if you’re an avid exerciser or athlete, keep pushing on with some minor modifications.

If you have any questions or concerns about exercise and how to have the healthiest pregnancy, talk to any of our doctors at your next appointment. All women and all pregnancies are different. We can help you figure out the best options for your unique situation.

Pregnancy-induced Hypertension AKA Preeclampsia

Preeclampsia is a condition that may occur during pregnancy, especially in the third trimester, when a woman is having a baby for the first time or the first time with a new partner. This condition can be hard to detect, and can lead to serious complications for the mother or her baby.

If you are pregnant it is important to know the warning signs of preeclampsia. Unfortunately, women are frequently not aware of which symptoms can be signs of potential danger. According to the Preeclampsia Foundation, these symptoms, many of which may be mistaken for normal pregnancy aches and pains, are what to look out for:

  • No symptoms. Some women have elevated blood pressure but have no clues to know it is present. You can’t usually feel that your blood pressure is up.
  • High blood pressure.  It’s usually 140/90 or greater, and can be an early indicator that preeclampsia is developing.
  • Protein in your urine. In preeclampsia your kidneys don’t work properly and protein normally protected by the kidneys leaks out into urine.
  • Swelling. Some swelling in pregnancy is normal, but when you notice that your swelling is excessive, such as around your face or your hands, this can be a sign of trouble.
  • Sudden weight gain. Weight gain of several pounds in just a few days can indicate that your blood vessels are allowing extra fluid to leak into your body’s tissues. Sometimes having extra salt in your diet makes this worse. Drinking more water can make it better.
  • Nausea or vomiting. This is significant when it comes on quickly, especially in the last 3 months of pregnancy. Most “morning sickness” goes away after the first trimester of pregnancy.
  • Abdominal or shoulder pain. This pain is usually found in your upper right quadrant of the abdomen where the liver is located.  It can be a sign of the HELLP syndrome, which is a severe form of preeclampsia with anemia, damage to the liver, and increased bleeding. Sometimes the pain can be felt in your back.
  • Headaches.  Dull or severe, throbbing headaches that don’t go away can be due to high blood pressure.
  • Change in vision.  Vision changes are among the most serious signs of preeclampsia. There can be blurred or double vision, flashing lights or spots. This indicates danger to you and your baby. If you have this, you should seek medical care right away.
  • Hyperreflexia, racing pulse, mental confusion, anxiety, shortness of breath, sense of impending doom. These symptoms may indicate a worsening of preeclampsia and that delivery may be needed soon, even if the baby is premature.

Sometimes preeclampsia may get worse in the 1-2 weeks after delivery. While we often hear that birth is the cure for preeclampsia, in some cases the symptoms may get worse when the patient is at home with her new baby. She may have headaches, swelling, and other changes that show her blood pressure has become worse instead of better. If you are experiencing any of the above symptoms after you have delivered, you must contact your physician about it so that your status can be evaluated and appropriate treatment can be given.

Prenatal care at our practice always includes watching closely for this potentially deadly condition. Talk to your doctor at your next appointment if you have any questions or concerns about preeclampsia or any other pregnancy-related conditions.

Robotic Surgery for Gynecological Problems

The field of robotic surgery has developed rapidly, and its use for gynecologic conditions has grown exponentially. What does this mean for a patient? Do you imagine an independent machine, maybe looking like C3PO from Star Wars or something? Well, the robot does look futuristic, but it is completely controlled by your surgeon, giving him or her more dexterity than the human hand and wrist. Here's what you can really expect if you're a candidate for this cutting edge technology. 

The current robotic surgical system consists of 3 components:   

  • A surgeon's console
  • A patient-side cart with four robotic arms 
  • A high-definition three-dimensional (3D) vision system.  

During robotic surgery, the primary surgeon sits at the console, using finger graspers to control the instruments. Foot pedals and a clutch are used for camera control, activation of energy sources, focusing, and switching the robotic arm. Four to five trocars are used, including one through which a 12-mm or 8-mm three-dimensional endoscope is placed. Instruments are passed through three to four ports, three of which can be controlled by the robotic arms. One additional arm, not controlled by the robot, may be placed as an “assistant” port. Assistant surgical team members pass robotic instruments and sutures through these ports for use by the primary surgeon. These ports also provide suction, irrigation, and countertraction. Instruments for suturing, clamping, endosurgery are also a part of this. The console provides three-dimensional imaging with improved depth perception, and the surgeon has autonomous control of the camera and instruments. Finally, the robotic arm, with its wristed joint and six degrees of freedom, allows for greater dexterity than unassisted surgery and decreases normal hand tremors. 

Robotics have also been found to give an edge in more complex surgeries. The conversion rate to open surgery is lesser with robotic assistance when compared to laparoscopy. For myomectomy surgery, endo wrist movement of robotic instrument allows better and precise suturing than conventional straight stick laparoscopy. The robotic platform is a logical step forward to laparoscopy and has become popular among gynecological surgeons world over. 

If you've been told you need gynecological surgery, our doctors have experience and expertise. Contact us for a consultation.