Are You Concerned About the Morning Sickness Associated with Pregnancy?

Waking Up Morning Sickness M.O.…..Morning sickness is a common problem affecting many women during early pregnancy.  To try to help with the symptoms, most medical professionals will advise eating several small meals during the day, eating low fat, bland foods, and trying to avoid smells that seem to increase the nausea.  Over my many years in practice, I often also advised popcorn, the insides of Italian bread, and ginger pops.

…..If this conservative management does not help, there is a recent FDA (U.S. Food and Drug Administration) approved treatment that may be of help.  Diclegis is the first medicine approved for this problem in over 25 years.  This combination of two substances was marketed many years ago as Bendectin, and it was removed from the market after a safety scare that was proved to be a false alarm.  However, the manufacturer stopped producing it because defending it in court was too costly.

…..Diclegis is a combination of two active ingredients, doxylamine and vitamin B6, and the FDA has granted  Diclegis a Pregnancy Category A status, meaning that controlled studies have not shown an increased risk to an unborn baby during pregnancy.  For the past few years, the American College of Obstetricians and Gynecologists has recommended this combination as a first-line treatment for morning sickness.

…..There is a set protocol on how to start and use Diclegis.  Drowsiness and sleepiness are the most common adverse effects reported by users.  These symptoms can be severe, so great caution is necessary.  As with all medications, you must have a thorough discussion with your health care provider before entertaining the use of this or any medication.

-Dr. P

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Preterm Births – Information You Should Be Aware Of

Baby Looking UpWhen a pregnant woman “breaks her water” usually it is the start of an exciting time of her pregnancy because labor has started or is about to begin.  This is fine if the pregnancy is near the due date, but if the water breaks and the pregnancy is not near the due date, then there is a problem.  Preterm premature rupture of membranes (PPROM) is a bad problem and is a leading factor in premature births.

  • About 12% of births in the US are preterm
  • Most pregnancies last about 40 weeks
  • Babies born between 32 and 37 weeks are considered preterm, and babies born before 32 weeks are considered early preterm
  • About 5% of births in the US are complicated by PPROM

Since the most common outcome of PPROM is delivery of the baby within 1 week of the water breaking, information about this potential complication must be available to everyone.

-Dr. P

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Hysterectomies in This Day and Age

.Surgery….A hysterectomy is the surgical removal of the uterus.  There are many reasons to have this surgical procedure, and the decision to undergo a hysterectomy must never be made lightly.  Today, the decisions are becoming more complicated as the surgical techniques change and more options are available.

…..The first laparoscopic hysterectomy was performed about 25 years ago, and this changed gynecological surgery forever.  The instruments used were very basic, the technique was new, and acceptance was gradual.

…..In 2008, only about 20% of hysterectomies performed in the USA were being performed with a laparoscopic technique, but by 2012 the number had risen to about 40%.  This minimally invasive route includes the robotic and the conventional laparoscopic procedures.  The refinement of instruments and robotic technology continues the march to an even larger percentage of hysterectomies being performed by the minimally invasive approaches.

…..Remember, before undergoing any surgery, do your research into the indication for the surgery and the type of procedure.  Check into the surgeon’s experience and background, and always ask many questions before any decisions are made!

-Dr. P

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You May Experience This Common Complication of Early Pregnancy

…..I would like to begin a review of one of the most common complications of early pregnancy, vaginal bleeding.  This is the number one reason patients will have an emergency visit in the first trimester, and it is a cause of great anxiety to patients and theirYou May Experience This Common Complication of Early Pregnancy families.  There are a few important facts you should be aware of:

  • About 15% of recognized pregnancies will end in miscarriage
  • 80% of miscarriages occur in the first trimester
  • Trauma, smoking, excessive alcohol use, and advanced maternal age increase the risk of first trimester bleeding
  • 25% of pregnant women will report first trimester bleeding or spotting
  • 8% of pregnant women report heavy vaginal bleeding
  • Of the patients who report bleeding, 75% will have 1 episode, 20% will have 2 episodes, and 10% will have 3 or greater episodes
  • The amount of bleeding is the most significant predictor of an impending miscarriage
  • Again, advanced maternal age is a significant risk factor for first trimester bleeding and subsequent miscarriage; 50% of pregnancies in women over 40 result in a miscarriage, with abnormal chromosomes in the fetus being a primary factor
  • For women under the age of 35, the rate of a spontaneous miscarriage is 2%.

-Dr. P

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Why Should You Get a Flu Shot Each Year?

…..The influenza vaccine comes in two types:

  • Inactivated, or killed vaccine, which is given by injection with a needle
  • Live, or attenuated (weakened) vaccine, which is sprayed into the nostril

…..The influenza viruses are always changing, and so each year scientists try to determine which viruses are going to cause the flu that year. In other words, a new vaccine is put together each year to prevent the flu for that season. It is for this reason that an annual vaccination is recommended.  After a person receives the vaccine injection, it takes about two weeks for the protection to develop, and the protection lasts for about a year.

Why Should You Get a Flu Shot Each Year

…..Some inactivated influenza vaccines contain a preservative called thimerosal while some vaccines are thimerosal-free. This has been a concern for many, but it has been shown not to be harmful to a pregnant woman or her baby, according to the American College of Obstetrics and Gynecology.

…..The U.S. Department of Health and Human Services recommends that all people 6 months of age and older should get the flu vaccine. Vaccination is especially important for people at a higher risk of severe influenza, including their close contacts.  Some of these close contacts can be healthcare workers and children younger than 6 months.

…..You should get the vaccine as soon as it is available for the new season. Even though most influenza occurs from October through May, the flu season can occasionally come earlier, so get the protection as early as possible.

-Dr. P

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Is the Stress in Your Mind Causing Stress on Your Hair?

…..Continuing our discussion on hair loss in women….

…..Remember how our mothers always told us that stress could cause so many problems and make us feel terrible?  As always, our mothers were right.  For women, a severe illness, psychological stress, or having a baby are inciting stressful events that can cause physical effects.  One of these effects is hair loss.Hair Loss  Patch Blog Post 2

…..Usually 90% of our hair is in the growth phase, with 10% in the resting phase.  Keep in mind that some hairs are always shedding in the resting phase, and it is usually a small and regular amount.

…..Telogen Effluvium (TE) is a condition of diffuse hair loss that is caused by an identifiable stressful life situation; three of those situations were stated above.  In TE, 70% of hairs are in the growth phase and 30% in the resting phase.  This results in about 3 times as many resting phase hairs being shed daily.  The hair loss is gradual and diffuse and may be similar in appearance to the loss associated with the female patterned hair loss called androgenic alopecia (AGA).

…..With TE, a woman usually is aware of shedding, but with AGA, the loss is gradual, and shedding is not usually a complaint that is presented.  Also with TE, the loss may not become apparent for several months after the stressful event.

…..To treat TE, you must first identify and resolve the stress the body has been subjected to.  With pregnancy or an acute illness, the hair loss is usually self-limiting with complete recovery within 6 months after having the baby or recovering from the illness.  When TE is caused from psychological stress, since the treatment and recovery can take some time, the hair recovery can also involve a prolonged period.

-Dr. P

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Women: Your Most Common Cause of Hair Loss

…..More about hair loss in women…Women Your Most Common Cause of Hair Loss

…..The most common cause of hair loss in women is androgenetic alopecia (AGA), which is also known as female pattern hair loss.  This is a genetic disease that can be inherited on many genes, but it does not affect everyone who carries the genes.  By menopause, 40% of all women will be affected in some way.  It is identified as a gradual onset of diffuse hair loss.

…..The problem’s basis is the male hormone found in all women.  It attaches to sites on the hair follicles and affects the follicles that are genetically susceptible.  These follicles have a shortening of the growth phase, and the hair from these follicles are short and thinner than normal ones.

…..Again, hair loss in women is generally diffuse, and there is usually a preservation of the frontal hairline.  This is distinct from male pattern hair loss, with frontal peak and top loss.  AGA’s onset is usually gradual with no specific bare areas.  There does not appear to be an increase in shedding because the hair growth does not become less but is only affected.

…..At the medical exam, the scalp should be examined for redness, signs of infection, and scarring.  A family history should be taken to look for a similar condition in other family members.  Usually, there is not an endocrine cause for this problem, but if general hirsutism accompanies the finding, then a full hormonal investigation should be started.

…..The only FDA-approved treatment is the topically applied vasodilator called Minoxidil (Rogaine).  It comes in an over-the-counter preparation of 2% and 5% foam or liquid, which are all effective.  There seems to be better results with the 5%, but there may be an increased chance of local irritation.  How it specifically works is uncertain but there seems to be an increased growth phase, and the hairs grow longer and stronger.  Remember, the treatment is 2x per day and forever.  When you stop, the hair you gained will be lost.  Lastly, you may not see any results for 3-4 months, so patience is needed.

-Dr. P

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Unraveling the Urinary Tract Infection (UTI)

…..UTIIn my practice, urinary tract infections are among the most common problems that I see.  It is estimated that 60 to 70% of all women will experience a UTI in their lifetime and that half will have a first time infection by the time they are 35.

…..Most women know they have a “bladder infection” because of the symptoms they experience.  These symptoms include:

  • Pain with urination
  • Increased urgency to urinate, with many times passage of just a few drops of urine
  • Increased frequency of urination
  • Pain, pressure, and/or fullness in the lower abdomen

…..If the infection of the urinary tract system has risen above the bladder and into the kidney, the symptoms change.  The patient appears to be sicker with more severe symptoms, which include:

  • Tender flank pain over the area of the kidneys
  • Fever and chills
  • Nausea and vomiting

…..Although the diagnosis of a UTI is usually made by a patient’s complaints, dipstick urine tests are commonly used to help confirm the diagnosis.  These tests look for certain markers in the urine that point to a UTI.  Dipstick urine tests are not totally conclusive.

…..The standard to confirm a UTI is the urine culture and sensitivity test at the laboratory.  This test will diagnose the bacteria causing the infection, and it will also provide the susceptibility of the bacteria to certain antibiotics.  The disadvantage of this test is the cost and the 48 hours it takes to get back the information.

…..There are many risk factors in pre-menopausal women for a UTI.  A few of these are:

  • Frequent or recent sexual activity
  • Past history of a UTI
  • Increased number of vaginal deliveries
  • Obesity
  • Diabetes

-Dr. P

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Vitamin D – More Important Than You May Think!

…..This past year has seen the discovery of vitamin D deficiency in a large portion of our population.  In my office, we never measured the value before but now I speak about low vitamin D many times a day. Today you will be given some basic points, and over the next few blogs you will have a good understanding of the situation.

  • Vitamin D is important to maintain bone health.
  • Some studies have reported that being low on vitamin D can be related to heart problems, cancer, diabetes, and autoimmune disease.  However, few true clinical trials have been taken.
  • Too much vitamin D should be avoided because of possible harm and lack of beneficial evidence.
  • The best measurement for the deficiency is the value of 25(OH)D in the blood.  The supplementation of the vitamin should be given to reach a target 25(OH)D value.

…..This is a start of your vitamin D education!

Vitamin D Benefits

-Dr. P

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