Insurance changes, high deductibles, and faulty marketplace applicability are just a few of the burdensome changes invoked as a result of the ACA. Despite the many changes we’re sure to see in our insurance plans, keep in mind that many of the currently available preventive health screenings not only will continue to be available, but importantly, will be covered at no cost to you (no deductible and no co-pay,) by the ACA mandates. Annual Pap smear screenings, mammograms, contraception, and vaccinations will be covered by most insurance plans as a “No-fee Preventative benefit”, even if you participate in a high deductible plan.
Whether you find yourself needing to purchase insurance on the marketplace, or not, it’s possible that you may find changes in your current insurance coverage, such as the institution of higher deductibles. Studies show that participants of high deductible plans are less likely to utilize health services, even those services that are covered at ‘no cost’.
Hi all, I wanted to discuss something that plagues a lot of women with pelvic pain, and that is endometriosis. Many of you know what that is. For those of you that are not familiar with it, please referred to previous post on this blog.
Traditionally, endometriosis is diagnosed via laparoscopic surgery. We can see the active lesions and cauterize them. Once the lesions are cauterized the pain will improve. It is well known that these lesions typically have a dark brown or "chocolate" color appearance. However, it is now agreed that these lesions have a wide range of colors depending how active they are. Some of these are clear which is difficult to see with traditional laparoscopy.
I'm hearing of women losing weight with the HCG injections, and I decided to look into it. While Dr. Sheri Emma, Creator of the Dr. Emma's HCG Protocol claims that this 'crash' diet allows you to loose weight while maintaining muscle, other researcher have shown the HCG injections to be no more beneficial than saline-water/placebo injections for weight loss. The HCG diet plan usually involves severe calorie restriction (500-1500 cal/day), and it's this significant caloric reduction that's likely responsible for the weight loss, rather than the HCG injections themselves. Dr. Emma quotes, "Remember, HCG does not make you loose weight - the diet makes you loose weight!"
Keep in mind, the safest and most healthy way to loose weight is still by moderate calorie restriction & Exercise! :)
Suzanne Hall, MD
Eastside Gynecology Obstetrics
Our busy lives as working women, mothers, wives, girlfriends, sisters, daughters and friends leave little time for ourselves. I'm trying to learn the importance of "Me Time", of which I'm learning to equate with a "balanced" life. I love being a "giver", but we can't forget to take time for ourselves, to rejuvenate and rest.
Check out my guest post on WhattoExpect.com on finding my "Me Time"...
Suzanne Hall, MD
In modern obstetrics, there is a growing trend in expecting mothers’ request for ‘elective’ Cesarean section (‘Cesarean Section on Maternal Request’.) This ‘elective’ cesarean delivery, is a maternal request for Cesarean section delivery, in the absence of any maternal or fetal need (nor medical indication) for Cesarean section birth. (This particular ‘request’ for Cesarean section refers to a maternal request for a first-time Cesarean delivery… not a request for a repeat Cesarean birth, as in the case of a mother with previous Cesarean Section deliveries.) In the U.S. 2.5% of births are performed by Cesarean section for this request. In my experience, concern and anxiety regarding pain in labor seem to represent the most common reason for this request.
When is the right time to start ‘the talk’ with teens about sex-related issues…how to say No -or- how to protect themselves against pregnancy and STDs if they are, or considering, sexual activity? Some studies do suggest that parents may underestimate their teen’s sexually activity. According to the CDC, among U.S. high school students surveyed in 2011, 47.4% have already had sexual intercourse.
As the health providers in our practice, we want to provide health guidance regarding responsible sexual behaviors, for both teens who are and who are not sexually active. We’ve developed a new campaign in our office to encourage health habits for teens, called “i-ProMiss Health.” Our teen patients will receive a personal wallet-sized card –a ‘personal health promise contract’-to sign (and keep with them) after considering their own personal decisions regarding the health related issues of abstinence, condom use, healthy eating and exercise. The personal wallet card will be accompanied by an “i-ProMiss Health” rubber band bracelet as a personal reminder token.
Hopefully our teens (and parents) appreciate it!
In the recent several years, public health initiatives have been underway to increase public awareness of the prevalence of the HPV (Human Papilloma Virus) among the sexually active population, it’s health consequences of genital warts and cervical cancer, and the recommendations for Gardasil, one the available vaccines effective in the prevention of HPV. How much do you know/understand about HPV?
Test your knowledge of HPV here, with this simple quiz:
1. Of sexually transmitted infections, the most common is:
- – HPV (the Human Papilloma Virus)
- – HSV (the Herpes Simplex Virus)
- – HIV (Human Immunodeficiency Virus)
2. The HPV virus is spread by:
- Genital contact, most commonly through sex
- Oral-genital contact
- Straight and same-sex partners
- All of the above
3. The HPV is the cause of most cases of both genital warts, and cervical cancer?
4. The majority of cases of HPV infection cause no (visible) signs of infection at all, and are cleared by our body’s own immune system?
5. The HPV is a ‘newly’ discovered virus, linked with genital warts and cervical cancer?
6. The HPV vaccines are more than 90% effective in preventing genital warts and cervical cancer in femalefemafemifemales vaccinated before their sexual debut?
(See next page for answers...)
Have you had embarrassing episodes of leaking urine? This is actually not uncommon for women. I’d like to simplify the explanation of the 2 most common reasons for urinary incontinence. We’ll start first with the anatomy…
Imagine the bladder as a ‘balloon’ that holds our urine, located centrally just above the mid pubic bone. (It actually dwells right on top of the lower uterus.) This balloon has a short ‘straw’ that empties it (the urethra.) The urethra exits the bladder at about a 45 degree angle, in a ‘locked’ angle disallowing urine’s unexpected release. For urination to actually occur, a complex neurologic system connects the brain’s signal (which we mentally initiate) to the bladder to ‘command’ urination, with the bladder’s function of ‘contracingt’ to empty the urine, and the urethra ‘relaxing’, to allow the urine to actually release.
Have you avoided having a mammogram due to fear of ‘pain’ from the testing? This question came up on a recent vacation, while chatting with some of my (non-medical) girlfriends. They related knowing women who’ve avoided having a mammogram because of concerns of the mammogram being too painful. They suggested I write a post about it.
Having ordered many mammograms for women over the years (and having experienced a few myself), though the occasional woman may relate ‘pain’ with the mammogram, most women do not describe the test as “painful”. Uncomfortable and scary…yes. But then again, pain is a subjective matter. In a recent study polling 200 women on their level of pain with a mammogram, 72% rated the “pain” as that equal to a ‘tight fitting shoe’, or a ‘mild headache’. Which of us hasn’t pushed on through their day with a tight fitting shoe, or a mild headache?
Our breasts tend to be more full and tender the week before our menstrual period. If you’re concerned about pain with the mammogram, I’d suggest scheduling the test just after your menstrual period, and not the week or so before your period. Caffeine can cause breast pain as well, so avoiding caffeinated beverages the week or so before the mammogram may also help. An over-the-counter pain reliever taken prior to the mammogram is an option as well.
Apprehension about having a mammogram is understandable. Our breast on a metal plate, with a second plate coming down to compress it…is scary. But, in my opinion, not scarier than the possibility of a missed diagnosis of breast cancer.
Speak with your healthcare provider about scheduling your mammogram, as well as ways to make the testing more comfortable.
Suzanne Hall, MD (@drsuzyyhall)
Eastside Gynecology Obstetrics, PC
Offices in Roseville, Grosse Pointe, Macomb, Rochester, MI
Understandably, for many persons, a new diagnosis of genital herpes may lead to feelings of shock, shame, guilt or embarrassment. Often times, patients are unaware of how common this virus is among the general population. Some studies have shown up to 1 in 5 of sexually active people have been infected with the Herpes virus, whether they’re aware of it or not.
Genital herpes is a treatable condition. Aside from being sexually transmitted, much of the negative stigma around this infection seems to come from the fact that you don’t ‘get rid of’ it, and that recurrences can happen. Herpes is a viral infection (like HPV,) and though the symptoms (a cold sore in the case of oral herpes, or a genital sore in the case of genital herpes) can be treated, the virus itself remains present in our blood stream indefinitely. Even in its dormant state (no symptoms present,) the virus remains detectable by blood test, and can lead to partner-to-partner spread of infection (from asymptomatic shedding of the virus) when no detectable ‘sore’ is present. Gonorrhea and chlamydia, different from the Herpes virus and HPV, are bacteria or bacterial-like infections that are cured with treatment, with no detectable bacteria remaining after adequate therapy (unless the individual is ‘re-infected’.)
Though a diagnosis of genital herpes can be an embarrassing nuisance, it’s actually a newborn baby who’s at the most serious risks from a genital herpes infection. A newborn baby infected with genital herpes is at risk for multi-organ infection, that can be fatal if left untreated. If you are pregnant, with a known history of genital herpes, it’s important to let your healthcare providers know that information. Certain measures (anti-viral medications in the last month of your pregnancy, and performing a Cesarean section if active lesions are present at the time of labor) should be taken, to decrease the risk of spread of infection to your newborn baby.
Is this Depression or PMS? According to ACOG, "Depression and anxiety disorders are the most common conditions that overlap with PMS. About one half of women seeking treatment for PMS have one of these disorders. The symptoms of depression and anxiety are much like the emotional symptoms of PMS. Women with depression, however, often have symptoms that are present all month long. These symptoms may worsen before or during their periods. Your health care provider will want to find out whether you have one of these conditions if you are having PMS symptoms." (posted 7/9/13 by @drsuzyyhall)
Breast/Nipple Discharge? Though most cases of nipple discharge (especially occurring with stimulation or expression of the breast) are benign (non-cancerous), an evaluation/exam by your doctor is usually warranted. (posted 5/28/13 by @drsuzyyhall)
Low Libido? Studies have shown Testosterone supplementation to be effective in treating low libido in menopausal women. While Estrogen Therapy may not directly effect libido, it does promote increased vaginal lubrication, improving vaginal pain with sex. Testosterone supplements are not approved by the FDA for treatment in women. Speak with your healthcare provider regarding safety concerns. (posted 4/3/13 by @drsuzyyhall.)
A natural birthing experience is desired by many expecting mothers…But what does ‘Natural Birth’ really mean? For some women it means a vaginal birth with little or no medical interventions, for some it means a vaginal birth without pain medications (or without an epidural), for others it may mean any accomplished vaginal birth, and not a cesarean section.
Nearly a third of babies in this country are delivered by cesarean section. The more recent adoption of early skin-to-skin contact and intraoperative breastfeeding, not only benefit maternal-infant bonding, but also benefits the baby in terms of earlier success with breastfeeding. It simulates a more ‘natural birthing’ experience, preventing the feeling of ‘disconnect’ for the parents of cesarean section babies, while separated from their baby in the operating suite.
As a practicing Ob/Gyn, I hold no strict or definite definition of ‘Natural Birth’. I allow the patient to decide and define whatever ‘Natural Birth’ means to them.
Suzanne Hall, MD (@drsuzyyhall)
In discussing the concerns of Menopausal Hormone Therapy (MHT) with patients in the office, it’s evident that ‘the fear’ of developing breast cancer from hormone use, by far outweighs the benefits of use, for many women. With breast cancer being the number one cancer diagnosed among US women, and the second leading cause of cancer-related deaths (second to lung cancer,) those concerns are certainly understandable.
Though concern for an association of breast cancer from hormone use have perplexed patients and the medical community for many years, in the last 10 years, that level of concern has escalated to nearly a level of fear. Despite some public perception of hormones as the cause of breast cancer, the medical evidence does not support hormones as a cause for breast cancer. Unlike the causal link between smoking and most cases of lung cancer, a causal link between hormone use and breast cancer has not been established. In fact, the cause of breast cancer is still unknown.
Expecting and new mothers are faced with many decisions in preparation for the care of their newborn baby, the decision to breastfeed, being among one of the most important ones. We’ve all heard the advice of family and friends that “breastfeeding is better for the baby”, but how true do we really know this to be?
The fact is, it is true. Medical research has shown human breast milk, over formula feeding, to benefit the infant in several ways. Some of those benefits include, improvement in gastrointestinal functioning, improvement in immune defenses, thereby reducing the occurrences of several acute illnesses, and enhancing the maternal-infant bonding, possibly reducing infant stress. Because of the proven health benefits to infants, many national health organizations have recommended exclusively breastfeeding infants for the first 6 months of life (i.e., Academy of Pediatrics, the American Congress of Obstetricians and Gynecologist, The World Health Organization.)
Normal labor begins after 37 weeks. Your "due date" is set at 40 weeks. If labor begins before 37 weeks, it's too soon.....preterm labor. About 1 in 10 pregnancies in the U.S. have a premature baby. But what about the patients that “don't feel good", may feel they’re “too big", or just “want the baby out". A premature baby -or "preemie"- can suffer serious illness, both acute and chronic; some could even suffer insurmountable complications leading to death. The earlier a baby is born, the greater the chance of health problems. Preemies grow more slowly, and may have problems with their eyes, ears, breathing, and nervous system. Learning and behavioral problems are more common in children born premature.
John Knapp M.D.
As an Ob/Gyn physician, it’s not uncommon for me to hear the question from patients, “Am I actually ABLE to conceive?” For some women who are planning pregnancy, as well as for some others who’ve never had a pregnancy (intended or not)…the question, “Can I get pregnant?” may be a looming concern.
Other than actually attaining a ‘positive’ pregnancy test, there really is no other specific test allowing us to know IF a woman CAN actually achieve pregnancy. What we do know is, that for the normal couple (those without risk factors/or a history of infertility, regularly sexually active,) the chances of conception are actually stacked in our favor. In fact, for regularly sexually active couples, there is a 15-25% probability of pregnancy with each menstrual cycle!
It is expected that nearly 90% of sexually active couples, without contraception, would become pregnant (intentionally or not) within one year. The one year mark is typically used in defining those couples with ‘infertility’…the inability to become pregnant, despite frequent, unprotected sex within one year. An infertility evaluation by your health care provider may be initiated at this time, and even earlier (at 6 months) for those women over 35.
Suzanne Hall, MD (@drsuzyyhall)
Eastside Gynecology Obstetrics
An exciting time for expecting parents is the first sensation of fetal movement, medically termed ‘quickening’. Though fetal movement can be seen by ultrasound as early as the first trimester, the perceived, physical sensation of fetal movement generally occurs by around the 20th week of the pregnancy. This sensation of fetal movement may vary among women, and among different pregnancies. Some first-time moms may not perceive this movement until up to 22nd-24th week of pregnancy, while others may recognize the sensation of movement as early as 16-18 weeks.
This sensation of early fetal movement has been described as feeling like the fluttering of a butterfly, a tickling, or a light tap. The differences in the timing of your perception of fetal movement may be based fetal/placental location, or the anatomy of your abdominal wall. Initially, it may be hard to distinguish these movements from a feeling of gas or a hunger pang. But once you recognize the sensation as fetal movement, you’ll most likely be reassured and happy with your baby’s activity!