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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’.
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!
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)
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.
What is a Certified Nurse-Midwife?
More and more women in the US are choosing a certified nurse-midwife (CNM) for their pregnancy, birth, postpartum, and well-woman care. Certified Nurse Midwives are licensed health care providers educated in nursing and midwifery. They have master’s degrees in nursing, certified by the American Midwifery Certification Board, and are licensed to practice midwifery in the state of Michigan. National statistics show that in 2009 CNMs attended 11.9% of vaginal births, an all time-high. This trend has been discussed in newspapers such as the New York Times and in movies such as The Business of Being Born. As a leader and innovator in women’s health care, Eastside Gynecology and Obstetrics has committed to bring midwifery services to their clients, the only practice that does so in the area.
The midwives at Eastside Gyn/OB provide personalized, individualized care. We nurture each mother and her family with sensitive, holistic care. Our clients love that they get to know the person who will be taking care of them for their birth. We also have a commitment to promoting physiologic labor and birth, believing that labor works best when allowed to begin in its own time and progress at its own pace. At the same time, we are trained to recognize those situations where intervention is warranted and have the benefit of a close and supportive working relationship with the physicians in the practice when referral or consultation is needed. As midwives, we aspire for you to have the birth experience that you desire. We promote mother-infant bonding immediately after birth, delayed cord clamping, breastfeeding, and childbirth classes such as hypnobirthing. We also desire for each birth to be a family experience for all who wish to be involved.
50%-90% of pregnant women experience symptoms of ‘morning sickness’ in the early months of pregnancy. These symptoms can range from mild intolerance to certain odors or food, to more significant, daily nausea and vomiting (N/V). Studies suggest that up to 25% of pregnant women experience nausea, 50% experience both nausea and vomiting, leaving only 25% of pregnant women unaffected. In those affected, the symptoms usually manifest by the 9th week of pregnancy.
Much is written and discussed about home/medical remedies for morning sickness, but much less is written/discussed about the (possible) causes for nausea and vomiting in pregnancy (NVP). Though the cause of NVP has not been proven, it has been postulated that NVP is an innate mechanism, presenting as a ‘protection’ for the developing fetus (an inherent ‘aversion’ to substances that could be harmful to the fetus.) Leading medical theories consider the adverse reaction of the ‘hormones of pregnancy’ as potentially causative (in the absence of other intestinal or medical problems that could present with N/V.)
At 15 years old I remember asking myself, “Is this what they mean by menstrual ‘cramps’?” The term ‘cramp’ just seemed too mild to explain the horrid, 1 or 2 day experience, which regularly preceded the start of my monthly period. Back pain, ‘front’ pain, nausea, and sweats…felt more like a suffering from the flu…with an elephant stepping on my back!... than what I’d describe as menstrual ‘cramps’. The usual ‘mother’s home remedies’ like a heating pad, hot tea, or over-the-counter pain reliever, hardly ever seemed to do enough, but I adhered to the regimen every month anyway…What else was I going to do?
As a Gynecologist, I now know the significance of the menstrual ‘cramps’. In our rhythmic, monthly, hormonal cycle, and in response to the rise in our ovarian hormones (estrogen and progesterone), our ovaries form the ‘dominant follicle’, which releases the fertilizable egg for that month. At the same time, the uterine lining develops a thick, shaggy layer (like a shag carpet) to enhance implantation of a fertilized egg (egg fertilized by a male sperm=pregnancy.) On the other hand, if no egg fertilization occurs (no pregnancy), the ovarian hormones decline, allowing for release/shedding of the previously developed thickened uterine lining tissue (representing our ‘menstrual flow’), and the obvious sign of menstrual bleeding.
If anyone should know the concerns of choosing pregnancy and childbirth later in life, as an Ob-Gyn physician, having given birth to my first child at 39 yo, I should think I’d be one of them. With my training and experience as an Ob-Gyn physician, I was fully aware of my risks in deciding on childbirth…as a woman of ‘advanced maternal age’. I counsel women on their risks nearly every day.
I already knew that at my age, it may take longer for me to get pregnant. I knew that advancing age is associated with subfertility (prolongation in time to achieve conception,) and I knew this to be related to altered/changing hormonal patterns as we age, leading to suboptimal ovulation. I already knew that there is decreased ovarian reserve (fewer fertilizable eggs remaining in our ovaries) as we age. I also knew that advancing age was associated with a higher risk of miscarriage, most likely related to the poorer quality of aging eggs, and the increased chances of fertilizing an egg containing abnormal chromosomal material...
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Suzanne Hall, MD (@drsuzyyhall)
Check out this amazing 'life-like' computerized graphic video of fibroids from simulated Myosure procedure!
The use of estrogen/progesterone containing Birth Control Pills have long been known to slightly increase one’s risk for Venous Thromboembolic events (i.e., deep vein blood clots.) Recent reports have put into question additional increased risk by use of BCPs containing the progesterone, dropserinone (Yasmin, Yaz, Beyaz, and their generics.) Available studies on this issue are inconsistent, some studies showing a fractional increased risk, others showing no increased risk. In comparing risks of VTE, the increased risk from any Birth Control Pill (3-9/10,000) is still significantly less than the increased risk of VTE in pregnancy (5-20/10,000), and the immediate post-delivery time period (40-65/10,000)… According to the FDA’s advisory committee, the benefits of all contraceptive methods still outweigh the risks.
(See WXYZ's interview with Dr. Suzanne Hall on their recent story on Yaz