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Month: March 2016

Preparing Your Daughter For Her First Gynecology Visit

As girls grow into teens, it’s important that they receive appropriate medical care. The American College of Obstetrics and Gynecology (ACOG) recommends that young women have their first visit with an obstetrician-gynecologist (OB/GYN) between the ages of 13 and 15. It’s important to take cues from your daughter to decide when the time is right. If she is having extreme discomfort with periods, has a lot of questions, or is becoming sexually active, it is never too early to make an appointment.

The idea of seeing a gynecologist or having a pelvic exam can be intimidating for any girl. You can ease your daughter’s worries and fears by explaining why the visit is necessary, giving her an idea of what to expect and addressing any questions she might have.

Choosing a Gynecologist for Your Daughter
For a decision as significant as choosing a gynecologist, it is imperative to get input from your daughter about what type of doctor she would be most comfortable with. Would she prefer a male or female doctor? Would she like to see the same doctor as you? These are just a couple examples of questions you should ask your daughter about choosing a gynecologist for her.

Explaining the Importance of the Visit
Before your daughter’s gynecology visit, it is important to set expectations for her about what the visit entails and explain why it is necessary that your daughter begins going to the doctor on a regular basis. You should explain to your daughter why she needs to see a gynecologist and how they can help her stay healthy.

A few reasons the visit is important:

  1. She can get accurate information and confidential answers to questions she has concerning sex, sexuality, her changing body, and menstruation.
  2. She can learn how to prevent pregnancy, sexually transmitted diseases and how to live a healthy lifestyle.
  3. For girls who experience missed periods, pain, or other reproductive problems, the doctor can assess the problems and offer treatment.

Reassure your daughter that even though there are a lot of different parts of the gynecological visit, the actual physical exam, the part she might feel most nervous about, doesn’t take long.

What to Expect During the Visit
During your daughter’s first visit, there is usually no internal examination and no PAP smear obtained. According to new guidelines for women regarding PAP smears, the first screening occurs at age 21. However, there will be a breast exam and an external examination of the genital area during the first visit.

Your daughter may be asked the following questions related to her medical and reproductive history:

  1. 1. When was your last period?
  2. 2. Are you sexually active? If so, are you using protection?
  3. 3. Are you experiencing any problems with your period, such as pain or heavy bleeding?
  4. 4. Do you have any discharge, sores or discomfort in the vaginal area?
  5. 5. Do you think you could be pregnant?

Encourage your daughter to answer these questions honestly. Her time with the gynecologist is completely confidential. Assure her that there is nothing the doctor hasn’t heard before and they are there to help.

Brief your daughter on family history, especially if you are not going to be in the room with her. Make sure to include any important medical information about siblings, parents, grandparents, aunts or uncles. One helpful way to make sure your teen remembers everything is to type up a family history for her to take into the room.

Prepare your daughter as much as possible by explaining, from your own experience, what these examinations are like. An encouraging experience can ease a young woman’s nerves and motivate her to schedule regular appointments to better manage her own health.

Please contact us if you have any questions regarding your daughter’s first gynecology visit or call Greenville Women’s Clinic at 252-757-3131.

Weight Loss. What’s the best option for you?

Weight loss.  This is an ongoing conversation throughout our Society.  It has become quite the industry not just in Medicine, but in our retail environment.  There are many weight loss programs, some focusing on nutrition, some on exercise and in the medical world, those involving medications or even surgery.  This plethora of options have led us to feel that the Science of weight loss is a bit of a mystery.  All the information out there can put you into a tailspin! So you may ask, which choice is right for me?  Patients ask me, “I don’t know where to start, how do you do it?  What can I take that is safe or is surgery right for me?”  Millions of dollars and hours are spent on this topic.  It is a topic best searched not alone but with the help of your Health Care Provider, friends and family.  There is power in the numbers when it comes to weight loss.  No matter the choice however, the final conclusion and solution is that which is right for you.  No one method or medicine is good for all. 

There are several schools of thought when it comes to weight loss.  There are some who say that weight loss is purely the practice of accounting, “calories in versus calories out.”  I would argue that this is only partly true.  There are others who would say, “add exercise -period.”  Again, I would argue that this is also partly true.  Then there are those who claim, “those Patients will never be able to do it on their own! #Surgery!”  In certain circumstances, this is partly true as well.  The bottom line…weight loss is not so much about Science; it is not a singular event.  Weight loss is about changing one’s lifestyle.  If we are overweight, obese or just not happy with our current physical state and well-being, then something about our current lifestyle is prohibitive to feeling our best.  This lifestyle must change. 

We hear a lot about diet and exercise, but not so much about the medical and surgical therapies available.  Medical versus surgical therapy depends on your medical history and personal circumstances.  Surgical therapy includes those that limit the size of your stomach or bypassing most of your stomach decreasing your absorption ability.  As for medical therapy, there are many options.  First, let me make clear that no one pill will lose weight for you.  The goal for weight loss medications is to help you overcome your barriers to weight loss beyond optimal diet and exercise.  Barriers include appetite or craving control, energy issues to maintain an exercise program or combination of all of the above.  The typical Patient is one who has a BMI greater than 30 who have failed to lose weight with regular diet and exercise or if they have a BMI of 27 or greater and have already developed diabetes and heart disease.  If you are considering weight loss surgery such as a gastric sleeve or bypass, this therapy may be helpful in preparation for it.  They are not indicators for all Patients so talk with your Health Care Provider about your concerns and challenges. 

Below is a list of medications to consider in your weight loss journey if you are determined to be a good candidate for medical therapy.  I do not endorse any specific one, but provide this for your information.  This is also not all inclusive but the most commonly used and available. 

  • Orlistat – Works by decreasing your fat absorption which helps with weight reduction and may improve your cholesterol levels.  Side effects may include loose stool or diarrhea.   
  • Metformin – if you are known to be pre-diabetic, may help improve your glycemic control and therefore lower insulin levels that would help with weight loss.  Side effects include loose stools however should improve with time.
  • Phentermine – a generic and widely available option, but not to be confused with the infamous Fen-Phen which was said to cause heart disease.  Phentermine is a stimulant and works to decrease your appetite and does increase your energy levels.  It does have addiction potential and is only advised to use for 12-weeks at a time.  Side effects may include dry mouth, difficulty sleeping, but more importantly may increase your heart rate and blood pressure, and therefore must be followed carefully by your Health Care Provider. 
  • Belviq – a serotonin-acting agent that may help regulate the control center for appetite, thereby helping you feel full sooner.  It is FDA approved to take for long term weight loss.  Side effects may include headache, nausea or fatigue. 

Lastly there are combination therapies available and include,

  • Qsymia – a long acting version of Phentermine and Topiramate which works to decrease appetite and cravings.  It is FDA approved to take for long term weight loss.  Topiramate has been used in the treatment of seizure disorder and migraines.  Side effects may include dry mouth, constipation or nerve disturbances. 
  • Contrave – combination of Buproprion and naltrexone that works to decrease your appetite and cravings.  This is not recommended as a first line medication but may be best for the person who is not only trying to lose weight but quit smoking as well. Buproprion has been used in the treatment of Depression or to help you quit smoking. We believe it works by helping regulate one of the brain’s hormones – epinephrine, which affect appetite control as well.  This medication cannot be used in someone with a seizure disorder or uncontrolled hypertension. 

Bottom line, you have options in your weight loss journey.  The best option is based upon many factors and best discussed and determined by working with your Health Care Provider.