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Year: 2017

What Does Motherhood Mean to You?

Motherhood, I invite you to think about what this word means to you?  As an Obstetrician, I am blessed to witness the miracle of pregnancy and childbirth where every delivery is like I am in awe for the first time.  But I would be remiss in not talking about my Patients who become a Mother in other ways.  Mothers who foster or adopt their children, human and furry alike.  Mothers who provide their own eggs or body for surrogacy so that someone else can become a mother.  Mothers who are working hard to overcome their infertility challenges to meet the child they know is out there.  Lastly there are the silent mothers who experienced the joy of a positive pregnancy test that sadly ends in miscarriage.  She did not get to see or hold this baby that entered her heart the moment she saw those two lines, but now has an angel above.  Every day thereafter is bittersweet for anyone who loses a pregnancy, a baby or a child.  Even with loss however I am sure you would agree that no matter how one comes to know motherhood, it is a leap of faith worth making.   

The road to motherhood is unique to everyone.  There was a time in my young life where the thought of becoming a mother or being around children effectively sent my heart racing with sense of angst and uncertainty.  I had a defined plan for my life.  Starting in the 7th grade, I knew I wanted to be in Medicine.  I was blessed by several influences and thankful to those who mothered me.  It was my teachers who nurtured me, and opened my eyes to the power of education and all its possibilities.  It was listening to the intriguing stories that my late Grandmother Joyce told of her life as a Registered Nurse in the ER.  She would share medical stories that sparked my interest, but her accounts went much deeper than story telling.  I saw the passion she had in helping others and the curious navigation through humanity that she made.  A journey of this kind could not be made without knowing the love, devotion and tireless work I saw in my Mother.  She also empowered me to pursue my dreams.  I had a defined plan for my life.  I vowed to let nothing stand in my way.  How and when would I insert having children into this equation did not seem possible should I pursue this dream? 

It was at the age of 21 however that my world was forever changed.  I fell in love with my husband and in our new life together also came a precious 4-year old little girl.  At the time I thought to myself, “Oh no!  Will I be Cruella de Vil to her?! How will I relate to her and better yet will she like me?”  Our story together evolved into the birth of something quite the opposite of that which I feared, I found the beauty in motherhood.  Life was no longer just about me; it was what was best for her and our family.  I was blessed to later officially adopt her.  The day she called me “Mom” for the first time, the day I saw my name on her birth certificate and the day she became a big sister to her two brothers are by far the best and proudest moments in my life.  I am so glad that the defined plan for my life was altered and my journey to Motherhood lead me to my beautiful miracles.   Thankfully the equation for my life allowed me to not only be blessed with family, but they joined me on my journey in Medicine. 

Don’t get me wrong and I am sure you would agree that this wonderful world called Motherhood comes with as much joy as there are and tears.  I struggle daily to balance my life as a Mother, Wife and a Physician.  Every minute you fret and question what will happen if I am not here?  Am I doing the best I can?  Did I make the right decision?  For my children, how can I best teach them to live and love in this good life?  How can I protect them from the world?  I have resolved to believe that I am human.  I try to do the best I can with what I have, and accept that this must be right for me, my family and my patients.  I find the humor in my crazy life and call it controlled chaos.   My Grandmother Joyce used to sing us a song by Doris Day “I love you a bushel and a peck.”  I always loved to hear her sing it, but there is one verse I never understood until now.  After she passed I wanted to find those words and know them exactly by heart,  I wanted my children to come to know and love this song just as I had.  I found the words and I especially love the verse and it goes…

I love you a bushel and a peck

A bushel and a peck though you make my heart a wreck

Make my heart a wreck and you make my life a mess

Make my life a mess, yes a mess of happiness

So, take the time to reflect on what motherhood means to you.  It is important to remember and cherish those who affected your past, your present and future with who you may call, or may call you, Mother. 

Heart Disease – Where do you stand?

Don’t become a statistic.  Know your numbers.  As we enter the month of February, it is time to put your best red dress on to help raise awareness and celebrate all the efforts to stomp out heart disease in women.  Please pay attention as what I am about to share with you can and will save lives, a life that could be your own.  Heart disease is the #1 killer for women, next to cancer however in recent studies they are now racing in a dead heat.  Do you know where you stand in this race?  It is a race you can hopefully sit out, so please read on. 

Heart disease represents just one of the 3 forms of cardiovascular disease that can adversely affect women.  In fact, the same process that causes a heart attack can also lead to stroke in the brain or body with serious lifelong disability and death.  We know women are different than men when it comes to cardiovascular disease.  It is a fact that women are not as easy to diagnose as men.  It is imperative to know your body well and to be your own advocate to evade the misdiagnoses that can occur due to our gender differences.  Are you at risk or ever experienced a heart attack?  Do you know for sure?  The fact is that about 35% of all heart attacks that occur in women go unnoticed or unreported.  It is not that we are oblivious or too busy; it is that we do not have the same symptoms as men.  We do not get that vice grip or elephant on your chest pain like our male counterparts.   We may instead experience extreme nausea with mild chest discomfort often mistaken as heartburn or a terrible stomach bug.  A woman will more often have pain in her neck, jaw or arms when a heart attack is happening.  A heart attack may even be as subtle as new onset of extreme fatigue, where family, work or stress may mistakenly be rationalized as to why one feels so badly.  Bottom line, unless you keep up with your well women’s health and numbers you may not ever know until it is too late.    

As women, our ovaries protect our cardiovascular health when it comes to that golden hormone produced called estrogen.  Up until about the age of 50 to 55, we have our angel wings, and estrogen helps promote the good cholesterol, called HDL that fights off the bad.  Bad cholesterol, being LDL, is what can block the vital vessels in our brain, heart or body resulting in a stroke or heart attack.  After age 50 to 55, when we officially enter menopause, the change of life, we are then a sitting duck!  Careful ladies, this is not just about menopause, as we know issues in our youth can lead to what happens later.  We know women who experience complications in pregnancy like high blood pressure or diabetes are certainly at risk for heart disease when they are older.  Further, medical conditions like obesity, high blood pressure, diabetes, polycystic ovarian disease, autoimmune disorders and even improper use of birth control or hormone replacement therapy can be a risk factor for a heart attack or stroke.  It is time that we take a stand, as we know the path it takes to fight and overcome this battle.   

Let’s talk numbers.  The American Heart Association has identified 7 areas that you should know and keep track to decrease your risk of heart disease or stroke. 

Absolutely no smoking!  I tell my patients to choose another bad habit!  I would rather you have that dark chocolate or glass of wine than a cigarette.  We know smoking accelerates the fatal process leading to heart attack or stroke. 

Get your physical activity.  Exercise can be wherever you choose as long as you get that heart pumping! I advise my Patients you can do whatever you want as long as you can sing a song and break a sweat – it is that great aerobic zone that trains your heart. 

Follow a heart healthy diet.  You should eat as much fresh fruit, vegetables and lean protein you can.  If it is in a box or doesn’t expire, then you don’t want it!  Processed foods are terrible for our health when it comes to heart disease and cancer prevention.    

Maintain a normal body weight.  Talk to your health care Provider to know where you stand. 

Control of cholesterol.  Have your levels checked now. 

Monitor your blood pressure.  High blood pressure damages your heart and body as it places undue stress on the blood flow and creates havoc on its way. 

Control your blood sugar.  High blood sugar and diabetes is known to damage every cell in our body.  Ask to be screened to know where you stand. 

Sounds easy enough?  In our present American culture, it has not proven to be so easy.  The fact is over 86-million Americans are affected by heart disease in some way and as a result, one person dies every 40-seconds in the United States.  We know what we need to do so save ourselves, but we somehow continue to fall prey to this disease. 

Get to your health care provider now and start the conversation.  Get your well women’s exam.  Ask to know your numbers and take this quiz as the life you save could be your own.  Go to https://www.goredforwomen.org/ for more information.  If you know your numbers, please plug them into this calculator and bring to your health care provider today.    http://www.cvriskcalculator.com/

Birth Control – Know Your Options

Do you know your birth control options?  Contraception is currently a hot topic in our political and social media world.  With the election of President-elect Donald Trump, the threat of an appeal to Obamacare immediately brings focus whether access to contraception will remain.  Would access to contraception be a target of the appeal or would it be inadvertently taken away in the aftermath of a repeal of Obamacare as a whole?  There are many unanswered questions and this uncertainty is driving this heated discussion across the country.  We as Obstetrician Gynecologists support access to contraception for any person who desires this measure in their life.  Access should be open to all persons regardless of health insurance status.  You may be thinking, “Why would anyone want to argue about birth control?  If someone wants to avoid pregnancy, it is their own prerogative, right?”  Well, since the late 1800s, birth control and politics have had nothing less than an inflammatory relationship.  No matter your stance or political or religious beliefs, be informed and be a part of the conversation. 

Obamacare has opened the door to well woman’s visits and access, to what I call a buffet of contraceptive options. Under the Affordable Care Act, a physical exam and birth control consultation is considered a preventative service.  It is therefore offered without having to pay a copay for these services.  Mind you, there are grandfathered, religious and short-term health insurance plans that are exempt and result in out of pocket costs.  For the majority, it is estimated that Obamacare has afforded women nearly 50% savings in their birth control expense and has been said to equate to 1.4 billion dollars.  There are officially as follows:

• Sterilization surgery

• Surgical sterilization implant

• Implantable rod

• Copper intrauterine device

• IUDs with progestin (a hormone)

• Shot/injection

• Oral contraceptives (the pill), with estrogen and progestin

• Oral contraceptives with only progestin

• Oral contraceptives, known as extended or continuous use that delay menstruation

• The patch

• Vaginal contraceptive ring

• Diaphragm

• Sponge

• Cervical cap

• Female condom

• Spermicide

• Emergency contraception (Plan B/morning after pill)

• Emergency contraception (a different oral medication named Ella)

Thanks to Obamacare, we now have a buffet of options to discuss with women and have been able to take cost concerns off the table.  When exploring a Patient’s contraceptive needs, I advise them that choice depends on personality and lifestyle.  I often say, “You may find that you try one, but you may try them all until you decide which option works best for you.” 

With Obamacare, the category of “implantable” birth control has lifted barriers to this more effective option.  The intrauterine device and implantable rod placed in the arm are known as LARCs – long-acting reversible contraception.  They are proven to be 99% effective in preventing pregnancy.  Compare this to pills and condoms which prevent pregnancy only 92% of the time.  The use of LARC has increased from 2.4% to 11.6% of all women using contraception from 2002 to most recent studies as of 2013.  Once placed, the rod and IUD can provide effective birth control for 3-5 years depending on the device chosen.  The cost of the device is well over $1000 and with Obamacare is now completely free.  If and when it is time to remove the device, it may be replaced with a new one or removed at any time to become pregnant right away.  Why wouldn’t every woman choose such a reliable and modern device?  It is a “set it and forget it,” until one is ready to pursue a pregnancy.  Prior to Obamacare, cost was a major barrier, but now it is lack of awareness and a historical bias that has hindered the rise in women choosing a LARC.  The implantable devices of decades past resulted in serious side effects and consequences and were removed from the market.  The LARC devices we have at present have proven safety but the reputation of devices past have left distaste among older generations who may be influencing the present. 

With the current political climate and uncertainty of contraceptive coverage, however calls to question what happens if contraceptive coverage is eliminated or the cost increases?  Social media has seen thousands discussing this topic.  Some are asking, “Should I hurry and obtain a LARC to have long term contraception before Obamacare is repealed?  But if I do, what happens when I want or need it taken out?  What would be the cost to me?”  We cannot answer many questions as it stands now, but in my present knowledge, I counsel Patients that a LARC is a great choice per its effectiveness to prevent pregnancy and from a cost perspective long term if even Obamacare was lost.  The removal of a LARC device without insurance coverage averages around $300.  If you keep the device in place for more than one year, it averages to equal the cost of birth control pills that one would have paid for that year.  If you keep the LARC in place even longer, then costs are clearly in favor of choosing a LARC at this time. 

When it comes to contraception, I counsel Patients on a daily basis that no choice is a wrong choice.  It is what is best for you, your situation and fertility plans.  With Obamacare, there is a buffet of contraceptive options, however if access if called into question over the coming years, it may be wise to consider your long-term goals and options.  When choosing a LARC, it is ideal if there are no immediate plans for fertility.  No matter your current life stage, stay tuned and be informed to support all women.  We pray the landscape of the future maintains contraceptive access for all.