Category: Greenville Women’s Clinic Blog

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.  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. 

February is American Heart Month – a time for all of us to refocus on preventing cardiovascular disease. If you’re not already taking good care of your heart, now is the time to start. Heart disease is the top killer among women in the United States. Many risk factors increase your chances of developing heart disease, including high blood pressure, high cholesterol, diabetes and being overweight.

One of the best ways to protect your heart and reduce your risk of disease is by eating a heart-healthy diet. Here are five steps to get you on the right track:

1. Load up on fruits, vegetables and whole grains.
These three factors are the keys to a heart-healthy diet. Balance your meals with a mix of high-fiber foods. Fiber helps regulate blood pressure and keeps you feeling full longer. Aim for four and a half cups of fruits and veggies a day and at least three ounces of whole grains.

2. Watch unhealthy fat and cholesterol.
Limiting the amount of saturated and trans fats you consume can lower your cholesterol levels and reduce your risk of coronary artery disease. Choose healthy fats like those found in olive oil, canola oil and trans fat-free margarine instead of the ones in butter, creamy sauces, hydrogenated margarine and shortening. Look for monounsaturated fats and polyunsaturated fats, like the ones found in healthy oils, nuts, seeds, soy and seafood.

3. Reduce your sodium intake.
Too much sodium can result in high blood pressure. Start by reducing the amount of salt you use as a seasoning when you cook, then begin paying attention to how much sodium is in the prepared foods you eat, like canned soup.

4. Go with low-fat protein.
Protein is an important part of your diet, but some types are better than others. Stay away from full-fat dairy products, egg yolks, fatty meats and cold cuts. Instead, opt for low-fat dairy, egg whites, lean meat, poultry, fish and legumes. Try substituting plant protein for animal protein to reduce your fat and cholesterol intake.

5. Make a meal schedule.
Knowing what to eat and what to avoid is just the beginning of maintaining a heart-healthy diet. To ensure that you stick to the plan, create a meal schedule for your household once a week. Choose heart-healthy recipes and add the ingredients to your shopping list. Not only can this help ensure a healthy diet, but it could also lower your grocery bills.

Studies show that healthy choices have resulted in fewer women dying from heart disease per day. Learn how to lower your chance for heart disease, ask your health provider questions about heart health and make sure you know the symptoms of a heart attack. There’s much more work to be done before heart disease becomes a thing of the past, but together we can do it. You can make a difference during American Heart Month!

January is a time to reflect on the changes we want to make in the upcoming year. One resolution anyone can benefit from would be making a goal to stress less. Stress can affect many aspects of physical and mental health, whether you realize it or not. Common symptoms of stress include:

Hair Loss
It’s normal for strands of hair to fall out over time and get replaced by new ones. When you’re under physical or emotional stress, the shedding of hair can speed up to the point where half to three-quarters of your hair can fall out.

Forgetfulness
We all have our moments of not being able to find our car keys. Research shows that the more stress we are under, the more often these mental lapses happen. Take a step back and consider whether any stress in your life may be playing a role in memory loss.

Dental Health
During the day and even while sleeping, people under stress may clench or grind their teeth. This action can wear down and damage teeth, causing joint problems leading to severe jaw and neck pain.

Skin Problems
One of the effects of stress is skin that’s more sensitive to irritants. Stress can worsen pre-existing conditions including rosacea, psoriasis and acne, as well as dehydrate the skin, permitting allergens, bacteria and pollutants to irritate it.

Substance Abuse
For individuals struggling with alcohol or drugs, stress can disrupt efforts to remain substance-free. Even for people who have abstained for a long time, stress can play a significant role in contributing to a relapse.

Sexual Problems
The effects of stress can extend to the bedroom. Cortisol is one of the hormones produced by stress. If elevated levels of Cortisol are being produced for a prolonged period of time, they suppress our sexual desire.

Irregular Menstrual Cycle
Your monthly flow is showing up early, late or not at all. When stressed,
your brain sends out signals that can alter or disrupt ovulation.

Inability to Concentrate
Being under pressure can affect how well our brains work. The good news? A month after the stressful period is over, your mental skills should return to normal.

Reduced Immunity
Excessive stress and anxiety can lead to an increased chance of getting sick. Keep daily stress under control as much as possible to offset the effects of past stress and encourage good health in the present.

Insomnia
While insomnia can stem from a variety of sources, one to consider is stress. Stress can cause a number of sleep-related issues including trouble falling asleep, difficulty staying asleep and poor-quality sleep.

Stress that’s left unchecked can contribute to health problems, such as high blood pressure, heart disease, obesity and diabetes. Stress relief can lead to improvements in your overall well-being. Try to get relief through regular exercise, enjoyable hobbies and spending time with loved ones. Take control of your symptoms and ring in the New Year with less stress.

Stop and think back to when you were a child. You will likely remember this as a time where you felt invincible, fearless, strong and able-bodied. You could do anything, be anyone, and get away with eating and drinking just about anything without worry. Are there health consequences to this fancy-free period of life?  There is disease I wish to call to your attention. It preys on children and will not appear until their later years. It most often comes without warning and usually in one quick SNAP! I am talking about your bones.

By the year 2020, over half of Americans will be diagnosed with weak or diseased bones, referred to as Osteopenia and Osteoporosis respectively. Osteoporosis leads to more than 2 million bone fractures per year in the United States. The most common bone fractures are those of the spine, hip and wrist. If you are elderly and fall and break a hip, you are at risk of dying within 3 months because of this fall. This is not only painful physically, but emotionally and financially. Medical care for fractures results in Americans incurring more than 18 billion per year in health care dollars, add losing time from work and the cost is greater. The startling fact is that this isn’t something that just happens; it is a process that evolves overtime dating back to your childhood. For most people it is preventable, and it cannot be stressed enough that prevention starts in childhood. It is imperative we teach our children about their health, and certainly their bones. We must be their role models, creating an awareness and healthy lifestyle that involves and protects the entire family.

Think back to that life-sized skeleton you had in Science class. How can such a dense, solid structure be so vulnerable? Bone is a living organ in our body, it provides us with our form and function, and protects our brain, heart and lungs. Just like the heart must beat to work, bone requires daily remodeling of its framework to remain resilient and strong. If it does not have the vital nutrients it needs for continuous maintenance, then the framework is compromised and weakened. This weakness is much like a brick wall that loses its mortar overtime if left unattended.

You may now be thinking how do I know if I’m at risk? What can I do to prevent this? Am I too late? The good thing is that bone is forgiving and the time to act is now. We can identify those at risk for bone disease. We know that women are five times more likely to develop osteoporosis; however more men are likely to die from this disease. The following factors cause or contribute to osteoporosis and bone fractures:

• You are over age 50
• Family history of osteoporosis or a bone fracture
• Onset of menopause before age 45 or having ovaries removed before age 50
• Breast cancer survivor after radiation and chemotherapy
• Certain medications such as steroids, seizure or thyroid medications
• Diseases of the thyroid and kidney, inflammatory bowel disease, rheumatoid arthritis, and lupus
• Low calcium intake
• Vitamin D insufficiency
• Excess vitamin A
• High caffeine or salt intake
• Aluminum (in antacids)
• Alcohol (three or more drinks per day)
• Inadequate physical activity or being immobile
• Smoking (self or loved one who smokes around you)
• Falling
• Being thin or petite
• Poor vision, even with glasses.

If you identify with any of these risk factors, talk with your health care provider. Take steps to stop this preventable illness. It’s never too late to start healthy habits through an active lifestyle, balanced diet rich in calcium and vitamin D and seeking treatment if you are at risk.  If you’re 65 or older, or have risk factors for bone disease at a younger age, there is a simple, non-invasive test. It is called a DEXA scan that assesses your current state of bone health. It takes less than 15 minutes and can be done when you fully dressed. Beyond assessing your bones directly, you can even be tested for nutritional or medical illnesses affecting your bones.  No matter your age, gender or ethnicity, take the time to stop this preventable illness. Talk to your health care provider and go online. The National Institute of Health and the National Osteoporosis Foundation are great places to start and seek reliable information.

Reference:  American College of Obstetrician Gynecologist at www.acog.org, National Institute of Health and the National Osteoporosis Foundation

Have you heard about the current debate over breast cancer screening?  It’s a heated topic. We are all at risk for breast cancer, even our male counterparts. Our risks increase with our age. Well, ladies, age is the current debate. What age is best to start breast cancer screening if you have no family history or risk factors?

Let’s look closely at this debate, which has come about because of new recommendations by the U.S. Preventive Services Task Force. This task force is recommending that a woman start her routine breast cancer screening NOT at age 40, but 10 years later — at age 50. To be clear, this is if you have no family history of breast cancer or risk factors like dense breasts, history of chest radiation or other medical concerns. The recommendation also states that mammogram screenings not be done annually but every two years, unless medically indicated otherwise.

You may be feeling a mix of emotions at this thought, especially if you have had breast cancer, know someone who has or if it’s in your family history.

You may be thinking, who are they and how are they suggesting this bold change? The USPSTF was created in 1984 as an independent panel of national medical experts who volunteer to review current health-care practices and then compare this to our evolving knowledge of evidence-based medicine. Based on this review, this panel then makes recommendations that aim to improve the health of all Americans through screening, counseling or primary care medical services offered. The U.S. Congress has authorized this panel to convene annually to present any needed recommendations to affect change to improve our health-care practices.

The panel believes that the practice of performing mammograms prior to age 50 in the general population does not warrant the risks to women of a younger age. Again, this means a woman without a family history or medical history placing her at risk for breast cancer. The most common harm of a mammogram prior to age 50 is a false or inaccurate reading, which results in additional unnecessary tests and procedures.

This is a major cost to our health-care system, as well. For instance, if a 40-year-old woman is told her mammogram shows possible tumors, she then goes on to have more imaging and, ultimately, a breast biopsy. If the biopsy shows normal breast tissue, the initial mammogram was therefore wrong. Could this biopsy have been avoided? Did this biopsy cause harm? Does this cause unnecessary anxiety or added discomfort to a woman? What are the overall costs to society? Bottom line, is it all worth it?  This is the argument.

I can tell you, there is a great divide in medical opinion about how and when breast cancer screening should be done in the United States. As an obstetrician gynecologist, our national organization, The American College of Obstetrician Gynecologists, has held firm that we believe it is best to start breast cancer screening at age 40 for ALL women. We also feel it is a personal decision and should be discussed with your health-care provider.

I feel strongly that the present debate might place our personal choices, access to screening and medical coverage in jeopardy over such divided opinions. It’s important that we remain a knowledgeable and active voice in this debate.

Let me show you some of the evidence for breast cancer that we know at present. Unless you have a family history of breast cancer, we all have a 1 in 8 risk of developing breast cancer in our lifetime. Think of you and seven of your girlfriends. One of you will develop breast cancer in your lifetime. If you have a family history, the chances are even higher. To make this even more real to you, let’s look at the evidence.

The lifetime risk of breast cancer by age is as follows:

• In her 20s, one woman in 1,760 has a chance of breast cancer.
• In her 30s, one woman in 220 has a chance of breast cancer.
• In her 40s, one woman in 69 has a chance of breast cancer.
• In her 50s, one woman in 42 has a chance of breast cancer.
• In her 60s, one woman in 29 has a chance of breast cancer.

Do you see how time is of essence when it comes to this cancer? It’s important to discuss and consider this debate, not just from a personal perspective but to help educate and advocate for all women. Breast cancer screening is proven to play an important role in diagnosing breast cancer early, and therefore improving a woman’s chances for survival through early treatment and ultimately a cure. The pain of losing a loved one from a completely detectable and survivable cancer cannot be described.

You have the power to be a part of this ongoing debate and the time is now. One would think it is only logical to find breast cancer fast and find it early, right? Well, unfortunately with this and really any cancer screening, it is not so simple. It is a matter of evidence-based medicine, meaning we track hard evidence about current medical practices and patient outcomes. This information is then used to apply a recommendation or practice which is best for the entire population. It is not just a matter of medicine, sadly, but of access, effectiveness, cost and certainly insurance coverage.  The guidelines for insurance coverage follow recommendations created by our national organizations and governmental guidelines.

You may become involved by contacting your local government representative. The U.S. Preventive Services Task Force has invited you to voice your opinion by going to their website, www.screeningforbreastcancer.org

Let’s talk about a serious issue that I bring up to Patients on a daily basis.  It is domestic and intimate partner violence.  What do these words mean to you?  It is a matter that I feel is important and essential to knowing you as Patient to best take care of you.  The fact is, you don’t know if someone is being abused if don’t ask.  If one is a victim, it is hard for her to bring it up herself.  By asking, it is a means to let you know that your Health care provider’s office is a safe place to start.  Domestic and intimate partner violence occurs when someone threatens or controls you, physically, emotionally or financially.  It can be an intimate partner or friend, or even a family member.   It occurs without regard to a woman’s rights, feelings, body and health.

Have you or do you know someone who has been abused or is being abused?  How do you know for sure?

Continue reading “Domestic & Intimate Partner Violence are Serious Issues”

If you had to turn in your health homework, what grade would you expect?  Did you get an “A” for effort, or did you earn a solid “C,” so think about it.  How well do you attend to your own health and wellness?  Do you take the time to get your physical and go to the dentist?  If so, were you told you needed to change your habits or seek necessary screenings like a colonoscopy?  Do you eat a balanced diet, exercise regularly and sleep well?  The bottom line, do you feel your best?  I challenge you no matter the grade you would expect to receive this year, how will you change your study habits to score better?  You see, there is already daily ongoing research being done about your health and Society as a whole.  Did you know an actual report card is published on the Internet about us?  It is a measure not only of our longevity, but our form and function as well.  This information is used to know where we are and where we need to go to reach our best state of health across all people.

Thanks to the Center for Women’s Health Research at UNC, we have a report of the current state of health of North Carolina Women.  This information is used to compare us to goals that are set nationally to ready Health People 2020 goals.  Information of all females over age 18 is reported. You may be thinking, what are they looking at?  How are we graded?

Continue reading “How do you score on your health report card?”

I speak about lifestyle and heart healthy habits on a daily basis when seeing women in my Practice.    I am looking out for the #1 killer that sieges the lives of American women each year.  Can you guess?  Heart disease.  Now is the time to remind us women to be hearty healthy.  You may see women wearing lots of red during the month of February, so break out your red wardrobe and wear it proudly to raise awareness.

We all heard about the ways to live a healthy life, but have we ever learned to how to actually do it?  The culture and lifestyle of an American is fast…fast-paced, fast-food and we certainly are very spoiled in this nation to have most everything at our fingertips…even the remote!  Our lifestyle however has trade-offs and one unfortunate trade-off is our health.  A life without activity, wholesome food and rest leads to obesity, a weakened heart and body and feeling as if you could easily fall flat out.  We do not have to accept this as Americans….Heart disease is a PREVENTABLE killer, but we have to make a mindful effort to stop it in its tracks.
Continue reading “February, the perfect time to be near and dear to your heart!”