The FDA approves first treatment for sexual desire disorder.

One of the most common complaints that we hear at the office is decreased libido or loss of sexual desire.  Honestly, we all go through times ourselves when the desire is just “not there”.  Many have asked for medicinal help but until now it was not available.  Viagra has been on the market for a while now for men.  Now, there is something new for women to try.  This week The U.S. Food and Drug Administration (FDA) approved the first treatment for sexual desire disorder for women.  Here is what they say about this “miracle” drug.

The U.S. Food and Drug Administration approved Addyi (flibanserin) to treat acquired, generalized hypoactive sexual desire disorder (HSDD) in premenopausal women. Prior to Addyi’s approval, there were no FDA-approved treatments for sexual desire disorders in men or women.

“Today’s approval provides women distressed by their low sexual desire with an approved treatment option,” said Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research (CDER). “The FDA strives to protect and advance the health of women, and we are committed to supporting the development of safe and effective treatments for female sexual dysfunction.”

HSDD is characterized by low sexual desire that causes marked distress or interpersonal difficulty and is not due to a co-existing medical or psychiatric condition, problems within the relationship, or the effects of a medication or other drug substance. HSDD is acquired when it develops in a patient who previously had no problems with sexual desire. HSDD is generalized when it occurs regardless of the type of sexual activity, the situation or the sexual partner.

“Because of a potentially serious interaction with alcohol, treatment with Addyi will only be available through certified health care professionals and certified pharmacies,” continued Dr. Woodcock. “Patients and prescribers should fully understand the risks associated with the use of Addyi before considering treatment.”

Addyi can cause severely low blood pressure (hypotension) and loss of consciousness (syncope). These risks are increased and more severe when patients drink alcohol or take Addyi with certain medicines (known as moderate or strong CYP3A4 inhibitors) that interfere with the breakdown of Addyi in the body. Because of the alcohol interaction, the use of alcohol is contraindicated while taking Addyi. Health care professionals must assess the likelihood of the patient reliably abstaining from alcohol before prescribing Addyi.

Addyi is being approved with a risk evaluation and mitigation strategy (REMS), which includes elements to assure safe use (ETASU). The FDA is requiring this REMS because of the increased risk of severe hypotension and syncope due to the interaction between Addyi and alcohol. The REMS requires that prescribers be certified with the REMS program by enrolling and completing training. Certified prescribers must counsel patients using a Patient-Provider Agreement Form about the increased risk of severe hypotension and syncope and about the importance of not drinking alcohol during treatment with Addyi. Additionally, pharmacies must be certified with the REMS program by enrolling and completing training. Certified pharmacies must only dispense Addyi to patients with a prescription from a certified prescriber. Additionally, pharmacists must counsel patients prior to dispensing not to drink alcohol during treatment with Addyi.

Addyi is also being approved with a Boxed Warning to highlight the risks of severe hypotension and syncope in patients who drink alcohol during treatment with Addyi, in those who also use moderate or strong CYP3A4 inhibitors, and in those who have liver impairment. Addyi is contraindicated in these patients. In addition, the FDA is requiring the company that owns Addyi to conduct three well-designed studies in women to better understand the known serious risks of the interaction between Addyi and alcohol.

Addyi is a serotonin 1A receptor agonist and a serotonin 2A receptor antagonist, but the mechanism by which the drug improves sexual desire and related distress is not known. Addyi is taken once daily. It is dosed at bedtime to help decrease the risk of adverse events occurring due to possible hypotension, syncope and central nervous system depression (such as sleepiness and sedation). Patients should discontinue treatment after eight weeks if they do not report an improvement in sexual desire and associated distress.

The effectiveness of the 100 mg bedtime dose of Addyi was evaluated in three 24-week randomized, double-blind, placebo-controlled trials in about 2,400 premenopausal women with acquired, generalized HSDD. The average age of the trial participants was 36 years, with an average duration of HSDD of approximately five years. In these trials, women counted the number of satisfying sexual events, reported sexual desire over the preceding four weeks (scored on a range of 1.2 to 6.0) and reported distress related to low sexual desire (on a range of 0 to 4). On average, treatment with Addyi increased the number of satisfying sexual events by 0.5 to one additional event per month over placebo increased the sexual desire score by 0.3 to 0.4 over placebo, and decreased the distress score related to sexual desire by 0.3 to 0.4 over placebo. Additional analyses explored whether the improvements with Addyi were meaningful to patients, taking into account the effects of treatment seen among those patients who reported feeling much improved or very much improved overall. Across the three trials, about 10 percent more Addyi-treated patients than placebo-treated patients reported meaningful improvements in satisfying sexual events, sexual desire or distress. Addyi has not been shown to enhance sexual performance.

The 100 mg bedtime dose of Addyi has been administered to about 3,000 generally healthy premenopausal women with acquired, generalized HSDD in clinical trials, of whom about 1,700 received treatment for at least six months and 850 received treatment for at least one year.

The most common adverse reactions associated with the use of Addyi are dizziness, somnolence (sleepiness), nausea, fatigue, insomnia and dry mouth.

The FDA has recognized for some time the challenges involved in developing treatments for female sexual dysfunction. The FDA held a public Patient-Focused Drug Development meeting and scientific workshop on female sexual dysfunction on October 27 and October 28, 2014, to solicit perspectives directly from patients about their condition and its impact on daily life, and to discuss the scientific challenges related to developing drugs to treat these disorders. The FDA continues to encourage drug development in this area.

Consumers and health care professionals are encouraged to report adverse reactions from the use of Addyi to the FDA’s MedWatch Adverse Event Reporting program at www.fda.gov/MedWatch or by calling 1-800-FDA-1088.

Addyi is marketed by Sprout Pharmaceuticals, based in Raleigh, North Carolina.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

What do you think?  Will you give it a try or wait and see what others have to say?  Let us know your thoughts.  We will also follow up with some patient testimonials soon!

Tanya Bolton

Lexington Women’s Health

Source: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm458734.htm

Humid, Hot and Carrying Child?

Excessive heat and humidity can be hard on anyone. Pregnancy only intensifies those feelings. If you are due in the summer or early fall, you can relate. You don’t have to have a miserable summer, but you do need to take a few extra precautions.

First of all, and I cannot reiterate this enough, keep yourself hydrated. That means making sure you drink plenty of fluids.  Water is best, but so are occasional juices and sports drinks which replace electrolytes that are being sweated away. Infuse fruits into your water to give it more taste if you need to. You do not want to let yourself get dehydrated. It can worsen pregnancy aches like swelling and can even trigger preterm contractions, so drink up!

During pregnancy, many women have increased sensitivity to the sun. This means you might burn more easily and may need to wear more sunscreen than usual.  Basically, you should never leave the house without wearing sunscreen with an SPF of at least 30. Make sure you cover all of your skin. Don’t overlook ears, neck or feet and remember to reapply every few hours and after swimming or towel drying.

Don’t rely on sunscreen alone to keep your skin protected.   Wear loose, lightly-colored clothing. This reflects the sun’s rays rather than absorbing them as dark colors do. Cotton, linen and natural fibers are best because they are light, airy and comfortable.

Wear a hat. The best choice is a hat with a wide brim that covers your face and neck. That fact that these are very fashionable at the moment is just another perk. The same can be said about a good pair of sunglasses. Don’t feel guilty about spending a little extra on a good pair of UV- filtered sun glasses.  They protect the eyes from painful sunburns, cataracts, and glaucoma.   Also, the skin around the eyes, including the lids, is one of the most prone areas to skin cancer!

Go to the pool!  If you’ve got a pool, use it often. If you don’t have one, get a large inflatable pool. These are relatively inexpensive and can hold several people. You’ll love the option of going to your back yard and relaxing in the cool water. If you have other children at home, they will love it too!  Now is not the time to consider tanning or laying in the sun – stay in the shade. A big umbrella with a glass of ice cold water should be your “go to” destination. If possible, use a canopy or position umbrella over the pool for the ultimate pregnancy paradise.

Sometimes, it’s better to just stay indoors.  If it’s too hot (heat index in the 90’s) stay inside with air conditioning. If you must go out, try to limit the outside activity to the cooler parts of the day such as early morning or evening. Also, carry a spray/mister bottle around with you. Nothing feels better than a cold mist on your face, forehead and neck.

All of these tips are simple to do, but sometimes it’s hard to know when you’ve been out too long. Get indoors at the first sign of dizziness, fatigue or excessive thirst. Lie down in a cool area and hydrate. If you don’t feel better soon, call your provider.

See you at the pool!

Tyler Halvaksz, CNM

Lexington Women’s Health

Minimally Invasive Robotic Surgery for Women

While no woman wants to face surgery, today the vast majority of gynecologic conditions can now be treated effectively without a big incision and shorter recovery time.   Robotic assisted surgery requires only a few small incisions, so you can get back to life faster – within days rather than the usual weeks required with traditional open abdominal surgery.

Robotic assisted surgery offers a minimally invasive option with all the impact of an open procedure for certain surgeries including urology, gynecology and cardiothoracic surgery.

At the cutting edge of robotic technology, the da Vinci Robotic Surgical Systems gives surgeons better images with three dimensional, true to life pictures in crisp detail. With this degree of accuracy, surgeons can operate in relatively confined spaces with significantly increased visualization and precision. These surgical instruments are designed to precisely mimic motions of the human hand and wrist.

Minimally invasive robotic gynecologic procedures include hysterectomy, sacrocolpopexy, ovarian cystectomy, and salpingo-oopherectomy (bilateral and unilateral). The most common is hysterectomy. If you are considering or your doctor has recommended a hysterectomy, you are not alone – one in three women in the U.S. will have a hysterectomy before turning 60. However, new technology like the da Vinci Surgical System has made the traditional hysterectomies a thing of the past.  The traditional abdominal hysterectomies are performed with open surgery, which requires a wide incision below the navel. This procedure can be painful, involving heavy medications, risk of infection and significant blood loss. After surgery, a recovery of at least 6 weeks is necessary. In addition, many patients are not happy with the scar left by the incision of a traditional abdominal hysterectomy.

Since minimally invasive surgeries require only tiny openings for instruments, patients leave the hospital without large, traumatic incisions. There are many other benefits as well: Minimally invasive entry points, smaller incisions, shorter hospital stay, tiny scars, decreased risk of infection, less scarring and blood clots, faster recovery time, speedier return to daily activities and in many cases, better clinical outcomes.

As you can see a minimally invasive robotic surgery will have you getting back to life much faster. As a woman, I understand those benefits and educate my patients to the best of my knowledge. If I am personally faced with having a hysterectomy, I will definitely choose the minimally invasive option.

Grace Gibbs, D.O., F.A.C.O.O.G.

Lexington Women’s Health

Mother’s Day 2015

Around here we celebrate Mother’s daily.  We are fortunate to be able to help many women on their journey to motherhood.  Mom’s and Moms-to-be should all be appreciated. After all, they give life!  Many of us are now Mother’s ourselves.  So this year not only are recognizing all the amazing Mother’s out there but we also get to share in the celebration.

This Mother’s Day we decided to write letters to our children.  Yes,  we all want flowers, candy, a card…something.  It just makes you feel recognized.  But honestly, our children are more of a gift that we ever imagined.

Here’s a few of our letters.  Hope they bring a smile to your face and warm your heart.  Happy Mother’s Day.

To my daughters,

My mom always told me “ You will understand when you have a daughter” and boy has this proven to be true.  You girls are such an amazing blessing to me and I cannot tell you how wonderful it is to be your mom.  Every day the first and last thing I do is thank God for each of you and to help me guide and protect you through the day.  You will hold my heart forever and I would give up everything for you.  I hope to one day be able to guide you through motherhood the way Nana does for me now.  Life will give you happiness, sadness, disappointment and extreme joy and I will  be right there for all of it.  We will have ups and downs but always know your momma will be with you every step of the way.  My love is endless and unconditional and with God’s guidance we will enjoy this life as Mother and Daughter.  I love you Alora and Addison with all that I am.

Mom

(Stacie Wilson, RT(T) RDMS  Ultrasound Supervisor)

To B &K,

It wasn’t until the day I found out I was expecting that I really knew what my purpose in life was going to be.  In honor of Mother’s Day I thought instead of it being about me, I would let you both know why it really is all about you.  From day one, the first breath you took, the first time I got to hold you, feel you, smell you, kiss you, you became my life.  In one instant all my hopes, joys, and even fears were unleashed.  Before I met you two, the word responsibility meant getting to work on time. Now it means guiding, feeding, teaching, protecting these two beautiful children, who are completely dependent on us for everything. The truth is, I’m more than okay with that and I want to do it for the rest of your lives. I hope you know:

• If I could hold your hand through all the scary parts of this thing called life, I would. If I could save you from every fall and swat away every insult, I would. If I could wipe up every tear and take away all your heartbreak and disappointments, I would. And when those times come, I will always be here.

• I’m on your side, no matter what. Even when you’ve done something so stupid, which believe me you will, you can always come to me and I will help you. We will get through it together.

• Be the hero! Unfortunately there are some cruel people in the world.  Stand up for what’s right and never be afraid to stand up for someone else! Be brave, be kind, be a light.

• You can do things, Even the hard things.  If you fail, try again. Never, ever be afraid to try.

• And last but not least smile, laugh, hug and love! Don’t take life too seriously.  Every day wake up and choose to be happy.  Your smiles are infectious. Share them with the world.

You’re going to grow up sooner than I’d like.  Some days you’ll love me. Some days you won’t (well, you’ll tell me you won’t but I will know better). Some days I’ll cross your mind. Some days I won’t. But years from now, I hope you know that throughout it all, I tried my best, worked my hardest, and loved you with everything I have.

Whether it’s our seasonal “To-do lists” or carrying on Dance Party Fridays on our morning drives to school, all I wish is that one day, you truly understand how I feel about the two of  you.  Being your mother is my greatest accomplishments and I will forever be grateful to you for giving me that gift.

I love you to the moon and back,

Mom

(Sarah Guildbault, Front Office Manager)

Dear K & K,

My love for each of you is something you will never truly comprehend until you have children of your own. How do I know this? Because it is something my mom use to tell me. On this mother’s day I want each of you to know that I love you with all of my heart and soul and everything I have to give and I want to celebrate the both of you. Being your mother is the greatest gift of all and I am honored to be called your mom. I thank God every day for blessing me with two wonderful children and I ask him to watch over and protect each you and for guidance as I go through this crazy thing called parenthood. There will be days that you will question my love and days you are mad at me, but just know no matter what my love will never change.

On this mother’ s day I would also like to thank each of you for the simple things you all do that mean so much to me. Thank you for kicking me throughout the middle of the night and for the very few hours of sleep I get. Thank you for our bath times, but most of all thank you for the little fingers that’s underneath the door trying to get in on the few times we do not bathe together. Thank you for ruining my shirts when you go to lay your head down on my shoulder with your dirty faces. Thank you for spraying me with cold water at the kitchen sink as I try to cook. Thank you for spitting up on me as I rock you to sleep in my arms. Thank you for all the slobbery wet kisses and the best bear hugs ever, and if it ever seems as though I am holding on a little tighter, it’s because I am. I know that one day those hugs and kisses will be few and far between. Thank you for showing me love in a way no one ever has. Thank you for loving me through my flaws and imperfections yet still thinking I am the best mom ever. Thank you for making me smile when I walk through the door after having a bad day. Thank you for making me the happiest person in the world knowing I have you guys to wake up to. Thank you for being my children.

As time continues to fly by there are a few things I want you guys to always remember. First and foremost keep God first in everything you do. Be kind. Be the first to forgive. Respect yourselves and never settle for less than you deserve, which is the best.  So on this mother’s day and every day forward just know how much I love you and how proud I am to be your mom.

Love,

Mom

(Chasity Clark, Clinical Assistant)

To my daughter

I could never image how much I could love someone till I had you! You may push my buttons and make me want to pull my hair out… J but I wouldn’t have it any other way. You are such an independent little girl for 2 years old which is incredible however very stressful and exhausting for Mommy! But I hope you keep that trait and become a successful and independent women in whatever you do. It’s astonishing how fast you developed such a spunky and outgoing personality and never miss a moment to make me laugh. It’s also so crazy how little you are and bring so much joy into to so many people life’s. I couldn’t have made a more perfect child if I tried and I am so blessed God decided I could be your mother. I am not perfect but you are the light of my life and make me strive to be a better person. “So much of me is made from what I learned from you, You are with me like a handprint on my heart”  -Author Unknown

Mommy

(Michelle Martin, RT(T) RDMS  Ultrasound Department)

Dear A,

Mother’s Day is set aside to honor Mothers for what they do and who they are.  But, if it wasn’t for you, I would not be part of this holiday.  I want you to know that I take pride in being your Mother.  I feel blessed and I am very thankful that God chose you to be my child.  My spunky, fun loving daughter!  I love you with every inch of my heart and with all that is in me.  You are blessed beyond measure and will succeed in all that you do and all that you dream of becoming.  You make being a mother fun and rewarding.  I love you.

Love,

Mom

(Misty Green, Billing Department)

Dear R & S,

I’ve loved you more than air since the day you were born.  I will never stop.  I will always hold you.  I will always be on your side.  I will always have my arms open and ears ready to listen.   If you need help, it can be me.  If you need love, it can be me.  If you need nothing, just company, it can still be me.  I’m so proud of you both.  You have hearts full of love and giggles full of joy.  I pray you will always live by the golden rule.  If you will simply love God, love people and serve others, then you have accomplished more than most.

All of my love,

Momma

(Tanya Bolton, Marketing Director)

Act of Kindness Challenge!

 Lets countdown to Christmas by doing acts of kindness for others this season! I’ve come up with some suggested acts that promise to bring a smile to anyone’s face. I have only included items that are FREE so no one has an excuse! Beginning December 14^th lets do “good deeds” each day. If you are unable to do that particular suggestion that day, simply choose another one on the list. I’m willing to bet that you will receive much more joy and Christmas spirit by giving with your heart instead of your wallet!

 

Day 1- Smile at everyone you see today.  A huge toothy smile that makes them wonder what has happened to you!  Smiling is contagious!  The amount of joy you can spread by actively trying to smile today could change many people’s day.

Day 2- Make someone’s shopping trip less stressful.  If you are healthy and able leave the closer parking spaces for someone else.  Another way to bring a smile to their face would be to share you coupons.  If you’re at the mall and have an extra $$ coupon then pass it on to the person behind you in line. I love it when people do this to me!

Day 3-Write a note.  Sit down for 2 minutes and write a hand written note or email to someone who has helped you recently.  It could be a store employee, doctor, teacher, babysitter, etc.  Let them know that you appreciate them and how they brightened your day.  You can also copy to their supervisor so that they may receive recognition.

Day 4-Do not complain about ANYTHING today.  Your mind effects what your mouth says and your mouth effects how your mind feels.  Today we are only spreading positive energy!

Day 5-Use the gift of gab.  Call a relative or friend who lives alone or doesn’t get out much.  Tell them you were just thinking about them and wanted to wish them a Merry Christmas!  You could be the only person they speak to today.

Day 6-Tell an employee that helps you “Thank you.  You are really good at your job!”  This can be anyone who helps you today.  A thank you goes a long way this time of year.

Day 7- Tell an elderly person that they look beautiful, carry their packages to their car or simply say I hope you have a Merry Christmas.  Sometimes our most cherished members of society are overlooked and lonely.

Day 8- Tell your spouse, significant other or best friend how much you care about them.  Let them know that your life is better because of them.  If that person is away you can send an email or leave a voice mail but it’s always better in person.

Day 9-Make someone’s trip to the grocery better! If you have coupons you’re not using leave them laying on top of that item.  When the next guest comes along they will find a little treat.  If you’re not a coupon cutter then simply offer to help someone out to their car.  If you see a Mother with a small child, get her a cart (one with a car attached is preferable!) If none of these opportunities arise simply say Merry Christmas to everyone you make eye contact with!

Day 10- Bite your tongue today.  No matter how busy or frustrated you are today be nice.  If you have nothing nice to say simply smile and reply, “Have a blessed day”.  If someone has been hateful to you that will make them feel like they are about 1 inch tall.  It may help out the next person they come in contact with too!

Christmas Eve- Relax, spend time with your family and think about all of the lives you have affected by spreading random acts of kindness.  This is truly what Christmas spirit should be about!

 

Tanya

Breast Cancer Through the Eyes of a Survivor… Who is also a Nurse

When ask to write a blog article, I did not know how to start. I tried googling it, asking others and then I just started to write what I know and hopefully you will get the jest of my story.

I was blind- sided with the diagnosis of breast cancer June 26, 2013. I faithfully had my mammograms every year, did self-breast exams, saw my gynecologist yearly, and decreased my caffeine intake until it was almost non-existent. I practiced what I preached. I am an OB/GYN nurse and have been for thirty plus years. I have four sisters with no issues and no relatives that I know about ever diagnosed with breast cancer. My mammograms always came back with several benign cyst, so my thought was my radiologist was mistaken, it was just a cyst.

After my mammogram, an ultrasound was performed and Dr. Kenney said,” I am so sorry it is breast cancer”.  A biopsy was performed and an MRI was scheduled for the following Tuesday. It all happened so fast that it is now just a blur.

I quickly had reversed the role of a nurse to a patient. The first thing we tell patients is not to do is go on the internet but where did I go straight to the uncaring, unedited, unbiased internet. Every horror story with pictures you can only imagine. I was starving for answers but was too proud to say I had no idea what I was facing.

The fear, confusion, and anger was all crashing in. My appointment with the general surgeon was expedited due to Dr. Reva Tackett and many prayers. The general surgeon was very informative I am sure, my husband at least got the information I was still in shock I suppose.

Was it going to be a lumpectomy and radiation, unilateral mastectomy or bilateral mastectomy and possibly chemo and radiation? I didn’t know. I just wanted the cancer gone.    I decided my breast were attached to me and I was not that attached to them! This was true until I woke up and they were gone. I will not lie this was pretty much devastating until I convinced myself that they were gone and I was not. Cancer used to be a death sentence.

Now the treatment regimen: Breast reconstruction had already begun with tissue expanders, chemo therapy starts in four weeks so another surgery to have a port put in to administer the chemo.   I thought I handled double mastectomy, tissue expanders, and drains, this couldn’t be worse.   WRONG!! The port surgery was a piece of cake. The first chemo not so bad until the third day, it was bad, hugging the toilet, even hard to hold my head up. After two rounds of chemo I lost my hair. I went to my hairdresser, Sherre, I have known since my high school prom and we both laughed and cried while she shaved the little scraggly parts of my hair that was left. I tried wearing wigs but I am more of the hat kind of woman.

It was time I quit focusing on the negative and start focusing on survival. Surviving takes strength and determination and mostly a great support team. My sons and family were a blessing. It was hard letting them see me like this and I am sure it was a very difficult time for them to see me like I was as well. The visits they would make with me were my highlights.  My friends and my co-workers kept me going as well. All the food, the prayers and hugs go a long way. Knowing they were there for me no matter what was and is a comfort.

I am now over a year out and just had my port removed. My hair, well any hair is good hair and it is coming back. My nails are now actually growing. The last reconstruction with tattoos and the sculpting of nipples was completed October 1st of this year. I had to ask if I could have UK blue tattooed areolas and if  the piercings automatically done,  but I guess it was not time to joke.

It seems like it has been a long process but it does make me appreciate things more! I really don’t sweat the small stuff nearly as much as I did.   I now have a beautiful fourteen month old granddaughter and a grandson on the way and God continues to bless me. My goal is to be a blessing to someone else. Even if it just to share my story and to let others know that breast cancer isn’t always a death sentence and to live life to its fullest and they are not alone.

Tammy Crupper, RN

Lexington Women’s Health

Colonoscopy

It is easy to be passionate about colon and rectal cancer prevention with colonoscopy.

For more than 20 years, we’ve known that removing polyps during colonoscopy reduces the incidence of colorectal cancer. In 2012, long-term follow-up data from the largest polyp registry came out in The New England Journal of Medicine demonstrating a reduction of more than 50 percent in deaths from colorectal cancer in patients who had polyps removed during colonoscopy.

Colonoscopy not only prevents cancer, it also saves lives. Given that cancer of the colon and rectum is the third most common cancer among men and women in the United States, the impact of regular screening with colonoscopy on the overall health of our country is huge.

Even though the data clearly support colonoscopy for colorectal cancer screening, some patients are still reluctant to have the test. Some reasons my patients tell me they aren’t willing to have a colonoscopy:

■ I can’t stand the prep.

■ I’m afraid it will hurt.

■ I had one before and I was awake the whole time.

■ It’s too expensive.

■ I can’t take time off from work or family.

There’s good news for anyone facing the prep — there are several different clean-out options for colonoscopy now. Many don’t require drinking a whole gallon of liquid.

While a patient may stay “awake” for the procedure, the medications given are used for their qualities of relieving pain, calming nerves and helping patients not remember the procedure.

Additionally, most insurance companies cover screening colonoscopy. Their goal is to prevent people from having very expensive cancer care, so it is in the insurers’ best interest to offer this coverage. If you do not have insurance, many hospitals have programs to work out a payment plan for the test.

The procedure takes on average 30 minutes to perform, and patients can go back to their usual activities the next day. Patients can even eat whatever they choose shortly after the exam. Most centers performing the test have very flexible appointments to meet the needs of patients’ busy schedules.

If you still have concerns about getting a colonoscopy, please talk to your health care provider. There are many options when it comes to preparation, where the test is performed and which types of medications are used. Odds are that there is a convenient option available to keep your colon healthy and cancer-free.

Dr. Jennifer D. Rea,  Colorectal Surgical and Gastroenterology

Cervical Cancer trends

The incidence of cervical cancer continues to drop despite increasing STD rates. This is due to more sensitive screening tests including computer imaged liquid cytology and HPV DNA tests.  The HPV vaccine is expected to reduce cervical cancer rates even more in the years to come.  The HPV vaccine has reduced infection rates by 56% (in the teenagers 14-19 years of age) and is recommended for girls aged 11-12 or girls 13-26, if they were never vaccinated. The screening guidelines keep changing, but don’t be confused.  This disease is deadly but can be prevented if you get regular screening. The incidence of cervical cancer continues to drop despite increasing STD rates. This is due to more sensitive screening tests including computer imaged liquid cytology and HPV DNA tests. The HPV vaccine is expected to reduce cervical cancer rates even more in the years to come. The HPV vaccine has reduced infection rates by 56% (in the teenagers 14-19 years of age) and is recommended for girls aged 11-12 or girls 13-26, if they were never vaccinated. The screening guidelines keep changing, but don’t be confused. This disease is deadly but can be prevented if you get regular screening. The Pap test is recommended for all women between the ages of 21 and 65 years old. If you are 30 years old or older, you may choose to have an HPV test along with the Pap test (co-testing). If you are older than 65 and have had normal Pap test results for several years, your doctor may tell you that you do not need to have a Pap test anymore. (Source: CDC fact sheet)

 

STDs are on the Increase

Here are some frightening facts.

-One in two sexually active persons will contact an STD/STI by age 25.

-Over 14 million people acquire HPV each year.

-By age 50, at least 80 percent of women will have acquired genital HPV infection.

-Each year, one in four teens contracts an STD.

The 4 most common STDs are: HPV, Chlamydia, Trichamoniasis, and Gonorrhea (source: American Sexual Health Association)

 

Don’t be tricked by a Lack of Symptoms

Trichomonas vaginalis (or “trich”) is a parasite that affects both men and women and is considered the most common curable STD. In the United States, an estimated 3.7 million people have the infection, but only about 30% ever develop any symptoms.  The parasite inhabits the vagina, penis or mouth and is transmitted during sex.  Infected people without symptoms can still pass the infection on to others. Symptoms can come and go and may include itching, burning after urination, or a thin discharge with an unusual smell. Having Trichamoniasis can make it feel unpleasant to have sex. Without treatment, the infection can last for months or even years. Trichamoniasis can increase the risk of getting or spreading other STDs like HIV or HPV, which causes cervical cancer. It is not possible to diagnose Trichamoniasis based on symptoms alone. For both men and women, the most sensitive laboratory test is the RNA (not DNA) test offered by Hologic. The best news is that Trich can be cured with a single dose of oral antibiotic medication. (Source: CDC fact sheet)        .

Did You Know?

The only cancer for which the Pap test screens is cervical cancer. It does not screen for ovarian, uterine, vaginal, or vulvar cancers. So even if you have a Pap test regularly, if you notice any signs or symptoms that are unusual for you, see a doctor to find out why you’re having them. (Source: FDA & College of American Pathologists)

 

Richard Lozano, MD

Cytopathologist at Pathology & Cytology

Advanced Maternal Age

As more women are delaying childbearing until later in life, it is important to understand the risk involved in waiting. Advanced maternal age generally refers to a woman who has reached her 35^th birthday by the date of delivery. The rate of births to women 35 and older has gradually increased, and in 2009, 14 percent of all babies were born to mothers 35 and older.

For most, the perceived risks outweigh the actual risk. An objective look at the risks of delivering after age 35 can be helpful to put them all into perspective.

One of the most common concerns for women in their 30s and 40s is whether they will be able to conceive. For most, the answer is yes. Studies show that fecundity (the rate at which a woman will conceive on the first attempted cycle) begins to slowly decline after age 32 through age 37. There is a more rapid decline from 37 to 45. Women 35 and older who want to conceive and have a history of irregular cycles, chronic pelvic pain or pelvic infections should have these problems evaluated by their healthcare provider prior to attempting pregnancy.

Aneuploidy, the presence of an extra or missing chromosome, can result in birth defects and developmental delay. The risk of Down’s syndrome, the most frequent chromosomal disorder seen in newborns, increases gradually with age. At 35, the risk is approximately 1 in 250 births. At 40, the risk increases to 1 in 50. If a woman delivers at 45, the risk is 1 in 10.

Chronic medical conditions such as high blood pressure and diabetes are more common in women of advanced maternal age. Even women 35 and older who have been perfectly healthy are at increased risk of developing pregnancy-induced hypertension and diabetes. Developing either condition can result in additional visits to the healthcare provider for monitoring the mother and the baby, bed rest and need for preterm delivery.

Cesarean section is more common in women 35 and older. Dysfunctional labor, complicating medical conditions and an increased rate of elective cesarean deliveries all contribute to a higher cesarean section rate.

Pregnancy and delivery are never risk-free. The risks encountered by women 35 and older are relative to the baseline risk and must be seen in light of the socioeconomic benefits of delayed childbearing. Preconception consultation can individualize and potentially reduce the risks for women considering a pregnancy at any age.

Jennifer Fuson, an OB/GYN with Lexington Women’s Health, practices at Central Baptist Hospital.

 

Doula Services

“I couldn’t have done it without you.”

I hear it all the time, and, although I know that each and every woman I serve would have given birth to their babies without my support, I also understand the value of a trained support person during birth. A doula provides continuous emotional, informational and physical support to women and their families. In the past 7 years I have been honored to see over 100 women become mothers, sometimes for the 3rd and 4th time, and it never ceases to amaze me. I still get teary-eyed when women speak to their babies for the first time, gaze into their eyes and count those precious fingers and toes. What makes these women feel that they couldn’t have given birth without my support? As a doula I never leave a woman’s side unless asked to do so. I wipe her brow with a wet cloth, know position changes that are helpful and constantly affirm her ability to become a mother. I help her understand informed consent so she can adequately determine for herself which path she will take if complications arise. I facilitate communication, never speaking on her behalf and allowing her to have open communication with her chosen care provider. I tell her what a good job she is doing with her birth and support her fully in whatever choices she makes, as well as give guidance and assurance to her birth partner if one is present. Doulas give confidence, and confidence is invaluable!

 

“When continuous labor support was provided by a doula, women experienced a: 31% decrease in the use of Pitocin, 28% decrease in the risk of C-section, 12% increase in the likelihood of a spontaneous vaginal birth, 9% decrease in the use of any medications for pain relief, 14% decrease in the risk of newborns being admitted to a special care nursery, 34% decrease in the risk of being dissatisfied with the birth experience.” Rebecca Dekkar, Evidence Based Birth (www.evidencebasedbirth.com)

Keeping those statistics in mind, who wouldn’t want to have a doula? Doulas can be found by asking care providers who they’ve worked with, searching doula databases, checking with local birth resources or asking friends and families who they have hired in the past. When you have narrowed your choices, you will want to set up in-person interviews to determine who will be the right person for your birth. Here are some suggestions of questions to ask during the interview process:

 

1. What is her level of training and is she certified or working toward certification? There are many reputable organizations including, but not limited to DONA and CAPPA who train and equip doulas to serve women while abiding by ethical standards. Finding out what the doula abides by is essential in knowing how she will respond within the birth environment you have chosen.
2. What is her level of experience? Every doula has to start somewhere and newer doulas are very excited and full of zeal for their new profession. If cost is a factor a newer doula is generally less expensive than a doula with up-to-date certifications and multiple birth experiences to draw from. The benefits of established doulas are that they have been exposed to the birth culture within the community, they have previous experiences from which to draw and they have good relationships already established with the providers in the area.
3. How does she view her role? A doula’s role is defined by you as the parent while maintaining ethical standards of conduct and respecting the care team you have established. She may do a lot of behind-the-scenes work or be more hands-on and actively encouraging to you. She may be there as a support to the birth partner as well so that he/she can be more actively supporting you as well. Doulas are not medical care providers and do not offer vaginal exams, checks of the fetal heart tones or blood pressure readings.
4. Does she have references? Are her own previous clients willing to vouch for her work and have your chosen birth care team worked well with her in the past? Speaking with a few previous clients can help determine if she will be the right doula for you. You can ask them what the doula did that most helped them or if there was anything they wished she had done differently or better.
5. How many births does she take per month and has she missed any and why? It is inevitable that full-time doulas will eventually miss a birth due to sickness or clients having babies on the same day, but this should be the exception and not the rule! When interviewing doulas ask who they provide back up for and how often.
6. How long would it take for her to reach you? If she has children does she have care arranged? A doula should be able to reach you fairly quickly, especially with adequate notice. Most will have a range of 1-2 hours depending on how far away they live. If childcare isn’t established then finding someone last-minute can prove difficult for most doulas. Ensure that she can attend to you fairly quickly and everything has been planned ahead for your birth. You should be a priority in her life!
7. How would she feel if you were to opt for medical intervention even if it weren’t indicated by research? A doula should respect all decisions made by you in all instances. She can help you communicate with your care providers to be sure you understand your options, but not speak on your behalf. A doula will help walk you through any questions you have, present alternatives that may have been looked over and allow you to make the final decision without pushing her own philosophy above yours.
8. What are your fees and policies? A doula should have everything outlined in a contractual agreement. This allows everyone to understand what happens in every birth situation. What happens if she misses the birth? What are her fees? What is the refund policy? Who is her back up? What is included? All of these questions are important and provide instant clarity of expectations.

 

Choosing a doula is something very personal and should be a smooth and fun experience for you. Call around, set up interviews and ask your important questions. Once you have taken some time to discuss and decide on the best doula for you, send in the deposit and relax, knowing you have made a wonderful decision regarding your pregnancy and birth. A healthy baby and healthy mom are important, but a positive birth experience is as well!

Enjoy your beautiful birth!

 

Julie Six is a local doula certified with DONA and CBI. She has attended over 100 births in the last 8 years and enjoys teaching Hypnobabies and helping women have easier more comfortable births. She is the owner and founder of the up and coming doula group, Birth Kentucky, LLC. For more information on finding a doula or childbirth classes in the Lexington, KY area please contact Baby Moon at 859-335-5949 or email julie@baby-moon.org