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

Jennifer Rea

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 35th 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

Why do they call it “morning sickness” when it lasts all day?

No one really knows what causes the nausea of pregnancy, but it affects over half of all pregnant women. It is thought to be related to the high hormone levels of pregnancy, like human chorionic gonadotropin (hcg) and estrogen.  The high progesterone level also relaxes a pregnant woman’s esophagus, so that she is more likely to have reflux and gagging.

Symptoms of nausea may be brought on by hunger or swings in blood sugar. Many notice that their nausea is worse when they are tired. Some moms report that smells may make their nausea worse. Sometimes even a vitamin is a trigger, but the vitamins are needed! There are some women who make extra saliva during pregnancy, and this constant swallowing makes them sicker.

The worst week of morning sickness is usually in the middle of the first trimester. By the second trimester, your body will have some relief.   If you need relief sooner, here are some things to try:

1.       Get lots of rest.   Fatigue can cause nausea even when you are not pregnant. What a great excuse to take a nap!

2.      Try frequent small meals that include some protein or fat.   The old advice of eating crackers may help temporarily, but a little cheese and turkey on the crackers will bring longer relief by keeping blood sugars stable. Sipping on flavored beverages all day long not only improve hydration, which makes you feel better, but may also help those with excess saliva production.

3.      Antacids. Tums contain calcium, and are good for pregnancy. In some cases, the heartburn and gagging is helped by pepcid 20 mg every day.

4.      Antihistamines. Doctors often prescribe antihistamines like phenergan to help with nausea, but benedryl (diphenhydramine) 25 mg as needed every 6 hours may also help.

OR   An older remedy for nausea was to recommend ½ of a unasom tablet (doxylamine 12.5 mg) every 6 hours.  Remember that any antihistamine may cause fatigue, and see step 1!

5.      Vitamin B supplementation.   Some people have less nausea with extra vitamin B6, 50 mg every day.

6.      Ginger. Ginger snap cookies, ginger ale, and candied ginger have all been said to improve nausea, though not well studied.

7.      Prescriptions have improved over the last 10 years. Doctors often recommend Zofran, Kytril, Reglan, Compazine or others to help with the nausea. Of course, all have side effects that should be discussed with a physician.

The extreme form of morning sickness is called hyperemesis. It causes relentless vomiting and can result in dehydration, weight loss, and nutritional deficiencies. While vomiting occasionally is common, hyperemesis occurs in less than 2% of pregnancies. Hyperemesis needs to be treated aggressively with medications and fluids, and should not be ignored.

 

Emily Cunningham, MD

Lexington Women’s Health

 Emily Cunningham 2014

 

The Robotic Surgery Revolution

So what’s all the hype about robotic surgery? If you would have told me ten years ago that I would be spending my days in the operating room with a robot assisting me, I would have thought you were crazy! But it’s true. When the difficult decision is made to undergo hysterectomy, we are often concerned about the amount of time required for recovery. We’re all too busy to be down for surgery! We want the least invasive option that will meet our needs safely.

 Robotic surgery has distinct advantages over traditional surgery requiring a large incision on the abdomen. Robotic surgery is done through small incisions less than one centimeter. It follows that there is less pain with robotic surgery. Robotic surgery is much more precise than other operations and as a result, there is less blood loss. Operations for women with multiple prior surgeries or a very large uterus can be done with robotic technique. If you are facing hysterectomy and are told you are not a candidate for minimally invasive surgery, certainly seek a second opinion! Chances are, you could be home the same day as your operation and back to most normal activities in 2 weeks!

 

Jennifer A. Fuson, MD

Jennifer Fuson 2014 Black and White

 

 

Excessive Menstrual Bleeding

Excessive menstrual bleeding affects millions of women every year. Women who are affected suffer decreased quality of life, reduced productivity in the workplace and the constant threat of inconvenience or embarrassment.  Chronic health conditions such as fatigue and anemia can result from heavy bleeding. Until recently, women were expected to suffer with the bleeding, take hormonal medications or have a traditional hysterectomy with a large abdominal incision. Today’s women are offered many newer options. Women suffering from heavy menstrual flow should talk with their healthcare provider about the options that may be appropriate for them. These generally include:

 

NSAID therapy. Medications such as Motrin®, Advil® or Aleve®, taken three to five days prior to menstruation, may reduce bleeding up to 30%. This treatment requires very regular cycles in order to work well.

 

Hormonal therapy. Hormones either in the form of oral contraceptive pills or cyclic progesterone can induce a regular and lighter flow. This treatment is very effective to induce regular menstrual cycles and may have the added benefit of improving acne and PMS.

 

Hormonal intrauterine system. Mirena® is a device that slowly releases progesterone in the uterine cavity. This dramatically reduces or even eliminates bleeding by keeping the lining very thin and healthy. It is an excellent alternative for people who want to avoid oral hormonal therapy. This requires only a simple office procedure, minimal discomfort and no down time.

 

Global endometrial ablation. Done in the office or operating room, this technique uses thermal energy to destroy the lining of the uterus, resulting in significantly decreased uterine bleeding. 85% of people will see reduced or even absent menstrual flow following ablation.

 

  1. This surgery is now often done on an outpatient basis with tiny incisions using traditional laparoscopic techniques or with the newer da Vinci robotic surgical system. These minimally invasive surgical procedures offer definitive treatment, and patients are able to get back to their lives quicker than ever before and with less pain. No longer are large abdominal incisions,extended hospital stays and long recoveries usually necessary.

Women experiencing excessive menstrual bleeding that affects their ability to enjoy a happy and productive life should speak with their provider about the treatment options that might be right for them. It is no longer necessary to plan family, recreational and work activities around episodes of heavy menstrual bleeding. Newer options available today make it easier than ever to be free from the uncertainty of heavy or irregular menstrual flow. Despite the newer nonsurgical options, hysterectomy is sometimes necessary.  When performed in a minimally invasive way, women can get back to doing the things they enjoy faster than ever before.

Jennifer Fuson, MD Lexington Women’s Health

Elective induced labor not without its risks

Induction of labor refers to stimulating labor to cause contractions before spontaneous natural labor begins. The term elective induction of labor is used when a woman undergoes stimulation of labor without a medical reason for doing so. A medical reason would include conditions that put the health or life of the mother or fetus at risk. Labor inductions are appealing for many reasons. First, they are convenient. The prospect of organizing a birth into an already overbooked family or work schedule can be very tempting. Excitement about meeting the infant, stress, discomfort and even pressure from friends and family are other reasons women may schedule an induction of labor. Although these seem like justifiable reasons to have a baby on a predetermined date, it is important to remember that labor induction is a medical procedure that could have life-threatening risks for both the mother and fetus.

Many methods are used to induce labor. Understanding those methods is an important part of understanding the overall risks involved. The more common methods include rupturing the amniotic membranes surrounding the fetus— often referred to as “breaking water”—and the use of intravenous Oxytocin, a synthetic form of a naturally occurring hormone that is responsible for labor and breastfeeding.

Studies have hown that the risk of Caesarean section can be as much as two-fold higher for women undergoing induction of labor. This is especially true for first-time mothers. Other associated risks include fever, infection, rupture of the
uterus, hemorrhage, blood transfusion and even death in rare instances. Fetuses
may experience stress during the process. Fetal distress is an indication for
Caesarean section.

There are also health care costs associated with induction of labor. Women who undergo labor induction require more medical intervention, more equipment, more medications and usually have longer hospital stays. Because of this, some insurance companies are now refusing to pay for elective labor inductions.

Women considering an induction of labor should discuss it with their doctor or
midwife. The discussion should include reasons induction might be appropriate,
risks, benefits and what procedures will be used to stimulate labor. Women should have a clear understanding of the entire process before proceeding. It is
important to remember that swollen feet and discomfort evident at the end of
pregnancy are only temporary conditions and that the most desired outcome for
any pregnancy is a healthy mother and a healthy baby.
Alisha C. Morgan, CNM