Nikki's Corner - A Health Blog
Jan 10, 2018, Nikki Says:
Genitourinary Syndrome of Menopause (GSM)
GSM is group of problems involving the vagina, urinary tract, and sexual difficulty due to the low estrogen state after menopause. These tend to be long term problems and progressively worsen. Over half of postmenopausal women will experience at least one of these complications. Common complaints are vaginal dryness, painful sex, vaginal itching, discharge, and pelvic pain. The lack of estrogen after menopause causes an elevated pH of vaginal fluid which promotes an overgrowth of bacteria that can lead to vaginal infections, UTI, and inflammation. Low estrogen also causes decreased blood supply to the vagina and urinary tract causing the vaginal walls to become thin and less elastic. This can cause painful sexual activity. The bladder and urethra are similarly affected, causing urinary incontinence and increased frequency of urination.
There are three types of medication treatments for these symptoms: systemic or topical hormone replacement and selective estrogen receptor modulators (SERM). Systemic hormone replacement is suggested for patients with GSM symptoms as well as additional menopause symptoms like hot flashes and a risk of low bone density. Topical treatment is recommended for patients who only have vaginal symptoms. Estrogen therapy, whether systemic or topical, will improve vaginal and urethra bacteria and help to prevent frequent vaginal infections and UTIs. There are certain individuals who should not take estrogen therapy, and this will be discussed at your visit. Ospemifene is a SERM which is a treatment for patients who cannot take estrogen therapy. It improves both vaginal structure and pH.
If you desire non-medication treatment of your GSM symptoms, homeopathic remedies and lifestyle changes may be considered. Homeopathic treatment studies show no improvement in the vaginal tissue, but does show improvement in vaginal flexibility. These treatments include black cohosh, dong quai, phytomedicines, nettle, comfrey root, motherwort, soy foods, and chaste tree extract. Some herbs can interact with certain medications, so make sure to contact your physician prior to starting any herbal medications. Increasing your sexual activity can also aid in relieving GSM symptoms. This maintains vaginal muscle conditioning, elasticity, and the natural lubricative response.
Another option for non-pharmacologic treatment is Thermiva, which is an in office procedure using radiofrequency energy to gently heat the vaginal tissue. Treatments are intended to tighten vaginal tissue and stimulate collagen production for the treatment of vaginal atrophy and dryness.
Genitourinary syndrome of menopause can severely affect your quality of life. If you suffer from any of these symptoms, call for an appointment for more information or to discuss your treatment options.
Nov 22, 2017, Nikki Says:
Tdap Vaccine in Pregnancy
As we discussed last month regarding the flu vaccine, newborns are very vulnerable to respiratory illness until they are able to receive their own vaccinations. Pertussis (also known as whooping cough) is a highly contagious respiratory illness. Early symptoms are fever, runny nose, and mild cough, which usually last 1 to 2 weeks. Later stage symptoms include fits of coughing follow by a high pitched “whoop” sound, vomiting after coughing, and exhaustion. Pertussis symptoms can last up to 4 months. The highest rate of complications related to a pertussis infection occurs in infants 3 months old and younger due to their narrow windpipe making breathing difficult with coughing. Infants can contract pertussis from family members, caregivers, and anyone else that they meet. Infants do not begin their own vaccine series to protect against pertussis until 2 months of age.
The Tdap vaccine protects against tetanus, diphtheria, and pertussis. As with the flu vaccine, this vaccine consists of an inactive form of the viruses, making it safe in pregnancy. The American College of Obstetrics and Gynecology recommend pregnant women receive this vaccine each pregnancy regardless of previous vaccination. Ideal timing is between 27 and 36 weeks. This allows for adequate maternal antibody response and transfer to your baby. The vaccine can be given outside of this timeframe for wound management, pertussis outbreak, or other extenuating circumstances.
Along with mothers, it is recommended that adolescents, adult family members, and caregivers who have not received the Tdap vaccine also receive the vaccine at least 2 weeks before coming in contact with baby. Feel free to call our office today to obtain yours or your family member’s vaccination.
Oct 12, 2017, Nikki Says:
Flu Vaccine in Pregnancy
Many women have questions as to whether the flu vaccine is necessary in pregnancy. There are many misconceptions about vaccination, such as, “I will get the flu from the vaccine”, “The vaccine will make me more susceptible to other respiratory illnesses”, “The flu vaccine is not safe in pregnancy”, “The vaccine will harm my baby”. All of these are incorrect. I hope the following information will help to put your mind at ease and encourage you to obtain this year’s flu vaccination.
Why should I get the flu vaccine? Normal changes in the immune system due to pregnancy put you at a higher risk to contract the flu and have a higher rate of complications. Pregnant women are 7 times more likely to suffer complications from flu infection than women who are not pregnant. There are also pregnancy specific complications, such as preterm labor and preterm birth. The flu vaccine triggers your immune system to make antibodies against the flu virus.
Who should get the flu vaccine? The Centers for Disease Control and Prevention recommend that everyone 6 months of age and older get the flu vaccine yearly. This includes women who are pregnant and breastfeeding. It is best to get the vaccine early in the flu season, which begins in October and peaks between December and February.
What type of flu vaccine should I get? There are 2 types of flu vaccines: a shot and a nasal mist. The shot contains a form of the inactive flu virus. The vaccine itself cannot cause illness. This form of vaccination is safe and can be given at any stage of pregnancy. The nasal mist is a live, weakened form of the virus. This form is not recommended for pregnant women but is safe after delivery, including during breastfeeding.
What is the affect on my baby? As previously mentioned, the flu vaccine activates your body to make antibodies against the flu virus. These antibodies cross the placenta during pregnancy and delivered in breast milk after birth. Babies cannot get the flu vaccine until they are 6 months old and these antibodies are their only protection.
The flu vaccine in pregnancy does “double duty” by protecting both you and baby. With flu season right around the corner, we encourage you to get the vaccine at your next visit. Feel free to contact the office with more questions or concerns.
Aug 22, 2017, Nikki Says:
The Female Athlete Triad
The Female Athlete Triad is a combination of amenorrhea (absence of periods), osteoporosis (weak bones), and disordered eating. This occurs when calorie intake does not provide enough energy for exercise-related use. This can lead to severe problems in a female’s reproductive, bone, and cardiovascular health. The athlete may have 1, 2, or all 3 components. Girls who are at the highest risk are participants in sports with endurance, aesthetic, or weight class components such as gymnastics, wrestling, dance, figure skating, cheerleading, long distance running, and pole vaulting. Female athletes require 45cal/kg of body weight daily. For example, a 120lb (54.5kg) athlete needs 2454 calories per day to meet her energy needs. Less than 30kcal/kg intake will disrupt menstrual function and bone mineralization.
Menstrual Function: Menstrual disturbances can be primary amenorrhea (no period by age 15), secondary amenorrhea (absence of periods for 3 consecutive months), or oligomenorrhea (cycles longer than 35 days).
Cardiovascular Health: Amenorrhea causes low estrogen levels, which can cause cardiac tissue dysfunction and elevated levels of total cholesterol and bad (low density lipoprotein) cholesterol.
Bone Health: Adolescence is the critical time for building bone strength. The maximum rate of bone formation occurs from ages 10 to 14. Stress fractures are a common occurrence in these athletes.
With improved caloric intake, menses can resume and catch up bone mass may be possible. Periods may take up to a year or longer after normal calorie intake resumes. If weight loss is necessary for the athlete, seek medical assessment and nutrition supervision before starting a weight loss plan. It is important for athletes, coaches, and parents to realize that menstrual dysfunction and restricted calorie intake is not normal in athletes and may be detrimental to their health and athletic performance. If you are concerned that you or a family member may be suffering from Female Athlete Triad, please call our office to set up an appointment for more information and to discuss a treatment plan.
Aug 3, 2017, Nikki Says:
The Skinny on Exercise:
Five Helpful Tips to Improve Motivation and Consistency with Exercise
1- Exercise at the same time each day.
Being in a certain environment at a certain time of day helps your mind to go into
autopilot, making exercise easier.
2- Be flexible with your goals.
If you are flexible with how long or vigorously you expect to exercise, it removes the
psychological punishment of “I failed”.
3- Widen your definition of exercise.
Many people think exercise has to last a certain amount of time and make you sweaty
and exhausted. Things like climbing stairs at work or walking the parking lot on your
lunch break are good ways to get exercise outside of a gym.
4- Have visual cues.
Have cues that prompt you to exercise, such as running shoes by the door or
headphones on the counter. This will remind you to get to it.
5- Exercise for pleasure, rather than weight loss or health goals.
When you are exercising for enjoyment, as opposed to a requirement, you will be more
likely to participate and more consistent with your exercise regimen.
Find the type of activity you enjoy, and get going!
Jun 29, 2017, Nikki Says:
Zika is a viral illness caused by a bite from an infected mosquito. There is also the possibility of spread via sexual activity and blood transfusions. There have been multiple documented cases in America with a growing prevalence of the disorder. The biggest concern at this time, is the effect on the fetus if a pregnant woman contracts the disease. The virus can cause microcephaly or other severe fatal brain or eye defects. Symptoms may include fever, red eyes, joint pain, headache, and a maculopapular rash. These symptoms generally last less than a week. Diagnosis is made by testing the blood, urine, or saliva for the presence of Zika virus RNA.
There is currently no vaccine or medication to prevent the disorder. Prevention involves proper condom use and efforts to prevent mosquito bites with the use of insect repellent, covering the body with clothing, mosquito nets, and getting rid of standing water where mosquitos reproduce.
For up-to-the minute information regarding Zika please follow the following links:
May 30, 2017, Nikki Says:
On April 20, 2017, the Food and Drug Administration updated the guidelines on the use of Codeine and Tramadol in breastfeeding women and children. Both medications are commonly used to treat pain and codeine can also be used to treat cough. It has been found that these medications have a serious risk of slowed or difficult breathing and death in children. These risks are especially high in children under 12 years. It is recommended to avoid these medications in breastfeeding mothers due to risk of harm to the infant.
Check back soon for more news and updates from our Physician's Assistant, Nikki McCann.