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Prevention of Osteoporosis and Vitamin D Deficiency

Osteoporosis is a disorder of the bone that makes it more likely to break. Osteoporosis prevention should start when women are young and continue throughout their lifetime. Of course, calcium and vitamin D is better if it comes from your diet, but if this is not possible, then a supplement would be recommended.

The Institute of Medicine recommends the following amounts daily:

Age (years) Calcium recommended dietary allowance (mg/day) Vitamin D recommended dietary allowance (IU/day)
9-18 1300 600
19-50 1000 600
51-70 1200 600
71 and older 1200 800

Vitamin D helps calcium be absorbed. While routine screening of vitamin D is not recommended, women with certain medical conditions that prevent vitamin D from being absorbed or women who take medications that affect vitamin D levels should be occasionally tested. Too much or too little vitamin D has risks, so the institute of medicine recommends no more than 4000 IU/day of vitamin D. If you are tested, and you are deficient, the following is the typical recommendation for supplementation. Keep in mind, that there are several ways to supplement vitamin D and there are no specific studies that say one way is better than the other. Typically, your vitamin D level would be rechecked in 3 months to make sure you are getting enough supplementation.

25 hydroxy-vitamin D level (ng/mL) Vitamin D3 dose
<10 50,000 IU once a week for 6 weeks, then 800 IU a day
10-20 800-1000 IU/day
20-30 600-800 IU/day

In general, we start looking for osteoporosis later in life when women are at a higher risk of fracture (breaking a bone). DEXA or bone density scans are recommended at age 65 or earlier if women are postmenopausal and have risk factors for osteoporosis. Risk factors include: smoking, drinking more than 3 alcoholic beverages a day, chronic steroid use (topical steroids are not a risk factor), body weight less than 127 lbs, rheumatoid arthritis, a parent with a hip fracture, or a medical condition/medication that causes bone loss.

If you had a bone density scan, your results will usually be sent to you in the mail. If you are having a routine DEXA (bone density scan), the important number is the T score. If your T score is -2.5 or less, then you have osteoporosis and we will work with you to find a good treatment regimen for you, or refer you to an osteoporosis specialist. A T score of between -1 and -2.5, then you have low bone mass. Low bone mass does not necessarily need treatment beyond calcium and vitamin D supplementation, unless your FRAX score is elevated. We will calculate this and let you know if you need treatment.

The post ABC’s Of Osteoporosis appeared first on Partners OB/GYN.

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Having a Baby Means Sharing Everything: Why Carrier Screening Matters

When you think about having children, you might think about what you’ll pass down to your children. Your height? Your eye color? But did you know that there are certain aspects of you that can be passed onto your children that you may not even know about. Genetic carrier screening allows us to look at your genes to understand aspects about you that could potentially affect your baby’s health.

What is Carrier Screening?

Carrier screening is a type of genetic testing that looks at your genes to see if you are a carrier for certain disorders that you can pass onto your children even if you do not have symptoms of that disorder. Carrier screening is completed by taking a sample of your blood and analyzing your DNA. Carrier screening can be completed before or during pregnancy and only needs to be completed once in your lifetime. When carrier screening is completed either prior to pregnancy or during pregnancy, it allows you to determine the likelihood your child having certain genetic disorders.

What is a Carrier?

A carrier is an individual who has only one gene for a genetic disorder that usually requires two genes for a person to have the disorder. A carrier usually does not have symptoms of the disorder that they are a carrier of. Therefore, the only way to know if you are a carrier is to complete carrier screening. If you are a carrier it does not necessarily mean that your child is at a high risk of having the disorder. If you are a carrier and your partner is also a carrier for that same disorder, there is an increased risk that your child will be affected.

What Carrier Screening Tests are Available?

Different genes are associated with different disorders. Some of the disorders that carrier status can be screened for include cystic fibrosis, spinal muscular atrophy, fragile X syndrome and blood disorders that affect red blood cells such as sickle cell anemia and thalassemia. The disorders screened for are determined based on various risk factors that your healthcare provider will help you determine. Most carrier screening is based on your ethnicity and family health history.

What do my results mean?

Negative or normal carrier screening is a good sign. It means that you are not a carrier for the disorders you were screened for. Positive or abnormal carrier screening means you are a carrier for one or more of the disorders screened for. The next step usually

involves screening your partner to better understand the risk for your future children. Often times a genetic counselor will go over and interpret the results with you.

Knowing your risk allows you to make informed decisions about family planning and testing options before, during or after pregnancy.

The post Carrier Screening in Pregnancy appeared first on Partners OB/GYN.

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How much exercise do I need?

Poor diet and physical inactivity, resulting in an energy imbalance (more calories consumed than expended), are the most important factors contributing to the increase in overweight and obesity in this country.

So Americans need to make time to exercise and find a way to work the recommended amount of physical activity into a busy schedule, whether its 30 minutes or 90. The good news: you can do it in bits and pieces!

For most healthy adults, the Department of Health and Human Services recommends these exercise guidelines:

  • Aerobic activity. Get at least 150 minutes of moderate aerobic activity (brisk walking) or 75 minutes of vigorous aerobic activity (running) a week, or a combination of moderate and vigorous activity. Even small amounts of physical activity are helpful, and accumulated activity throughout the day adds up to provide health benefit.
  • Strength training. Do strength training exercises for all major muscle groups at least two times a week. Aim to do a single set of each exercise, using a weight or resistance level heavy enough to tire your muscles after about 12 to 15 repetitions.

As a general goal, aim for at least 30 minutes of moderate physical activity every day. If you want to lose weight, maintain weight loss or meet specific fitness goals, you may need to exercise more. Learn more here with our article “I’m exercising but not losing weight“.

Meeting the 30-minute threshold will help a person maintain a healthy weight and reap health benefits like lowering the risk of heart disease, osteoporosis, diabetes, and hypertension.

Is 30 minutes enough?

30 minutes a day if you’re a person of normal body weight and you just want the health benefits of being physically active, 60 minutes if you want to control your weight, and 90 minutes if you want to lose and sustain.

You should strive to be as physically active as you can throughout the day.

Suggestions on how to do it!!!!

  • Be physically active by doing things you actually enjoy
  • Make it a group event
  • Simple things matter- take the stairs, park far away from entrance
  • Try something new- rock climb, swim, snow shoe
  • Find a support system and reward yourself
  • Start with 30minutes and see how you do

We are all BUSY!! 

Short on long chunks of time? Even brief bouts of activity offer benefits!  Decrease your sitting time and make regular physical activity part of your lifestyle!

The post Get up and MOVE, the benefits of Exercise appeared first on Partners OB/GYN.

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What is GBS?

Group B beta-hemolytic streptococcus (GBS) is a common type of bacteria that is often found in the reproductive tract, urinary tract or digestive tract of healthy women and men. This means that the bacteria is supposed to be present in these areas. This bacteria does not usually cause serious illness and most individuals with the bacteria do not show symptoms. One in four adult women will be colonized with GBS vaginally or rectally. GBS is not sexually transmitted.

Why do we test for GBS during pregnancy?

A woman who has GBS later in pregnancy can potentially pass GBS on to her baby during child birth. Even though the bacteria is normal for the woman, it can be harmful to the baby, leading to infections in the newborn. GBS affects 1 in every 2,000 babies in the United States. Not every baby who is born to a mother positive for GBS will become ill. However, if infection develops it can be severe. The most common newborn infections associated with GBS are lung infections, blood infections, and meningitis. Therefore, testing for GBS is a vital part of routine prenatal care. Treatment of maternal GBS during labor can help prevent newborn GBS associated infections.

How will I know if I have GBS?

Routine screening for GBS is recommended for all women during each pregnancy. The test is performed between 35 and 37 weeks of pregnancy and involves a swab of both the vagina and rectum. This test is quick and not painful. Because women typically do not have symptoms associated with the presence of GBS, all pregnant women are tested.

What happens if my GBS test is positive?

If a woman tests positive for GBS during her pregnancy, she will receive antibiotics during labor and delivery to prevent GBS from being passed to the newborn baby. The antibiotics must be given during labor as the bacteria may recur if treated too early. Penicillin is the most common antibiotic used to treat GBS but alternatives are available if you are allergic to this.

The post Not Just Another Pregnancy Test: Why Group B Strep Matters appeared first on Partners OB/GYN.

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Everyone talks about chlamydia, gonorrhea, and HIV. But there is another STI (Sexually transmitted infection) that is much more common — HPV, or Human Papillomavirus.

What is HPV?

Human papillomavirus (HPV) is the most common sexually transmitted infection. Nearly all sexually active women and men will have HPV at some point in their lives. There are over 150 types of HPV. Low risk types of HPV cause genital warts while high risk types of HPV can lead to cancers including cancer of the cervix, vagina, vulva, mouth/throat, anus/rectum and penis. HPV is spread by intimate skin-to-skin contact including vaginal, anal, or oral sex with someone who has the virus.

Will I know if I have HPV?

Most people with HPV have no signs or symptoms. Most HPV infections are temporary, do not cause any health problems, and 90% resolve on their own within two years. Signs or symptoms of HPV can develop years after contracting the virus making it nearly impossible to know when you first became infected. When the virus persists there is a chance of developing cervical precancer or cancer. This usually takes many years.

How do I reduce my risk?

Since HPV is transmitted by sexual contact, having multiple sexual partners is associated with increased risk. Condom use can reduce risk of contracting HPV. The HPV vaccine greatly reduces risk of contracting an HPV infection, providing nearly 100% protection against cervical cancer and genital warts. Girls and boys should get the HPV vaccine as a series of shots that can be administered as early as age 9. Routine cervical cancer screening through pap and HPV testing is recommended for women ages 21 to 65 as an essential part of preventive health care.

The post The number one STI is not what you think. appeared first on Partners OB/GYN.

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In recent months there has been a surge (pun intended) of media and patient interest in energy-based devices to treat gynecologic symptoms such as vaginal laxity, pain with intercourse, vaginal atrophy, dryness, itching, urinary incontinence and other concerns related to menopause and sexual function.  There are two main categories of these devices: laser technology and radiofrequency energy.  The underlying principle is to promote the body’s natural collagen production process and improve cellular integrity, tone, function and lubrication.

In early research, radiofrequency energy devices appear to be better positioned to treat urinary incontinence and vaginal relaxation syndrome over lasers.  After careful consideration of current options on the market, we at Partners Obstetrics and Gynecology have decided to offer the Viveve  cryogen-cooled monopolar radiofrequency (CMRF) device as a non-invasive, painless, office-based treatment option for our patients.

As with anything new, it is usually not the first go to treatment but an option to try if other treatments have failed or a patient is not a candidate.  In fact, in July of 2018, the FDA released a statement reiterating the need for research and randomized clinical trials to gather information and allow these treatments to gain widespread acceptance.  The American College of Obstetricians and Gynecologists as well as the North American Menopause Society have both continued to support research for this.

At Partners Obstetrics and Gynecology it is our mission to advocate for female sexual health and wellness through and individualized approach with each patient but at the same time offer responsible use of innovative technology and evidence based treatment options for optimal success in your health care.

The post What is a techno vagina? appeared first on Partners OB/GYN.

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Drs. Kohls and Votel spent a week in Honduras working with One World Surgery which functions within an organization called NPH, Nuestros Pequeños Hermanos, “our little brothers “. NPH has ranches in Mexico and Central America that house orphaned children as well as those whose parents cannot care for them and gives them education, health care and instruction in trades through high school. The kids can continue to college and even beyond if they so choose. A few in NPH Honduras have done that and have come back to work on the ranch and at the Holy Family Surgery Center which is now run through One World Surgery. The medical director, an orthopedic surgeon, is such a case!
The HFSC now runs year round instead of occasionally and is staffed by Honduran medical care providers with help from visiting brigades of Americans, both medical and non medical. There are plenty of jobs for both types, from surgery, to perioperative nursing care, to the making of 900 tortillas daily on the ranch. The opportunity to interact with the “pequenos” or kids who live there is wonderful, too. Dr Kohls has a godchild whom she has sponsored for 6 years who is now in high school. There are many more who would love a sponsor! The doctors see patients in clinic, too, offering non surgical treatment as well. Most of the care given here is free and the recipients are sincerely grateful as well as infinitely patient, waiting hours to days to be seen, traveling great distances. Many have no other option and the Honduran medical system has little to offer most citizens. Drs Kohls and Votel encourage questions about their experience and can help you get more information if you want to have your own adventure. We are so blessed in this country that to work a week for those less fortunate in return for their gratitude and love is a privilege.

CLICK HERE to see their video.

The post The Doctors volunteer in Honduras appeared first on Partners OB/GYN.

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Many women have taken a pregnancy test. But what is being tested when you pee on a stick? Is it a hormone? Is it a chemical, like estrogen or progesterone, or maybe testosterone if the baby is a boy?

The urine pregnancy test is looking for a chemical called beta hCG. This is actually secreted by the embryo.  The beta hCG then passes into the mother’s bloodstream and is eventually filtered through the kidneys. From the kidneys, the chemical passes in the urine. Hence, it can be detected in the urine and in the blood. Except in rare cases, a positive beta hCG in the urine or blood means that a woman is pregnant.

When we (or you) test in the urine it gives only a “negative” or “positive” result. There’s no number attached to it. The blood test is measuring the same chemical but it gives a number.  In a normal pregnancy, the beta HCG should double every 48 hours most of the time. This is why we test it more than once in some patients. Depending on whether it is going up, down, or staying the same, the beta hCG gives alot of information about a pregnancy in the early stages.

The post What’s in a pregnancy test? appeared first on Partners OB/GYN.

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There has been a recent discussion and trend towards gentle cesarean sections. The question is what does this mean? What happens during a cesarean section?

For those of us who have had cesarean sections (me included, I’ve had three), the experience can be disconnected. Or in other words, a little surgical. I’ll use myself as an example. When the decision was made to have a cesarean section with my first, I was wheeled into the operating room, given a re-bolus of my epidural. They laid me down, tilted me to the left, and then wiped my belly clean with sterile solution. Then the drapes went on, which are blue. The blue drape is strategically placed to keep gory stuff hidden from the mother. This also hides the birth from her as well. Eventually, my husband was called in and he stood by my side at the head of the bed. He couldn’t see anything. I couldn’t see anything. We could hear everyone talking. And then finally, the surgeon warned me about the pressure, and oh what a feeling. It felt like the assistant was standing on my chest. Then the pressure ended and boom, I became a mother with the birth of my baby boy. A minute later, they showed him to us and brought him to the warmer where they cleaned and dried him. My husband went to the warmer and stayed with him the rest of the time. Eventually, I got to hold him after we were in the recovery room, which was about 1 hour later. This little baby is now 16 years old, 6 foot 4 inches tall, and healthy as can be. His size (back then and now) is another blog post for another day.

Sounds a little sterile, and surgical, and distant. I didn’t feel like I was a part of the delivery. But, having a cesarean section is not a simple procedure. It is a major surgery and gets treated like that. Complications can happen within minutes, and for that reason, the people at the head of bed aren’t included in the surgical part of the procedure With a cesarean section, whether it is planned or not, it feels like a surgery instead of a delivery.

Why this matters?

Having a vaginal birth is totally different. Mom is involved every step of the way. In fact, we can’t have the baby without mom being involved the entire time. It’s her body, her input and bodily functions that determine all stages of labor and delivery.

Studies reveal that women who have cesarean sections are less satisfied with their childbirth experience than those who deliver vaginally. There’s also concern about bonding between mom and baby and breastfeeding outcomes after a cesarean section. Being involved in the delivery is very important to many women and this desire has guided the medial field to search for ways to accomplish this request. Obviously, they can’t help with the surgery and dad can’t cut the cord because the area is a sterile field.

What we can offer?

In response, we’ve made some subtle improvements to give parents and family more involvement in the delivery. These changes have proven to help in many ways.

A clear drape instead of a blue drape
We can use a clear drape so that everyone at the head of the bed can witness the birth. At the time of delivery, the blue drape is lowered and mom can witness her baby being born through a clear drape that is under the blue one. Once the delivery is done, the blue drape is rasied up again, so we can shield everyone from the scary side of major surgery.
Immediate skin to skin contact
Once the baby is born and the cord is clamped, if all is well, the baby is brought directly to mom and placed on mom’s chest, which is called skin-to-skin. This dramatically increases mom’s satisfaction with the delivery. It also increases breastfeeding rates, bonding, and sleep behaviors for both mom and baby. The baby is being warmed and dried while on mom’s chest. Skin-to-skin can go on until mom is taken to the post-anesthesia care unit.
This also allows for immediate breast feeding if mom is able.
The bottom line is that we try to have little to no separation between mom and baby.
Anesthesia (the people at the head of the bed) can be make subtle changes as well
Heart-monitoring equipment is positioned more strategically so that it does not interfere with baby going skin-to-skin on the chest or with breast feeding.
The epidural or spinal can be tailored so that the upper body is not affected as much as the lower body, so you can move the upper body to hold baby.
Your hands can be released and not strapped down so you can hold your baby.
Your head and upper body and be lifted so you can see more.
Slow delivery of the baby
This is where the baby is slowly delivered through the incision, instead of us pushing the baby out. This allows time for the chest to be squeezed, as in a vaginal birth, to clear the lungs of fluid.
Most of us do not do this, as we have yet to prove whether it is beneficial.
I mention this because there are a lot of social media posts about this technique. Just know, the verdict is not out regarding this.
The goals are simple. Let mom be a part of the birth experience. Let mom, baby, and family stay together as long as they want. Thanks to the women (moms, midwives, who have guided the medical field to make these changes possible so everyone who walks the path of a cesarean section can have the best experience possible.

Here’s me and my baby boy after delivery. I have that confused and tired look. He looks happy.

The post What is a GENTLE cesarean section? appeared first on Partners OB/GYN.

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What is a kegel exercise?

Kegel exercises are when you contract the muscles of your pelvic floor and then relax them moments later. The aim is to improve the tone of those muscles. It’s like doing a bicep curl to build the bicep muscle, but instead you contract the vaginal muscles to build the pelvic core (PC).

Dr. Arnold Kegel first introduced these exercises to help women recover after delivery when they had incontinence. But through the years we’ve learned that Kegel exercises are not just for postdelivery strength training, but can be used by women (and men) to keep the PC strong and resilient against daily wear and tear.

Why should I do kegel exercises?
  • It builds awareness of the vaginal muscles
  • Can increase sexual sensations and help achieve orgasm
  • Can help with urinary incontinence
  • Can help if you’re struggling with fecal difficulties
  • Reduces pelvic pain during sex
  • Can help women experience an easier labor
  • Can help with the female organs from prolapsing
  • Helps strengthen your core because the pelvic muscles are also part of the pelvic core
Sounds great, how do I do a kegel exercise?

First, you have to dentify the right muscles to contract and then relax. This is tough to explain in an article. If you don’t mind, I’ll explain as if I am doing a pelvic exam. When doctors do a pelvic exam, we insert 2 fingers into the vagina. A kegel exercise is when you squeeze the muscles of the vagina around the fingers during an exam. In order to properly do that, you have to use both the abdominal muscles and the vaginal muscles that cover the bladder and rectum. You essentially are using the entire core.

Another way to describe a Kegel exercise is to use the same muscles as if you are trying to stop urine from flowing. This is hard to do. We don’t recommend doing Kegel exercises in this manner. But the point is to show you which muscles need to be enlisted to do a proper kegel.

Always do Kegel exercises with an empty bladder. Squeeze the muscles and hold for 2 to 3 seconds and then release. Try to do this with 5 repititions, 6 times a day. We all work hard for a better, healthier body. Don’t forget that the PC needs just as much attention as the rest of your body. Happy kegeling.

The post What is a Kegel? appeared first on Partners OB/GYN.

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