Friday, November 23, 2012

Great News for Ladies with Normal Paps: ACOG Revised Pap Guidelines (November 2012)

For many of you that have visited the office in the last few months and had a pap smear, you may remember me saying, “I think the guidelines are going to change some day soon, and we won’t have to do paps quite so frequently.” That beautiful day is today. The American Congress of Obstetrics and Gynecology (the body that makes evidence-based recommendations for practicing providers to follow) just this month has made some new recommendations regarding normal paps and how frequently they need to be performed. Please note, these are NOT the recommendations for anyone that has a history of an abnormal pap. You may want to talk with your provider to if you have a history of an abnormal and are wondering about frequency of pap smears. Here are the ACOG November 2012 updated pap guidelines (#2 and #3 are NEW from the 12/2009 ACOG update).
1. No paps are necessary before age 21.
2. Women ages 21-29 need pap smear (without HPV testing) every 3 years.
3. Women ages 30-65 need pap smear WITH co-testing for high risk HPV (Human Papilloma Virus) every 5 years. Alternatively, women ages 30-65 could have paps without HPV co-testing every 3 years.
4. If a woman has undergone a hysterectomy with removal of her cervix and she has no history of cervical dysplasia (greater than or equal to Cervical Intraepithelial Neoplasia 2—CIN 2), she needs no more paps for the rest of her life.
5. Women can stop paps at age 65 if they have never had CIN 2 or worse cervical dysplasia, and have had 3 normal paps in last 10 years (or 2 normal paps with negative HPV testing).

Please know, all though we are not collecting cells from the cervix to screen for cervical cancer with a pap every year, we DO need to screen for other cancers every year at your annual visit with your OB/Gyn provider. We still need to do breast, uterine, and ovarian exams, keep an eye on blood pressure and cholesterol, and check in for other risk-reducing preventative health care. Your OB/Gyn providers are more than happy to review

Thursday, November 15, 2012

Surprised with Joy

As many of you know, I have been trying to focus my time and efforts recently on my oral boards and just found out Monday that I've passed. A lot of folks have asked, "Haven't you already passed your boards?" Very astute! I actually have passed 4 sets of "boards" through med school and after residency. These were my oral boards, where for 3 hours I am asked to defend why I practice OB/Gyn like I do, why I made the decisions I made in my first year. Most OB/Gyns don't take oral boards this early--I just wanted them out of the way. The past year, but especially the last 6 months, have been hard on my family and working life, but I am thankful for a husband who demonstrates to me Christ-like love and sacrifice.

This past weekend (after I had flown to Dallas to take my boards, but before I had received my score) I went on an overnight retreat with our high school ministry, as I lead a group of freshman girls on Wednesday nights, but have never had a time where I could spend overnight time with them. I approached the weekend with the expectation of God helping me to foster stronger relationships with my girls and to lead them closer to our Christ. However, in the prayer chapel 3 of my girls asked to pray with me. I was completely overwhelmed with a sentiment and feeling of "being taken care of.". As if God was saying to me, "I got this, Rachel. None of this is of you, it's me." I thought the weekend would entail "doing work", but God has shown me once again that it is He who sustains me and refreshes me. To God be the glory, for GREAT things he has done.

Thursday, July 19, 2012

Low libido/sex drive

Sorry it's been awhile, everyone, I have been in hot pursuit of finishing my preparation for oral boards and it's been a little too long since I've posted here on the blog.  I've been getting quite a few emails and consultations regarding low sex drive, so I thought I'd share what my usual conversation entails.

Unfortunately for women, sex is so multifactorial that we can't just take a pill or have a go-to trick that will help us with sex drive.  Women need all of the pieces of the puzzle to fit before we we feel good enough to have sex.  We need to feel loved, cared for, stress-free, we take more time for arousal and sometimes husbands can become impatient in this process.  Before we talk medications, I like to discuss behavior modifications.  I usually try to tell my patients to start with  the following things and see if there isn't improvement in libido:

1.  Trying to have more sexual thoughts about your husband throughout the day (have a goal of 3 times each day, men think about sex more than 20 times a day on average--we're just trying to level the playing field here).

2.  Make kissing and touching your husband a priority.  Before you leave each other in the morning, when you see each other again, make kissing and touching a MUST.  I know it seems silly, but have a goal of a few long, sustained kisses/touches each day.

3.  Taking more time with foreplay than you usually do.

4.  Making sure sex is comfortable for you.  If lubrication is a problem, mineral oil (instead of KY jelly) may help, you can get mineral oil at a drugstore.

5.  Having alone time with your husband.  It's hard to make a physical/sexual connection if you haven't made a mental or spiritual connection in awhile.  "Alone time" or "date night" might help to open up the lines of communication, which in turn helps you both to feel on the same page enough to want to sleep in the same bed.

6.  Aim for at least 7 hours of sleep.  A woman that isn't sleeping is living at a higher stress hormone (cortisol) level--that definitely does not help with libido, it drops sexual desire to the basement.

Just trying to help a sister out ;)
Peace to you all,
Dr. Rachel

Thursday, May 3, 2012

Sufferers of mild depression--let's talk about "mind-body scans"

It seems as though its been a week of seeing women for their annual female visit and by the end we unearth some ongoing depression. Please know, I am not talking about major depression, as I do feel that medications are beneficial for women that are having major depressive symptoms that include thinking about harming yourself.)

Ladies, there are so many of us suffering from anxiety and depression.
I wanted to pass on to you something that I have learned to incorporate as one of my "habits" that has helped me get to the bottom of my feelings, as I am not one to always know exactly what I'm feeling. Our emotions are directly tied to not only our mental
health, but also our physical health. So on top of regular exercise
and a clean diet, I think utilizing a MIND-BODY SCAN can help us
process "what's wrong." I've tried to explain this to patients during
their appointments, but typically don't have enough time to get into
detail. So here, for your at-home-use, is how to do a MIND-BODY SCAN.

A MIND-BODY SCAN is something to use when you're feeling anxiety, anger,
fear, or just "unsettled". Here's how it works: get to a quiet place
where you can think (I use the bathroom) and go from head to toe,
concentrating on what feels different with your body (are your
shoulders tense, are you clenching your jaw, do you feel like all of
the energy in your body has been zapped?) and address those things by
asking yourself 5 "why" questions.

For example: "Why am I so angry?"

Because I wanted my husband to help me out more.

"Why do I want him to
help me out more?"

Because I feel alone and like I'm a single parent.

"Why do I feel like a single parent?"

Because I feel like I need to
take care of every need of my children so they don't feel abandoned.

"Why do I feel like my children will feel abandoned?"

Because I have memories
of feeling frightened and alone as a child/teenager and don't want my
children to feel this.

Please know, I'm of the "get to the bottom of your demons before we
start medications" school. I would live to hear feedback from anyone who tries or regularly uses MIND-BODY SCANS.

Sunday, April 22, 2012

Why OB? Because there's nothing greater in this world!

This week I led the 8th grade girls' House group and we talked about my favorite subject: female anatomy.  Specifically, we talked about each of our "parts", their functions, and why God designed them the way he did.  We also talked about the way God created sex to be, and how that is different than what the fallen world presents us with.

True confession: I started mentoring 8th grade girls through our Wednesday night small groups because I had a week at work where I had three new OB patients that were 14 or 15, and I treated a 13 year-old with Chlamydia.  I could feel the Holy Spirit pulling at my heartstrings and whispering to me, "Rachel, you need to be a part of healing this destruction in the lives of young ladies."  And that's how I started being a 8th grade girl's house leader.

When I gave my talk on Wednesday, we left a huge portion of time for questions and answers.  I was pretty surprised by all of the questions (from 8th grade girls) about pregnancy and breastfeeding!  They asked how I felt about abortion, they asked if I had ever had to deal with babies dying during pregnancy, and how bodies change during pregnancy.  Ultimately, I ended by saying, "To me, there is no greater way that God demonstrates his power and perfection than by bringing new life into this world though women during pregnany.  To me, there is no greater honor in this life than to help women through this glorious process, however humble pregnancy may make us at times.  This, ladies, is why I have chosen to do obstetrics."

Thursday, April 5, 2012

Picky eaters--don't give in!

I know I talked a little about this in my Hearts at Home, but I wanted to pass along something that has helped our family in dealing with our picky 4 year old, Jude. Whenever we get a "Yuck! I'm not eating this!" at dinner time from Jude, we adopt this attitude: "That's fine, but you'll have it for breakfast then lunch if you don't try it now, and no snacks in the meantime." Usually, and Jude is pretty strong willed, he ends up eating it for breakfast. I can only think of one time that he didn't eat until the next night's dinner. I encourage you parents that are trying to provide your kids with whole foods and not giving in to the processed foods that are SO marketed to our children--our kids WILL eat when they're hungry, we just have to stick to our guns!

Sunday, March 25, 2012

We're one week out from the big Hearts at Home lecture!  I just wanted to check in with you all and see how you were doing on your habits.  Anyone start with multivitamin and fish oil?  How did the week go for you?  Is it starting to become more of your daily routine?  I wanted to encourage you to take a habit on  this week if you haven't already.  I think multivitamin and fish oil is a great one to start!  I thought I'd post the ones I am most familiar with and that we discussed in the lecture:
Fish oil: Carlson's finest fish oil, Nordic Naturals Fish Oil.
Multivitamin: New Chapter Organics Prenatal, NOW Special Two.
I'd love to hear how you all are doing!

Sunday, March 18, 2012

My Heart Overflows

This week has been a week of overwhelming joy, my heart overflows with thankfulness.  On Wednesday, my small group of 8th grade girls and I did a night of prayer stations based on ACTS (Adoration, Confession, Thanksgiving, and Supplication).  Just when I was beginning to feel like faith wasn't all that important to my girls, they overwhelmed me when they wrote out the names of God as their prayers of Adoration.  As I read them out loud, I began to weep, one of the girls had to take over for me.  God is drawing us together.  Friday and Saturday brought Hearts at Home, again another overwhelming outpouring of encouragement to me as a mother and health care provider from those at the conference who let me know how much my session on Nutrition "mattered" and "changed their lives."  I truly felt the Holy Spirit at my side at 2:40pm on Friday and Saturday, thank you to all who prayed.  God continually told me on Friday and Saturday, "I've always been by your side, Rachel, why would I not be at your side today?"  I got to finish this week baptizing one of my 8th grade girls during the Junior High service at Eastview--I've never baptized anyone before; again, my heart overflows.  Praise to you, dear Lord, who pushes us into molds we don't think we fit into.  Bless you, Father, for always being our sustenance, you have overwhelmed me with joy.

Thursday, March 15, 2012

Family Friendly Super Shakes

Tomorrow I'm presenting on nutrition at the Hearts at Home Conference, so Micah and Jude joined me in the kitchen to show the ladies how we get sneaky veggies at our house. All three of my kids love these nutritional powerhouse shakes and they have a blast making them. I think they also enjoyed being on camera. What do you think?

Monday, March 12, 2012

Hearts Nutrition talk is only 4 days away!

Only 4 short days until Hearts at Home--get ready for some good times!  So far over 1,000 ladies will be coming to talk nutrition with me!