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- Nurse Barb
Has the switch flipped and you’re starting to think about becoming pregnant? Have you started to notice more pregnant women everywhere you go?
Does it seem like there’s a new mom pushing a stroller on every street corner? Do you see Dads with little ones in carriers? If so, you just might be starting to think about becoming a mom yourself. This is sometimes known as the pre-contemplative phase where ideas take seed and start to grow in your mind.
Questions to consider
Every woman approaches this process from their own unique perspective. Here’s some questions to consider:
Meet my friend Trisha. She loves to fly so much that when she’s not a private corporate jet pilot, she can be found winging her way across the country working as a flight attendant.
Trisha is a healthy woman in her 40’s who is passionate about staying in shape. She loves to walk or bike to the beach and then swims in the ocean to stay in shape. She is energetic and enthusiastic and loves new adventures.
I am a sponsored blog partner of Ensure, and all of the opinions contained in this post are my own. Please do check below for additional disclosures.
Many of my patients talk about how their bodies change after 50, from sagging skin and wrinkles to weight gain around the abdomen. We discuss weight and resistance training, but there’s something more that is often overlooked – are we getting enough protein for our muscles?
After age 40 we all lose about 8% of our lean muscle mass each decade. That means that by age 70, most adults will have lost about ¼ of their muscle mass. After age 70, people continue to lose 15% of their muscle mass per decade. When a person is in the hospital or is confined to bed, their muscle loss is accelerated.
Many people are surprised to learn that our hearts and many organs are made of muscle or surrounded by muscle, which means that it’s not just the large muscles in our legs and arms that are affected by muscle loss, also known as sarcopenia. (more…)
This blog was written by Brad Synder, FNP-C – NP & Education Coordinator, who has worked at FAME Medical hospital and clinics in Karatu, Tanzania for several years. He now travels back to volunteer his time. I consider Brad a friend and have learned so much from him about how to listen and how to work with and learn from colleagues who care for people 1/2 way around the world.
It’s being a chameleon, becoming whoever the person you’re with needs you to be. It’s waking up everyday knowing that undoubtedly you will change a life and in return have yours changed. It’s pushing yourself to new limits, frequently on the edge of comfort as you try your best to fix and heal the person in front of you. It’s brainstorming at the bedside with a team of gifted clinicians trying to figure out the cause of a man’s internal bleeding as his blood counts continue to drop. It’s checking on a 1 day old then suddenly grabbing the oxygen and performing a resuscitation when he changes without any warning. It’s coming together in a moment’s notice and becoming one skilled unit, fighting the battle to keep a little life alive. It’s winning the battle.
It’s watching a doctor’s skill as he diagnoses cardiac anomalies with an echo or saves a woman from bleeding out during a complicated C-section. It’s opening books and crunching numbers as you try to solve a medical mystery alongside other uncertain fighters pulling deep on dusty knowledge and experience. It’s coming to a solution while vulnerably admitting that you’re not 100% certain of this plan, but it’s the best we can do with what we have. It’s feeling the slight relief of a definitive partnership amidst ambiguity and uncertainty. It’s seeing a nurse take peanut butter and a spoon into the room of a patient with severe burns and watching her patiently give one spoon at a time. It’s looking into her determined eyes as she says, “I know I can’t fix the burns but this is what I can do, so I’m doing it.” It’s feeling a rush of compassion flow through your body.
It’s a nurse’s poignant assessment as she picks up danger signs in pregnancy and prevents a catastrophe. It’s giving a woman a chance to be a mother, one of life’s greatest gifts. It’s a counselor gently comforting a suicidal woman buried deep in a cloud of depression with the fear of no way out. It’s giving her a glimpse of light and the possibility that this doesn’t have to last forever. It’s walking into a room as a midwife with experience twice as long as you’ve been alive turns the breech baby of a woman in active labor. It’s hearing the cry of a healthy baby and taking a collective sigh of relief. It’s feeling grateful to have such skilled, passionate people on your team.
It’s hearing the gentle humming of a mother who just lost her 6-year old to a battle against sickle cell disease. It’s walking outside with a father as he holds back tears surrounded by family and friends and giving him a safe space to feel whatever he needs to feel. It’s being a quiet presence as he sobs in your arms in a moment of utter grief and disbelief. It’s realizing that pain like this can only be felt by others who have experienced such a profound loss.
It’s staying up through the night diligently monitoring two premature babies as they struggle to survive in an incubator instead of the safety of their mother’s womb. It’s reading neonatology articles, emailing colleagues and adapting guidelines to what we can do here. It’s watching mothers give their babies life-saving breast milk to keep their tiny bodies growing. It’s praying that it all works out. It’s going home and preparing to wake up and do it all over again tomorrow. It’s holding onto hope. It’s who we are. It’s why we’re here.
It’s important to note that guidelines are just that, guidelines based upon data from large populations, however they may not apply to every woman that you encounter, especially to those who have unique circumstances and let’s face it, are more challenging and more rewarding as we provide personalized, individualized care.
The current American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines for pap smears differ from those of the US Preventive Services Task Force (USPSTF)
The USPSTF guidelines recommend that Pap smears be stopped at age 65 if there have been adequate prior screens, however it’s not clear what the definition is of adequate prior screens.
There are as many different experiences of menopause as there are women. For some women, menopause arrives like a gentle breeze with barely a feeling of warmth or any other bothersome symptom, while others experience menopause like a Class 5 Tropical storm with overnight drenching hot flashes and night sweats, mood changes and a complete disruption in life.
While many clinicians understandably and appropriately focus on hot flashes and night sweats, many women may be more concerned with sleep disturbances, weight gain, loss of libido, vaginal dryness, incontinence and mood changes.
When women come to my office with any one or all of the following complaints from no periods to excessive bleeding, difficulty losing weight, excessive hair growth and acne or infertility, I see this as an important opportunity to change a woman’s life for the better. Many of these women have seen many other health care providers, who more often than not aren’t able to provide a diagnosis or who may not be able to provide a comprehensive plan of care. Many women with PCOS have symptoms that impact their appearance, their self-esteem, sense of shame and guilt as well as fears of infertility.
Using the Rotterdam Criteria for diagnosis provides an objective starting point for evaluating women. A diagnosis of PCOS can be made if 2 out of the following 3 conditions are met: Signs of hyperandrogenism such as hirsuitism, acne, absence of regular ovulation and/or seeing 10 or more small cysts on 1 or both ovaries with an ultrasound.
It’s estimated that 1.4 million US women will experience abnormal uterine bleeding (AUB) each year. This includes an estimated 50% of women in perimenopause, who have an increased incidence of polyps, fibroids and who are not ovulating which leads to their AUB. In addition, over half of women with heavy menstrual bleeding report that their periods interfere with their lives compared to women with lighter cycles.
The American Congress of Obstetricians and Gynecologists (ACOG) defines Abnormal Uterine Bleeding this way
ACOG Definition of Abnormal Uterine Bleeding (AUB)
Bleeding that requires more than 1 pad/hour for more than 1 day
Bleeding for more than 7 days at a time
Bleeding intervals that are less than 20 days apart
Bleeding in excess of 80 cc a month
– a super tampon or pad can hold approximately 10 cc of blood
Bleeding that causes anemia
Bleeding that leads to disruption in life style
Source: ACOG, Committee Opinion. April 2013 (reaffirmed 2015), number 557.
I just gave a talk to a group of about 75 women at midlife. When I asked for a show of hands for how many women experience urine leaking with a cough, sneeze or laugh, about 1/2 raised their hands.
Yes, about a third to a half of us are having a little pee pee problem. Fear not! There’s an App for that now too!
Strengthening the pelvic floor means you’ll be less like to deal with this possibility.
When I ask my patients to do a Kegel or to try to squeeze their pelvic floor muscles during an exam, it’s clear that only about 1/2 are able to isolate and squeeze the right muscles. Many use their abdominal muscles, many push out and many simply don’t have the sensation. Once we work on how to do the exercises and get women started practicing, most report that their lives have changed, for the better because they aren’t leaking at all or nearly as much.
We’re all busy, so here’s some options to help you stay dry and a surprising option at the end.
At home Kegels! There’s an App for that
For women who want to work on their pelvic floor muscles in the privacy of their own home, here’s a few new options:
Discreet vaginal inserts
Lightweight, small, discreet vaginal inserts that use Bluetooth technology connected to your smartphone so you can see if you’re doing your Kegels correctly. (more…)