Pregnant? You Need Vitamins

Brianne Anderson, MD, OB-GYN

While pregnant, eating healthy is one of the best things you can do for your baby. However, your body has a higher need for certain vitamins and minerals, like folate and calcium, during this time. Your doctor will prescribe prenatal vitamins to help your body meet these requirements.

Why Folate?

Folate is very important for the growth of your baby. It is most vital to get enough folate in the months before you get pregnant and in the early months of your pregnancy. When you get enough folate, it lowers the chances of your baby having birth defects of the brain and spinal cord.

If you’re taking a prenatal vitamin, you probably get all the folate you need. But you can also get folate from food. Foods high in folate include:

  • Vegetables, especially brussels sprouts and green, leafy vegetables like spinach
  • Whole grains, enriched breads and fortified cereals
  • Fruits like bananas and oranges
  • Liver
  • Peas and beans

Why Calcium?

Calcium helps keep bones strong and healthy. When you’re pregnant, your baby takes calcium from your body to develop and grow bones. If you don’t get enough calcium, your bones could become weak. Prenatal vitamins have calcium, but you can get some from foods too. Milk and milk products are filled with calcium. Dark green, leafy vegetables, like broccoli, and sardines also are high in calcium.

As soon as you think you’re pregnant, see your doctor.

Call 504-897-7777 or visit touro.com/findadoc to find a physician.

Dr. Brianne Anderson specializes in OB/GYN at Crescent City Physicians, Inc., a subsidiary of Touro Infirmary. After earning her medical degree from Tulane University School of Medicine in New Orleans, Dr. Anderson completed residency at University of Mississippi Medical Center in Jackson, MS. Dr. Anderson is board certified by the American Board of Obstetrics and Gynecology. Dr. Anderson values the physician/patient relationship because she strives to understand what is important to her patients and become a confidant to guide them through varying stages of life.

Are Your Menstrual Cycles Normal?

Arelis Figueroa, MD

A lot of women wonder whether their cycle is normal and when they should make an appointment with an OB-GYN. Here’s how to tell the difference.

What’s Normal, What’s Not

You count the length of your menstrual cycle from the first day of one period to the first day of the next. An average cycle lasts 28 days. But anywhere between 21 and 35 days is considered normal for adult women. Your period should account for two to seven of those days.

When your cycle falls outside these bounds, it’s considered irregular. Watch for these symptoms:

  • Cycles that last for less than 21 days or more than 35 days
  • Cycles that suddenly start to vary widely from month to month
  • Periods that last for fewer than two day or more than seven days
  • Skipped periods when you aren’t pregnant
  • Excessively heavy flow during your periods
  • Bleeding between periods, called “spotting”

If you experience any of these symptoms, talk with your doctor. The rise and fall of your hormones control your menstrual cycles. Having irregular cycles might signal a condition affecting your hormone levels. Or it might be a sign of a structural problem with your reproductive organs.

Causes of Irregular Cycles

Young teens and women nearing menopause often have longer periods or unpredictable cycles. Beyond that, several health issues can throw your cycles out of whack. They include:

  • Polycystic ovary syndrome (a hormonal imbalance in women)
  • Hyperprolactinemia (an abnormally high level of the hormone prolactin)
  • Eating disorders
  • Thyroid disorders
  • Uncontrolled diabetes

Having irregular periods is more than just a nuisance. If the underlying issue isn’t treated, it may lead to other health problems over time. You may also find it harder to get pregnant, if you’re trying to conceive. So, let your doctor know if your menstrual cycles seem to be off. Depending on the source of the problem, treatment options may include hormonal treatments, other medicines and surgery.

Are you at risk for endometriosis?

Women who have endometriosis experience menstrual pain and bleeding worse than other women. Talk with your doctor if your menstrual pain is extreme.

Click here to learn more about endometriosis.
Click here to learn more about menstrual disorders.

Figueroa,ArelisDr. Arelis Figueroa, a Crescent City Physicians obstetrician and gynecologist, supports her patients through pregnancy and beyond, helping new moms establish healthy practices that benefit their families. A native of Puerto Rico, she speaks Spanish and English, working with patients whose language barriers might have otherwise kept them from getting care.

Hidden Scar Breast Cancer Surgery at Touro

John Colfry, MD

Hidden scar™ breast cancer surgery, an advanced treatment expanding options for women undergoing breast surgery, is now available at Touro. John Colfry, MD, a Breast Surgical Oncologist with Touro’s Crescent City Physicians is one of the first surgeons in the New Orleans area to be a certified Hidden Scar surgeon.

Less Physical Reminder

Each year, approximately 405,000 women are diagnosed with breast cancer that requires surgery. Many women are unaware of all the surgical options available, including minimally invasive approaches that can help restore their self-image and allow them to begin healing emotionally. Hidden Scar Breast Cancer Surgery is an advanced approach to breast cancer surgery that hides incision scars, minimizing the daily emotional reminder of a breast cancer diagnosis.

“Whether a patient is having a lumpectomy or a nipple-sparing mastectomy, Hidden Scar surgery allows for optimal cosmetic results,” says Dr. Colfry. “With this more sophisticated approach to breast cancer surgery, a woman can have more self-confidence after having battled breast cancer.”

Single Incision, Less Scarring

Hidden Scar Breast Cancer Surgery allows Dr. Colfry to remove the cancerous tissue through a single incision made in an inconspicuous area, preserving the natural shape of the breast while reducing visible scarring.

“My diagnosis of breast cancer resulted in my choice of bilateral mastectomy,” explains patient Carol V. Sharp. “The excellent cosmetic result and minimal scar accomplished by my skilled surgeon, Dr. Colfry, exceeded even my own expectations.”

Patients who undergo this approach are at no higher risk for recurrence than patients who undergo any other type of technique. Hidden Scar Breast Cancer Surgery may be appropriate for a wide range of breast cancer patients undergoing nipple-sparing mastectomy or breast-conserving (lumpectomy) procedures.

Comprehensive Cancer Care

To learn more about Hidden Scar Breast Cancer Surgery and the other services we offer patients with cancer, visit us online at www.touro.com/cancer.

Dr. John Colfry specializes in treating breast cancer with the most advanced surgical options available. Dr. Colfry is a MD Anderson fellowship-trained breast surgical oncologist who is an expert in this field. He works closely with plastic and reconstructive surgeons to give patients the best cosmetic results and options. Our breast surgical oncologist is also experienced with oncoplastic surgery, an approach to breast cancer surgery that combines plastic surgery techniques with lumpectomy and spares many women from mastectomy.

Pregnancy and Exercise

Jamie Sias, M.D.

Research shows that regular exercise, with the approval of your healthcare provider, can often help to reduce the physical discomforts of pregnancy, reduce stress, improve energy and help with your recovery after giving birth. There is also evidence that physical activity may be beneficial for women with gestational diabetes. If you haven’t worked out before, use your pregnancy as a motivation for both you and your baby. Your body and hormones are changing, and exercise can help you cope with these changes.

What exercises are safe?

According to the American College of Obstetricians and Gynecologists, women who exercised and were physically fit before pregnancy can safely continue exercising throughout their pregnancy. As long as you are you not overdoing your exercises, you should be good. However, if you were inactive before pregnancy or have any medical or pregnancy complications, we highly recommend you talk to your healthcare provider before starting an exercise routine.

There’s an age-old myth that exercising while pregnant can harm the baby. However, there is no evidence that this myth is true. Strenuous exercising will not harm your baby, but it will cause you to become tiresome more quickly than it did preterm. Therefore, it is recommended to perform low-impact exercises during your pregnancy.

Here’s a list of safe activities:

  • Swimming
  • Brisk walking
  • Indoor cycling
  • Stair climbing machines
  • Low-impact aerobics
  • Low-impact dancing
  • Jogging (in moderation)
  • Yoga

When exercising, it’s important to remember to warm up, stretch and cool down. Also, drink plenty of water and take breaks if needed.

Who should not exercise?

Exercise may not be safe if you have any of these conditions:

  • Preterm labor in current or past pregnancies
  • Vaginal bleeding
  • Cervical problems
  • Leaking of amniotic fluid
  • Shortness of breath
  • Dizziness and/or fainting
  • Decreased fetal activity or other complications
  • Increased heart rate (tachycardia), although heart rate is typically higher in pregnant women
  • Certain health problems, like high blood pressure or heart disease

What are exercises are not safe?

The following are some exercises to avoid while pregnant:

  • Horseback riding
  • Water skiing
  • Scuba diving
  • High altitude skiing
  • Contact sports
  • Any exercise that can cause a serious fall
  • Exercising on your back after the first trimester (because of reduced blood flow to the uterus)
  • Vigorous exercise in hot, humid weather, as pregnant women are less efficient at exchanging heat
  • Exercise involving holding your breath during exertion. This can cause an increased intra-abdominal pressure

If you start to experience any dizziness, faintness, chest pain, nausea, contractions and vaginal bleeding, stop exercising and contact your physician.

Join Touro for Healthy Mom, Healthy Baby: nutrition and wellness during pregnancy and beyond

Maintaining a healthy lifestyle is one of the most important things you can do for both yourself and baby during pregnancy and after delivery. Join Touro dietitian Julie Fortenberry and Yoga Instructor Kelley Howard Gill from Wild Lotus Yoga for an informative class on nutrition and wellness for expectant and new mothers

Click here to learn more or to register for an upcoming class.

Dr. Jamie Sias is an OB/GYN with Crescent City Physicians, Inc., a subsidiary of Touro Infirmary. She received her undergraduate degree from Xavier University of Louisiana and earned her medical degree from Louisiana State University School of Medicine. Dr. Sias cares for patients at two convenient locations, Mid-City and St. Claude.

Women’s Guide to Staying Healthy

Dr. Jennifer Laguaite

By making healthier lifestyle choices and receiving regular wellness exams and preventive screenings, women can reduce certain health risks. It’s never too late to become a healthier you.

Here are 10 things you can do to help you live longer, live better and live happier.

  1. Be informed.

Learn about health promotion and disease prevention and ask your healthcare provider for specific information regarding your needs.

  1. Be good to your bones.

For healthy bones, be sure to replenish your stock of calcium every day with calcium-rich foods, such as milk and other dairy products, tofu, leafy green vegetables, canned salmon or sardines and calcium-fortified juices or breads. It is recommended to consume 3 cups of fat-free, low-fat or milk substitutes per day. Speak with your healthcare provider about calcium supplements.

  1. Drink in moderation and avoid illegal drugs.

For women, the definition of moderate drinking stops at one drink a day. The National Institute on Alcohol Abuse and Alcoholism defines a drink as one 5-ounce glass of wine, one 12-ounce bottle of beer or wine cooler and 1.5 ounces of 80-proof distilled spirits. Remember that the alcohol content of each type of drink can vary widely. Where illicit drugs are concerned, there is no such thing as “moderate” use.

  1. Take medicine wisely.

Read the labels, follow the instructions carefully, and remind your healthcare provider or pharmacist about any other medicines or supplements you might be taking. For your safety, to lower your risk for adverse side effects or medicine interactions, you should let your healthcare provider know if you use any illicit or “recreational” drugs. If you have any questions about possible side effects, call your healthcare provider or pharmacist.

  1. Play it safe.

Avoid injuries. Buckle up. Wear a bike helmet. Use smoke and carbon monoxide detectors. Wear sunscreen, UV protected sunglasses and dress appropriately. Also, practice safe sex by using condoms to protect against sexually transmitted diseases.

  1. Get checked.

Get regular checkups, preventive exam and immunizations. Do not forget self-exams too. The American Congress of Obstetricians and Gynecologists recommends that women have their first Pap test at age 21. Women ages 21 to 29 should have a Pap test every 3 years. Women 30 and older are recommended to have co-testing every 5 years.

  1. Don’t smoke.

Smoking is the leading preventable cause of death in our country.

  1. Eat smart.

Remember to eat plenty of fruits, vegetables and whole grains. Enjoy a variety of foods with a balance of food from each food group. It is recommended to eat 5 to 9 servings of fruits and vegetables daily.

  1. Get moving.

The other secret to good health: just 30 minutes of physical activity, accumulated over the course of each day, can radically improve the way you look and feel, both physically and mentally.

  1. Be happy.

Take time for yourself. Practice mindfulness and meditation. Get connected with family, friends and your community.

Click here to visit Touro’s Health Library to learn more about women’s health.

Dr. Jennifer Laguaite is an OB/GYN with Crescent City Physicians, Inc., a subsidiary of Touro Infirmary. She earned her medical degree from Louisiana State University School of Medicine and completed post graduate training at Ochsner Medical Center. Dr. Laguaite cares for patients at two convenient locations, Uptown and Old Metairie.

Menopause Myths

Dr. Arelis Figueroa
OB/GYN, Crescent City Physicians, Inc.

Myth 1: Menopause begins at 51

On average, menopause begins for most women at 51. However, it’s a process in which symptoms can come and go, making it difficult to determine the start date. The most important thing to remember is that menopause can be very different for every woman depending on age, genetics, environmental issues, and even race.

Myth 2: Hot flashes are the first sign of menopause

Mature Woman Experiencing Hot Flush From Menopause

Hot flashes can occur years prior to menopause during a period known as perimenopause. While menopause is technically defined by a one-year absence of a monthly period, hot flashes occur for an average of 4 years or longer. Menopause symptoms last an average of 7 years.  Other than hot flashes, symptoms of menopause include:

  • Fatigue
  • Irregular periods, light or very heavy menses
  • Anxiety, irritability, mood swings, depression
  • Weight gain, cravings
  • Sleep issues
  • Hair loss
  • Fuzzy thinking, forgetfulness
  • Low libido

Myth 3: Weight gain is unavoidable during menopause

Menopause doesn’t automatically equal 20 extra pounds. Women just notice weight gain because of all the other changes of menopause. Weight gain is likely to happen if women don’t alter physical activity in relation to diet. Hormonal imbalances of menopause can also add to the problem as the body responds by protecting itself by storing more fat. The only way around it is to watch what you eat and push yourself to be more active.  It’s what everyone tells you but no one wants to hear, more exercise and better diet. As a bonus, better nutrition can help regulate hormones, protect bones and keep you heart healthy.

Myth 4: Hormone replacement therapy is dangerous

There is a lot of misinformation about Hormone Replacement Therapy (HRT) and that is largely because of unreliable results from early HRT studies. While there are definitely women who should avoid HRT (like breast cancer survivors), there are others that believe it helps their symptoms enormously.

Myth 5: HRT is the only treatment available for menopause symptoms

There are actually a variety of options available beyond hormone replacement. It’s important to discuss the risks and benefits of these possibilities with your physician. There are certain antidepressants, and medications for neurological and diabetic nerve pain for menopause treatment that can be prescribed by your physician. Natural products — though not regulated by the Food and Drug Administration for safety and efficacy — include soy, vitamin E and black cohosh. Vaginal creams can work for moisture, PH balance and the thinning skin in the vagina.  Acupuncture, reflexology and increased exercise have all been evidentially effective for multiple symptoms. I also recommend wearing layered clothing, increasing cold drinks, decreasing air temperature especially at night, and avoiding caffeine and alcohol. Hot flashes can be very disturbing for women and disrupt their daily life, so why not try anything available that is not a danger to the patient.

Myth 6: Emotional symptoms of menopause are all in your head

Pensive Mature woman

Talk to your doctor about what you’re feeling. Women might not see psychological issues as pertinent to talk to their doctors about, but do discuss them with your GYN, especially if you don’t see another primary care physician. Some women think we only deal with certain aspects of the female body, but OB/GYNs deal treat the whole woman.

Figueroa,ArelisDr. Arelis Figueroa, a Crescent City Physicians obstetrician and gynecologist, supports her patients through pregnancy and beyond, helping new moms establish healthy practices that benefit their families. A native of Puerto Rico, she speaks Spanish and English, working with patients whose language barriers might have otherwise kept them from getting care.

Postpartum Urinary Incontinence

Alexandra Gatti, PT, DPT

Incontinence Post Baby

Pre-pregnancy, many women don’t worry about their pelvic floor or bladder. However, soon after giving birth, a laugh, sneeze or sudden movement can cause surprise urine leakage. During pregnancy, many women experience some form of urinary incontinence, a loss of urine control. Unfortunately, incontinence can linger after pregnancy. Studies show that women who give birth vaginally are more likely to experience urinary incontinence a year postpartum compared to women who have cesarean sections.

Mid 30's Woman with strong smile at sunset.

The most common type of incontinence among women is stress incontinence.  Stress incontinence involves involuntary leakage of urine that occurs when a woman stresses her abdomen, such as in jumping, sneezing, laughing or coughing. In stress incontinence, the bladder sphincter is unable to hold in urine. Studies show about two-thirds of women with stress incontinence also experience urge incontinence, which is caused by an overactive bladder. Urge incontinence is when the need to urinate comes on very quickly or leakage occurs when the bladder is full. The muscles surrounding the urethra may be affected.

Urinary incontinence can range from a slight loss of urine to severe, frequent leakage. Urinary incontinence can be treated, and treatment depends on the severity of symptoms and the type of incontinence. Here are a few treatment methods for this condition:

Pelvic Exercises

Kegels: Kegel exercises are a method that can be used to help control urinary incontinence. It can help to strengthen and tighten the pelvic muscles. To perform Kegels, you want to work on both coordination and endurance of your pelvic floor muscles. This means contracting and relaxing the muscles quickly and also working on the holding ability of the muscles. To find the right muscles to squeeze, think about the sensation of holding back gas or stopping the flow of urine mid-stream. That feeling is your pelvic floor muscles contracting. Squeeze those muscles up and in for just a second and then release. Repeat this 10 times. Then you can tighten the muscles and hold for 10 seconds. Relax and repeat again for 10 seconds. If you can’t maintain that squeeze for 10 seconds yet, you can work up to 10 seconds over time. The easiest position to do this exercise in is lying down as your muscles get stronger you can transition to doing the exercises sitting then standing to challenge the muscles and help strengthen them further.

Biofeedback: A specially trained physical therapist (PT) places electrodes on your skin or a small sensor can be placed inside the vagina while you perform a series of pelvic floor exercises. The sensors provide visual and auditory feedback to show you and your PT if you are contracting the right muscles. Biofeedback helps you to gain awareness and control of your pelvic muscles.

Vaginal Weight Training: Small weights are held within the vagina by tightening the vaginal muscles. This may be done for 15 minutes, twice daily, for 4 to 6 weeks.

Pelvic Floor Electrical Stimulation: Mild electrical pulses stimulate muscle contractions, which can be done along with Kegel exercises.

Woman Stomach Ache

Techniques

Bladder Training. In bladder training, you resist the urge to go to the bathroom by waiting a little longer before you go. You follow this pattern for a period of time. You consistently extend the schedule and continue to lengthen the time until you are up to three or four hours between bathroom visits.

Schedule Toileting. You use a chart or diary to record the times that you urinate, your fluid intake and any leakage. This will allow you to create a schedule so you can avoid leaking in the future by going to the bathroom at scheduled times.

Other Methods

Medicines. This includes specific drugs for incontinence as well as estrogen therapy. The medicine can help control muscle spasms in the bladder or strengthen the muscles in the urethra. Other medicine can help to relax an overactive bladder. This may be helpful along with other treatments for women with urinary incontinence who are past menopause.

Surgery. This is an option if the incontinence is related to problems such as an abnormally positioned bladder or a prolapse. It may be used if other treatments don’t work or incontinence is severe.

Adult diapers. Modern diapers are more comfortable and no longer bulky. You can wear them under everyday clothing without visibility.

Pessary Device. This device is used if your leakage is more severe or if a pelvic organ prolapse is present. A stiff cone is sized, fitted and inserted into your vagina to help support the urethra and prevent your bladder from leaking.

There are plenty of other devices and products that can help with urinary incontinence. The most important step in diagnosing a urinary incontinence is talking your health care provider. Urinary incontinence should not be ignored or it can become a long-term problem. A pelvic floor physical therapist may be able to help strengthen your pelvic floor muscles to treat your incontinence.

Visit touro.com/findadoc to find a physician or urologist.

Alexandra Gatti received her Doctorate degree in Physical Therapy from Northeastern University in 2010. She started her physical therapy career as an inpatient acute care physical therapist at Saint Mary’s Medical Center in San Francisco, CA and then ventured to Beth Israel Deaconess Medical Center in Boston, MA where she specialized in pelvic floor physical therapy for both men and women.  She has successfully completed the Herman and Wallace Pelvic Floor Rehabilitation Institute’s Pelvic Floor level one and level two courses and the American Physical Therapy Association (APTA) course on managing chronic pelvic pain. She is a member of the APTA and Women’s Health Section of the APTA. She is conversational in Spanish and has worked with a diverse patient population both at home and abroad. She started at Touro Infirmary in New Orleans, LA in early 2016 focusing on the pelvic floor physical therapy and cancer rehabilitation programs.

Your Health at Any Age

Steps for Aging Gracefully

Aarti Pais, M.D

There always seems to be a new health study or report on how to live healthy and this can prove to be confusing at times. Women not only make decisions for themselves but for their families as well. Keeping track of everything can sometimes become overwhelming and while caring for our loved ones, we tend to neglect taking care of ourselves.

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Establishing Your Women’s Health Team

Women should establish both a Primary Care Physician and an OB-GYN to manage their health

Jennifer Lapeyrolerie, M.D.

If you’re like many women, you have an OB/GYN who you would follow to the moon and back. He or she delivered your baby and has seen you at your best and your worst. You don’t miss your annual gynecologist visit. But who do you see when you’re sick? Do you try and tough it out, or do you turn to urgent care? A better answer: establish a primary care doctor who can manage your overall health, including sick visits, along with the care you receive from your OB/GYN and other specialists.

Your primary care provider takes care of your general health. But to manage your whole health—over your entire life—you’ll likely need to assemble a team of healthcare providers. For women, at the top of the must-have specialists list is a gynecologist.

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Bone Health: Keeping Your Bones Healthy for Life

Bone Health Basics

Kim Faught, RN

Did you know that your bones are not hard and lifeless? They are actually living, growing tissue made up of 3 different materials that make them strong and flexible:

  • Calcium: makes bones flexible
  • Calcium-phosphate mineral complexes: make bones strong and hard
  • Living bone cells: remove and replace weakened sections of bone

You have the greatest amount of bone between the ages of 18-25. The more bone you have during these years, the less likely you are to break a bone or develop osteoporosis later in life. As you age, you begin to lose more bone than you make. Bone loss increases in women after menopause when estrogen levels decrease. In fact, women can lose 20% of their bone density during the first 5-7 years after menopause. This bone loss can lead to osteoporosis, a condition where you lose too much bone, make too little bone, or both. Menopause is the time to take action against osteoporosis. If you have experienced menopause, ask your physician about your risk for osteoporosis. Touro for Women is here to help you keep your bones healthy for life.

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