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What Is Endometriosis and How Do I Know If I Have It?

Endometriosis commercials are everywhere.

I CAN KEEP PUSHING THROUGH MY ENDO PAIN OR I CAN… Add for Orlissa

The thing about marketing like this is that it makes anyone and everyone think that they have the disorder. You think- I have pain around my menstrual cycle, so maybe I have Endometriosis.

Leave it to The Gyneco-bLogic to offer some clarification. It’s what we do.

What is Endometriosis?

From the American College of Obstetricians and Gynecologists (ACOG), the definition of endometriosis is as follows.

Endometriosis is a condition in which the type of tissue that forms the lining of the uterus (the endometrium) is found outside the uterus. Endometriosis implants respond to changes in estrogen, a female hormone. The implants may grow and bleed like the uterine lining does during the menstrual cycle. Surrounding tissue can become irritated, inflamed, and swollen. The breakdown and bleeding of this tissue each month also can cause scar tissue, called adhesions, to form. Sometimes adhesions can cause organs to stick together. The bleeding, inflammation, and scarring can cause pain, especially before and during menstruation.

That means that the tissue that is inside of the uterus can SOMEHOW make it outside of the uterus and cause problems. What kind of problems? To name a few:

  • Pain during and outside of menstrual cycles
  • Fertility issues
  • Scarring in the abdomen

Fertility issues can come from scarring that blocks the fallopian tubes, but also inflammation that actually damages sperm or egg and interferes with their normal movement.

Mild endometriosis symptoms can mimic the basic aspects of being a woman- painful crampy periods. In more severe cases, pelvic pain can be present even without menstrual cycles, during intercourse and with urination. The problem is that none of these symptoms are SOLELY UNIQUE to endometriosis. Ovarian cysts, fibroids, urinary tract infections and just having girl parts can mimic these symptoms.

So, how do I know if I actually have Endometriosis.

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How will I know?

If enough symptoms seem to fit the description, your doctor (me for some of you) may try medications to treat it. Endometriosis ends up sometimes being diagnosed based on whether or not the treatment works.

But Doc, why can’t you just perform a test to diagnoses Endometriosis?

Because the only way to definitely diagnose Endometriosis is to have a surgery called a Laparoscopy and have areas biopsied. Ultrasound can sometimes suggest Endometriosis, but it isn’t perfect. Endometriosis can be present without any findings on ultrasound and vice versa, findings can suggest endometriosis and be wrong.

The NEW MEDICATION that is being advertised for the management of Endometriosis is different than previous meds.

  • It is an oral pill, rather than a shot. The previous medication in this class was a shot you would receive in the office every 1-3 months. This is easier for a person to take on their own rather than having to come into the office for a shot.
  • This medication is stronger and more effective than birth control pills, which can often improve milder endometriosis symptoms.
  • It may also allow women to experience relief of Endometriosis symptoms without having surgery.

For the record, I AM IN NO WAY ENDORSING THE NEW MEDICATION. I don’t receive any money from drug companies to talk about or promote particular products. I did, however, see the series of commercials and think, If I didn’t know better, I’d wonder if this medication was for me.

In the end,

… if you think that you have Endometriosis, see your doctor. They may be able to make the diagnosis based on your symptoms, or may be able to try different management option to improve your symptoms. Most importantly, they can also rule out other harmful diagnoses. It’s important to investigate many possibilities when you are experiencing chronic or cyclic pain.

Don’t ignore pain.

Thanks for reading. Please help us grow by following us here and on social at @thegynecoblogic.

If you want to see articles about specific topics, use the hashtag #popcornhealth or #askdrwendy. I am soon to start a video series on @dreverywoman entitled, Every Woman Needs To Know. Tell me what you WANT to know and I’ll tell you what you NEED to know.

Thanks for the love from The Gyneco-bLogic!

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Wendy Goodall McDonald M.D.Leave a comment

Avoid Getting Sick This Winter Naturally: Try Elderberry

I love my job. I blog about it, I rap about it, I sing about it. But I REALLY love my VACATIONS. Vacations away. Stay-cations at home. They all provide an invaluable reset, catch-up, self-care that is so needed.

See, I work a lot. I can easily put in 80 plus hours per week of work seeing patients in the office, delivering babies, returning calls, doing surgeries, providing results, reviewing labs. That doesn’t leave as much time as I would like to see my kids, to open mail, to write (which I really enjoy if you haven’t noticed) and to do other things I love.

I was less than thrilled when I woke up Monday morning in chilly Chicago feeling congested and stuffy with sinus pressure and a scratchy throat.

Not my week off. Not my kids’ Spring Break. Not now.

Hark, I remember seeing my husband popping these herbal Elderberry lozenges that were supposed to keep away colds. And wasn’t he eating Kiwi fruit like it was going out of style when he felt like he was getting sick?

So I riffled through our junk drawer in the kitchen (don’t judge. If you don’t have a junk drawer you need one.) There they were. Sambucus Elderberry Lozenges.

I probably had two or three throughout the next 24 hours, and maybe another two Kiwi fruit. What usually happens when I get sick is I spend day 1 with a nose that won’t stop running. Day 2 involves a nose that I can’t unplug. Day 3 is characterized by a stuffy head and snot-a-plenty. Day 4 starts the up-swing. This time, day 1 was Monday. I found the Sambucus lozenges in the afternoon on Monday. I had one then and another couple on Tuesday with the Kiwi Fruit.

By Wednesday, I was a new woman.

My wellness caught me by surprise. It was like one of those movie moments where the actor just escaped death and comically touches his or her face and body to see if they are still there. I was like, “Wait, I feel good? How is this real?”

Oh, it was real.

Sambucus ebulus  is an ancient medicinal herb. Elderberry is another name for it —Pliny the ‘Elder’ first described its therapeutic use. A few studies demonstrate that elderberries have anti-inflammatory properties. Elderberries may even have anti-microbial and anti-viral activities. Regarding the common cold, one study shows that elderberries may decrease the duration of a cold by a couple of days in air-travelers.(4, 5).

What I’m telling you is that I am a believer and I will from henceforth keep these little purple gems stocked up in my house for the anytime-I-feel-a-little-something-coming-on consumption.

I hope you too can find relief with these lozenges and Kiwi fruit. I think Kiwi are in season. I just bought some from Coscto. Check out this post about other proven home remedies to cheat colds, like Sambucus. Especially since winter doesn’t seem to be going anywhere any time soon here in the Midwest.

Don’t forget to like and follow us here and on social media. Please and thank you!

 

 

Wendy Goodall McDonald M.D.Leave a comment

The Best Birth Plan: Doctor approved with the safety of Mom and Baby in mind

Birth plans are IN. Every app, every mommy website, every natural birth instructional anything contains mention of and often a template for a birth plan. In this post I will answer the following questions:

  1. What is a birth plan?
  2. What are some common misconceptions between doctor and patient?
  3. What are things that you, the mother, can do to increase chances for a vaginal delivery?
  4. What factors are unpredictable, so that you won’t be shocked if you encounter them?
  5. What items SHOULD be on EVERY PARENT’S birth plan?

Wait, you’ve haven’t heard of a birth plan? jonas-kakaroto-458503-unsplash

Well, a birth plan is essentially a written guide crafted by the mother that lists her requests for her labor management and delivery. Sometimes it contains lists of medications that are requested and ones to avoid. Sometimes it contains requests for who will participate in the labor and delivery- Attending physician versus midwife versus resident versus medical student etc. Sometimes it contains statements like this:

I do not want a C-section.

Why do people create birth plans?

The answer is simply two words: Vaginal Delivery. A birth plan is like a recipe for the best Thanksgiving dinner delivery. Most people want their baby to come out of their vagina as healthy as possible. At the end of the day, they want an uneventful vaginal delivery. If you get the ingredients just right, that baked macaroni and cheese delivery will be amazing. Right?

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It is a delicate line to walk as a physician.

BIRTH PLAN FOR MY PERFECT DELIVERY

No induction.

No pain medication.

No IV fluids.

No Pitocin.

No breaking the bag of water.

No C-section. No C-section. No C-section.

GLOWING VAGINAL DELIVERY

These are common components of birth plans, large and small. It is technology’s fault that vaginal deliveries don’t always happen. It is because we doctors want to rush ladies through the labor process and have a baby before our own dinner time. If we doctors would let labor happen on its own, with minimal intervention, there would be less C-sections. Right? Wrong. I have no incentive to rush your labor. I am not motivated during your labor by any other goal than to get you and baby through labor and delivery unscathed.

I want to tackle a few facts.

  • 99% of OB/GYNs want you to have a vaginal delivery as much as you do.
  • There are things you can do to increase your chances for having a vaginal delivery, and I will share those.
  • There are factors that are out of both the doctor’s and patients control that can lead to a c-section, birth plan or no birth plan. I will give some examples.

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Picture this: You need to get from one end of the country to the other. You have never traveled outside in the elements before. You can’t drive and the only map you have is one drawn by a friend or acquaintance who once traveled a long distance on foot in the past. The only difference is that they started from a different place and had a different destination than you. Some had luggage, some didn’t. Some exercised, some didn’t. Some traveled in the summer. Some traveled in the winter. Some traveled over mountains. Some over flat land. Some traveled 2 miles, and some traveled 20 miles.

Oh and one friend had a brand new prosthetic leg when she made the trek.

In my analogy, the distance represents the labor course. I’ve cared for women who were in labor for 5 hours and women who were in labor for 5 days. The luggage represents not only the woman’s weight, which can matter in labor, but also the size and shape of her pelvis. How easy or hard is it for this baby to make it through the pelvis? The season and weather can represent the baby’s well being, which is very unpredictable, variable and can change in an instant without warning. The prosthetic leg represents the different circumstances that make us each unique. Maybe this woman has fibroids. Another woman has had surgery on her cervix. Another has severe back pain resulting from a slipped disc. They are all different, and because of this, the labor course is unlikely to be the same.

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Where do I, the OB/GYN, fit into the mix of this analogy? Well, rather than being guided by a person or people who have traveled a hand full of times over limited terrain and have drawn you a picture, consider me an in-person hiking guide who has made thousands of trips over variable terrain in every season in every storm. Who do you want as your guide?

Technology is not the enemy.

In places and countries where interventions are not available, there may be less C-sections, but there are more complications. In the United States, one of the biggest risks for a woman in labor is hemorrhage or excessive blood loss. A working IV is essential to be able to give fluids during labor for baby’s safety, but also to slow the effects and allow intervention during hemorrhage. While a person is bleeding excessively, this is the WORST time to try to start an IV (the veins practically disappear) or to find out that an IV that does not have fluid flowing through it is not working or had clotted shut. In my hospital, you can still walk and be mobile with an IV. It is like a labor seatbelt.

Likewise, monitoring the baby’s heart beat ensures that you and baby are getting through labor safely. Some desire to not have their babies monitored because they don’t want interventions as a result of monitoring. Keep in mind, if the baby looks healthy and safe, interventions aren’t necessary. If the baby looks like they aren’t getting enough oxygen based on the heart rate, this may lead to intervention, but you would want that intervention. In that moment, the safety of you and baby is more important than the route you take on you cross-country trek.

If you are in a car accident, that is not the time to put on the seat belt. It is the time to use it. Allow the IV.

Pregnant trimester

Some things that a woman can do to increase her chance of having a vaginal delivery are to exercise before and during the pregnancy, to try to be at a healthy, non-obese body weight at the beginning of the pregnancy, to keep diabetes and high blood pressure under good control if present, and to deliver before 2 weeks past the due date. These are just a few examples.

Some factors that are relatively out of the mother and doctor’s control are the baby’s ability to tolerate labor, the size and shape of a woman’s pelvis, the size of the baby (sometimes it is just genetic) and the baby’s position. I am actually writing a post about some factors that may increase breech or head up positioning at term (the due date) and some ways to encourage normal positioning. Stay tuned for that.

Labor, unlike many other aspects of life, is very difficult to control.

Most people can walk a short distance. A few blocks or even a mile or two on foot on a mild spring day could literally be a walk in the park. But what if your destination is a little farther. What if you unexpectedly have two suitcases, you are wearing high heels, and your grandma who gets short of breath when she walks is with you? In a blizzard? How are you going to get to your destination in one piece with all of your stuff and your grandma? That’s what your guide is for.

So what SHOULD you put on your birth plan? At my hospital most of these items are automatic, but just in case, here are some suggestions for a term (not premature) pregnancy:

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  1. What kind of pain management am I interested in, if any.
  2. I would like any labor interventions discussed with me for understanding and clarity.
  3. I would like skin-to-skin with myself and baby if the baby is breathing well. Dry the baby first to maintain body temperature but then chest-to-chest contact with mom is important.
  4. I would like delayed cord clamping for at least 30 seconds if there is no meconium and baby is breathing well.
  5. I would like BLANK PERSON to cut the cord.
  6. I would like to breastfeed if possible. It is the healthiest thing for baby if I am able. I understand that occasionally supplementation is necessary depending on the amount of baby’s weight loss and/or blood sugar measurements.
  7. Do I want music playing? Who is bringing the play list.

While these are not the only items that can go on a birth plan, notice that these few suggestions do not include labor management. You have to trust that your doctor is making appropriate decisions with and for you and your baby’s safety. If you aren’t clear about the reasons things are happening during the management of your labor, ask for explanations from the nurse and/or doctor.

Informed consent and shared decision making…

… means that we – the doctor and the patient – discuss the management, including, risks, benefits and alternatives of the various options and together come to a mutually agreed upon decision. This will continue to foster trust and allow the labor process to take place with low risk for complications and with clear expectations.

My birth plan as your doctor: To get you and baby through your delivery as safely as possible, with as little intervention as is necessary, but as SAFELY AS POSSIBLE. Try this:

The OB/GYN Serenity Prayer

In pregnancy, grant me the SERENITY to accept the things I cannot change,

The KNOWLEDGE and MOTIVATION to change the things that can increase my chances for having my dream delivery,

The PEACE and UNDERSTANDING that my healthcare providers have the best interests of myself and my baby at heart,

And the WISDOM to know the DIFFERENCE between what can be changed and what cannot while understanding all associated risks, benefits and alternatives.

What do you think?

I made this little video one day in my car…

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unsplash-logoAlex Hockett
unsplash-logoJonas Kakaroto
unsplash-logoJanko Ferlič
unsplash-logoAndre Adjahoe

Wendy Goodall McDonald M.D.2 Comments

What NOT to Say to a Pregnant Woman: Take a pregnant pause

Everyone knows not to ask a woman if she is pregnant…

for fear of mutual embarrassment if the assumption is incorrect. Even though that should be common knowledge, that is not the only pregnancy mistake that a person can make. Would you walk up to a perfect stranger and call them fat? What would you say if someone you had never met walked up and put their hand on your midsection? I have noticed that many actions that are not polite or socially acceptable in everyday life are somehow okay when pregnancy is involved. I seek to create new rules to apply to social encounters with pregnant women so as to not unintentionally offend.

Here’s what NOT to say (or do) to a pregnant woman:

Look, don’t touch

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Just because a baby is under that belly, that does not eliminate the need for personal space. Ask before you reach out your un-sanitized hand to touch my belly. There are multiple layers of me between your hand and my baby. Even if there weren’t, I actually believe that a perfect stranger shouldn’t touch my baby without permission and hand-sanitizer anyway.

Don’t try to guess how far along I am

You are wrong, and you will undoubtedly hurt my feelings. If you guess too few weeks or months, you will make me feel like my baby isn’t growing well enough. If you guess too many, then I’ll think that I’m either fat or have a really big baby who I will struggle to deliver. Pregnant women are never the “right” size to onlookers. Just ask, don’t guess.

Try not to criticize

If you have asked how far along I am, keep any commentary related to my answer to yourself. Just say “Aww, that’s nice” rather than “You are so big/small.” If I tell you the name, it is not license for you to issue an opinion, unless of course you like it. If you ask if it is a boy or a girl and I don’t know, that’s my choice. If I do know, don’t feel sorry for me if I’m not having what you think I want or should have. Sample response: “Aww, he/she is going to be so pretty/handsome,” or “I know you are excited to find out who is in there.”

Don’t over-share your birth story

From your own stories to those of friends and family, if it wasn’t normal, I don’t need to hear about it. Consider this, what purpose is your delivery story going to serve me? (a) Will it stop something terrible from happening to me? I’m shaking my head. (b) Will it give me nightmares until my delivery? (c) Will it reassure me that everything will be okay when my day comes. If the answer is anything but (c), keep it to yourself.

Okay, enough with the negative.

What is acceptable to say to a woman who is pregnant with child?

  • Tell her she is beautiful, no matter how self-deprecating she is to herself.
  • Remind her to drink plenty of water and eat a healthy diet for this beautiful baby.
  • Wish her a safe and happy pregnancy and delivery.
  • Make sure her “what to expect” from you is loving, joyous and nothing less.

Thank you for following. Don’t forget to follow us on social at @thegynecoblogic.

Wendy Goodall McDonald M.D.4 Comments

Happy Heart Month!

Heart healthy month

Happy February! February is American heart month, a time to assess our healthy (and maybe not so healthy) habits. For women especially it is extremely important to be aware of our personal risk factors, familial risk factors, and bad habits that may put us a risk for heart attacks, stroke, high blood pressure, overall heart disease in the future.

Exercise: Often when I am seeing women in the office, we discuss the benefits of tyler-nix-1088199-unsplash.jpgexercise. The heart is, essentially, one big muscle. The more we use it, the more efficient it becomes as well as stronger. One thing I stress to women, is exercise doesn’t mean going to the often intimidating gym (everyone knows how I feel about the gym: Be……Happy? What my gym experience taught me about self-care and self-love. ) for 2 hours a day, dedicating your life to becoming an insta-famous fitness model, and becoming the burpee champion in your office. Exercise just means staying active. It means walking more throughout the day (ie taking the stairs, parking far away, walking a lap around the grocery store before actually shopping). I started wearing a step-tracker a few years ago and I was shocked how little I actually walked in my daily routine, and how big of a difference small changes really made in my overall step count.

Knowing your numbers: Two of the top three leading causes of heart disease are high blood pressure and high cholesterol. Seeing your physician can help gauge where you stand, what your numbers are, and what you need to do to make better choices to improve them.  Another important number to know is your BMI. This can be misleading depending on body type, but overall is a good guide as to where your weight should be in relationship to your height. Diet very heavily affects blood pressure and cholesterol, as well as central obesity, so minimizing fried food, extra salt, processed food and complex carbs can help significantly to improve both your cholesterol and blood pressure.

Speaking of diet: I am writing this post in Chicago, which is the pizza haven of the IMG_4425world. I love pizza. Thin crust, deep dish, veggie, pineapple, etc etc etc. The trick to eating healthier isn’t trying to eliminate everything good in your life, but what I call, accessorizing your dinner. Eat some veggies (peppers, asparagus, broccoli) before chowing down. Also, check the labels. A common misconception is that fruit juice is healthy because it is fruit. IT IS NOT. It is full of sugar and probably one of the worst things you can drink. Plain water is the best.

The fun stuff: Smoking is the third top leading cause of heart disease. There is absolutely no excuse to smoke. There are resources that can help you quit, not to mention the amount of money you would save by not smoking. (How to help someone quit smoking AND vaping… and why you should keep trying ) I have nothing more to say about this. Just stop smoking.  Alcohol is also a contributor to unhealthy hearts. Limiting alcohol to one drink a night is a good rule of thumb.

Hormone Replacement Therapy: Ah I saved the controversial one for last. Estrogen, the hormone that is not only responsible for timing of the menstrual cycle, helps protect the vessels that pump blood through the body reducing the risk of heart attack and stroke. After the menopause hits, the estrogen levels drop. This is also a major reason the number one killer for women is in fact, heart disease. It is a dramatic shift in what the body is used to. The decision to go on HRT is a complex one that is specific to each woman’s history, risk factors, and family history. It is important to discuss this with your physician to determine if HRT is the right decision for you.

There are some factors we cannot control in terms of heart disease. Family history, daily stress, menopause. However, making small changes throughout the day can really add up into making our overall health significantly better. Ok everyone put down your phones and do 10 jumping jacks 😉 Happy Hearts!

 

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Does Alcohol Make You Warmer? Precautions for this frigid Polar Vortex

So global warming isn’t a thing?

Presently, here in Chicago we are breaking records. The temperature has BROKEN the record for the coldest temperature on January 30th in Chicago ever. The temperature dipped to 21 degrees below zero and the wind chill is less than 50 below. The ALL TIME record low temperature in Chicago is 27 below. That feels like it is around the corner.

I recently learned a few things in preparation for this record breaking polar vortex that are relevant for anyone living in a region with extremely cold temperatures. Here we go.

Keep water dripping from faucets

Also keep your cabinets open under sinks and in kitchens to try to keep your pipes from freezing. Make sure cleaning supplies are out of reach of pets or small children. Keeping the room temperature above 60 degrees will help.

If your pipes freeze, DO NOT USE A BLOW TORCH TO UNTHAW YOUR PIPES. Crazy? No, that is a thing. But don’t do it because the integrity of the pipe can be compromised. A hair dryer is a much safer way to unthaw frozen pipes.

Be mindful of furniture or fabrics near space heaters.

Photo by YIFEI CHEN on Unsplash

We recently had a crayon incident that left our room smokey and took our space heater out of commission at the hands of a melted crayon. Furniture these days is easily ignited and burns very quickly. I wrote an article about fire safety and evacuation practices here. Make sure everyone has a healthy FEAR of the space heater.

Cold air can affect how well you breathe.

If you must go outside, the air is not usual air.

From runnersworld.com:

Cold air is very dry. The burning sensation you feel when breathing in cold air is probably due to the combination of heat and water exchange that is occurring early in the inspiration of cold, dry air. For most people, this sensation goes away after a few breaths. It is not known to cause harm in a healthy lung, but can trigger an attack of bronchospasm in someone with asthma.

Keep your inhaler handy and consider wearing a scarf over your face or a facemask.

What about Alcohol? Will that warm me up?

This is a common question and one that is misleading. What happens when you drink alcohol is that you physically feel warmer because of the skin flushing and rerouting of blood flow that can occur. It can also lead to sweating, but actually your CORE body temperature drops during this process.

That means, alcohol can actually make you MORE prone to hypothermia, the dangerously low body temperature that can be life threatening. While alcohol may numb the sensation of cold and take your mind off of your choice of residence (#MidwestFail), it will not warm your body in a healthy way.

Avoid excessive alcohol when you are cold. It will only make the situation worse.

Thanks for reading. Don’t forget to follow us on Facebook and Instagram at @thegynecoblogic.

You needed this pic in your life. You’re welcome.

Wendy Goodall McDonald M.D.Leave a comment

Dear Loved Ones: I’m Having A Baby and The Doctor Told Me To Tell You This

Dear Family and Friends,

I’m grateful for your love and support. I (we) couldn’t be happier that you are planning to see our little bundle of joy when he or she arrives. There are a few things that my doctor wanted to make SURE I told you before you see the little one for the first time.

Wash your hands

This is the first and MOST IMPORTANT thing on my short list. Every surface harbors germs that my baby has never seen. Door handles, railings, elevator buttons, cars and public transportation. Even if you wash your hands when you come over, PLEASE wash them again or use hand sanitizer before holding the baby. I know our little one will need to be exposed to germs eventually, but not fresh out of the gate.

Please don’t kiss the baby on the face or hands

Baby cheeks and hands are the cutest, but also the closest to their mouth. My baby will be constantly touching their face and putting their hands in their mouth. I’d love it if you would kiss the baby on the top of the head or on their feet. Please leave their hands and cheeks for looking, rather than touching.

Please get your vaccines before coming to see or hold the baby

If you are medically able, I would love it if you would make sure you have had a Whooping Cough vaccine, known as the Tdap, within the last 10 years. This is actually a Tetanus shot, but the whooping cough part is the P, which stands for Pertussis. You can get this vaccine at your doctor’s office, or at your local pharmacy, like Walgreens or CVS. Target even often carries this vaccine.

Also, if it is Flu season, I would appreciate it if you would also get a Flu vaccine. Newborn babies are most susceptible to Whooping Cough and Influenza. We just want our baby to be as safe as possible. If you are curious about HOW VACCINES WORK, click here to be taken to another article on this site.

If you are sick at ALL, please keep your distance

I’ll be happy to send you more pictures than you can handle, but please don’t come to see the baby or hold the baby if you are sick. Even a mild cold can make a newborn infant extremely sick. Adults can fight viruses way better than small babies. I really appreciate you respecting this tender baby space.

If you smoke, please wash your hands AND change your clothing

While I thank you for NOT SMOKING around the baby, the sediment from the clothes that you wear while smoking can still increase the baby’s risk for lung infections, ear infections, asthma and SIDS. Please bring a different clean shirt to wear if you want to hold the baby.

While I appreciate your advice, please be mindful that every baby is different

Whether you raised me or other children, I know you have a wealth of experience that is invaluable. If you feel like sharing, please do, but remember that my baby is not your baby. My child may not respond to the same things yours did. If my child doesn’t eat or sleep like yours, for example, so be it.

I will make sure that my baby is safe by consulting with my PEDIATRICIAN regularly. I only ask that you remember that additional advice can also lead to stress and anxiety when a parent is made to feel like they aren’t doing something “RIGHT.” Dispense advice sparingly, please.

Any help around the house that you can offer will be appreciated, even if I don’t accept it

YES. Please ask if you can bring by food or wash some dishes. I love the offer of help. I may have it all together, but I may not. Please don’t hesitate to ask, and I WILL TRY to let go of some things and let you help me.

Lastly, remember that you get to go home and sleep tonight. I don’t

My little one may be working out their daytime, nighttime schedule. And’ he or she is absolutely going to need to eat every few hours, even overnight. That means that I will need to sleep at some point during the day. If you can limit the duration of your visits so that I can sleep while my baby sleeps when the sun is up, that will help me when the sun goes down.

Also, as sweet as it is for you to hold the baby while they sleep, he or she will need to get used to sleeping in the bassinet or crib too. It’s okay to put the baby down to sleep sometimes.

Thank you for reading this article. It helps me to feel safer and more comfortable as a new parent knowing that you care about the things that I care about.

If my OB/GYN thinks these things are important, I do too. I love you for respecting that.

Let’s have a BABY!

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Wendy Goodall McDonald M.D.Leave a comment

My Vagina Keeps Itching But It’s NOT Yeast

Here’s the usual story:

Doc, I’ve been itching but I don’t think it is yeast. My vagina itches on the outside, more on one side than the other. Over-the-counter yeast medications don’t work, and the symptoms are sometimes worst at night.

Well, here are my top five usual suspects and what you can do about them. I will also provide links to products that I recommend for my patients practically every day. As a self-proclaimed Amazon Prime addict, that’s were I’m sending y’all. #PrimeEnabler

Eczema or Vaginal Dryness

From NationalEczema.org:

Eczema is the name for a group of conditions that cause the skin to become red, itchy and inflamed. There are several types of eczema: atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema, seborrheic dermatitis and stasis dermatitis.

Wait, I can get that in the vulvar area? (Reminder: The vulva is the term for the external vagina.) Yes, a person can develop eczema of the vulva. This is a diagnosis that is usually made by a dermatologist and may require a biopsy. If you suspect that Eczema may be your diagnosis, try Aquaphor twice a day.

Click the pic to be taken to Amazon

Vaginal dryness needs a vaginal moisturizer #Menopause

Sometimes itching is caused by dryness. Menopause a prime culprit for this symptom. Though hormonal modulation can help, like oral, topical or transdermal patches, hormones do come with some slight risks that can be more relevant depending on a persons medical or family history.

If you are looking for a non-hormonal option to manage vaginal dryness, Replens is a long-lasting moisturizer that should last 2-3 days per application. Some of my patients use it when they plan to be sexually active, and others use it when they are just dryer than usual. It’s nice to have on hand.

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Herpes or other Sexually Transmitted Infections

I have written so, so many posts about this topic, from lumps and bumps to things to know about chlamydia to top STDs to know about. Suffice it to say that some sexually transmitted infections can cause symptoms like itching. Even if you don’t suspect a partner’s infidelity, recurrent irritation that doesn’t respond to antifungal (anti-yeast) medication may warrant a rule-out-STD doctor visit. Just take it off the table.

Also, take a mirror and look down there. If itching or irritation is followed by painful bumps or broken skin areas, you may need testing for herpes. It is important that you see your doctor WHILE you are having the symptoms and have the lesions swabbed with a q-tip. That is the best way to rule in or rule out Herpes as a diagnosis. Google images are often FAR MORE INTENSE than day-to-day herpetic lesions. They can be subtle in appearance, but they are usually painful to touch.

Contact Dermatitis

One of my first questions is often: Have you changed your detergent, soaps, fabric softener? This is because irritation can come from new products in contact with the skin. This is especially true for those who travel for work and use hotel products that change frequently.

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Try using sensitive skin soaps for the external vulva. Remember, the inside does not need soap. Fresh water only. For clothing, try washing undergarments in products for sensitive skin, like All Free and Clear.

My new favorite body wash is this one:

Click the pic to be taken to Amazon

I don’t often come across a body wash that I can use on my whole body. I have sensitive places that are very particular about products. This one is my latest favorite, for those who want a whole body solution that actually gets you clean. Let me know what you think in the comments. Again, this one isn’t based on any evidence, just personal preference.

Lichen Sclerosis or other Inflammatory Disorders

The hallmark of this one is itching that occurs primarily at night. The itching is not responsive to anti-fungal creams and lumps or bumps are not often present. Women say that the itching wakes them up at night and they are compelled to scratch.

Here is the crazy part though: This chronic inflammation is worsened by scratching. It’s call the itch-scratch cycle. One of the ways to manage this is with topical steroids to control the inflammation. The other thing that is important is for you to NOT SCRATCH IT. If that means applying a cold compress, or taking a Benadryl as a sleep aid for a few nights, try that. If none of that helps, you should definitely see your doctor because your itching could be caused by a…

Precancerous changes of the skin

Yes, pre-cancer and cancer of the vulva can manifest with itching. How do we differentiate that from other causes? By biopsy. My usual process is to first test for yeast, bacterial vaginosis and STDs. Then I may try a topical steroid as long as there aren’t any visible lesions that I should swab or biopsy.

If NONE OF THAT WORKS, a biopsy is necessary. It just is. I have been surprised before by an area on a woman’s body that looked normal, but just was itchy. If you think about it, itching can save a woman’s life. A biopsied area that reveals advanced pre-cancer can be treated with removal of the affected skin. Most times, the remove area does not leave a woman with any deformities. The vulva heals so well, sometimes it’s hard to even see what was removed.

The Point Is, Don’t Ignore Itching

If you are not getting relief from natural or over-the-counter remedies, PLEASE see your doctor. We can help you get to the BOTTOM of the situation. Please forgive me for that pun. #punlife

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Wendy Goodall McDonald M.D.Leave a comment

What’s Pap-pening? What You Should Know About HPV and Abnormal Pap Tests

My patients have told me that they don’t like when I call them on the phone. It’s not that they don’t like me, but rather they have learned to expect that normal results will come electronically or from my medical assistant. Abnormal results, however, will come directly from me. “I’m calling to tell you that your Pap came back abnormal.” “My what?” “Your Papanicolaou test.” “My Papanico-what?” Let’s break things down from the basics to the details.
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The Pap test looks for pre-cancerous cells on the cervix.

These cells are graded by level from normal, to slightly abnormal, to significantly abnormal, to cancer. You can rest assured that if your doctor calls saying you have an abnormal pap, you don’t have cancer. Otherwise he or she would have said, “You have cancer.” Pap testing can be done from as frequently as every 6 months, to as infrequently as every 2-3 years in some cases. You and your doctor can discuss how often your pap should be done. The Pap is a screening test that randomly collects a sample of cells from the cervix. If abnormal cells are detected, often a more targeted test is indicated to determine if the Pap accurately represents the cells of your cervix. That targeted test is called a colposcopy.

HPV, or Human Papilloma Virus, is the virus that causes precancerous changes on the cervix.

It is also the virus that causes genital warts, though different strains are responsible for warts. HPV is tested as an adjunct to certain Pap results, and is routinely tested over the age of 30. If you test positive for HPV, you will never know when, where and from whom you contracted it. Men aren’t tested for it. Imagine that your Pap is like that T-Rex in Jurassic Park, the first movie. It only saw the people if they moved. Similarly, the Pap will only detect HPV if it is “moving”, or replicating. HPV could have been present for years even with normal testing, but if it was dormant in a small quantity, it may not have been detected.

HPV does not necessarily stay forever.

It is a virus that your body can, in theory, fight off and destroy. Staying healthy and eliminating or minimizing exposure can help your body to have the immune strength to fight this virus. I stated that you cannot know a partner status, but condom use can at least decrease potential exposure. There is an FDA approved vaccine for HPV. It protects against the 9 most common strains of HPV. This is especially important to administer BEFORE exposure, meaning girls and boys should ideally get the vaccine before the onset of sexual activity. Getting the vaccine does not mean you can skip paps (#sorrynotsorry) and you should still see the gyne at least annually.

And NOW men and women can get the HPV vaccine up to age 45

I wrote an entire post about that. Click here for more on the new guidelines.
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Rarely does someone get cervical cancer if they follow the screening guidelines and recommendations from their doctor. Even if you get that call about an abnormal pap, if you do your part and follow up for testing as recommended, you can avoid devastating results and stay safe.
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Wendy Goodall McDonald M.D.7 Comments
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