A Rexburg couple had Christmas come early this year, in the form of identical triplet girls.

​Olivia and Connor Gressel welcomed Lina, Jane, and Marceline (Marcy) on December 20, more than two months ahead of their original due date of February 27.

The girls are the first-ever set of triplets born at Mountain View Hospital in Idaho Falls, but that's not the only thing that sets them apart.

Olivia's doctor, OBGYN Dr. Pamela Denson says that the odds of getting pregnant with triplets in the first place is about 1 in 5,000, and that's with the help of fertility treatments like IVF. Olivia also had an IUD and multiples don't run in either her's or Connor's families. This makes the girls extremely rare mono tri triplets.

"They each share the same placenta, but they're each in their own individual sac," Denson said. "I mean, the chance of that is about 1 in 100,000 in itself. And then add the chance of getting pregnant just with an IUD. I mean, it's kind of crazy. The probability of getting pregnant with mono tri triplets, where they're all sharing the same placenta and they're identical with an IUD is somewhere around 1 in 10 million. So I told her she needs to go to Vegas."
Born more than two months early, the girls are in the NICU at Mountain View Hospital, and Olivia says they're doing great.

"They're doing really good from what the doctors have told us, they're doing better than they would have expected, which is so relieving for us," Olivia and Connor said. Olivia had been seeing a specialist, as well as Dr. Denson once a week, and went in for a routine checkup Monday.

"I just mentioned it to her, 'Hey, I've just been having this pain'," Olivia said. "And she said, 'Oh, well, we should, we should check you.' And she did, and I had dilated to like a three, and she's like, 'Oh, OK, well, let's put you in the hospital because you're going to have these babies and we just want everything to be safe'. So she said, 'We'll just check you in until you have them.' And that was a huge surprise."

Doctors planned on keeping Olivia until Wednesday, but about an hour later when she was checked on again, they saw she had dilated more, and decided to perform a C-section.

Dad Connor said the girls are already developing personalities. "Jane, we thought she was kind of the more submissive one in the womb, she was getting kicked a whole time by Marcy and Lina and so we kind of assumed she was going to be the more docile one," Connor said. "And even when they came out, we saw that Marceline, she would kick really hard. And so we're like, 'Oh, yeah, she's a fighter'. She's definitely the aggressor in this case. But then one of the nurses just told us today that Jane's actually been pretty aggressive and kind of being a little feisty. So that was a little surprising because we thought she was so sweet, like 'Our Jane, are you sure?' And so we've kind of noticed a little bit of personality there. Lina has just been calm as much as you can be."

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​Credit - By Rachel Fabbi Local News 8

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**Image via Pexels

Starting a business is an exciting but challenging adventure. Add in a new baby, and this challenge can seem even more daunting. Do not let that cute little face intimidate you. You can start a successful company and still tend to your new family member if you tap into these four recommendations from Teton Women's Health Center.
 
1. Create a Schedule
While you will often do double duty as a parent and entrepreneur, creating a schedule helps you and your partner work together to maximize time. It ensures all family duties are addressed, your little one is tended to and you still have time dedicated solely to your business development.
 
Compare your two schedules, including baby duties, work, household errands, chores, and extracurriculars. Develop a family schedule that allots baby-free time for you to focus solely on your business.
 
2. Streamline Work Tasks
Finding strategic ways to streamline work projects helps your company progress faster and gives you more time to snuggle your new bundle of joy. A great example is applying for an employer identification number. An EIN is a tax ID number that the IRS uses to identify your company and track payroll taxes. Applying for one saves you time and energy down the road when you file your federal and state taxes, be it annually or quarterly.
 
Marketing is another area to streamline business procedures. Complete a thorough market research analysis to get a comprehensive understanding of your audience and their needs. Knowing this data right away helps you create effective marketing campaigns so you don't waste time and energy on unimpactful advertising.
 
A well-designed logo is essential to separate your business from the competition, build brand awareness and make a strong first impression on consumers. Instead of spending time and money hiring a design company, you should use an online logo maker to make it yourself. There are varieties of designs, fonts, and colors; you simply choose an icon, style, and text to create a unique logo. According to one report, using a signature color for your company can enhance brand recognition by 80%, so use a signature color with your logo and throughout your products, marketing, and website design.
 
3. Invest in Baby Accessories
A few quality products can put your baby at ease during the day. Not only can a white noise machine help your baby sleep better, but it also drowns out work noise, like typing, phone calls, or music. Just be sure the noise is less than 50 decibels. Otherwise, it could damage your baby's hearing.
 
Purchase a quality rocker for your little one as well. Rockers today offer loads of bells and whistles, such as vibrations, Bluetooth players, and built-in noise machines. This investment also puts your baby to sleep so you can complete items on your to-do list.
 
4. Find a Reliable Sitter
There are times when both you and your spouse have commitments and need an extra hand to help with the baby. Find a trustworthy babysitter who lives close by. Friends and family members make excellent sitters; otherwise, find a young adult in your neighborhood. Community websites often have options for parents to post about local sitter recommendations, or you can search an online babysitter directory.
 
Being proactive helps you find balance during this challenging stage of life. By making strategic choices, you can successfully launch a business while still giving your little one the love and attention he or she needs.

Article courtesy of Daisy Jones

(Photo by Pixabay)

We know that physical health is crucial, but so too is our mental health. With the stress of daily life and so many of us pressed for time, it’s difficult to find ways to enhance or implement changes to boost our mental health. Fortunately, there are several easy ways to do just that. With a little planning and an open mind, you can live your best life.
 
Set small goals
 
Many people are perfectionists to some degree, but it can be difficult to live up to our own expectations. Knowing how to set small goals and work to attain them will help you derive satisfaction, feel a sense of pride, and will keep you from feeling overwhelmed. Keeping realistic expectations is one of the keys to success, no matter what the goal is.
 
Take a new approach at work
 
Work is one of the top stressors for adults, and many Americans are dissatisfied with their jobs. Most likely, it’s not the actual work that causes unhappiness so much as how we manage our feelings and behaviors related to our job. Simple tweaks like adjusting your perspective with a monotonous task, or remembering to slow down, or even changing your work schedule slightly can make a significant impact.
 
Outsource tasks
 
Aside from work, personal responsibilities are right up there in the list of top stressors. Yes, we all have these stressors, but implementing certain hacks can reduce frustration or even eliminate unnecessary stress. For example, if you struggle with getting home to walk your dog every evening, consider hiring a dog walker. If you’re overwhelmed with making dinner every night of the week, try meal-prepping, or turn to a meal delivery service.
 
Exercise
 
Getting in daily exercise is a well-known mood booster, and it’s especially effective if you spend time outside. Soaking up the sunshine can improve positive thoughts and keep you looking forward. Remember those small goals we talked about? Well, daily movement is one of them. Make an appointment with yourself to spend at least 30 minutes every day walking, going for a run, taking a hike, bicycling or enjoying a fitness class. You’ll enjoy an improved mood and better sleep.
 
Learn to relax and focus
 
Meditation and yoga can help you learn to focus on the present moment, boost your energy levels, relieve anxiety, and learn breathing techniques that will allow you to relax just about anywhere you are. These techniques are especially helpful when you’re dealing with work or family frustrations.
 
Put work into relationships
 
Whether it’s with a significant other or a family member, working on your relationships can help you achieve happiness or closure. Have a formerly close friend you’ve lost touch with? Write a letter, or make a phone call. Keeping healthy relationships alive and well will help you feel better on a daily basis.
 
Avoid stress triggers
 
In the age of technology, when everyone has a smartphone at hand, it can be difficult to avoid stressful interactions, particularly when it comes to social media, which can be especially harmful to people who suffer from anxiety or depression.  Be sure to take care when using these modes of interaction, especially if you know it triggers uncomfortable feelings.
 
Journal
 
Not everyone is comfortable with talking about their feelings or issues, and that’s okay. Instead, start a journal and write down negative thoughts instead of venting about them to others. Relieving yourself of those thoughts will allow you to focus on the positive things in your life.
 
Go Back to School
 
Many people find completing a degree to be a good way to boost mental health. While increasing your education can certainly help you earn more money, it also keeps you focused and engaged, which is precisely the kind of mental exercise that will make you feel better about yourself.  There are plenty of online programs that work around your schedule, so it is easier than ever to start or finish a college degree.
 
We’re all navigating a crazy time in our lives, which is why devoting time to our mental well-being is so necessary. Slow down, consider these tips, and see what you can do to find calm and peace in your life.
 
 Article courtesy of Elena Stewart

The path to becoming a parent isn’t as simple for some families as it is for others. The good news is that those who can’t have children on their own now have multiple options for starting or growing their family. Surrogacy is one of those options that is becoming more popular in the U.S. This jump shows that more people than ever before are touched by the process of surrogacy in some fashion.
 
Teton Women’s Health Center offers unparalleled obstetrics and gynecological care at both Mountain View Hospital and Eastern Idaho Regional Medical Center. Call today to schedule your appointment. 208-523-2060
 
 
What is Surrogacy?
Surrogacy is a form of assisted reproduction in which a woman carries and delivers a child for the intended parents who want to start a family. There are two types of surrogacy. Traditional surrogacy is when a woman uses her own eggs to conceive for another family, meaning she would be genetically related to the baby. Gestational surrogacy (sometimes called a gestational carrier) is when a woman is not genetically related to the child she is carrying. In this case, the egg and sperm are joined through IVF, and the embryo is placed in the surrogate’s uterus. Because there are more sensitive legal issues involved when the surrogate is genetically related to the child, gestational surrogacy is far more common than traditional surrogacy.
 
What Are the Ways You Can Be Involved in Surrogacy?
 
Becoming a Surrogate
 
Some families choose to have someone they know as a surrogate, while others go through an agency. If you’re considering becoming a surrogate, an agency will start by conducting medical and psychological exams to make sure you’re a qualified candidate. When you are chosen by a family, you and the intended parents will each complete legal agreements. As part of the process, you will need to take hormonal supplements that prepare your uterus for the embryo before it is transferred. You and the intended parents will stay in close communication throughout the pregnancy.
 
Besides becoming familiar with the process, you also need to be informed about what to expect physically, emotionally, and financially as a surrogate. There are multiple financial benefits, which can include paid travel and compensation for lost wages, life insurance, and money for various other expenses. All of this compensation is in addition to the fee you receive for being a surrogate.
 
Becoming an Egg Donor
 
In some situations, the intended parent will use her own eggs or even use eggs that she has previously frozen. In other situations, though, egg donors are needed for surrogacy. This is sometimes called third-party reproduction, when the child is not genetically related to one or both intended parents.
 
Just as potential surrogates go through a screening process, you would undergo screening that includes a complete medical history. If you are chosen as an egg donor, the process involves injections that help sync your cycle with that of the gestational carrier. You can also expect ultrasounds and an office procedure to retrieve the eggs. Egg donors typically receive some financial compensation, but this can vary depending on the agency you use.
 
Becoming an Intended Parent
 
When you can’t have a baby on your own, for whatever reason, you face a big decision about which path to take to becoming a parent. If you’re new to the world of surrogacy, you probably have LOTS of questions. There are all kinds of myths about surrogacy. You may worry that the surrogate will try to take custody or that you will have a hard time bonding with your child. These myths are easily busted once you get further into researching the realities of surrogacy. Many people who are considering surrogacy also feel reassured from personal stories, like these families featured in the Dallas News.
 
As a new parent, you’ll have to plan for your baby’s arrival. This includes shopping for a stroller, car seat, and crib. You’ll also need to babyproof your home. Install gates on your stairs, secure heavy objects to prevent them from falling, and add guards to outlets and sharp corners. When you’re a new parent, it’s easy to neglect self-care, but your well-being is essential to your and your baby’s health. Before your baby’s arrival, relieve stress by decluttering your home, creating a space to exercise or meditate at home, and investing in some comfortable clothing like T-shirts and leggings to help you relax.
 
Ultimately, the decision to use surrogacy is very personal. No matter what part you play, it’s a decision to make based on what feels right for you and your family. For those who choose surrogacy, it can be extremely rewarding to be part of such a life-giving process.
 
Guest Post by Elena Stewart
Photo credit: Pexels

The COVID pandemic has had profound impact on everyone’s life last year, and pregnant women have not been an exception.  Despite living through quarantine, masking, social distancing, development of vaccination, and sometimes even experiencing COVID firsthand, the uncertainty of how COVID may affect you or a loved one may be the most stressful experience of them all.  Unfortunately, there are still unknowns about the virus and vaccination, but today’s blog will focus on what has been learned so far.
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How dangerous is COVID for women of childbearing age? 
As of writing this blog, there have been 586,659 deaths attributed to COVID in the US.  Of those, 2.7% or 15,909 have been in the age group less than 45 years old, which would be the age group including women of childbearing age.  (https://www.cdc.gov/nchs/covid19/mortality-overview.htm)

We have demographic data for age on 26 million of the cases of COVID, and of those 26 million, 64.5% of cases occurred in those 49 years old or less.  (https://covid.cdc.gov/covid-data-tracker/#demographics)  Assuming a similar distribution among the total cases of 33,292,045, that would mean 21,473,369 cases occurred in those 49 or less.  So, 15,909 divided by 21,473,369 means that the chance of dying from COVID in this age group if infected is roughly .07%  Another study looked specifically at pregnancy (https://www.bmj.com/content/370/bmj.m3320), and it showed 339 deaths from all causes in pregnant women with known COVID of 41,664 total pregnant women with known COVID.  This worked out to 0.02%  More severe COVID in this study was associated with increased maternal BMI, medical comorbidities, hypertension, diabetes and preeclampsia.  Looking at these numbers would suggest a maternal mortality risk of 0.02-0.07% from COVID, although mothers with health conditions listed above would potentially have an increased risk.

How do COVID vaccines work?
There are 3 main types being evaluated:

1. mRNA vaccines – this is the newest type of vaccine, and it works by using material (mRNA) from the COVID virus that instructs the body’s cells to make proteins specific to the virus.  After exposure to these proteins, the body creates T and B lymphocytes to fight the virus if exposed to COVID in the future.  These include the Pfizer and Moderna vaccines.  Each requires 2 injections to obtain immunity.
2. Protein subunit vaccines – these vaccines introduce a protein from the COVID virus to prompt the body to create T lymphocytes and antibodies to fight the virus if exposed in the future.  This is similar to how the Hepatitis B vaccines work and one of the pertussis (whooping cough) vaccines.
3. Vector vaccines – these vaccines use another virus modified to contain genetic material from COVID.  Once introduced into the cell, the genetic material from COVID instructs the cells to make proteins that will induce B and T lymphocytes.  Johnson and Johnson makes a vector vaccine, and it only requires one injection to obtain immunity.  Astrazenaca also makes a vector vaccine.

(https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/how-they-work.html?s_cid=10491:how%20the%20covid%20vaccine%20works:sem.ga:p:RG:GM:gen:PTN:FY21)

Are COVID vaccines effective?
Johnson and Johnson vaccines are 66% effective at preventing COVID 19 illness in people who haven’t been exposed previously; fortunately, none of those who got COVID more than 4 weeks after vaccination were hospitalized.  (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/janssen.html) 

The Pfizer vaccine is purported to have 95% efficacy at preventing laboratory detected illness in those without evidence of previous infection.  (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Pfizer-BioNTech.html)  The Moderna vaccine is reported to be similarly effective at 94%  (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/Moderna.html) 

These numbers are a little difficult to track from an independent source as breakthrough cases (infections without hospitalization or death following vaccination) are not reported to VAERS.

Are COVID vaccines safe?
At this time, COVID vaccines have received an emergency use authorization.  This means that the FDA makes a product available to the public based on the “best available evidence,” without waiting for all of the evidence necessary for formal FDA approval.  For formal FDA approval, adequate evidence must be necessary to determine that a product is safe and effective for its intended use and can be manufactured to meet quality standards.  (https://www.fda.gov/consumers/consumer-updates/understanding-regulatory-terminology-potential-preventions-and-treatments-covid-19)

Currently, the big side effects making the news are anaphylaxis (severe allergic reaction in 2-5 per million), thrombosis with thrombocytopenia syndrome (36 of 11 million with the J&J vaccine, highest risk in women under 50), myocarditis (511 cases reported, 323 confirmed mostly with mRNA vaccination, most common in young males), and death associated with vaccination (5,343).  Now, to clarify on the last number.  These deaths have been reported to VAERS as occurring after vaccination, although at this time there isn’t a way to discern whether the vaccination was the direct cause of death.  If a causal link was shown, it would constitute a rate of 0.0017%  (https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety/adverse-events.html)

Does natural immunity from COVID provide protection?
In Lombardi, Italy 1,579 patients were followed for an average of 280 days after COVID 19 infection, and of those, only 5 (0.31%) were reinfected.  Of those 5, only one was hospitalized.  (https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2780557)

Over 5 months, 1,359 caregivers at Cleveland Clinic who had previous COVID 19 infection and did not receive vaccination had no recurrent COVID infections detected.  (https://www.medrxiv.org/content/10.1101/2021.06.01.21258176v2.full)

What do the experts say?
Formal evaluation of the COVID vaccines in pregnant women with controlled studies have not yet been published, although some trials are in the works.  Because of this lack of information, the WHO suggests vaccination with mRNA vaccines only for pregnant women with either high risk of exposure, ie healthcare workers, or those with comorbidities that may increase risk of severe disease.  (https://www.who.int/news-room/feature-stories/detail/the-moderna-covid-19-mrna-1273-vaccine-what-you-need-to-know)

 ACOG suggests that all women, including pregnant and lactating women, have access to COVID 19 vaccination, as well as the most current safety information, and that they should be supported in whatever decision they make.  (https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2020/12/covid-19-vaccination-considerations-for-obstetric-gynecologic-care)

In summary, there are still a lot of unknowns regarding COVID 19 infection, vaccination and particularly how each might affect pregnancy.  We don’t yet know how long immunity from vaccination or previous infection lasts, although it looks like both may provide initial protection against COVID 19 infection or reinfection, respectively.  We will continue to await information on efficacy of the vaccine and immunity against different COVID variants.  Even though we have some idea how COVID 19 may affect a pregnant woman during her pregnancy, we don’t yet know how either infection or vaccination may affect a developing fetus in the long term, and unfortunately, by the time we do, the babies most affected will no longer be babies, and the pregnant women most affected will no longer be pregnant.  At TWHC, we will continue to monitor what data is available and provide updates as we can.  In the meantime, our goal is to provide the relevant information for each mother-to-be so that she can make the best decision for her.

Dr. Nick

While gender transition medications/procedures aren’t services that our office offers, we still get questions from parents about the effects of these treatments on adolescents.  Based on these questions, we’ve looked into health implications for those who elect to undergo these treatments.  Here’s what we’ve found:
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Clinics that treat gender dysphoria have noticed some interesting trends in the number of adolescents identifying as trans in the last decade.  First, the number of adolescents identifying as trans has increased dramatically.  Second, gender clinics have seen a huge shift from primarily transfeminine patients (assigned male at birth) to a majority of transmasculine patients (assigned female at birth).  Historically, gender dysphoria presented in early childhood (ages 2 to 4) and was predominant in those born as boys.  Suddenly, we have seen a huge increase in individuals identifying as trans and instead of young boys with gender dysphoria, its adolescent girls with gender dysphoria.  So, what happened?  There are lots of possible explanations, from the influence of social media to the fact that it is more acceptable now adays to come out as trans.  The purpose of this blog is not to determine the reason behind this huge shift in demographics in the trans movement, but rather review the risks associated with medications for gender transitioning and surgery in adolescent natal girls.  What do these medications/surgeries do, are they permanent and what are the risks associated with taking them?

1. Puberty Blockers: When a girl enters puberty, her hypothalamus signals the pituitary which is a gland in the brain to send signals to the ovary to start producing hormones which will allow ovulation to occur (release of an egg from the ovary).  Puberty blockers usually a drug called Lupron, will shut down this entire process and prevent puberty from happening.  So, is this safe to do to a teenager who has not undergone puberty yet?  What are the risks?  First, these puberty blockers will stunt a teenage girl from growing in height and weight any further. She will likely be very short, as her longterm height will essentially be whatever height she is at time of beginning the medications.   It will also prevent breast formation, pubic hair/underarm hair and menstruation.  There is also concern that this will affect brain development and IQ as well.  Suppression of normal bone development also increases the risk of osteoporosis- her bones will be brittle, and she will more susceptible to fractures if she falls.  If a child moves from this to cross sex hormones like testosterone, the likelihood of becoming infertile is essentially guaranteed. 
2. Cross Sex Hormones: For teenage girls who have already been through puberty who are considering transitioning to male, the medication of choice is testosterone.  Testosterone does a lot of good things for mood, especially for someone who suffers from anxiety or depression.  It suppresses anxiety and lifts depression and produces a form of euphoria.  It makes you bold and unafraid.  It increases muscle mass and makes you stronger and increases your sex drive.  Testosterone redistributes fat away from the thighs and hips, and it causes body and facial hair to grow.  The girl will look like a boy.  It also causes severe vaginal atrophy (thinning, drying, inflammation of the vaginal walls that makes intercourse painful and can cause painful urinary symptoms as well).  After a few months on testosterone, the voice will crack just like an adolescent boy entering puberty), severe acne may follow, and even male pattern baldness.  It will cause the nose to become rounder and the jaw squarer.  Because testosterone thickens the blood, it increases the risk of having a heart attack by five times what a woman not on testosterone would have.  It also increases the risk of having a stroke, blood clots, and diabetes.  Testosterone also increases the risk of uterine cancer because of the effect it has on the lining of the uterus, and longterm use markedly increases the chances of permanent infertility.  Within several months after beginning testosterone, the changes to the body, like facial hair and voice changes, are all likely permanent.  These changes will persist even if she decides to transition back.    
3. “Top Surgery”:   For adolescents considering transitioning, the desire to proceed with bilateral mastectomy (removal of both breasts) is not uncommon.  One of the biggest misconceptions about this surgery, since breast augmentation is so common, is that if they change their mind, they can just get a “boob job”.  Unfortunately, this is not true.  Once the breast tissue is removed, if spacers are not placed at the time of removal (like we do for breast reconstruction following mastectomy for breast cancer), there is no way to do an augmentation that will look like real breasts again.  These individuals will also lose the ability to breastfeed it they ever decide to detransition or have a family.  Other risks include scar appearance, infection, seroma formation (where fluid accumulates and then drains), pain, bleeding, and distortion of the nipple. 

Hopefully, this blog helps to explain how gender transitioning medications and surgeries work as well as the risks involved for adolescent natal girls (born as a girl).  While we don’t feel that it’s our place to decide what’s best for your teen’s health, particularly regarding services that we don’t offer, we did want to provide patients and their parents (if the patients are minors) with information about the medical implications of these decisions.  Knowing about the potential side effects and being aware of the permanence of these therapies is important in making a well-informed decision that will affect their future. 
Dr. Pam

If you’ve been to a doctor’s office while planning or during a pregnancy, chances are quite good folic acid (to prevent neural tube defects), DHA (to promote baby’s brain development) and iron (for prevention of anemia) have been recommended.  These relatively universal recommendations have been shown to help promote health pregnancies, and safety of these supplements have been well established.  Unfortunately, as nutritional supplements are regulated by the FDA, there is a lot of misleading information or simply limited information about most nutritional supplements.  While some of these supplements may be beneficial, others may in fact be harmful in pregnancy, even some of the “natural” ones.  Here’s a short list of some of the more commonly asked about supplements and what information is available for them.

1. Tabacum – an herbal product used for nausea/vomiting in pregnancy.  Unfortunately, this tobacco-based supplement contains nicotine and should definitely be avoided in pregnancy as it can cause harm to a baby’s brain and lungs.
2. Melatonin – this supplement has actually garnered a lot of interest in pregnancy studies, and there are some ongoing studies to assess whether it may reduce risk of preeclampsia and growth restriction in pregnancy.  However, at this time, safety data in pregnancy is relatively limited, and since Unisom with doxylamine has an extensive safety profile (and can help with nausea in pregnancy), doxylamine is would typically be advised rather than melatnonin until further safety testing can be done.
3. Kombucha – often used as a source of probiotics, this fermented food can contain alcohol as a part of the fermentation process, so kombucha should be avoided as alcohol intake in pregnancy can be associated with birth defects and intellectual/behavioral disorders.
4. CBD – although many people may be aware of the potential for marijuana and THC use in pregnancy to affect a baby’s brain development and increase the risk for a smaller or preterm baby, it may be less well-known that CBD use in pregnancy should also be avoided.  In addition to potential for liver toxicity, there is also concern for negative effects on the developing male reproductive system.
5. Astragalus – used to boost immunity, energy or even milk production postpartum, it can cause irregular heartbeat, dizziness and may be passed along to the fetus during pregnancy and lactation, so it should be avoided during and after pregnancy.
6. Red raspberry leaf- taken as a tea to reduce labor pain, nausea and miscarriage while increasing milk production, it appears to be relatively safe, although it hasn’t been proven to be effective for treating any of the above claims.
7. Nux vomica – this herbal treatment for nausea should undoubtedly be avoided in pregnancy as it contains strychnine, which can be harmful to both mom and baby.  In fact, the primary use of strychnine today is as rat poison.
8. Vitamin A – one of the trickier supplements in pregnancy.  Very low levels can potentially be associated with growth restriction, hearing loss for baby, insulin resistance for the baby later in life, and some birth defects such as microcephaly or kidney defects.  Too much is also bad – increased risk of miscarriage and heart/nervous system defects.  A typical prenatal vitamin often helps walk the line between too much/too little, although supplementing with more than 5000 IU per day should be avoided during pregnancy, and intake should not exceed more than 25000 IU per week.

Supplement use in pregnancy can be complicated, and the limited or misleading information available can make the decision of whether or not to take them very confusing.  Unfortunately, your provider may have little to add to the conversation as most of these products don’t have controlled studies available to quote, and they aren’t regulated by the FDA.  Generally, it often makes sense to err on the side of caution as even if the supplements may not have inherent risk, these products are not infrequently contaminated by other products that may not be safe in pregnancy.  The bottom line is that all supplements used in pregnancy should be reviewed with your provider so that you can make the best possible decisions regarding supplement use in your pregnancy.

​Dr. Nick

Ever wonder how often other couples are “doing it?”  Turns out, there have been a number of studies to look into that very question (I guess researchers are curious, too!).  Based on the results of these studies, it looks like relationship status, age, financial status and maybe even access to digital distractions play a role.  Here’s what the results say:
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According to a 2017 study in The Archives of Sexual Behavior, the average couple has sex about once a week, or some 54 times a year according to one study.  As expected, age plays a role with 20 year-olds having sex around 80 times per year with 60 year-olds having sex about 20 times per year.  Another study from the Kinsey Research Institute in Indiana shows a similar trend in age, but with increased frequency across the board:  approximately 112 times per year for those under thirty and about 52 times per year for those over 50.  Either way, it looks like younger people tend to have more sex.

 Overall, the frequency of intercourse sharply declined between 2001 and 2012 after increasing between 1991 and 2001.  In fact, one British study shows that about half of people in serious relationships haven’t had sex in a year.  The biggest decline in sexual frequency seems to have occurred in married couples.  In the 90s, married couples had intercourse more frequently than never married individuals, but now never-married individuals have sex more often.  Overall, the frequency change of intercourse is much less pronounced for singles.  Some factors that may be responsible for this decline are financial stress, increased spread of work into the home, difficulty for younger individuals moving relationships from virtual to real life, social media distractions and increased access to/quality of online pornography with reduced need to find real life partners.  In fact, the development of the smartphone coincides rather closely with the decline in sexual frequency.

So, how often should you have sex?  While there’s no right or wrong answer for the best frequency of sex in relationships, a study in Social Psychological and Personality Science suggests that couples are happiest that have sex at least once per week.  Although there wasn’t an increase in relationship satisfaction with increased sexual frequency beyond once weekly, there was dissatisfaction for those having sex less frequently than once a week.  There are also some health benefits from sex that should be considered as well:  in addition to bolstering the immune system, sex can lower blood pressure and heart attack risk.  Also, sex can improve sleep, reduce chronic pain and reduce stress.  There are also gender-specific benefits:  for women, sex and orgasm can improve pelvic floor function/decrease bladder leakage, and for men who ejaculate 21 or more times per month, prostate cancer risk is reduced.

The bottom line is that sex should be fun (if done safely and with consent).  It can improve relationship quality and even provide some health benefits.  While work, kids, finances and phones can reduce desire for sex, it may pay off to try to have intercourse anyway.  Increased sexual frequency tends to increase libido, which in turn increases frequency and more desire for frequency.  Even scheduled intercourse counts and can lead to more spontaneous adventures.  If you’re interested in more sex, be sure to talk to your partner as over half of women and men in committed relationships want more sex.  After all, it’s springtime-don’t neglect the “birds and the bees.”

Dr. Nick

Poor Sleep is one of the most common complaints that I hear from patients.  Lack of restful sleep can lead to daytime sleepiness that affects our performance at work or school.  It can also affect our relationships with our families and can even lead to car accidents.   So, once you recognize that you are having a hard time falling asleep, what are some things you can do to help fix your sleep?  The first step is focusing on sleep hygiene.  What is sleep hygiene?  Sleep hygiene is taking control of your sleep behavior and your environment to help optimize your sleep.  Its like cleaning the house before you have guests over for dinner.  While not a necessity, if you are having problems sleeping it may make falling and staying asleep a much smoother process. 

1. Make your bedroom as dark as possible.  Our sleep cycles are controlled by circadian rhythms. Darkness causes the pineal gland to release melatonin which makes you sleepy.  Ridding your room of unnecessary light is an important step.  Start with making sure your curtains/blinds are blocking as much light as possible.  This also includes all screens: Televisions, cell phones, tablets, computers all emit light.  If you cannot eliminate all light from the room, invest in an eye mask to prevent light from reaching your eyes.
2. Back to screens, if you can’t turn your phone off or like to read e readers before bedtime, switch to the red-light predominant option under settings and lower the brightness as much as possible.  Most iPhones also have a setting where the phone switches to red light at a certain time.  There are also special glasses that block blue light and filters that you can purchase to place on devices to decrease blue light. 
3. Make sure your bedding is comfortable.  Some people like firm mattresses and some like it soft.  Whatever your like, make sure you have it, and it works for you. Also invest in your bedding.  Make sure your sheets are comfortable. If you are one of those people that gets really hot at night, invest in moisture wicking sheets (SHEEX is one company that makes these).  If you get really cold, then invest in extra blankets or flannel sheets.
4. Is your partner, kids or your pets preventing you from sleeping?  If you have a partner that snores loudly, just remember that you do not have to sleep in the same room.  Same goes for the pets and kids.  Ear plugs may also work. 
5. What to avoid before bedtime- Tobacco (nicotine is a stimulant), caffeine (also a stimulant and this includes chocolate ☹).  Also try not to eat 2 hours before bedtime.  This will allow for better digestion and help promote sleep.
6. Exercise promotes sleep but usually only if you exercise in the morning.  At the very least, try to wind down strenuous exercise at least a few hours before bed.  Its harder to shut down if you perform vigorous exercise in the evenings right before bedtime.

After trying all this, if you are still having difficulty falling asleep or staying asleep and don’t feel well-rested the following morning, it may be time to have a talk with your provider.  You may need a sleep study to determine the exact cause of your sleep problems.  Remember poor sleep increases the risk of Alzheimer’s disease, obesity, heart disease, mood disorders, and the list goes on and on.  Making sure that you can achieve restful sleep most nights is vital to your overall health. 
 
Dr. Pam

​If you’re the type to make New Year’s resolutions, you’re now over a month in.  At this point, it’s easy to get discouraged if your fitness starts to plateau and your weight loss has started to slow down.  You’ve been working out 5 days a week, and now you’ve been eating healthier than you ever have.  Or have you?  It’s not unusual for some creative marketing to mislead you regarding the healthiness of some of your favorite foods and snacks.  Here are some of the most common pitfalls of “healthy” eating.

1.  Gluten free – while eating a gluten-free diet can be very important to those with celiac disease or gluten sensitivity, it can also be a trap for those simply looking for healthy dietary alternatives.  Obviously, limiting carbohydrate intake by focusing on lean meats, non-starchy vegetables and some dairy is a great idea, beware of gluten-free bread and other gluten-free processed foods.  These gluten-free alternatives tend to be lower in protein as well as vitamins than the gluten-containing foods they replace.
2. Protein bars and breakfast bars – these easy meal supplementing or meal-replacement options can sometimes be misleading when touted as healthy food choices.  Some bars, in fact, have high protein, lots of vitamins and low carbs, and these can be helpful additions to your diet, especially when you’re short on time.  However, some have large amounts of added sugars and high levels of saturated fats and/or sodium.  Be sure to check out the nutritional content, and if there is a large amount of added sugar, then that protein bar is simply a candy bar masquerading as a healthy choice.
3. Low fat foods – while it seems intuitive to think that low-fat foods are inherently healthier than their full-fat replacements, this generally isn’t the case.  For instance, low-fat flavored yogurt and low-fat sweetened breakfast cereal have large amounts of added sweeteners for flavor.  This typically not only increases calorie content, but the fat of the non-sweetened alternatives is no longer there to help with satiety.  The bottom line is that you end up with more calories per serving, and you eat more because you’re less full.  Other low-fat traps can include frozen yogurt, low-fat peanut butter, low fat cereal bars, and low-fat pastries and cookies.
4. Diet soda – no calories and enough flavor to satisfy your sweet tooth?  Seems like a no brainer for a healthy diet alternative.  Unfortunately, that’s not exactly the case.  Studies suggest that these artificial sweeteners may still cause insulin release, and over time, sustained insulin release can develop into insulin resistance, weight gain and even diabetes.  Also, these artificial sweeteners are hundreds of times sweeter than sugar, which may make it harder to satisfy your cravings for sweets, and when taken at the same time as real carbs, can cause negative changes in how your body metabolizes carbs in the future.

The bottom line is that there’s no simple fix for healthy eating.  Eating non-processed foods means shopping for produce (that expires), meat and poultry (that can spoil), and dairy (that can go bad as well).  All of these choices typically require prep time, thoughtful shopping and meal planning, but if you’re serious about your weight loss goals, then it’s definitely the right choice.  By starting your 2021 with a new wellness routine, you can make the long-term changes in your health you’ve been striving for.
Dr. Nick