We always strive for our patients to have an uncomplicated easy vaginal delivery with minimal tearing and discomfort.  However, sometimes a c-section is necessary to get both baby and mom safely through the labor and delivery process.  Some reasons for a c-section include the following: fetal distress in labor, problems with the placenta, position of the baby in the uterus, the cervix stops dilating or the baby stops moving down through the pelvis….
For many moms having their first c-section, a lot of times this is the first major surgery they have ever had.  They have lots of questions but have very little idea on the best way to get through the recovery.  Here are some tips that we hope can help you through the process.

1. Use a belly band:  So, both hospitals will provide you with a belly band if you have had a c-section; if you don’t get one right away- just ask your nurse for one.  When you are walking and moving around this will really provide you with the back and abdominal support you need to make the recovery process easier. 
2. Use a pillow when contracting your abs!  Anything that works your abdominal muscles, like coughing and laughing, can be pretty painful after a c-section.  We recommend placing a pillow on your abdomen before coughing and laughing to provide some support and help ease the discomfort your will feel when using your abdominal muscles. 
3. Make sure you stay on top of the pain!  I’ve seen lots of patients try to tough it out and not take pain medication because they did not like the way it made them feel.  For the first 3 days, it is very important to use these medications to help with the pain.  Initially we want your body to focus on healing, not on fighting pain.  Everyday will get better, and once the pain has improved, then you can decrease the amount of pain medication that you are taking.
4. Don’t compare your recovery to others.  I always hear family members talk about how they had a vaginal delivery without an epidural and toughed it out or stopped taking pain medication 1 day after the c-section.  Don’t let other people get to you.  This is not a contest.  If your family and friends are not being supportive, then you may have to consider temporarily limiting their access to you and the baby.  This time is about your recovery, not theirs!
5. Do what you can to prevent constipation before it happens!  Make sure you drink as much fluid as you can.  Usually we will provide you with a stool softener after your deliver. Recovering from a c-section and constipation can make you pretty miserable- we are there to help if you are struggling. 
6. Breastfeeding is hard, especially if you have just had a c-section!  This is a very anxiety provoking process for most new moms, especially if they had an unanticipated c-section.  Your milk probably has not come in and you are pretty sore from your c-section and your baby is not latching on- this is a pretty classic scenario.  Take a deep breath, utilize the nursing staff and lactation consultant and don’t fret- your milk probably won’t come in until the moment you’re are discharged.  Please let us know if you are struggling and need help.  If you decide breast feeding is not for you- that is ok- we are here to provide support, whatever your decision may be!

For most new moms, pregnancy is just the beginning of the baby challenge, and especially for those recovering from a cesarean section, the newborn time can seem even more daunting as you recover from surgery.  Please let others spoil you and take care of you while you are healing.  Try to take advantage of friends and family if they are available.  Utilize their help with the baby, meal planning, cleaning and whatever else they may offer and try to get some sleep!

​Dr. Pam

​Ever wonder why your fried and marinated foods taste so good?  A big part of the richness and flavors you love come from the oils you cook with.  That being said, just like adding a pound of butter to your popcorn, we wouldn’t necessarily endorse cooking or preparing your food in a vat of oil either.  Moderation is always helpful with any cooking oil, but if you’re looking for a comparison, here’s the scoop on some of the most common cooking oils:

1.  Olive oil – a good standby with lots of monosaturated fats.  These “good fats” have been linked to a Mediterranean diet, which has in turn been shown to have some cardiovascular health benefits.  That being said, it does have a low “smoke point,” making it good for cooking, dipping or sautéing, but probably not ideal for baking. 
2. Canola oil – high in polyunsaturated fat as well as high in smoke point with less flavor makes it a good choice for baking or frying.
3. Coconut oil – obviously a super-healthy choice, right?  Actually, it probably isn’t.  While some studies have linked coconut to everything from loss of belly fat to improved cholesterol, it turns out that if you look more closely, the studies were in fact touting the benefits of medium-chain triglycerides (MCTs).  Even though you can make MCT oil from coconut oil, it generally only composes about 15% of the coconut oil.  That’s kind of like calling a Snicker’s a healthy food option because it has peanuts.  Also, typical coconut oil has a very high saturated fat content (about the same as lard), and this type of fat has been linked to heart disease.
4. Avocado oil – composed largely of monounsaturated fat and with a naturally buttery flavor, this is a very versatile cooking option.  It’s high smoke point also allows for a variety of cooking techniques.  That being said, it is a bit pricier than some of the other cooking options.
5. Nut oils – hazelnut oil combines monosaturated fat and vitamin E, but even though its high smoke point allows for many types of cooking, don’t use it unless you want to add a pretty pungent nut flavor.  Macadamia nut oil has a slightly less pronounced nutty taste, so it can be used for grilling and salad dressings.  It also packs a combination of omega fatty acids to promote heart health.  Peanut oil is often used in stir-fry, and has a relatively even balance of poly- and monounsaturated fats.
6. Corn oil – commonly used for frying and cooking, it contains a combination of monounsaturated and polyunsaturated fats similar to olive oil, but it may be even more effective at lowering cholesterol and blood pressure.
7. Palm oil – given it’s high percentage of saturated fats (over 50%), it would generally be advised to consider other oil-based options.

So, there you have it:  a quick rundown on some common cooking oils.  The bottom line is to remember to avoid any types of trans fats, limit saturated fats, and, again, use these oils in moderation.  Even one serving of olive oil has over 100 calories, and even though there’s a lot of “good fat” in it, you’d still be consuming 14 grams of fat with each tablespoon!  So, pick your oils carefully and happy cooking!
Dr. Nick

In this day and age with two working parents, its so easy to stop by the frozen aisle in your grocery store and grab a quick-frozen meal for dinner.  I never thought much about it or felt that it was a potential health hazard.  However, a recent study out of France shows that frozen dinners (which are considered “ultra-processed foods”) are not only dangerous to your health but also increases your risk of early death!
Ultra-processed foods are foods that are “manufactured industrially from multiple ingredients that usually include additives used for technological or cosmetic purposes.”  They are consumed in the form of snacks, desserts, or ready to eat or heat meals.  The study examined the health and physical habits of 45,000 adults over a two-year period and they found a 14 percent higher risk of early death for each 10 percent increase in consumption of ultra- processed foods.
So, what about frozen foods makes it so unhealthy?

1. Added Starch: Many frozen foods have added starch to keep the frozen foods tasting fresh.  Starch is just extra glucose and all this extra sugar increases the risk of developing insulin resistance and eventually diabetes. 
2. Added Trans-fat: Frozen foods are usually full of trans-fat.  Foods that have a lot of trans fat contribute to raising cholesterol and putting you at an increase risk of heart disease. 
3. Added Salt: Salt is a well-known preservative.  Most frozen foods contain more salt than what you would add if you made the meal out of scratch for immediate consumption.  This can increase your cholesterol and your blood pressure.
4. Lots of preservatives: there are lots of other preservatives that are added to frozen foods to improve the texture and keep them tasting fresh.  Many of these have not been well tested by the FDA and most manufacturers don’t need permission to use these preservatives. 

I think it is easy to forget that frozen foods are still ultra-processed foods.  I always thought of frozen foods as freshly prepared foods that were just frozen- kind of like when your friends bring you freezer meals after you had a baby.  Unfortunately, frozen foods bought at the store have lots of preservatives, additives and extras that you did not likely anticipate.  So, before you stop by the frozen aisle to buy dinner for the family, remember that despite all the fancy packaging and healthy claims, these quick-fix options can increase your risk for hypertension, diabetes and even early death.  The best choice is to buy fresh ingredients and cook the meal yourself.  You know exactly what is in the meal and can tweak the sugar and salt amount to your own dietary needs.  Not to mention, busy moms can still freeze the leftovers for later 😊

Dr. Pam 

For most couples getting pregnant is simple and easy.  They just get pregnant and don’t have to go through expensive infertility testing and years of praying and hoping for a successful pregnancy.  For others it is a difficult struggle.  While there are many reasons couples may suffer from infertility, one of the biggest hurdles that prevents them from getting pregnant is the financial aspect.  Infertility treatment is expensive and not covered by most insurances.

So, I get this question a lot from patients struggling from infertility.  If you are going to dip into your personal savings or take out a loan to start a family, what makes more financial sense IVF or adoption? 

Let’s start with IVF.  Let’s just review what IVF is first.  The infertility specialist will extract some of your eggs and then add your partners sperm in a laboratory outside of your body and then at the appropriate time place that embryo in your uterus.  Now, what does IVF cost?   On average, one IVF cycle will cost somewhere between $10,000-$15,000.  Of course, the variation in cost is also dependent on the reason for infertility and a lot of other parameters.  Now this in no way guarantees you a baby.  However, the technology is improving every day and the success rate is rather impressive at certain facilities.  A good percentage of youngish (early thirties) healthy women will likely get pregnant by three cycles.  

My patients that pursue IVF frequently get asked- why not just adopt?  Well for one it is way more expensive than the average person realizes.  The average adoption in the U.S. costs between $27,000-$30,000.  The average adoption overseas can cost as much as $58,000-$65,000.  Most patients have this perception that adoption is cheaper until they have already invested in the process.  And again, just because you spend this money, there is no guarantee that you will get a baby.  Another consideration with adoption is time.  Even under the best of circumstances, adoption can take years to bring a child home.  

Another less well-known option that is much more affordable than IVF or traditional adoption is embryo adoption/transfer.  When couples go through IVF, they usually end up creating more embryos that they can use.  So, thousands of embryos sit in a lab and go unused.  With this procedure, couples with infertility will use donated embryos and just have them placed in their uterus at the appropriate time.  The cost of this procedure is about $3,000-$5,000.  

The decision on how to expand your family if you suffer from infertility is very complex.  It is important that you educate yourself on your personal fertility.  If the cause of infertility is known, treatment will likely be a lot more successful.  Know and research different options on building your family before deciding whether it be IVF, adoption or even foster care.  If electing to try IVF or embryo transfer, be sure to research your local infertility specialists and make sure you know their pregnancy rates.  The best programs out there will have a high pregnancy rate and a lower number of embryos transferred.  We are fortunate to have two options here in town:  Idaho Fertility Center and Reproductive Care Center.  If seeking adoption (and there are definitely many children who would benefit from these services), then be sure to research and find a reputable adoption agency.  Your needs may vary depending on the area from where you are hoping to adopt a child.  Whatever you decide, good luck in finding the best option for you to bring the newest member of your family into your home :)

​Dr. Pam

As fitness wearables become more commonplace, many people may assume that if I wear my new gear and take my steps, I will instantly begin to look just like (insert your favorite fitness model’s name here).  I mean, it sounds simple.  Take 10,000 steps per day, burn an extra 500 calories per day, or 3,500 per week (the amount in a pound of fat), and then you’ll just walk any extra weight right off.  Unfortunately, as many people have discovered, that’s not exactly the case, and here’s a few reasons for these fitness setbacks:

1. Your actual body composition differs from the weight used in this calculation:  These metrics are for a 180 lb person who travels 5 miles in 10,000 steps and burns roughly 100 calories per mile.  So, if you only weight 120 lbs, then you’d really only burn about 300 calories over the same 5 miles.  Also, if your stride is too short to travel 5 miles in your 10,000 steps (ie perhaps you’re a bit more petite than allows for long enough strides to reach your 5 miles), then you may also miss out on hitting your burned calories goal.  Also, even at rest body composition can play a role in your metabolism with muscle burning 7-10 calories per pound per day whereas a pound of fat may only burn 2-3 calories per day.  Thus, even if you hit the 500 calories from the 10,000 steps, you may still not see results if you have a higher fat to muscle ratio as your baseline metabolic rate (calories burned at rest) is slower.  Also, as you lose weight, the amount of effort to burn the same calories in exercise increases while your basal metabolic rate decreases. 
2. Say you weigh exactly 180 lbs and your body composition exactly matches that of the test subjects.  Intensity in your travel may also affect the number of calories burned.  Walking at a 4mph pace (or a mile every 15 minutes) would put you on track for 500 calories burned.   So, it takes roughly an hour and fifteen minutes of walking to burn those 500 calories.  Say you increased your pace to 6mph (a mile every 10 minutes).  You could look to burn 444 of those 500 calories in just 30 minutes, or with only 3 miles of effort instead of 5 miles.  Add another 4 minutes of running, and you’d match the 500 calorie output in just 34 minutes instead of an hour and fifteen.  Alternatively, if you walked more slowly than 4mph, then it would take a longer time to burn 500 calories, so you’d need to extend your walking time to reach your goal.
3. Gender also plays a role in metabolism.  For instance, following puberty, most men began to increase their lean body mass as testosterone levels increase, whereas for women, we don’t see such a surge in lean muscle as testosterone levels are naturally lower than for men.  That being said, participation in activities, such as weight lifting, that increase lean body mass may cause a slight increase in metabolism
4. Age can also play a role.  As we age, we may begin to see a decrease in muscle mass over time.  This can be due to participating in less weight-bearing and strength-training activity, dietary changes and also that maintaining lean mass may become a little more difficult due to simply being older.  In addition to the loss of muscle mass from the changes listed above, the parts of the body responsible for metabolism begin to wear down.  While staying active and paying attention to diet can help offset these changes, the bottom line is that the whole pizza you could eat without gaining an ounce at 20 will make you gain weight at 40.
5. Speaking of diet, one of the biggest misconceptions about exercise is that once done, you can now eat whatever you want.  You know the extra 500 calories you burned?  Check out the number you’re putting back in your post-workout smoothie.  Or in your post-workout splurge at whatever fastfood you might be treating yourself with.  It’s so easy to “treat” yourself with more calories than you burned exercising, not too mention more vigorous exercise often makes us hungry, so we tend to eat more than when not exercising anyway.

The bottom line is that there’s no easy way to lose weight and stay fit.  Those who tend to have the most success make changes that they can live with long term.  Results from a crash diet and daily intense workouts will only last as long as your motivation.  Ultimately, you will gain the weight back.  If you hate running, then you won’t keep doing it.  If you find that you love hot yoga and long walks with your dog, then do that.  If you’re eating 500 calories a day and are always hungry, then you can’t do that forever, and the weight will come back.  It's the same with diet pills you take for a few months and then have to stop for heart health.  Switching out healthier recipes for foods you already love to eat can be something you can allows for not feeling deprived while making positive progress.  The bottom line is that more calories have to be expended than consumed for weight loss to happen.  Gradually eating more healthily and learning to be active in a fun way are changes can allow for lifelong success.
Dr. Nick

Looking for a little more motivation to keep up with your New Year’s health goals?  New data from the American Cancer Society suggests that being overweight or obese increases your risk of both developing and dying from cancer.  As many as 8% of all cancers and 7% of all cancer deaths are thought to be caused by excess body weight, even if you’re otherwise healthy.

There is a clear association between obesity/being overweight and endometrial cancer, (menopausal) breast cancer, colon cancer, esophageal, renal (kidney) and pancreatic cancer.  There may also be a link to ovarian, cervical, gallbladder, liver, multiple myeloma, and non-Hodgkin lymphoma as well as aggressive prostate cancer (while prostate cancer is not a concern for women, it may affect your partner).  Even for normal weight women, having increased belly fat is associated with the development of cancer. 

Why do researchers think this happens?  It seems like “healthy” and “obese” may not go together after all, as obesity can have negative effects on immune function, inflammation, and hormone.  These changes can impact not only overall health but may play a role in the development of certain cancers.  For instance, excess estrogen production from adipose (fat) tissue can change the flow and length of the menstrual cycle, and this unopposed estrogen is associated with the development of endometrial cancer.  This same mechanism may contribute to some types of breast cancer as well.

Even a small amount of weight loss may be helpful for decreasing cancer risk, and, of course, there is a reduction in heart disease and diabetes.  Weight loss can also be helpful in bringing some predictability back to the menstrual cycle without the need for hormonal birth control to regulate bleeding. 

Given all of the benefits above, not to mention an improved sense of overall wellbeing, now is the perfect time to start making and working toward your own health goals for 2019.  Whether that’s to take an exercise class, run an 5K or just lose those pesky (fill in the blank) pounds, we hope that this information can help provide some motivation.  Good luck living your best 2019!
​
Dr. Nick

​I get this question a lot- my doctor found an ovarian cyst on ultrasound- what does this mean?  This really depends on what kind of cyst it is, and trust me there are lots of different types of ovarian cysts.  The most common type of cysts are functional cysts, so let’s go over those first.
There are two types of functional cysts (also known as simple cysts): Follicle cysts and corpus luteum cysts.  Functional cysts rarely cause pain and often disappear on their own without any intervention.

1. Follicle Cysts: During the menstrual cycle, an egg grows in a sac called a follicle, which is in the ovaries.  Usually this sac will break open and release an egg (Ovulation!).  Sometimes the follicle won’t break open and the fluid inside the follicle can form a cyst on the ovary.   This is part of normal female physiology and rarely causes any issues.  That being said, occasionally ovulation can cause a small amount of bleeding into an ovary (a hemorrhagic cyst), and this can be painful.  The good news, though, is that even hemorrhagic ovarian cysts often resolve on their own without intervention, kind of like a bruise that can be sore at first but then gets better.  Even though this type of bleeding can occur in both follicular cysts and corpus luteum cysts, it is still pretty uncommon. 
2. Corpus luteum cysts: During ovulation an egg is released from a follicle.  If pregnancy occurs, the follicle will seal off and a mass of cells on the inside will help produce progesterone during early pregnancy.  This progesterone is important in maintaining a pregnancy and this cyst will continue to produce this hormone until the placenta takes over.  This type of cyst is usually easily visualized on ultrasound in early pregnancy. 

Complex cysts:

1. Dermoid cysts: These are also known as teratomas and can contain hair, skin and teeth because they form from embryonic cells.  While this sounds scary, these cysts are usually benign and very slow growing.  If they are large, they can cause pain and you may at risk for ovarian torsion (torsion is where the ovary twists on itself which decreases the blood flow to the ovary and can cause severe pain).  In this situation, your doctor may encourage you to have it removed.  However, if it is small, it is reasonable to watch it unless it is causing problems.
2. Cystadenomas: This is a benign tumor that arises from the surface of the ovary and can be filled with fluid or mucous.  Often these can be very large which can cause pain and increase your risk of ovarian torsion.  Based on the appearance, size and whether it is causing symptoms, your provider may encourage you to have it removed.
3. Endometriomas: These are blood filled cysts that form on the ovaries because of a condition called endometriosis.  Treatment of endometriosis and endometriomas is complex and you will likely need to have an extensive discussion with your provider based on symptoms and appearance on imaging. 
4. Polycystic Ovaries: Polycystic ovarian syndrome is a condition where multiple small simple ovarian cysts form because of a hormone imbalance that prevents ovulation.  This can cause menstrual irregularities and infertility.  Treatment would be geared towards symptoms being experienced by PCOS. 
5. Cancer: While this is not common, some ovarian cysts can be malignant as well

The treatment for cysts is based on what these cysts are.  Remember most cysts in reproductive age women are functional or simple cysts and they usually resolve on their own without any intervention.  If you are having unusual pelvic pain, please visit your physician to discuss whether you need an imaging study to determine what is causing the pain, and obviously for severe pain, please visit the ER.  Hope this helps!

​Dr. Pam

Pregnancy can lead to a range of pain, discomfort, and inconvenient symptoms. Roughly half of all women experience back pain alone at some point in their pregnancy. Although there’s no way to completely remove these symptoms, physical therapy can be a great way to reduce their intensity.

But the benefits of physical therapy go well beyond simple recovery. PT can help with everything from rehabilitation following an injury to promoting mobility, and it is often especially effective for pregnant women. Consider talking to your doctor about direct access physical therapy if you experience discomfort or other issues during your pregnancy.

Back Pain and Pregnancy

As mentioned above, back pain is among the most common symptoms experienced during pregnancy. Your body is forced to deal with a number of extreme changes throughout your pregnancy, many of which can lead to back pain. These are some of the most common causes:

• Increased weight
• Lower posture quality
• Hormonal changes
• Additional stress

Women now have their first child at an average age of 28, with pregnancy becoming more and more normal later in life. One difficulty many women experience during pregnancy is a more sedentary lifestyle, which can leave your body less prepared for the physical strains involved in being pregnant.

Looking for Physical Therapy Treatment

Although many people associate physical therapy with sports and injury recovery, it can actually have a significant impact on the things that cause back pain during pregnancy. Once you find a physical therapist, you’ll work closely with them to develop a treatment plan based on your health record and goals.

Physical therapy can help you correct several issues that may be contributing to your symptoms:

• Low muscular strength
• Poor joint alignment
• Bad posture
• Reduced flexibility

Each of these problems can affect your body in a variety of ways, and part of the PT approach involves attempting to improve your general physical health. When your body is under increased stress from pregnancy, it needs additional nutrients and exercise to maintain your normal lifestyle.

How to Choose a Physical Therapist

With so many PT options available, it can be difficult to make a decision or even know what to look for in a physical therapist and clinic. We recommend starting with these considerations along with anything else you think could be relevant:

• exercises you can do at home outside of treatment
• a certified physical therapist with experience in pregnancy PT
• an approach that allows you to adjust your exercise program as issues arise and communicate openly with your physical therapist

Pregnancy can be both physically and emotionally overwhelming, and helping your body manage this extra stress will help you live your normal life and feel comfortable throughout your pregnancy. Physical therapy is a great way to reduce your symptoms while pregnant and even help manage your recovery after delivery.

​Better PT