When the day comes that you know your latest child will be your last, there are two main types of sterilization procedures:  tubal ligation for women and vasectomy for men.  Or, I suppose there’s abstinence, although you might have a bit more trouble selling that idea to your partner 😉  So, what’s the difference between a tubal and a vasectomy, and how do you know which is right for you?
​
From an effectiveness standpoint, both typically have a failure rate of less than 1%, although there is a bit of a caveat for vasectomy that we will explain later.  Both are meant to be permanent procedures.  Despite the availability of tubal or vasectomy reversal procedures, there is no guarantee of successful reversal or pregnancy, and these procedures are generally not covered by insurance.  So, if you’re not 100% sure, then it may make sense to consider long-acting but reversible contraception options, such as implants or IUDs, that are almost equally effective in preventing pregnancy.
So, what are some advantages of tubal ligation?  The main advantage of tubal ligation in comparison to vasectomy is that it is immediately effective.  If done at the time of a cesarean section, then there is no additional recovery time or any significant increase in the amount of bleeding or operative time during surgery.  Even as a separate procedure, the patient would go home the same day as her surgery.

What are some disadvantages of tubal ligation?  If done as a separate procedure, then it would require 1 or 2 abdominal incisions to perform depending on when it is done, and it may also require general anesthesia.  Also, it does involve operating near the organs in the abdominal cavity with the small possibility of trauma to those organs.  That being said, a common misconception is that the procedure may affect hormonal balance or menstrual flow.  In and of itself, a tubal ligation would have no effect on hormone production as it involves the tubes next to the ovaries but not the ovaries or their blood supply.  Additionally, for women who do notice an increase in menstrual flow after the procedure this is typically due to either transition away from hormonal contraception (that makes menses lighter) or a small increase in perceived flow because if a portion of the menstrual flow previously drained through the fallopian tubes and into the abdomen, it now passes through the vagina.

Well, what about vasectomy?  The biggest advantage is that a vasectomy may be done in the office under local anesthesia.  It doesn’t involve operating in the abdominal cavity, so there is no risk to internal organs.  Lastly, recovery time is generally less than for a tubal ligation.

Any disadvantages for vasectomy before I sign my partner up?  The main disadvantage is that it can take several months (or longer) to become effective.  Thus, pregnancy is still possible until follow-up testing confirms that there are no residual sperm in the vas deferens beyond where the vasectomy has been performed.  Also, there is a very small risk of chronic testicular pain or nerve irritation.  Despite a common vasectomy misconception that the procedure will take away libido or ability to perform sexually, a recent study in Europe suggests that men who had previously had vasectomy noted improved erectile function, sexual desire, orgasm and intercourse satisfaction.  

In summary, both tubal ligation and vasectomy are both reasonable options for permanent sterilization.  The key word, though, is permanent, and this should probably be a decision that you and your partner reach together.  If there’s any doubt that another baby may be in your future, then definitely select something reversible.  If you’re sure you’re sure, then make an appointment with either your ob/gyn (for you) or a urologist (for your partner).  This can be a great option to take away the stress of unplanned pregnancy, and you may find that when there’s no longer worry about an unplanned surprise 9 months from now, the decreased stress = better sex!

Dr. Nick

There are so many trendy foods out there right now.  They are supposed to be super healthy and save you from everything: cancer, environmental pollution, you name it.  So, is this just hype or is there any truth to the current hype around these super foods? 

1. Coconut Oil: Everywhere you look, someone is trying to get you to consume coconut oil by the spoonful literally.   So, what is so great about coconut oil? The current hype around coconut oil claims that it is the world’s most friendly fat because of its effects on metabolism and its ability to boost feelings of fullness.  Some people are currently encouraging others to consume it by the spoonful to help them attain their weight loss goals.  Unfortunately, this is not likely going to work.  Adding calorie dense coconut oil without decreasing calories elsewhere will likely just cause you to gain weight.  It may be beneficial to substitute it for other fats that you plan on consuming, but otherwise it will probably just add to your expanding waist line. 
2. Juicing Diet:  Have your ever been to a health food store where people are waiting in line to get their “green juice”?  The claim is that it is an efficient way to get your antioxidants and nutrients in one quick drink:  you can lose weight and decrease your risk of getting cancer.  Is any of this true?  Once you juice fruits and vegetables, you remove all the fiber and your body doesn’t have to work so hard to absorb all the nutrients.  So, technically it does help your body absorb the vitamins and minerals better.  However, there are lots of disadvantages to juicing that people forget.  First, when you remove all the fiber from the fruits and vegetable, you are more likely to feel hungry throughout the day.  Fiber is what promotes that feeling of fullness that prevents you from consuming unnecessary calories.  When you are trying to lose weight, the worst thing you can do is snack all day.  Consuming all these extra calories because you are always hungry will likely just lead to weight gain.  Also, while fruit is considered “good for you”, it contains a ton of sugar.  By consuming sugary drinks all day instead of consuming real food, this plan will make you more susceptible to insulin resistance and diabetes.  Also, fiber is very important to gut health and digestion as it helps slow down the absorption of sugar.  Eliminating fiber from your diet is very detrimental to your overall digestion and weight loss goals. 
3. Nutrient Water: There are lots of popular nutrient waters these days like cactus, watermelon, and maple. The idea is that you are hydrating and getting your vitamins too!  Don’t fall for it.  This is very similar to juicing stuff.  Most people forget all the extra calories that they are consuming.  I promise you there is nothing magical in watermelon or cactus-its not going to detox you or decrease your exposure to environmental pollutant or decrease your risk of getting cancer.  Its just going to make you consume more calories and negatively impact your weight loss goals.  I promise you all you need for adequate hydration is good old H2O.   If you need to flavor your water- add a sprig of mint or a piece of lemon. 

There are so many fad foods out there that I could probably write a book full of blogs on this topic alone.  If you eat healthy and stay active, you will probably meet your health and fitness goals.  All these fads are just a way marketing firms have devised to make you consume their product.  Unfortunately, most of these are probably negatively impacting all the hard work you are putting into trying to stay healthy.  That being said, don't give up on your health goals!  Good luck this summer as you work towards your healthiest year yet!

​Dr. Pam  

With the rise of so many social media platforms, it seems like boredom is practically a thing of the past.  Waiting in line at the store-let’s check Facebook.  In the doctor’s office (not that you ever have to wait here 😉 )-who’s posted on Instagram.  Eating dinner with your family-what’s Donald Trump tweeting about now?  There are so many ways to see what your friends are doing that you can just message each other across the room rather than having an actual conversation.

​But, is that really good for you?  It turns out that maybe it’s not.  Studies suggest that there’s an association between social media use and depression, insomnia, anxiety, and even eating disorders.  For instance, Instagram use has been associated with development of body image issues in adolescents.  Social media use in general can be disruptive of normal sleep both from the setting of needing a dopamine fix (got to have another “like”!) or simply being anxious about “missing out” on the latest and greatest posts.

Ironically, the more time people spend on social media, the more socially isolated they feel.  While it’s unclear whether people who feel socially isolated spend more time on Facebook or whether use causes feelings of social isolation, one thing seems certain:  Facebook friends have a different impact on health than friends you spend time with in “real life.”  Whereas having friends can boost happiness, reduce stress, improve confidence and cope with tragedy, social media friends are more likely to trigger feelings of envy or even depression as their posts often inspire comparison between your life and theirs.  Besides, if someone posted it on social media, that perfect haircut, trim figure and cute outfit has to be a reflection of their daily life (and there was surely only one photo needed to capture that fabulous shot).

That being said, social media probably isn’t all bad.  First of all, it doesn’t seem to affect everyone equally.  Additionally, those who are using social media to broaden their actual social network (ie planning to hang out with their new friends in social settings) and those who use online relationship building as a way to build confidence for real-world relationships may derive some benefits.  Lastly, it can help provide support for those with chronic and/or severe illness.

So, what’s the final answer?  Much like most things in life, social media is neither entirely good nor entirely bad.  If you’ve reached the point of sleep deprivation, depression, envy, insecurity, frustration or anxiety over missing out (apparently FOMO, or “fear of missing out,” is an actual thing), then you probably need a break.  If you find that you’re generally happy on social media (for yourself and others) and you’re building stronger, more meaningful relationships online that carry over into your social calendar, then you’re probably ok.  Good luck on perfecting your duck face!  😊

Dr. Nick