For many women, just “getting through” labor and delivering the baby should be the end of birth-related pain, right?  Unfortunately, that’s not always the case.  From vaginal tears to breastfeeding (yes, that can sometimes be pretty miserable, too), for some women the delivery is only the beginning of their postpartum discomfort.

​So, what can hurt so much compared to labor and delivery?  According to ACOG (the American Congress of Obstetricians and Gynecologists), somewhere between 53-79% of women experience tearing during childbirth whereas their British counterparts estimate that number to be as high as 90%.  Either way, chances are good that moms having vaginal births will have some type of laceration.  Not only can the repair process be extra uncomfortable for moms without an epidural, but suture in such a sensitive area can definitely cause some discomfort for some time after delivery.  We also know that some amount of labial swelling is also normal after delivery, and this is especially true for women who push for a long period of time.  In some cases, we can even see extra separation of the pubic bone where it stretches to accommodate a baby's head (pubic symphysis diastasis).  As for breastfeeding, pain can happen from the latch process, cracked nipples with thrush, mastitis and even the uterine contractions associated with breastfeeding.  Breastfeeding causes release of oxytocin, the same hormone used to stimulate labor, and this can result in pretty significant uterine contractions for some moms.  Lastly, moms who need cesarean delivery are expected to have pain after their surgery, too.

Is there anything to do about all this fun stuff?  During suturing of a vaginal tear, moms who have an epidural are already a little ahead of the game, although we certainly do our best to help numb the area with lidocaine for those who don’t have an epidural.  That being said, even with an amount of lidocaine injections that would be drool-inducing in the mouth, it’s quite a challenge for us to effectively numb the vagina.  Ice packs can be a big help for some of the labial swelling after delivery.  Occasional sitz baths may also be beneficial for women with tears as can stool softeners to help prevent constipation and straining in the area of a vaginal repair.  Pubic symphysis diastasis may require physical therapy or even a walker for a brief time.  With breastfeeding, moms are encouraged to take advantage of the knowledge of a lactation consultant to ensure proper latching and nipple care.  Thrush and cracked nipples often respond well to topical treatment whereas mastitis generally requires antibiotics to resolve.  Regrettably, there’s not much we can do to suppress contractions when breastfeeding.  Tylenol and Ibuprofen are also helpful for pain following a vaginal delivery, although postoperative pain from a cesarean delivery is likely to require something stronger.

For many fortunate moms, pain from labor and delivery fades soon after their baby is born; however, for others, some amount of discomfort may persist a bit longer.  Collaborating with your provider is generally the best way to ensure a satisfactory healing process, so if you are having issues, be sure to let them know.  The sooner you feel better after delivery, the more time you can focus on loving that new baby 😊

Dr. Nick

As we head toward winter (I’m pretty sure I blinked and missed fall), it seems like more and more people are fighting colds.  Whether you have a sick child, spouse or friend to blame, coughs and runny nose and fevers seem to become the norm this time of year, and for every cold you get, I’ll be you have a friend whose great grandmother always had just the cure for what was ailing you.  So, do any of those home remedies work?  Let’s see what science says.

1. Tea – studies have shown some benefit for sore throat and congestion from drinking horehound tea, thyme tea can help with cough, and blackberry tea can help with diarrhea.  Score one for Grandma!
2. Toddy – for those looking to add a “special” ingredient to their hot drink of choice, alcohol may help with vasodilation and improve congestion briefly.  Just remember, one is going to be more than enough when you’re not feeling well.
3. Eucalyptus Oil – when heated with water and the vapors inhaled, it too can help with loosening mucus, but please don’t get your face too close to the hot water!!
4. Vitamin C – this one’s kind of a wash.  While it doesn’t actually prevent a cold, supplementing with extra vitamin C when sick may shorten the duration of your cold.
5. Ginger – this natural ingredient may help with nausea.
6. Peppermint Oil – topical application (to skin of the forehead and temples, preferably with some olive oil to prevent irritation) can reduce some types of headache symptoms.
7. Feverfew – another option for headache symptoms that may be affective in some cases.
8. Kratom – a supposedly natural and safe pain reliever; unfortunately, it’s not.  It may be as addictive as opioids, and it has a high potential for addiction, with a number of deaths attributed to the supplement.  Not to mention, it’s been contaminated with opioids in some cases.
9. Neti Pots – another wash.  While irrigation of the nose may help free mucus and debris to help with congestion, be sure to clean the pots and use distilled water as bacterial infections have occurred following unsanitized uses.  For similar relief without the risk, over-the-counter saline nasal spray is a good option.
10. Probiotics – definitely beneficial, especially if you have to take antibiotics, but with a caveat:  these are best consumed from fermented foods as there have been no studies to assess either the safety or efficacy of probiotic supplements, despite the fact that probiotics are a multibillion dollar industry.
11. Zinc – 80-90mg per day of this supplement may help shorten the duration of your cold.  Just beware if having diarrhea as too much zinc can worsen symptoms.
12. Chicken Noodle Soup – what would a list like this be without chicken noodle soup?  It turns out, it can help provide nutrients when a sore throat makes swallowing difficult, it has mild anti-inflammatory properties, and the warmth can help with congestion.  (Besides, am I really going to argue with Grandma on this one?)

So, there you have it.  While these options may not get you right back on your feet when you’re not feeling well, some of these home remedies can help.  Maybe we shouldn’t doubt Grandma…sometimes she just knows best 😊

​**If your illness causes severe nausea/vomiting, high fever, intractable pain or any other concerning symptoms that seem beyond a simple cold, be sure to talk to your doctor. 

Dr. Nick

I get this question a lot: “Ever since I had my babies, my trouble spots have only gotten worse. I have tried everything- diet, exercise, more crunches than I ever thought I could do. Doctor, what do you think about CoolSculpting? “

Fat is such a complicated thing to get rid of. Of course, there is liposuction, tummy tucks and lifts for everywhere. Most of these procedures require surgical intervention in the operating room by a plastic surgeon (unless, of course, you want to end up on the latest reality tv show that specializes in botched outcomes). These procedures unfortunately require time to perform, down time from work and are rather expensive.  Who has time for that? Recently we have seen the advent of non-invasive fat reducing procedures such as CoolSculpting and Sculpsure. The purpose of these procedures is to get rid of those trouble spots that the crunches aren’t touching. 

First- what is CoolSculpting? Coolsculpting is an FDA-approved treatment that involves freezing fat cells. There is an applicator that applies suction to the area that you want to target and the applicator brings the temperature of the fat cells down to the point where they are irreversibly damaged. These cells eventually die and are then eliminated by the body, which is why it takes a few weeks to see the final effects of the procedure. This technology is really for specific trouble spots that are large enough to adhere to the applicator- tummy fat, love handles, thighs, bra fat, banana roll (fat underneath your butt).

Instead of freezing fat cells, Sculpsure uses heat to kill fat cells and then the body eliminates those cells within a couple of weeks. Because it is using heat to kill fat cells, this can be a more painful procedure especially for people with sensitive skin.

The biggest advantage of these minimally invasive fat reducing procedures is that there is very little down time and the risks are minimal compared to more comprehensive surgical procedures like liposuction and tummy tucks. The biggest disadvantage is that they only target specific areas, the results take weeks to appreciate, and can be very variable: up to 15% of participants did not see any improvement after treatments. At $1500 per trouble spot, that can be pretty frustrating.

If you are considering a fat reducing procedure, of course we always recommend that you give that cheap, old-fashioned option a try first- diet and exercise.  If that doesn’t work, we recommend that you consult with a board-certified plastic surgeon to discuss your options before making a decision.  While Coolsculpting may be the perfect remedy to eliminating fat in certain areas, there may be certain instances in which a more traditional surgical approach would help you achieve your desired goals.  While this is not a service we offer, we hope this information is helpful!

Dr.  Pam

As Pam and I are learning how to be parents (yep, even as physicians, we kind of have to wing it), one group that we look to for guidance is the American Academy of Pediatrics (AAP).  It turns out that they have a number of guidelines for how to raise the healthiest possible child.  Given that only about 1 in 20 children meet the recommendations for screen time, sleep and exercise (and about 1/3 fail to meet any of the guidelines), we thought we’d review them here to let you know what we’ve learned.

​So, let’s start with screen time.  The AAP recommends that if a child is less than 18 months, he or she should have no screen time unless it is in the setting of video chats with family/friends.  For 2 to 5 year-olds, screen time should be limited to 1 hour per day or less, and the content should be high-quality and co-viewed with parents.  For those children older than 5, a “family media plan” should be used to determine the optimal amount of viewing.  Why is this important?  More than 2 hours of “recreational” screen time has been associated with poor cognitive development.  To put that in perspective, on average, 8 to 11 year-olds spend about 3 ½ hours per day watching a screen. 

One of the other potential concerns with extra screen time is that there is often an associated loss of sleep.  The guidelines for sleep suggest start with 12-16 hours from 4 to 12 months, 11-14 hours from 1 to 2 years, 10-13 hours from 3 to 5 years, 9-12 hours from 6 to 12 years, and 8-10 hours from 13 to 18 years.  To help reach these goals, the AAP suggests not having screens in the bedroom of children and to turn off screens 30 minutes prior to bedtime.  Lack of sleep alone can increase risk of depression, hypertension, obesity and general injuries, but combined with excess screen time there can also be loss of attention, memory, language ability and task completion.

Loss of sleep can also promote fatigue, which, in turn, can result in decreased likelihood of children reaching the recommended amount of physical activity daily.  Starting as young as 1 year and until the age of 4, toddlers should have at least 1 and up to several hours of physical activity daily.  Beginning at age 5 and until age 21, children should have at least one hour per day of moderate to vigorous activity, and vigorous activity should encompass at least 3 days per week.

Given the rising prevalence of childhood obesity, which affects nearly 1 in 5 children, and ADHD, which affects as many as 1 in 20, it seems important to minimize the chances of having a child affected by either of these conditions.  By trying to encourage children to get outside (as much as Idaho weather will allow), perhaps we can help them find fun physical activities to do while decreasing screen time and helping them be tired enough to sleep well at night.  Although with children having a mind of their own, I guess we’ll see.  Good luck to all of the parents out there trying to incorporate tech into the lives of their children!

Dr. Nick