Blog Archives

What Can I do About Stretch Marks?

11/29/2016

1.       What are stretch marks?  Stretch marks happen when the skin is abnormally stretched or expanded over a short period of time.  This can happen with pregnancy, weight gain, or during periods of rapid growth, like puberty.  Stretch marks affect pregnant women, adolescent females when they are going through their growth spurt and adolescent males for the same reason.  When the skin stretches, it causes the connective tissue in the dermis to break down and then scarring ensues.  There are hundreds of products out there that tout improvement in the appearance of stretch marks- and most of them do this at a pretty hefty price!  So the question is: Do they work?

2.       Do creams with Vitamin E and Cocoa Butter help to alleviate the appearance of stretch marks?  Vitamin E and Cocoa Butter help to provide hydration to the skin but once stretch marks have occurred, the damage is usually done and the ability of creams and moisturizers to reverse this process is rather difficult.  Keeping the skin well moisturized can help delay the breakdown of the proteins in the skin as it stretches. However, once stretch marks have occurred, these products will not likely be able to ameliorate their appearance.

3.       What about peels?  Some chemical peels that contain high concentrations of TCA (trichloroacetic acid) may help improve the appearance of stretch marks.  However, if you are considering this option, please go to a dermatologist or cosmetic surgeon with experience using this type of peel.

4.       How about laser treatment?  Some studies have shown improvement in the appearance of stretch marks after multiple sessions, usually softening their appearance, but not completely eliminating them.  This will also come at a hefty price tag.

5.       How about products containing tretinoin (Retin-A)? Remember you cannot use any products containing Retin-A while you are pregnant!!!!  That being said, some studies have shown some improvement in the appearance of stretch marks (20%) with use of these products.  While this is not much, it likely will be cheaper than some of the alternative options.

6.       How about Microdermabrasion?  Some studies have shown some improvement if aggressive sessions with microdermabrasion were done while the striae are still purple, however little improvement was noted otherwise.

7.       Massage therapy?  There are some who feel that massaging the skin before formation of striae may help prevent stretch marks from forming.  However, once the skin is broken down, no amount of massage therapy is likely to make a difference.

8.       The important thing when dealing with stretch marks is to focus on preventative measures: stay well hydrated (at least 64 oz of water daily) and keep your skin well hydrated with topical moisturizers.  Once stretch marks form- nothing will get rid of them, but some of the products mentioned above can help soften their appearance.  Keep your expectations realistic before you empty out your savings account.

Dr. Pam

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How to Survive the Holidays with your Sanity and your Waistline Intact

11/22/2016

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As Thanksgiving nears, we begin to look forward to a season of delicious foods, family visits, and presents; however, the stress of the holidays can definitely affect one’s ability to enjoy and reflect on the blessings of the season. In a departure from routine, here are a few suggestions gathered from a variety of publications to on how to make the most of this special time of the year.

Winter in general tends to make me sad. Why? You’re not alone. Seasonal affective disorder (SAD) affects as many as 10% of people in some parts of the country, particularly in areas where winter weather is more severe. Symptoms include depression, fatigue, oversleeping or overeating, and social withdrawal. The cause for SAD is uncertain, although reduced sunlight and an evolutionary response to expected food shortages during the winter in human prehistory are thought to play a role. Current treatments include increasing light exposure either naturally or with artificial sources (light therapy), exercise, vitamin D and/or melatonin supplementation, increasing supportive social interactions, prescription SSRIs or some combination of the above. That means, even the most annoying relatives can sometimes be beneficial for your mood :)

That being said, some of those relatives really drive me nuts, and the anxiety of being the perfect holiday host really is a nightmare. What can I do? The first step to limiting some of the stress of the holidays is managing expectations. Believe it or not, those “perfect” holiday gatherings your remember from your childhood probably weren’t that perfect either, if you really stop to think about it, and it certainly won’t be the end of the world if the stuffing turns out a little dry or your father-in-law and your uncle have a rather “passionate” discussion about the election outcome. Sometimes, those unplanned memories are the ones that make the holiday special.

Other potential stress reducers involve delegation of responsibilities (certainly make your signature dish but maybe your mother-in-law can make that green bean casserole you hate to make anyway), scheduling separate gatherings for family members who really can’t stand each other (your mom as thankful for your dad’s new wife as he is), scheduling some activities to get the family out of the house for a bit (shopping, movies, ball games, etc.) and remembering that it’s ok to take a few minutes for yourself, too (you’re the host, not the concierge). Even when you think there’s not a solution to how to manage family or cook the perfect turkey, someone has probably already figured it out for you, so ask a friend! Or, if that doesn’t work, there’s always the Butterball hotline (seriously!!) to answer all of your turkey cooking questions :)

Lastly, is there a way to make it through the holidays and still fit into my pre-Christmas clothes? While the temptation is there to graze through the holiday season (personally, my kryptonite is gingerbread...mmm...what was I talking about again?) and ignore your weight until January, there are steps you can take to limit the damage. Just Google healthy Thanksgiving sides, and you’ll get a huge list of recipes. Although that being said, quinoa stuffing may not be the biggest hit at your holiday gathering. Alternatively, just remember the words “portion control.” Just because you can eat that third slice of pumpkin pie doesn’t mean you’ll enjoy it. The average American consumes roughly 4,500 calories at the Thanksgiving meal alone (just half of that is more than adequate in day), and here’s how they get there: stuffing (500 calories per cup), green bean casserole (there are beans in there somewhere, right?), mashed potatoes (400-600 calories depending on butter, gravy, etc), apple pie (400 calories per slice before whipped cream), cornbread (200 calories per slice), mac and cheese (the “winner” at as many as 1,000 calories per serving), canned cranberry sauce (110 calories per 1/4 cup), and sweet potatoe casserole (450 calories). All that cream, gravy and butter? No wonder Thanksgiving veggies taste so good!

Any final tips? Try to get outside! While not easy at this time of year, if you can find the winter activity you love, it can help with decreasing the effects of SAD, decreasing stress, and mitigating the effects of those extra sweets. Whether walking, jogging, skiing, snowmobiling or even just chasing your children with a snowball (sometimes a stress relief on multiple levels), finding your favorite winter activity can help to round out your best holiday season yet :)

Dr Nick

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Breastfeeding: Mind Your Own **** Business!

11/15/2016

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So now that you are pregnant and approaching the end of your pregnancy, you have to decide how you are going to feed your baby: breast milk or formula. I promise you that everyone you know will have an opinion: friends, grandparents, neighbors, 4th cousins, and even the cashier at the grocery store.

What are the advantages of breastfeeding for your baby? For baby, breast milk provides them with mom’s antibodies and protects them from lots of infections that can make them sick. Breastfeeding also decreases the chances that the baby will develop obesity, diabetes, asthma, and SIDS (Sudden Infant Death Syndrome) later in life.

What are the advantages of breastfeeding for mom? Breastfeeding burns more than 500 calories a day and helps you drop that baby weight. It decreases your future chance of developing breast and ovarian cancer. It can be a form of birth control for the first six months, but I would still talk to your provider about a back-up option. The most enticing feature of breastfeeding is probably that it is free! Formula can cost upwards of $1,000.00 for the first year.

The American Academy of Pediatrics recommends that mothers breastfeed for the first year of life. However, less than half of moms are breastfeeding at the 6-month mark. So if breastfeeding is so great, why are so few moms breastfeeding after the first 6 months?

1. For lots of moms breastfeeding and pumping are painful. For some women and babies, latching on comes naturally, and for others it does not.
2. The emotional rollercoaster: for some women breastfeeding affects their emotions in a not so pleasant way.
3. Moms are exhausted: between feeding your baby, pumping and all of life’s other chores, moms are not getting any sleep.
4. Some women don’t produce enough milk, and watching a baby scream because of hunger is not a pleasant scenario.
5. Some babies do not tolerate breast milk or have bad reflux, and this can make breastfeeding difficult.
6. I just don't want to breastfeed. And this is totally acceptable!

So many first- time moms complain to me about how their decision to not breastfeed is met with hostility and cruelty. They even describe how complete strangers accuse them of being a “bad mother”. Frankly, it probably isn't anyone else’s business. The decision to breastfeed or not is a personal one. You should discuss it with your provider if you feel like you need help. Just because you breastfeed does not mean that your baby will not get sick, and there are plenty of babies that are exclusively formula fed that do just fine. The most important thing is to have a happy, healthy and comfortable mom and baby!

Pam

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Why Does Your OBGYN Get so Worked up about High Blood Pressure in Pregnancy?

11/8/2016

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From a physician standpoint, explaining the problems of high blood pressure is one of the most frustrating topics to discuss with patients. Often, a woman may not feel sick, and there is also often an element of denial, i.e. “I’m healthy, and I feel OK, so you must be confused.” This is particularly common in those cases where high blood pressure was likely present even before pregnancy began. So, here’s a brief overview of why your doctor cares.

First of all, what types of high blood pressure cause problems in pregnancy? There are 3 main classes of blood pressure in pregnancy. These are noted as a systolic blood pressure greater than or equal to 140 or a diastolic blood pressure greater than or equal to 90. The first class is chronic hypertension. This occurs when elevated blood pressure is present before 20 weeks of pregnancy and is generally unrelated to pregnancy. This type of elevated blood pressure is usually before pregnancy. Just because you don’t check your BP outside of pregnancy doesn’t mean it’s not there :) The next two types are related to pregnancy: gestational hypertension, which develops after 20 weeks and does not cause spillage of protein in the urine, and preeclampsia, which also occurs after 20 weeks but is associated with proteinuria.

So, what happens if I have chronic hypertension during pregnancy? There can be actually be some lowering of chronic hypertension during the middle of pregnancy before an increase toward the end of pregnancy; however, the need for good control of your blood pressure is certainly important. Chronic hypertension places a mother at risk for fetal growth restriction (small baby), development of preeclampsia (just because you have chronic hypertension doesn’t get you off the hook for preeclampsia), placental abruption (early separation of the placenta prior to delivery causing bleeding and risk of fetal loss if not immediately managed), and also increased risk of cesarean section.

What about gestational hypertension or preeclampsia? These are managed similarly in their mild forms, and gestational hypertension may in fact be a mild form of preeclampsia. With development of gestational hypertension or mild preeclampsia, this condition must be monitored closely to ensure that severe preeclampsia doesn’t develop. In addition to the risks noted with chronic hypertension, women with preeclampsia are at risk for need for preterm delivery, maternal kidney or liver dysfunction, hemorrhage and even seizures. With severe preeclampsia, women may even be at risk for maternal death. After pregnancy, women with a history of preeclampsia have an increased risk for development of cardiovascular disease such as stroke, heart attack, elevated blood pressure and kidney dysfunction. They are also at risk for having preeclampsia again in a future pregnancy.

What happens to my baby if I have preeclampsia? Additional monitoring is required to monitor for development of severe preeclampsia. If you do develop severe preeclampsia, then your baby will likely have to be delivered early. Risks associated with preterm delivery may include respiratory distress, cerebral palsy, need for NICU stay, feeding issues or even loss of the baby in some cases; however, as bad as those risks sound, there may be a point in pregnancy where these risks are less than those associated with continuing the pregnancy.

How is elevated blood pressure treated in pregnancy? You may require medication to bring down your blood pressure, lab monitoring to check for development of severe preeclampsia, monitoring to check for fetal distress or even early delivery (with or without administration of steroids and/or magnesium prior to delivery). Magnesium may also be required to help prevent seizures associated with severe preeclampsia.

Are there risk factors for preeclampsia? First pregnancies, history of preeclampsia in other pregnancies, personal history of chronic hypertension or kidney disease, age 40 or older, carrying more than one baby, personal history of diabetes, clotting disorder or lupus, maternal obesity and pregnancy via in vitro fertilization.

Can I prevent preeclampsia? The best way to prevent preeclampsia is to ensure that you are as healthy as possible prior to beginning the pregnancy. If you are obese, weight loss may help reduce your risks. For chronic hypertension or diabetes, ensure that these are well-controlled prior to conceiving. If you have had a history of delivery prior to 34 weeks due to preeclampsia, your doctor may start you on a daily baby aspirin.

So, even though you might not feel miserable due to your high blood pressure, it is still very important to maintain good control in order to have the healthiest pregnancy outcome possible. If you have any of the risk factors listed above, be sure to talk to your provider about how to minimize your risks in your current (or future) pregnancies :)

Nick

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Where’s my Pregnancy “Glow”? The Closest Thing I Have is the Big Zit on my Bright Red Nose: Acne in Pregnancy and What You Can Do About It

11/1/2016

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When you found out you were pregnant, you were probably expecting that healthy pregnancy glow. Unfortunately, not all pregnant women are so lucky, and instead, your face is littered with zits even worse than during those awful teenage years. So, now what do I do?

1. I have not had bad acne in years, so why now? Acne can be very severe in pregnancy. The increased hormone levels (particularly androgens) in the first trimester increases the skin’s production of natural oils, and many women have severe outbreaks in the first trimester.

2. What products can I use for acne while I am pregnant? Using small amounts of salicylic acid, benzoyl peroxide, and finacea is safe in pregnancy. Large amounts can potentially be absorbed in the bloodstream, so please limit your use to small quantities. This is especially true of salicylic acid, which is related to aspirin. In LARGE doses aspirin and aspirin containing products can increase the risk of miscarriage and cause heart problems for the baby (That being said, do not be alarmed if your provider places you on baby aspirin as this small dose will not have this effect).

3. Is Proactiv safe? Yes. Proactiv is just benzoyl peroxide, salicylic acid and glycolic acid. Again, as long as you use it in small quantities, it is safe in pregnancy.

4. Can I get facials for my acne while I am pregnant? Yes, for the most part facials are safe in pregnancy, and after the fun of early pregnancy (nausea, zits, etc) you probably deserve one :) However, please make sure that your technician is aware that your are pregnant, so they can avoid the following: Retinol or Retin A containing products, accutane and large amounts of salicylic acid. Retinol, accutane and Retin A contain large amounts of vitamin A, and this substance can cause birth defects. If your technician is going to use a peel, please avoid salicylic acid peels as large quantities are not safe in pregnancy. Peels that use glycolic acid, TCA or lactic acid should be safe in pregnancy. Extractions are safe in pregnancy, but be careful because your skin may be more sensitive while you are pregnant.

5. Are my prescription antibiotic creams that I use for acne safe in pregnancy? It depends on which antibiotic you are using. Clindamycin or erythromycin based creams are fine while pregnant. However, you should avoid tetracycline, doxycycline, and minocycline because they can affect your baby’s teeth.

6. If you use anti-wrinkle cream and are pregnant, please stop now because most of these creams all contain retinol based products. These products contain high amounts of vitamin A and are not safe in pregnancy.

I promise you, your skin will get better! Acne in pregnancy is usually worst during the first trimester and improves as the pregnancy goes on. When washing your face, make sure you use a gentle, oil-free, alcohol-free, and non-abrasive cleanser. Avoid over-cleansing as it can overstimulate your skin’s oil glands. More than anything, resist the urge to pick or “pop zits”. This can make your acne worse and cause unsightly blemishes or scarring to form. Just be patient, and you'll have your skin back back to normal soon :)

Pam

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**While we are excited to answer your questions, please be aware that the links below are not intended to provide urgent or emergent medical advice. Thank you!

What Can I do About Stretch Marks?

How to Survive the Holidays with your Sanity and your Waistline Intact

Breastfeeding: Mind Your Own **** Business!

Why Does Your OBGYN Get so Worked up about High Blood Pressure in Pregnancy?

Where’s my Pregnancy “Glow”? The Closest Thing I Have is the Big Zit on my Bright Red Nose: Acne in Pregnancy and What You Can Do About It

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Be sure to follow us on social media for the latest updates at Teton Women's Health Center!**While we are excited to answer your questions, please be aware that the links below are not intended to provide urgent or emergent medical advice. Thank you!

Be sure to follow us on social media for the latest updates at Teton Women's Health Center!

**While we are excited to answer your questions, please be aware that the links below are not intended to provide urgent or emergent medical advice. Thank you!