​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

What are probiotics?  Probiotics are bacteria.  Yep, they’re the same type of organism responsible for pneumonia or strep throat or gonorrhea.  Fortunately, not all bacteria are bad, and, in fact, many of them are part of a healthy body.  There are actually more bacteria in your intestine than there are cells in your body.  While typically the “good” bacteria outnumber the “bad” bacteria, problems begin to occur when there are shifts in the types of bacteria usually found in the healthy body.  This type of imbalance can lead to bowel issues, weight gain, some skin conditions and may be a contributing factor to bacterial vaginosis.

​What are the most common types of probiotics?  Bifidobacterium may be helpful in treating IBS (irritable bowel syndrome), and this bacteria can be found in certain dairy products.  Another common probiotic that can be helpful for bowel symptoms is lactobacillus.  It can be found in a number of fermented foods.  Lastly, saccharomyces boulardii, a yeast, and bacillus coagulans, another bacteria, can also be helpful for digestive issues.

Why take probiotics?  A diverse gastrointestinal flora (lots of different kinds of bacteria in your digestive tract) may help reduce irritable bowel symptoms, manage weight, improve diarrhea after antibiotics, increase immune function, bolster mental and heart health, and decrease the severity of allergy symptoms.  That being said, research hasn’t been able to consistently show these benefits in all studies, and there is still a lot of research to be done.

Is there anyone who shouldn’t take probiotics?  Anyone who has a suppressed immune system or serious health conditions should probably avoid taking these supplements, and pregnant women should also use caution.  Remember, effective probiotics are live bacteria, and some bacteria can call illnesses.  More common side effects are GI distress, although serious allergic reactions or infections can sometimes occur.  Since probiotics are a nutritional supplement rather than a medication, the FDA guarantees neither the safety or efficacy of a probiotic supplement.

What is the best way to get probiotics?  The simplest way to incorporate probiotics is often to supplement, but since these supplements aren’t FDA regulated, the quality can vary a lot from one supplement to the next.  For instance, probiotics have to be both living and highly concentrated to be effective, so any process that either kills the bacteria or doesn’t adequately protect the bacteria from stomach acid isn’t going to allow proper supplementation.  For a more natural way to add probiotics, look toward fermented foods such as yogurt, kimchi, sauerkraut, kefir milk, and some cheeses. 

Another option to improve gastrointestinal health is to feed the bacteria already present in the intestines.   Bacteria in the bowel thrives on fiber, so increasing daily intake of fruits and vegetables can be helpful in improving overall GI health by nurturing the good bacteria already present in the bowels.  In fact, for the roughly half of people who have “resistant” gastrointestinal flora, this may be more effective than a probiotic supplement that will end up making for some expensive poop.  Even for those whose GI tract welcomes the new probiotics, these bacteria are more likely to grow (and their hosts reap benefits) when fed a high fiber diet.

So, there you have it.  Probiotics seem to have a lot of promise for helping with a variety of health conditions, but for now, the best way to incorporate them into the diet and who is most likely to benefit from them is still up for debate.  In the meantime, it appears that an old-fashioned high fiber diet will still be a winner whether you plan to supplement or not 😊

Dr. Nick

​I get this question all the time:  'My due date is here- is there anything I can do to help get this process started?'  Let’s take a quick look at some of the popular ways of trying to serve that eviction notice…

1. Exercise: Being active and getting the heart rate up is a great way to get your body ready for labor.  Even something as simple as going on walks can help bring that baby into the pelvis and place some pressure on your cervix making it more favorable for the labor process.  While there is no good evidence supporting this option, it may help you prepare for labor itself which is a physically intense ordeal. 
2. Intercourse: Sex can help through multiple different mechanisms.  First, semen contains prostaglandins which can help dilate and thin out the cervix.  Second, sex can help release a hormone called oxytocin which can cause contractions.
3. Evening Primrose Oil: This oil comes from the evening primrose plant and contains linolenic acid which is thought to trigger a prostaglandin response in the body.  This can be taken orally or placed vaginally.  However, while it is easily accessible, there are very few studies to show any benefit on the cervical ripening process.  One study even found that women who took the supplement were in labor for longer that those who had not taken it.  While it likely has no effect on breastfeeding, it can act as a blood thinner (possibly predisposing to heavier bleeding with delivery) and can have side effects like headaches and GI distress.  I would probably stay away from this one until more research is done. 
4. Red Raspberry Leaf Tea: The mechanism of action here is not clear.  However, some feel this tea “helps tone up the muscles of the uterus thereby preparing it for labor”.  However, there are no studies showing that red raspberry leaf tea can induce labor.  Since there aren’t any significant side effects, I guess if nothing else it can help you relax.
5. Castor Oil: Castor Oil is a laxative and stimulates your bowels by causing spasms.  The idea is this intestinal irritation can cause uterine contractions.  However, if you are not already in labor, this is likely only going to give you diarrhea and lots of GI distress.   I would definitely skip this one unless you want to be sick to your stomach. 
6. Nipple Stimulation: Nipple stimulation causes the release of oxytocin which can cause contractions.  This would be somewhat similar to being in the hospital and being given Pitocin.  However, in the hospital your baby’s heart rate would be continuously monitored while on medication, ensuring that contractions were not causing any distress for your baby.  Please do not do this if your baby is not being monitored because we would have no way to ensure that the baby is not being stressed by those contraction.  Plus, it sounds pretty painful!!!
7. Membrane Stripping: Membranes stripping is done while checking your cervix.  Your provider will separate the amniotic sac from the cervix causing the release of prostaglandins.  This really only helps induce labor if your cervix is already favorable.  Stripping membranes on an unfavorable cervix is very difficult (and painful) to do and not likely going to cause any cervical change or thinning.  Membrane stripping can cause some cramping and spotting and can also increase the chance of your water breaking.  If your water breaks or if you are bleeding and not just spotting, you should go to labor and delivery and be evaluated immediately.
8. Acupuncture, acupressure and massage: No proof that any of this helps induce labor.  However, it may provide a little bit of relaxation.  And your partner probably owes you some massage at this point ;)

So, that’s the scoop on starting labor.  For many women, the body will probably go into labor when it is ready, no matter what you do or don’t try at home.  For others, the body may need a little help to get things going, particularly if you are past your due date.  Ultimately, regardless of how your labor starts, the most important thing is a healthy baby and mommy at the end of your labor 😊

​Dr. Pam

Winter time in Idaho is definitely not for the faint of heart.  In order to really thrive here, finding a winter activity to motivate you to get outdoors is key.  If you’ve been looking for a few reasons to go outside, other than throwing snowballs at your kids 😉, here’s a good place to start.  And for the record, please don’t throw things at your kids. 

1.  Looking to reduce risk of cancer, autoimmune disease and blood pressure?  Getting outside in nature can reduce the inflammation that can contribute to these illnesses.
2. Want to score higher on tests and improve memory and focus?  Take a walk.  Being outside in the woods rather than an urban environment can improve short-term memory by up to 20% for some individuals and has even been shown to increase focus in some individuals with ADHD.
3. Looking to destress?  Being outside in wooded areas can reduce both your resting heartrate and cortisol levels, both of which are markers of stress.
4. The holidays as well as the colder, darker days can certainly be a trigger for both anxiety and depression.  For a little relief, get outside, especially to exercise, which can exaggerate the improvement for both issues.  Even just getting outside can help make us happier.
5. As winter approaches (ok, fine-it’s here), we often see an increase in the incidence of illnesses and colds.  Some new data suggests that forest environments can improve immune function, which in turn may decrease severity and frequency of viral illness.
6. Trouble falling asleep?  Camping outside (maybe not in the winter unless you’re really brave or know a really good cuddler) can help reset your internal clock to improve your sleep pattern.
7. Trying to lose a few pounds?  Those who exercise outside are more likely to stick to their routine and often see improved weight loss results compared to those who exercise indoors.  Also, those who exercise in the cold vs warm weather are more likely to burn more fat in comparison to breaking down muscle.
8. Lastly, it’s a good reason to make friends with someone who has a sauna or hot tub.  Many people find both of these activities relaxing, and some see improved muscle soreness or stiffness.  If you’re going to exercise hard in winter, why not relax hard, too?

So, what to do during the Idaho winters?  It’s easy to get outside during our beautiful summer months, whether to walk, run, bike, hike, fish, etc, but finding fun winter activities can sometimes be a challenge.  The simplest activity is going to be continuing walks, although for some days snowshoes may be beneficial.  Winter photos can also be amazing, and hiking to that perfect spot can be good motivation to get some outdoor time.  For those who are more athletically inclined, downhill or crosscountry skiing, fat-tire biking or hunting may be for you.  Snowmobiling can also be good incentive to get outdoors.  Regardless of what you decide to do, be sure to bundle up as excess cold exposure can negate the positive health benefits of being outdoors.  Not to mention, it’s hard to enjoy anything if you’re spending your day shivering.  Happy winter, and we hope to see you outside 😊

​Dr. Nick

I find that while talking to expecting moms, there is a huge interest in figuring out which newest line of baby gear will be that perfect item to help their baby sleep or the newest in baby bottle technology.   However, the focus on mom and what will help her get through that initial tough postpartum period while she is recovering from pregnancy and birth is often overlooked.  So, I took an informal poll of my new moms to see what items helped them the most after having a baby. 

1. Dermoplast was a big one.  After a vaginal delivery, a lot of women require some stitches in the perineal area and dermoplast is a benzocaine spray that numbs that area while you are recovering.   I’ve had a lot of patients specifically say that the dermoplast was a lifesaver!
2. Postpartum Corsets, bands and wraps: A lot of my patients have found relief using these postpartum to help with back support and compression until the uterus goes down to its normal size.  Bellefit was probably one of the more popular bands.  Many of my patients who have had a cesarean section just use the one that they get from the hospital. 
3. Nursing gear: If you plan on breastfeeding, make sure you have all your nursing gear sorted out prior to delivery.  Most insurances now cover the cost of pumps.  All you have to do is ask your provider for a prescription to take it to your insurance-approved location and they will give you a pump.   Research the pump that you are interested in and confirm that your insurance covers it.  Make sure you have some comfortable nursing bras on hand.  Nursing pads can be cloth or disposable.  I have found that many prefer the cloth nursing pads because they are more absorbent.  Nursing is one of those things that comes really easy to some and is really hard for some.  Some people produce lots of milk and their baby latches on perfectly.  For others it is not quite this easy.  I think the most important thing you can do is be prepared ahead of time so you are not scrambling for these items while trying to figure out how to nurse a newborn. 
4. Do I need scar cream for my cesarean section to make it less noticeable?  For most I would say no.  However, there are some people that are more prone to keloid scars.  If that is the case, I would discuss this with your provider and find out what skin closure technique they recommend to minimize scarring.  Generally, this shouldn't be applied until after the skin edges have fully sealed.  If you already have an noticeable scar, usually a revision of the scar can be done with a subsequent cesarean section to improve the cosmetic appearance. 
5. Constipation: If you are prone to constipation, then this can make the postpartum period absolutely miserable.  Make sure you drink 64 oz of water, stool softeners twice a day, and if you cant get enough fiber in your diet, be sure to start taking a fiber supplement now.

The postpartum period is really hard.  While some may feel like it’s a long vacation, the reality is you are recovering from nine months of pregnancy and birth and adjusting to the needs of a newborn.  This can be especially hard if you don’t have friends and family close by.  Hope this helps!

Dr. Pam

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