Posts made in June, 2014

Staples or Sutures after Cesarean Section?

Posted by on Jun 23, 2014 in News | 0 comments

Pregnant momCesarean section or C-section is a surgical method to deliver an infant and it has been on the rise in the last two decades in the United States. It is estimated that more than 30 percent of deliveries occur via C-section today. C-section is required when the baby is too large or in a breech position or the baby is in distress. Doctors may decide to do C-section when the labor does not progress as time goes by or placenta separates from the uterus before the baby (placental abruption) or in a medical emergency.

Some of the planned C-sections are due to mother’s request as a preferred method of delivery. In any case, there are two ways to make skin incision. One is horizontal (bikini line) and the other is vertical (midline). Bikini line incision is more common because of less pain after the delivery and it heals faster. Uterine incision can also be horizontal or vertical and it depends on many factors. The goal is to deliver the baby quickly without causing trauma.

After the delivery, there are two options for closing the belly skin. Doctors can either use staples or sutures. Studies are being conducted to see which method has a better outcome and greater patient satisfaction. In one study, researchers compared wound infection rate after closure with staples or subcuticular sutures (sutures in the fatty layer below the skin). They found that women from staples group have increased rate of wound disruption or infection at 4 to 6 weeks after the C-section. No significant differences were reported in terms of pain, cosmetic appeal and patient satisfaction between women who received staples and those who received sutures.

Furthermore, researchers compared wound complications after closing the belly skin with staples or subcuticular sutures in the two groups. Again, they found a higher chance of wound complications among staples group compared to sutures group. In conclusion, suture is less likely to cause wound disruption, infection or complications. Even though it requires additional 10 minutes to close the belly skin with sutures, it seems to be a better method.

Contributed by Patricia Hsiao M.D.
Sources: mayoclinic.com, nlm.nih.gov/medlineplus/news, ncbi.nlm.nih.gov, uptodate.com

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Menopause

Posted by on Jun 2, 2014 in News | 0 comments

Menopause
Menopause is a normal, biological process in woman’s life that marks the end of the reproductive period. Menopause is defined as the end of menstruation (period) when the ovaries are no longer producing eggs. You are considered to have gone through menopause if your last menstrual period was 12 months ago. Typically, most women go through menopause between 45 and 55 years of age. The average age of menopause is 51.

Perimenopause is menopausal transition when your period starts to change and becomes irregular. It could be years before your period stops completely. During that time, your body goes through hormonal changes that result in menopausal symptoms such as hot flashes, night sweats, vaginal dryness, and sleep problems. Symptoms may be mild in some women but it can be severe and lasted longer in others. Postmenopause follows menopause and you are considered postmenopausal woman the rest of your life. Menopause before the age of 40 is considered early menopause. It could be due to certain medical conditions or unknown reason.

Here are some common questions:
Would I still have menopausal symptoms if I had my uterus removed (hysterectomy)?
Yes, you will still have menopausal symptoms because the hormones (estrogen and progesterone) are produced by the ovaries. The decline of these hormones causes menopausal symptoms.

Would I have menopause if I had my uterus and ovaries removed?
You will have menopause once your ovaries are removed due to lack of estrogen and progesterone.

What are menopausal symptoms?
Menopausal symptoms are irregular period, hot flashes, night sweats, irregular heartbeats, vaginal dryness, vaginal infection, incontinence, sleep problem and mood swing.

What happens to your period during menopausal transition?
During menopausal transition, a lot of women experience irregular period. Your period may become more or less frequent, heavier or lighter, last longer than usual. You may also have spotting between your periods or missing periods in some months.

Can I still get pregnant during menopausal transition?
Yes. The chance of getting pregnant in the late 40s or early 50s is low but still probable. Therefore, it is important to continue with the birth control pills or use condom until you no longer have period for 12 months. Talk to your doctor if you are not sure. The doctor can check your hormone levels to determine if you have gone through menopause or not.

What are hot flashes?
Hot flashes are sudden heat to the upper part of the body. Your face and neck may get red. Some women have red blotches on the chest, back and arms. Severe hot flashes can cause you to sweat at night and it may disrupt your sleep.

What kind of sleep problem will I have during menopausal transition?
You may have hard time falling asleep or waking up too early in the morning. It may also be due to night sweats.

What happens when I have vaginal dryness?
You may have discomfort or pain during sexual intercourse and more prone to get vaginal infections. Vaginal dryness is due to the decline of the hormone called estrogen.

What other problems I may encounter around the time of menopause?
Some women find it difficult to hold the urine long enough while others complain of urine leaking out with coughing, sneezing, laughing and exercise.

Would my mood be affected by menopause?
You may feel irritable, anxious or uninterested in normal activities around the time of menopause. People with history of depression are more likely to experience mood swing. Seek medical attention if you think you are suffering from depression symptoms.

Do I need treatment for menopausal symptoms?
Not everyone will need treatment for menopausal symptoms. The doctor may prescribe short-term hormonal therapy to those with severe hot flashes, night sweats and mood swing.

What medications are available for menopausal symptoms?
Hormonal therapy and non-hormonal therapy are available to treat menopausal symptoms.

What hormonal therapy is available to treat menopausal symptoms?
Hormonal therapy is for short-term basic. If you still have uterus, you will be given estrogen and progesterone. If you had your uterus removed, you will take estrogen alone. There are some risks and benefits from taking hormonal therapy and those include heart attack, stroke, cancer and blood clot. While you are on hormonal therapy, you will need regular Pap Smear, pelvic and breast exam.

What non-hormonal therapy is available?
For those who are not candidates for hormonal therapy, seizure medication called gabapentin (Neurontin) and antidepressant such as paroxetine (Paxil), fluoxetine (Prozac), citalopram (Celexa) and others are used to treat hot flashes.

What is estrogen cream for?
If you just have the vaginal dryness, your doctor can prescribe you vaginal estrogen cream.

What can I do to control the urine leakage?
Your doctor may instruct you how to perform Kegel exercise to strength your pelvic muscles to have better control of the urinary problem. First, you empty your bladder then, stop it midstream and hold it for a few seconds. After that, let it go completely. Practice this technique three to five times a day.

What conditions am I at risk after menopause?
Estrogen protects women from heart diseases, therefore; women are at lower risk for heart diseases than men before menopause. But after menopause, the risk for heart diseases is the same for men and women. Thus, it is important to have a yearly physical exam and monitor your blood glucose, blood pressure and cholesterol.

Estrogen also promotes bone health. After menopause, you are at higher risk for a condition called osteoporosis where bones become weak and fragile. Your doctor will do bone scan to check your bone density several years after menopause. You would need to increase your calcium and vitamin D to prevent from osteoporosis. Women over 51 should get 1200 mg of calcium and 600 IU of vitamin D daily.

What lifestyle changes should I adapt to stay healthy?
Eat a healthy, balanced diet with plenty of fruits and vegetables. Try to get protein from lean meats and low-fat dairy products. Engage in regular exercise such as walking or light weight-bearing training at least 30 minutes a day for four to five days a week. Quit smoking if you smoke. Limit your alcohol intake to one glass of wine a day.

Contributed by Patricia Hsiao M.D.
Sources: womenshealth.gov, nia.nih.gov, ncbi.nlm.nih.gov, uptodate.com

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