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A Little Information About PrEP: Pre-Exposure Prophylaxis

PrEP stands for pre-exposure prophylaxis. It’s a once daily medication intended to be taken prior to HIV exposure to help prevent infection. PrEP is recommended for anyone who is HIV negative, but is at high risk for infection. The brand name for the most commonly prescribed medication is Truvada and it consists of these two medications: Tenofovir and Entricitabine. Per the CDC, when taken daily PrEP can reduce your risk of HIV, infection from sex and by about 99% and from injection drug use by about 74%.

Now these medications are much less effective if not taken consistently. You will need an HIV test before you start taking PrEP and every three months, as long as you are taking it. Your doctor will also test your kidney function before prescribing Truvada and every six months, as long as you are taking the medication. You will need to be consistent about taking this medication daily. This medication does not prevent other STDs, so condoms are still needed.

All of the following place you in the high risk for HIV infection.

  1. If you are a woman who is HIV negative with a partner who is positive for HIV or AIDS.
  2. If you are sexually active in an area that has high numbers of HIV.
  3. If you do not use condoms at all, or use them inconsistently.
  4. If you have other STDs.
  5. If you exchange sex for drugs, money, food, or shelter.
  6. If you inject illegal drugs.
  7. If you are dependent on alcohol.

Black people are by far the group most effected by HIV infection in the United States. Per the CDC, in 2018 we made up 13% of the population and 42% of all new HIV diagnoses. Black women are the group the hardest hit with an infection rate 15 times that of white women and five times that of Latino women.

What are possible side effects for PrEP?

Stomach pain, weight loss, headache, nausea, and diarrhea are the most common side effects. Now these symptoms typically go away spontaneously within a few weeks.

How expensive is PrEP?

PrEP can be expensive. Most insurance plans cover all or most of the medication. In some cases, cost assistance may be available.

Can PrEP be taken while you were trying to get pregnant?

Yes. We recommend that you start taking medication one month before you start trying to conceive and continuing it for one month after you have gotten pregnant.

Can PrEP be taken during pregnancy?

Most experts agree that it is safe to take, these medications are used to treat HIV positive women during pregnancy. There are no reports of birth defects caused by PrEP.

Can PrEP be taken while breastfeeding?

If you are HIV negative and high risk for HIV infection, PrEP can be taken while breastfeeding small amounts of the medications can be found in breast milk, but the amounts are so small it is unlikely to harm the baby.

Also remember to always use condoms.

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Understanding Miscarriages

The medical term for miscarriage is spontaneous abortion. It refers to early pregnancy loss in the first trimester, or during the first 13 weeks of pregnancy. Unfortunately, early pregnancy loss is common and is thought to affect 10% of known pregnancies. In reality, this number is even more common as some losses go unrecognized. You get into a situation where a woman just thinks that she had a weird period and doesn’t even recognize that she experienced a loss. Most early pregnancy losses are the result of a genetic issue. When mom and dad’s chromosomes link up, the body can detect that there may be an abnormality that is not compatible with growth and development, and the pregnancy may result in a loss.

Now, a lot of women wrestle with whether or not something they did or did not do caused or contributed to their loss. Put this out of your mind, don’t even entertain it. In most cases, neither you nor your partner had any responsibility in this. It is not something you could control or change.

Smoking, alcohol and caffeine have been studied as potential causes. The jury is still out in regards to smoking and alcohol. In other words, results are conflicting. At any rate, don’t do it. Moderate amounts of caffeine consumption, which is less than 200 milligrams per day, the equivalent of two cups of coffee per day, does not appear to increase risk.

The risk of early pregnancy loss does increase as we get older, particularly over the age of 40.

What do you typically experience with a pregnancy loss?

Bleeding and cramping are the most common symptoms. The cramping is similar to that experienced with a menstrual cycle, and the bleeding can be anywhere from spotting, to bleeding like a period, to even heavier bleeding. If you experience any of these symptoms, contact your healthcare provider.

Also keep in mind, you might experience spotting at various times throughout your pregnancy. The tissue is very sensitive in pregnancy. There’s a massive increase in blood flow to the area. Anytime something rubs up against the tissue of the cervix or the vaginal walls, such as intercourse, pelvic exams, or ultrasounds with the use of the vaginal probe, it can cause spotting.

How is early pregnancy loss typically diagnosed?

Typically by taking a history and performing a physical exam. An ultrasound may also be necessary. A blood test, measuring the pregnancy hormone or human chorionic gonadotropin, HCG, may also be necessary. The ultrasound and blood tests may need to be repeated for confirmation.

What are the options for early pregnancy loss?

Your physician will work with you to tailor your treatment plan specific to your situation. Options may include allowing the tissue to pass naturally. Medications may also be used to help expel the tissue. In some cases, surgery may be recommended. Your physician will review the specifics of each management plan with you in detail.

Another thing to keep in mind is if your blood type is RH negative, RH is rhesus factor, a protein found on your red blood cells, you may receive a shot of RH immunoglobulin. This is to help prevent future serious problems if the mother is RH negative and the fetus is RH positive.

What happens next?

We typically recommend pelvic rest, which means nothing in the vagina for a period of two weeks after a loss to help prevent infection. When should you be concerned? If you have a temperature with a fever of 100.4 or more, you have severe nausea, vomiting where nothing is staying down, everything you eat and drink is coming back up. If you experience severe pain that typical over the counter pain medications are not helping. If you have heavy bleeding where you are soaking, flooding your pad, having to change it every hour because it is soaked, saturated, and this goes on for more than an hour, seek medical care.

If you find that you are having trouble coping with your loss, talk to your provider, be open and honest about your feelings. Seeking counseling services, grief support groups, and spiritual support may also be helpful. Please know that most women can and will go on to have healthy, successful pregnancies. Recurrent pregnancy loss is rare. If you wish to try again, we recommend waiting until after your next normal cycle. If you do not desire pregnancy, we recommend starting a reliable form of contraception.

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Is Vaginal Steaming safe?

Vaginal steaming, aka V-steaming, aka Yoni steaming has been described as “a facial for your vagina.” It’s an ancient procedure dating back centuries that has been described in both the Mayan and Central American culture. This alternative health procedure has recently reemerged in spas over the last decade and has been touted by certain celebrities. The procedure consist of sitting or squatting over a bowl of steaming water infused with herbs, some of which might include mugwort, wormwood, basil, and rosemary. The warmth of the steam is supposed to soften and open up the pores of the skin of the vagina so that the herbs can be absorbed into the skin and affect the vagina and reproductive organs, such as the uterus, tubes, and ovaries and impart medicinal effects such as cleansing and revitalization.

What are the proposed benefits?

The procedure is said to improve unwanted symptoms of the menstrual cycle, such as cramping, bloating, heavy and irregular bleeding. Other listed benefits include increased fertility, promoting healing after childbirth, and alleviating menopausal symptoms. I also found reports of the procedure being used to address stress, depression, hemorrhoids, fatigue and headaches.

Does it really work?

There is no scientific evidence to substantiate the reported benefits of vaginal steaming. One potential benefit is that the moist heat may increase blood flow to the vaginal vulvar area, which could potentially increase sexual arousal and function. This has not been well studied.

There are many potential harms.

  1. Adding moisture or heat to the vagina may facilitate an environment that allows yeast and other vaginal infections to thrive.
  2. The vaginal skin is delicate, sensitive, and easily traumatized. Adding heat to this area may cause scalding or burning. These types of burns are very painful and difficult to treat.
  3. We have no idea how this herbal steam may affect you. You could be fine, or it could cause serious irritations. We also have no idea of the effects of this herbal steam on a developing fetus. There have been some reports of herbs that can increase your risk for a miscarriage. This procedure should not be performed while pregnant.
What’s the bottom line?

We do not recommend this practice. In fact, other procedures that tout similar benefits, like douching, have long been discouraged. The vagina is a self-cleaning organ, it does not need our help. A healthy vagina has both good and bad bacteria, as well as yeast maintained in their proper balance. Doing things to manipulate this environment, such as douching, steaming, or using certain feminine hygiene products can upset this balance and increase your risk for vaginal infections.

There is no evidence that the herbal steam can penetrate the vulvar vaginal tissues or have any effects on the reproductive organs. In the same token, there is no scientific evidence to substantiate any of the previously made claims. The vagina’s fine just the way it is, leave it alone. To take it even a step further. It’s this type of rhetoric that continues to perpetuate negative self-images of women by insinuating that vaginas are somehow bad, dirty, disgusting, and are in need of outside manipulation to set them right, none of which is true.

So to sum it up, sis, we don’t recommend vaginal steaming. Get your medical advice from medical professionals. Educate yourself with reliable sources of information, know the facts, let’s change the narrative.

That’s all for today folks. As always, I appreciate you, take good care and stay healthy friends. If you enjoyed this video and want to see more like it, be sure and hit the like button and follow us @docwoodus for all the latest updates.

Take care.

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What’s the real deal on seafood consumption during pregnancy?

Seafood is an important source of protein, iron and zinc – all important nutrients for baby’s growth and development.

It is also an important source of omega-3 fatty acids, a type of fat naturally found in many different kinds of fish. We believe they are important in fetal brain and eye development, both before and after birth. To benefit the most from omega-3 fatty acids, we recommend you pay attention to your consumption prior to and during pregnancy, as well as while breastfeeding. You can also get your recommended dose of omega-3 fatty acids from the nutritional supplement DHA. The recommended dose for DHA is 200 milligrams daily. Now be sure and pay attention to the label on your prenatal vitamins as all prenatal vitamins do not contain DHA.

We recommend 2-3 servings of seafood per week, which is the equivalent of about 8-12 ounces. Now, if you need assistance understanding what a serving size is, use the palm of your hand. The palm of an adult hand is the equivalent to about 4 ounces.

Your best seafood choices during pregnancy include fish like shrimp, tilapia, salmon, and catfish. There are other fish that contain a moderate amount of mercury, and for that reason, we recommend that you limit your consumption to 1 serving a week, no more than 6 ounces. Too much mercury consumption during pregnancy has been associated with vision and hearing problems as well as major organ damage.

Fish in the moderate category include your tunas. These are yellowfin, white, and albacore tuna, and it includes canned, fresh, or frozen tuna. Sea bass, snapper, grouper, and mahi mahi also fall in the moderate category. Avoid fish with the highest mercury concentration such as big-eye tuna, shark, marlin, and roughy. If you are eating fish caught by friends and family, check for advisories in your area regarding safe consumption. If there are no advisories available, limit your consumption of that fish to 1 serving per week and do not eat any other fish that week. Be sure and remember, pregnant women should avoid eating all raw and undercooked seafood, eggs, and meat.

That’s it for today, guys. As always, I appreciate you, take good care, and stay healthy friends.

If you enjoyed this video and want to see more like it, be sure and hit the like button and follow us @docwoodus.

Thank you.

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What are safe exercises during pregnancy?

If you’re healthy and your pregnancy is normal, it is safe to continue or start regular physical activity. Regular physical activity does not increase your risk for a miscarriage, early delivery, or low birth weight. Have a discussion with your physician early on in your prenatal visits. Once you get the okay to proceed, go on to discuss which activities are safe for you.

Exercise improves your general fitness. It can reduce back pain and can also improve constipation during pregnancy. It can promote healthy weight gain and help you lose the baby weight after delivery. Exercise may also decrease your risk for gestational diabetes, preeclampsia, and C-section. We recommend 30 minutes of aerobic exercise most days out of the week, or five days a week. If you were very physically active prior to pregnancy, in most cases, you can continue your level of activity, just have a discussion with your physician to determine if it is safe for you to proceed.

Keep in mind that pregnancy hormones can relax your joints, so if you’re doing high-impact activities, you may be increasing your risk for injury. Also, remember that as your center of gravity changes and your blood volumes increase, this can make you more unstable on your feet and increase your risk for falling. Pregnancy increases your body’s oxygen demands, which can make strenuous activity more difficult as well. In general, listen to your body.

Be sure to drink plenty of water and avoid dehydration.

Wear a properly fitted sports bra or consider a belly band for extra support. Avoid becoming overheated. Avoid standing still or lying flat on your back for prolonged periods of time.

Safe exercises include:
  • walking
  • swimming or other water activities
  • stationary bicycling
  • modified yoga or Pilates.

If you are an experienced athlete, in most cases, you can continue doing your level of activity. Just have a discussion with your physician to make sure it is safe to proceed.

 

Exercises to avoid include:
  • contact sports
  • anything that increases your risk for falling
  • skydiving
  • scuba diving
  • hot yoga
  • high altitude activities.

When should you stop exercising?

If you have bleeding, leakage of fluid, or regular contractions. If you feel dizzy or faint, if you feel short of breath prior to exercising, if you experience chest pain, headaches, muscle weakness, calf pain, or swelling; all of these things are warning signs to listen to your body and take a break.

Why should you keep exercising?

After baby is born, it can improve your mood, help you lose the baby weight, and decrease your risk for blood clots.

That’s it for today, guys. As always, I appreciate you. Take care and stay healthy, friends. If you enjoyed this video, hit the like button and follow us @docwoodus is for all the latest updates.

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How to take Black maternal health into your own hands

We’ve discussed disparities in black maternal health outcomes in detail. Here’s what you can do about it.

Pick a provider who gets it.

One who understands & respects that your cultural nuances inform your medical decisions.

Research shows health outcomes for black patients are better when they are treated by black doctors. This is critical given POC generally experience poorer health outcomes across a variety of diseases & conditions. These findings are attributed to improved communication between black patients & black physicians.

“Black doctors are more likely to provide a comfortable setting to black patients, perhaps because of shared experiences or backgrounds.”

 

– Dr. Marcella Alsan
Lead Researcher on the 2018 Stanford study examining the impact of physician diversity on medical decisions & outcomes among black men

Check the bedside mannerisms.

Choose someone who invites you to actively participate in the decision making process-presents options/opinions not mandates/directives, and asks for & respects yours in return.

As a physician, I don’t care how many books I’ve read or cases I’ve seen, I’ve not spent a single day in your shoes. Unless we have history, I’m using a 15-20 minute interaction with you to make the best informed decision I can. The bottom line is nobody knows your body like you do. Show up. Don’t be a spectator. Use your voice. Be persistent. Make you thoughts, concerns, & questions known.

 

Help me, Help you.

Educate yourself. Equip yourself to actively participate in your care.

Lack of education leads to loss of options. This leaves you at the mercy of what somebody tells you. And what that somebody chooses to tell you (or withholds from you) is informed by their implicit bias. Find out everything you can about your health from reliable resources. Take notes. Seek out a 2nd opinion (or even a 3rd or 4th opinion) if necessary.

 

Don’t be afraid to switch providers.

You have options. Find a provider who sees you, hears you, & has a plan to optimize you.

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Important Notice Regarding Covid-19

We are closely monitoring developments around the spread of the coronavirus (COVID-19).
The safety of our employees and you, our valued patients, is critical, which is why we are taking the following preventative measures:

  • All employees and patients who are ill are to remain home and reschedule appointments
  • Maintaining a sterile and sanitized work environment
  • Sanitizing all office areas constantly with medical-grade germicide
  • Requiring frequent hand washing (20 seconds with soap and hot water) for all staff
  • Providing hand sanitizer stations throughout the facility
  • Limiting guests to 1 per patient
  • Requiring masks of all individuals in the facility
  • Closely monitoring and communicating COVID-19 developments

And as an additional proactive measure, we do ask that all patients and guest who have a fever, symptoms of a respiratory infection, or have been exposed to a person with coronavirus, the flu or any other communicable disease OR have traveled recently to areas noted as high risk by the CDC, RESCHEDULE their appointments.

As always, thank you for your continued support and trust.

Woodus Obstetrics & Gynecology