Structure Sunday : Abnormalities of Amniotic Fluid

Consider the standard prenatal visit. Sometimes I think it doesn't seem like we do much. We obtain weight and vital signs, dip urine, and measure the belly in a decidedly 19th century way, with a tape measure. But we learn more than you might imagine. We can get a sense of whether the baby's interval growth is tracking, and whether or not there is a lag or an acceleration. Any concerns raised at this simple low-tech appointment can lead to further more intensive, high tech studies, such as ultrasound. At ultrasound we can not only see the various measurements of the baby but we can also see features of the placenta albeit more subtly.  Finally, we can see the amniotic fluid. The amniotic fluid reveals a great deal about the pregnancy. Most of the time we check amniotic fluid, it is in the normal range. However, it is not uncommon to find abnormal levels of amniotic fluid, either high or low. High amniotic fluid is called polyhydramnios, whereas, low amniotic fluid is called oligohydramnios. Amniotic fluid is an early indicator of the well-being of the pregnancy and the baby. You might say it is our canary in the coal mine. Learn more HERE. 

Food Friday: Feeding the growing baby: growth restriction and growth acceleration

Whether a baby is large or small depends on two things : the innate qualities of the baby and the maternal enviroment in which he or she grows. The growth rate and specific size measurements of the baby tell us a great deal, which is why we are continuously tracking them by exam and by Ultrasound. Major deviations in any direction are a source for concern.

Click HERE to learn more. 

Wellness Wednesday: Knowledge is Power. Get some.

I recently finished and published the website's pages on Infections in Pregnancy. At the bottom of those pages, I have added that much again in a new section called "Other infections of Perinatal Significance". Now this may sound way too scientific and unrelated to daily life, but nothing could be further from the truth. These are the big time everyday infections we hear of each week: Pertussis (whooping cough), Bacterial Vaginosis, Toxoplasmosis, Influenza, Herpes, Chicken Pox, and more. Learn more about these common infections and how they pose special risks to pregnant women. Learn what you can do to protect yourself and those around you. 

And, also coming tomorrow, will be a special section on Preterm Labor. Learn the facts and figures as we know them, and how we handle Preterm Labor today. Hint: It is not how we handled it even 5 years ago. 

Back on Track Tuesday: Gestational Diabetes Mellitus

Thanks for all your well wishes. I am making a good recovery. 

We bring you back to your regularly scheduled programming (Old time radio announcer voice here) , "Gestational Diabetes".

My suspicion that we see more of this every year is substantiated. Gestational or pregnancy-related Diabetes (GDM) is on the rise. It seems to track right along with the obesity epidemic. However, it is a cloud with a very silver lining. In many cases, the women I see who receive a diagnosis of GDM see me as their primary doctor, and, like many others, come in regularly only when they are pregnant. As such, it is golden opportunity for effective lifestyle intervention. 

GDM patients receive a whole package of nutritional, fitness and lifestyle advice, treatment and monitoring which I think, in the final analysis, will add years to their lives. They learn about the pleasure and ease of good nutrition, about personal organization, and about optimizing health. They do this through learning to craft meal and snack plans with the diabetic educator and my office. They learn to structure their days to a very high degree as a result of having to have blood sugar checks, medication and meals and snacks at just the right time. They are also introduced to mild regular exercise or at least physical therapy, which they uniformly enjoy. They report weekly for monitoring and feedback. Most of the time they achieve great results and feel good about themselves. 

And here's the cherry on top: If patients keep up the nutrition and exercise after baby is born, their weight and body composition drift naturally toward the optimal. And that's worth its weight in gold. 

Learn more HERE on our page about Gestational Diabetes Mellitus. 

Wellness Wednesday: Exercise in Pregnancy

 When I was a little girl in the 1960s, pregnant women wore loose billowing clothes in futile efforts to hide their pregnancies. The round silhouette of the pregnant belly was considered too suggestive for public presentation. Pregnant women were encouraged to stay home out of sight and rest. 

Fast forward to 2015 and not only are women wearing yoga pants in public, but pregnant women are too, complete with body conscious form fitting exercise tops in bright colors. They are out and about flying that pregnancy flag and getting fit. I love it. Do you exercise ? Would you continue your exercise in pregnancy? Review the facts on the subject here on my page on Exercise and Pregnancy. 

Food (sort of) Friday: Prenatal Vitamins

Prenatal Vitamins are a standard part of prenatal care. But did you know they should be started at least three months before pregnancy ? And did you know that 50 % of all pregnancies are unplanned ? Given these two facts you could make an argument for all women of childbearing age to take prenatal vitamins all of the time. 

What makes prenatal vitamins so special ?

Mayo Clinic recommends that a prenatal vitamin include at least the following : 

• Folic acid — 400 to 800 micrograms
• Calcium — 250 milligrams
• Iron — 30 milligrams
• Vitamin C — 50 milligrams
• Zinc — 15 milligrams
• Copper — 2 milligrams
• Vitamin B-6 — 2 milligrams
• Vitamin D — 400 international units

Consider folic acid. This is given to prevent defects of the baby's brain and spinal cord, what we call neural tube defects. These defects form in the first 28 days after conception, so often times the woman does not even know she's pregnant. This is why it is ideal for women to be on them in the three months before pregnancy. As soon as a woman decides to try to become pregnant she should start a prenatal vitamin. 

Prenatal Vitamins are not always easy to take. I recommend taking a gummy prenatal vitamins  if nausea is a problem. I also recommend taking them with food in the evening. Sometimes they cause constipation. Of course that is best dealt with by fluids, fiber, fruit and vegetables, but stool softeners can be used .

Pregnant women need more of just about every nutrient. This also includes calcium and iron, in addition to folic acid. Calcium is necessary for building bone. Iron is necessary for manufacturing red blood cells which carry oxygen to mom and baby. A deficiency of iron results in anemia, which is suboptimal for both mom and baby. Personally, I think Calcium taken separately from the Prenatal vitamin or iron causes them both to absorb better. It is also good to note that Calcium citrate is the most easily absorbed type of Calcium. Additionally, calcium should be paired with vitamin D. Most over the counter calcium supplements do just this. 

Newer data also indicate that it is beneficial for pregnant women to ensure that they are consuming at least 200 milligrams of DHA (docosahexaenoic acid) in addition to their prenatal vitamins. This seems to be beneficial for the development of unborn baby's brain. It is available by supplement or incorporated into a prescription prenatal vitamin. 

But vitamins are not the whole story. I have prepared a page devoted entirely to preparation for a planned pregnancy. You might be surprised to see some of the things that it contains. Have a look HERE.

Wellness Wednesday: Wellness in Menopause

More and more of us will be in menopause as time passes by. Our lifespans are increasing along with the quality of our health care and our knowledge about fitness, nutrition and health in general. So get rid of old stereotypes about menopause and menopausal women and learn the facts HERE. 

Wellness Wednesday: Sleep and Sleep deprivation

Sleep is our primary detox. It is undervalued in our culture and underestimated as a factor in health. While I am supportive of the hard core work and play ethic of the modern era, I am compelled to highlight this very important area of self care. 

Read some sobering evidence here. 

Wellness Wednesday: What does it take to exercise ?

Gina at the summit of the " Dish"  run at Stanford, after her 20th reunion. http://web.stanford.edu/group/runningclub/Runs/Dish.htm

There is a great deal one could say about exercise. However, talking or writing about exercise is only useful if it leads to people actually doing it. So, since I am committing the Wednesday column to the topic of exercise, I decided to reach out and ask about your interests and needs on the subject of exercise. I would like to tailor the column to meet these needs. Here is a link to a short survey that will be fun and illuminating to take. 

https://www.surveymonkey.com/s/6K8MQP6

Gina with Zumba Royalty Acea Theroux Zes and Nancy Mehring 

I have really decided to give exercise some serious focus because I really feel it is at the center of optimal mental and physical health. If you have mediocre exercise and excellent nutrition you are probably moderately healthy. However if you have mediocre nutrition and excellent exercise you are probably very healthy. Plus, good nutrition seems to follow in the wake of good exercise, but not as much the other way around. And of course, the worst attitude can be fixed better by a good workout than a good meal.

I realize there are serious and challenging obstacles to exercise, from money to peer support to childcare challenges, injury, chronic illness, social culture, motivation, depression and more. But I would like to explore and deconstruct these and look for solutions. 

I am hoping this survey and its results will help pin some of these reasons down and help us solve them. 

Next Wednesday I will post the results, and add a few thoughts of my own from over twenty years in medical practice and over 40 years exercising regularly. 

Many thanks, Dr. Gina 

Medical Monday: Another Obstacle to Health Care: Anti-science

What does vagina steaming and the recent measles outbreak having common ? Need a hint ? OK. What can make people on both sides of the political spectrum mad ? You guessed it ! The anti - science movement. 

According to that venerable site rationalwiki.org, anti science 

" refers to persons or organizations that promote their ideology over scientifically-verified evidence,[3] usually either by denying said evidence and/or creating their own." 

Recall that science is advanced through the scientific method, which involves testing hypotheses with experiments, then revising said hypotheses. Experiments should be on done on that which is measurable, done blinded, controlled, and should be reproducible and peer reviewed by the appropriate scientific institution. Science is always undergoing a process of refinement based on observable facts. 

This should be clear. Yet the media and advertising to which we are daily exposed has become a brew of fake science and real science. How is a person to know the difference ? Well you can use your gut feeling of course. ( And I have a bad feeling about vagina steaming.)  Or, you can have a look at my section of this site where I try to give some help on this issue. It is called Information and Learning. I try to give you some tools with which to navigate the information stream coming at you every day. 

Let's look at some hot news topics where anti-science is in play: climate change, genetic engineering, vaccines, juice cleanses, GMO food, stem cell research, and yes vagina steaming. These topics are especially hot in election years, and when money is involved. 

Here is a great article in Scientific American about a science quiz given to presidential candidates 2012. 

Click here to either laugh or cry. 

Here too, is a fair handed look at anti-vaccine sentiment on both sides of the aisle from Slate. 

Here is fantastic compendium of articles from various writers on the anti-science movement from Huffington Post. 

I would like everyone to take a charitable look at the nature of our national dialog. Feelings are running high, especially in the wake of the recent measles outbreak. In this climate, where there are many voices clamoring to be heard, let us keep the dialog civil and ahem, scientific, whenever possible. 

In that spirit, I will share with you an article about one of my favorite most well intentioned celebrity health gurus, Gwyneth Paltrow. Don't get me wrong, I love Gwyneth. Her site, Goop.com is full of lovely recipes and pretty unaffordable clothes. She has a holistic approach and a lovely positive attitude which really does count for a lot. HOWEVER, I cite this article below to show that sweet well intentioned people can get it wrong. Enjoy, and remember that laughter and affection are the best medicines. 

Three Reasons You Definitely Shouldn't Get Your Vagina Steamed , from Women's Health 

Food Friday: I'll drink to that

Drinks 

Modern drinks are the most deranged dietary items on the modern menu. Consider "Rock Star"  and the like. They are the deliberate and crass result of corporate engineering for maximal addictiveness at the least cost. Cheap artificial colors, caffeine, sugar and flavorings combined with carbonated water are all put into a flashy package, and marketed aggressively to young and old alike. 

Little did we know that rapidly digesting frequently consumed sugary drinks like these would have more to do with the obesity epidemic than consumption of actual dietary fat. But we should have known. 

Now we have in sharp focus the fact that simple carbohydrates of all kinds, sugar and flour included,  jet into our bloodstream faster than we can metabolize them. That spike in blood sugars triggers the body to store fat and very shortly thereafter, one is left devoid of energy in the so called sugar crash. 

Not only has this contributed to obesity, it has also contributed to heart disease, diabetes and the like. Moreover, these phenomena wreck havoc on mood and attention span, conceivably influencing behavior in both children and adults. Finally there is increasing evidence that foods like this contribute to irrtation in the gastrointestinal tract, possibly making us vulnerable to more inflammation and even autoimmune disease. 

Rant over. My newly minted section on Nutrition is just a beginning, but I would like to show the Drinks section to you. In it, I discuss more about carbohydrate metabolism and even go into the Glycemic index. Don't worry, we will do a lot more than talk about what not to eat. The most fun is yet to come when we get to the great things that we should be eating and drinking. This blog post will highlight drinks from a nutritional point of view. Click on the beverage below to read more. 

Food Friday: A fresh look at fat

If you grew up in the 70s, you will recall the extreme emphasis on the low fat diet. Thank goodness that singular emphasis has gone by the wayside. Back then, the best science of the day indicated that saturated fat and cholesterol was the primary concern. Therefore, we were cautioned to reduce our consumption of things like beef, butter, and heavily marbleized meats from feedlot cows, which are full of saturated fat. 

Here is a section from this websites page on Fats. 

The Chemistry : 

Different fats are different hydrocarbons. They have different levels of saturation, meaning a varying number of hydrogen atoms along their carbon chain structures. Fats can be classified as polyunsaturated, monounsaturated and saturated. More hydrogen atoms makes the chain more saturated, solid and more stable to temperature.  Unsaturated fats are more liquid at a given temperature, and  clog the arteries less.

Click HERE to learn more. 

omega three fatty acids

Back in the seventies, we were encouraged to substitute margarine for butter since it was made of less saturated fat, including some trans fats. Since then we have discovered the dangers of trans fats, which, have been prevalent in margarines. There is also concern that overly unsaturated so called polyunsaturated fats are easily oxidized , and then become unhealthy to consume. 

More importantly, we have discovered the benefits of monounsaturates like olive oil, which reduce cardiac risk. Additionally we have come to understand the short chain fatty acids, like omega 3s which actually reduce risk of cardiac disease and also help with inflammatory disorders. 

Finally we have come to understand that it is our carbohydrate intake that has contributed greatly to the problem of obesity, which leads to so many other problems including heart disease. In particular, our simple refined carbohydrate ( e.g. white flour products)  and plain old sugar intake has been off the biological charts. These are almost always processed foods not found in nature and they enter our bodies very rapidly. We cannot metabolize them quickly enough and they are stored as fat. Additionally they can raise triglycerides, which in women, are more associated with heart disease than cholesterol. 

Taking all of this into consideration, what are the current recommendations ? Roughly a quarter of our calories should be each from fat and protein, and half from carbs. But the devil's in the details. The fats should all be healthy ones like olive oil, avocado, and walnuts, and the carbs should be complex, unrefined, and nutritious. You probably think I mean whole wheat seedy bread. Actually I mean carbs even more complex than that: vegetables and fruits.  Yes, they provide carbs too. 

In summary, our current thinking on consuming fats, and avoiding becoming fat has changed quite a bit in the last 40 years. And quite frankly, we are eating quite a bit better because of it. Diet conscious folks used to run around with a diet coke, and slice of wheat toast and margarine for breakfast. These days, it would be more like an omelette with kale and fresh tomatoes, salsa, fresh fruit, green tea, and a small bowl of oat bran cereal with olive oil and sea salt. Bon appetite. 

Medical Monday: Increasing concern over narcotic pain medications

The Flathead Valley has a problem with narcotics. I am told this is not unique to our Valley. I never thought I would have this much first hand experience with narcotics, even heroin. 

Problems with narcotics affect our women of childbearing age. Narcotic use in pregnancy is associated with low birth weight, preterm labor, SIDS and several major birth defects, as well as a lengthy neonatal withdrawal. 

Narcotics are a class of drug which acts in our body though our body's own neurotransmitter and receptor system. We have many neurotransmitters, tiny molecular messengers that allow us to feel sensations and even emotions. Neurotransmitters like dopamine bind, lock and key style, to specific receptors in nerve cells and set off a reaction which make perception possible. 

Narcotics also fit these nerve cell receptors. While bound at the receptor, narcotics can block pain and simulate pleasure. That is why they work, and that is why they are abused. 

If only that were the whole story. You see, when a narcotic binds at the receptor, it stimulates an electrical potential, or pulse, down to the end of the nerve cell, and there another neurotransmitter is secreted, further conveying the signal. If there is constantly narcotic at the receptor, the molecules at the other end get depleted and the system no longer works. 

The patient initially experiences relief with use of the narcotic. If too much is used for too long, it begins to no longer work. Worse still, more drug barely produces the feeling of being at baseline. No drug comes to feel worse than bad; hideous, in fact.  More and more needs to be used to even feel baseline. This is the basis of addiction. 

Patients, caregivers, and bad luck are responsible when things get out of hand. It is always easier to give or take a pill than to treat, cure, or work on things. Physical methods like exercises and therapy take time and are not always perfect. Surgery is expensive, and not always the answer to pain. Other nonnarcotic medications may be partial solutions. 

Life can be hard and confusing. Well meaning people can slip unknowingly from using pain meds to treat real pain, to using them to treat other things like withdrawal, anxiety, or their ability to deal with life. Those of us who care about these people need to start from a place of knowledge and compassion. No one really signs up to be miserable. 

Wellness Wednesday: What is Wellness ?

Did you realize the concept of wellness wasn't always around ? According to an article in the November issue of Real Simple, the term did not appear in the English language until the 16th century. Until then we simply thought of the absence of disease.  

After World War Two, the World Health Organization ( WHO ) explicitly defined health as not simply the absence of disease, but rather a state of " complete physical mental and social well-being ". The concept of " High Level Wellness"  was defined in a book of the same name in 1961. And finally the first " Wellness Center " was opened in northern California in 1975, and was catapulted to both fame and ridicule with its spot on the TV news show 60 minutes in 1979. Today the general public and the medical profession take wellness very seriously. I agree with the WHO definition of what it is. What interests me is how to attain it.

My first comment is this: that wellness is not a one time goal. Rather it is a constant work in progress. It is borne of a repetitive but dynamic rhythm of daily activities that we must consciously put into place. If I have emphasized anything about health maintenance in my practice it is this: that no one thing that will confer wellness. It is a comprehensive approach which says that every thing you do or take into your body must be for a good health promoting purpose. Whether it is a food, an exercise, or even a manner of communication, it should be for the good. If these good things are done so often as to become habits, their cumulative result is wellness. In other words, it is the summation of all the well chosen good small things and actions in the day, experienced repeatedly over time. 

In this spirit I would like to introduce the concept of optimal health. Yes there is great satisfaction in curing disease. But there is even more in teaching people how to move toward optimal wellness.  And with that in mind I would like to share a terrific website :

Greatist.com

Of course it is a play on the word "greatest" and I take it to mean someone who studies and tries to embody that which is great. The site offers tips not only on nutrition and fitness, but also addresses optimal life functioning in general. So check it out, as a part of your quest for wellness. 

For more information see: 

The Eight Dimensions of Wellness 

MEDICAL MONDAY: The medical facts behind helmets and skiing.

This article is written in honor of my brave niece who is recovering from a ski accident. 

She is very athletic and very experienced. She is not reckless, and was wearing a helmet. Nonetheless, she caught an edge, lost a ski,  flew out of bounds, hit a tree, lost consciousness and went down a tree well. Luckily, a patrol just happened to be skiing right behind her and dashed down after her. She and my sister in law, who nearly passed by the single ski on the trail, hauled her out, and our awesome Alert Helicopter evacuated her. Her helmet suffered a big gash. She got a concussion and some hairline spine fractures. People keep saying she is so lucky that that she was wearing a helmet. 

It wasn't luck. The data and recommendations are crystal clear and their family follows them. I have summarized them here for you. They come from a review article which was published in the Journal of Trauma and Acute Care Surgery in April of 2014. This review combined the findings of 16 prior well designed studies which examined the effects of helmet wearing on both skiers and boarders. Here are some of their key findings: 

• Injuries in boarders are more numerous and more serious.
• Incidence of injuries are higher in males, and those under 17 years of age. 
• A 1996 study showed the average inpatient cost of a skiing or boarding injury to be $22,000.
• There are 600,000 ski and snow boarding related injuries per year in North America.
• About a fifth of these are head injuries.
• About a fifth of these head injuries are severe enough to cause loss of consciousness of concussion.
• That's about 24,000 people per year losing consciousness or having a concussion with their head injury.
• The 16 studies collectively showed anywhere between a 30%-60 % reduced incidence of head injury while wearing a helmet. 
• They also showed decreased incidence of loss of consciousness upon striking a fixed object while wearing a helmet. 
• Wearing a helmet is not associated with increased rates of other injuries, poorer responses to stimuli, or riskier behaviors. 

The authors concluded that helmets should be strongly recommended and that policies should be put into place to promote their usage. 

My niece is going to be fine. But she has a few challenging weeks ahead of her. She will miss her finals, miss her sports, and end up with lots of physical therapy and doctor visits instead. We are just grateful she is with us and, and still moving and smiling. 

Medical Monday: More questions than answers on gluten and gut health

We are all aware of the new interest in gluten free diets. Should you be concerned ? To answer, I would first say that if you are well and feeling fine, you need simply eat properly and exercise regularly to keep it that way. You need not avoid gluten. However, if you suffer from bloating and cramping, a visit to your doctor is in order. To prepare, keep a simple food and symptom diary. Be prepared to undergo certain lab studies, or even get a referral to the Gastroenterologist. There are many conditions which might cause these symptoms. Sometimes it is challenging finding out what is wrong. 

Celiac disease is an autoimmune destruction of the lining of the gut, stimulated by gluten, in those that react to it. Gluten is a protein in various grains. Gluten intolerance is very specific reaction and even a small amount can set it off. It can be diagnosed by blood work and sampling at colonoscopy.  Avoidance of gluten allows the lining of the gut to heal. 

If celiac disease proceeds unchecked, the lining of the bowel becomes overly permeable, giving rise to the so called " leaky gut. " The leaky gut is associated with various forms of autoimmunity, but it is not known whether it is the cause or the effect. Regardless, a leaky gut means poor digestion and increased inflammation. 

People without celiac disease can get a leaky gut. They may suffer from other chronic or autoimmune illnesses, or from high levels of chronic stress which influence the gut directly. They may simply have a very unhealthy diet or take in toxic substances like alcohol and tobacco which damage the lining of the gut, leading to a cascade of additional problems later. Again, it is unclear whether the leaky gut is the cause of the effect. 

According to Dr. David Rakel, Assistant Professor and Director of the Integrative Medicine Program, Department of Family Medicine, University of Wisconsin, Madison, treatment for a leaky gut includes the Four R's. 

The four R's are: 

1. Remove irritants

2. Replace enzyme agents 

3. Reinoculate with probiotics 

4. Repair the mucosal lining with exercise fiber and fluids. 

For more information, please see his excellent handout here. 

I hope this reduces concern about this hot topic. Just be aware, it is a relatively new area of study, and we do not yet have all the answers. Beware of any blanket prescriptions or quick fixes out on the market. And by all means, whatever you do, enjoy your meals. 

Structure Sunday: Holidays, the Happy Disruption

I have been meaning to write a post about how routine is the basis of all health maintenance.  It has to do with how small simple tasks repeated over and over in time, create health. Or wealth, for that matter. Everyone knows that small consistent contributions to a savings account make large gains over time. One could also argue that consistent routine is the basis of most work or creative productivity. 

But health is our wealth, and what I want to emphasize is the regularity of just a couple things: nutrition in three healthy meals and snacks, and regular 6 days per week of exercise. If these could be done simply, moderately, and consistently, without a lot of stress or fanfare, it would be awesome.

However, it is the holiday season. Holidays can be disruptive, to health, wealth, nutrition, exercise and work. And as you have seen, I am a bit off schedule in certain things. For example, I took some time off from the blog due to sheer merriment and kids being home from college. But I have been thinking about you all, and how you are faring, during this festive and sometimes disruptive season. 

Here are my simple suggestions for keeping the happy in the holidays. Try to keep to your exercise above all, especially since you're perhaps eating richer food this season. Even if you eat treats, such as those on this holiday table, don't fret. Sample them in moderation, by all means, but be sure to include healthy holiday food in the menu. 

And since it is the holiday season, I feel I can ask for a few more things. Have ice water or plain club soda on every table, and ladies, no more than one 8 ounce glass of beer, wine, or champagne per day. Try to sleep at least 7 hours per night. Finally, develop a holiday month plan, right down to gifts, wrapping, invitations, and meals. I am a big advocate of plotting all this on a calendar, and refining what works bests year after year.

Routines, large and small, will help you keep the holidays merry and bright. 

Medical Monday: A plague of pyelonephritis !

I don't know about other professions, but in medicine there is an old intern's tale that things come in threes. It can be ectopics, miscarriages, twins, or this last week : pyelonephritis. Pyelonephritis is infection in the kidneys. It's awful. But good news: it's easy to diagnose and treat. I might add, it's easy to prevent. 

What is it and how can it be prevented ? To start thinking about kidney infections, think first about bladder infections. They are very common. Women get them because their urethra is all of about 3 cm long and the bacteria in the area can ascend quite easily. Whenever there is irritation or dehydration, infection has a chance to set up.

An undiagnosed or neglected bladder infection simply ascends up the urethra to the kidney, and if the patient is dehydrated, run down, or otherwise compromised in some other way, she can develop a kidney infection. Forms of " other compromise"  include, but are not limited to, kidney stones, other illnesses or pregnancy. 

Bladder infections have the symptoms of burning, urgency, or difficulty voiding. They are diagnosed by symptoms and a dip test. They are easy to treat with tablets taken by mouth and generous hydration with water. 

Kidney infection symptoms are more systemic, including fever aches, nausea, and backache. These infections are deep within the body and have gotten through several defenses. They require IV antibiotics or shots, and good hydration. If a pregnant woman gets a kidney infection, she must be admitted to the hospital, usually for a few days. Pyelonephritis is linked with preterm labor. 

How can we prevent kidney and bladder infections ? First and foremost, hydrate well. Women need 2 liters of water a day, and pregnant women need 3 liters per day. A good rule of thumb is to keep your urine looking nearly clear. Urinate after sex. Keep yourself well rested and in a good general state of health. Finally, don't wait to call in if you think you might have a bladder infection. If you wait too long, you could get pyelonephritis. 

Medical Monday: Two newer vaccines in the spotlight

It's November, when rates of upper respiratory infection tends to rise. Everyone is tuned into the idea of getting a flu shot. Most people know that it's especially important for pregnant women. But did you know that the TDAP is now given in the latter part of pregnancy ?

TDAP vaccination has been proven safe and effective for prevention of pertussis. TDAP stands for tetanus diphtheria and PERTUSSIS, otherwise known as whooping cough. A relatively recent recommendation is to give it between 27 and 36 weeks of gestation. We don't wait until the end of pregnancy since we want there to be enough time for mom to create protective antibodies to pass to baby. That way, baby is protected against pertussis from the moment of birth. 

In other vaccine related news, the HPV vaccine rates are still lower than they should be. HPV stands for human papilloma virus, and it is cause of genital warts and cervical cancer. HPV vaccination should be given to both boys and girls around age 11-12. It is given in three doses over 6 months, and is very well tolerated. It can be given until 26 years of age. A recent report indicated that states with high vaccination rates have low cervical cancer rates, and visa versa. This is some of the first longer term data emerging from the HPV vaccine experience. Happily it is preventing disease as well as expected. We have just got to do more to promote its adoption. 

Source: Medline Plus from the National Library of Medicine.