Patient Education
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Patient Education Resources Patch "causes" Blood Clots? By Ian H. Taras, MD Below are excerpts from a news story from 11/05. My comments are in ALL-CAPS. Print Story: Warning Issued for Birth-Control Patch on Yahoo! News (AP) Until now, regulators and patch-maker Ortho McNeil, a Johnson and Johnson subsidiary, had maintained the patch was expected to be associated with similar risks as the pill. But a strongly worded warning was added to the patch label Thursday that says women using the patch will be exposed to about 60 percent more estrogen than those using typical birth control pills. MOST PILLS TODAY ARE AT THE 35 MCG LEVEL SO 60% MORE WOULD BE 56 MCG. THERE ARE STILL 50 MCG PILLS ON THE MARKET. THOUGH THEY ARE LESS POPULAR THAN THE 20-35 MCG PILLS. THE STUDY ALSO SHOWS THAT THE PEAK DOSE OF ESTROGEN IS 25% LOWER THAN THE 35 MCG PILLS (BECAUSE A PATCH IS STEADY INPUT AS OPPOSED TO PEAKS AND VALLEYS OF TAKING A PILL EVERY 24 HOURS), SO THE NET EFFECT MAY BE SOMETHING LIKE A 42 MCG PILL? Thursday's warning comes four months after The Associated Press reported that patch users die and suffer blood clots at a rate three times higher than women taking the pill. HOW MANY PEOPLE A YEAR GET BLOOD CLOTS (DVT)? 1-2/10,000 ON NO MEDICATIONS, 2-4/10,000 ON OCPS, 4-8/10,000 ON THE PATCH (IN THIS 1 STUDY WITH 2-4/10,000 IN ANOTHER STUDY), & ABOUT 10/10,000 IF YOU GET PREGNANT!!! TAKE HOME MESSAGE, GETTING PREGNANT CAN MORE THAN QUADRUPLE YOUR RISK FOR DVT! THAT IS HOW THE MEDIA CAN BIAS YOUR THINKING. Citing federal death and injury reports, the AP also found that about a dozen women, most in their late teens and early 20s, died in 2004 from blood clots believed to be related to the birth-control patch, and dozens more survived strokes and other clot-related problems. More than 4 million women have used the patch since it went on sale in 2002. ABOUT 1.2 MILLION PEOPLE USED THE PATCHES IN THE US IN 2004 SO IF 12 PEOPLE DIED FROM IT THAT IS 10 PEOPLE DIED FOR EVERY MILLION WHO USED THE PATCH. IF THAT IS 3X GREATER THAN THE PILL THEN THE PILL WOULD BE ABOUT 3-4 PEOPLE WHO DIED FOR EVERY MILLION WHO USED THE BIRTH CONTROL PILL. DOES THAT PUT IT IN PERSPECTIVE? DO YOU REALIZE THAT WHEN YOU ARE PREGNANT THAT YOUR RISK FOR BLOOD CLOTS IS 5X GREATER THAN THE REGULAR POPULATION? OTHER RISK FACTORS FOR BLOOD CLOTS INCLUDE: Immobility, Injuries, Inherited Clotting Disorders, Infections, Inflammatory Diseases, Pregnancy & Post-Partum, Oral Contraceptives, Cancer, Smoking, Obesity, Air Travel with Prolonged Sitting. THERE IS SOME UNDERLYING PREDISPOSITION THAT LEADS TO THE HYPERCOAGULABILITY. IN THE EARLY '90S THEY THOUGHT THAT ORTHO TRICYCLEN AND SOME OF THE OTHER NEWER PILLS HAD A DOUBLE INCIDENCE OF DVT; THAT WAS LATER ESSENTIALLY DISPROVEN. WHILE THIS NEW STUDY MAY OR MAY NOT BE ACCURATE, THE ABSOLUTE NUMBERS MUST BE ASSESSED IN THE FACE OF THE HEADLINE CATCHING "DOUBLE OR TRIPPLE THE RISK!" GOTO www.DVT.net FOR MORE INFO ON BLOOD CLOTS, RISK ASSESSMENT AND INFORMATION. Sincerely, Ian H. Taras, M.D., Ob/Gyn www.DrTaras.com Hormones, Breast Cancer & The Media By Ian H. Taras, M.D., Ob/Gyn July 10, 2002 TO MY PATIENTS: HORMONE REPLACEMENT THERAPY & THE MEDIA There has been much media hype in the last few days that have fueled patient concerns and worries. A colleague of mine fielded 163 calls today on this hot button topic of hormone replacement therapy (HRT), then stopped taking calls and referred them to a generic phone number. I thought it best to write down my thoughts, and also give you resources to better make informed decisions. If I were only allowed one statement it would be this: Do not change anything! This is not much a do about nothing, yet nonetheless fear-provoking percentages are being strewn about. The most recent study, which the media have been referring to, studied 27,000 women over the course of about 5 years. 16,000 of these women were taking combination estrogen & progestins or a placebo (sugar pill). All of the hype has to do with this arm (part) of the research. The other arm of this study was the 11,000 women randomized to estrogen alone (had a hysterectomy) or placebo. This part has none of the conclusions listed and in fact they continued the study because they did not find any increased risks. The most commonly prescribed and studied estrogen is Premarin and the most commonly prescribed combination HRT is PremPro, PremPhase or Premarin + Provera. Other combination HRT pills (patches and creams were not studied and may lead to different conclusions) include Activella, FemHRT, Prefest or ‘Natural’ Combination HRT but one can not extrapolate or make any new conclusions about these as they were not studied. THE GOOD: Combination HRT was found to reduce the risk of Colon Cancer and Osteoporosis hip fractures! The study showed a 37% reduction in colon cancer, where colon cancer is in the top 3 of cancer killers of women! This was a new benefit proven which had been postulated or thought of in the past. Osteoporosis prevention was one of the 3 major HRT indications. Though this was good news, it was no surprise. The other indications for HRT include prevention of menopausal symptoms (hot flashes, sweats, mood instability) and vaginal atrophy. All the other reasons from this study, good and bad, affect you in ways that you don’t feel on a daily basis… if you stop your HRT, these will return! THE BAD: Combination HRT (not estrogen alone in this study) can increase your chance for getting breast cancer, heart attacks and strokes. Here is where the confusion begins. A 26% increase for breast cancer would mean, for instance, that instead of the usual 32 women who get breast cancer for every 9968 women who do not get breast cancer, now there would be 40 women who get breast cancer for every 9960 women who do not get breast cancer. What is that in absolute (real) percentage increase? The study is talking about increasing your risk by LESS THAN 0.1 %!!! That is it! Sure any increase is bad, but did you know that most studies show that women who are on HRT when diagnosed with breast cancer, on average, have their cancers diagnosed earlier and more treatable? The same number ‘games’ can be said of the increase risk for the others. THE UGLY: In my relatively short time since graduation from medical school, 10 years ago, I have seen studies make splashy headlines one day and 6 months later, when time has been given to critically refute them, the retraction is given a paragraph buried on ‘page 38!’ My Father, Edward Taras, M.D., has been an Ob/Gyn for over 40 years and concurs with this observation. To put this study of 16,000 women in perspective, there have been approximately 400,000 women studied to date when it comes to HRT and Breast Cancer, and many of those studies have refuted these new findings! I urge you not to just go off your HRT! You can consult 1-800-4-CANCER or www.Cancer.gov, www.ACOG.org for more generic information, or Premarin’s parent company, Wyeth can be reached at (888) 797-5638 or (800) 934-5556 or www.Wyeth.com. This is an individualized concern and this letter tries to address a topic far to vast for a simple phone call or e-mail. If you wish to make an appointment, you can do so either with my Father or myself. Dr. Ed has more availability on Wednesdays and has agreed to see my patients on a consultation only basis, or you can wait to discuss it with me at your next regularly scheduled visit. I believe we should focus on finding a cure for breast cancer. To date our office has raised over $25,000 for breast and ovarian cancer research through the Revlon 5K Run/Walk for women. Last May we had 64 patients, family and friends join together and charter a bus to join 65,000 other runners and walkers to help raise money for research. Won’t you join us next year? Sincerely, Ian H. Taras, M.D., Ob/Gyn Hormones, Breast Cancer & The Media By Ian H. Taras, M.D., Ob/Gyn July 10, 2002 TO MY PATIENTS: HORMONE REPLACEMENT THERAPY & THE MEDIA There has been much media hype in the last few days that have fueled patient concerns and worries. A colleague of mine fielded 163 calls today on this hot button topic of hormone replacement therapy (HRT), then stopped taking calls and referred them to a generic phone number. I thought it best to write down my thoughts, and also give you resources to better make informed decisions. If I were only allowed one statement it would be this: Do not change anything! This is not much a do about nothing, yet nonetheless fear-provoking percentages are being strewn about. The most recent study, which the media have been referring to, studied 27,000 women over the course of about 5 years. 16,000 of these women were taking combination estrogen & progestins or a placebo (sugar pill). All of the hype has to do with this arm (part) of the research. The other arm of this study was the 11,000 women randomized to estrogen alone (had a hysterectomy) or placebo. This part has none of the conclusions listed and in fact they continued the study because they did not find any increased risks. The most commonly prescribed and studied estrogen is Premarin and the most commonly prescribed combination HRT is PremPro, PremPhase or Premarin + Provera. Other combination HRT pills (patches and creams were not studied and may lead to different conclusions) include Activella, FemHRT, Prefest or ‘Natural’ Combination HRT but one can not extrapolate or make any new conclusions about these as they were not studied. THE GOOD: Combination HRT was found to reduce the risk of Colon Cancer and Osteoporosis hip fractures! The study showed a 37% reduction in colon cancer, where colon cancer is in the top 3 of cancer killers of women! This was a new benefit proven which had been postulated or thought of in the past. Osteoporosis prevention was one of the 3 major HRT indications. Though this was good news, it was no surprise. The other indications for HRT include prevention of menopausal symptoms (hot flashes, sweats, mood instability) and vaginal atrophy. All the other reasons from this study, good and bad, affect you in ways that you don’t feel on a daily basis… if you stop your HRT, these will return! THE BAD: Combination HRT (not estrogen alone in this study) can increase your chance for getting breast cancer, heart attacks and strokes. Here is where the confusion begins. A 26% increase for breast cancer would mean, for instance, that instead of the usual 32 women who get breast cancer for every 9968 women who do not get breast cancer, now there would be 40 women who get breast cancer for every 9960 women who do not get breast cancer. What is that in absolute (real) percentage increase? The study is talking about increasing your risk by LESS THAN 0.1 %!!! That is it! Sure any increase is bad, but did you know that most studies show that women who are on HRT when diagnosed with breast cancer, on average, have their cancers diagnosed earlier and more treatable? The same number ‘games’ can be said of the increase risk for the others. THE UGLY: In my relatively short time since graduation from medical school, 10 years ago, I have seen studies make splashy headlines one day and 6 months later, when time has been given to critically refute them, the retraction is given a paragraph buried on ‘page 38!’ My Father, Edward Taras, M.D., has been an Ob/Gyn for over 40 years and concurs with this observation. To put this study of 16,000 women in perspective, there have been approximately 400,000 women studied to date when it comes to HRT and Breast Cancer, and many of those studies have refuted these new findings! I urge you not to just go off your HRT! You can consult 1-800-4-CANCER or www.Cancer.gov, www.ACOG.org for more generic information, or Premarin’s parent company, Wyeth can be reached at (888) 797-5638 or (800) 934-5556 or www.Wyeth.com. This is an individualized concern and this letter tries to address a topic far to vast for a simple phone call or e-mail. If you wish to make an appointment, you can do so either with my Father or myself. Dr. Ed has more availability on Wednesdays and has agreed to see my patients on a consultation only basis, or you can wait to discuss it with me at your next regularly scheduled visit. I believe we should focus on finding a cure for breast cancer. To date our office has raised over $25,000 for breast and ovarian cancer research through the Revlon 5K Run/Walk for women. Last May we had 64 patients, family and friends join together and charter a bus to join 65,000 other runners and walkers to help raise money for research. Won’t you join us next year? Sincerely, Ian H. Taras, M.D., Ob/Gyn HPV Vaccine-Dr. Taras' Thoughts By Ian H. Taras, MD This edition of the Taras Times comes as we close out the month of February '07 (the month of "Love") and turn into March (the month of "Luck"). Love & Luck are integrally linked to this special edition of the Taras Times... All about HPV! There has been increased media exposure about a 2006 vaccine breakthrough to attempt to eradicate HPV (Human Papilloma Virus) the sexually transmitted causative agent in over 90% of cervical cancers and abnormal Pap smears. The vaccine, Gardasil, is FDA approved for women 9-26 years old who have never had any HPV exposure. Gardasil covers 4 strains of HPV. Those 4 strains cover 70% of the cervical cancers and 90% of the genital warts of all the HPV prevalent strains (though there are over a hundred other HPV strains that make up the other minority). Of those 4 strains, 2 protect against genital warts and 2 protect against cervical changes that lead to abnormal Pap smears & eventually to cervical cancer. Four for the price of one! Definitions and interpretations: 1) Only the government can test for specific HPV strains, so "HPV naive" has been interpreted as someone who has not had sex. While this is the FDA approved indication, other authoritative bodies agree (like ACOG-American College of Ob/Gyns & ACS-American Cancer Society), just because you have had sex should not preclude you from getting the vaccine. Even if you have been told that you have HPV, we don't know which one(s) you have been exposed to & the vaccine can provide coverage against "the other 3"; you can still get benefit from getting the HPV vaccine, even if you have been exposed to HPV 2) How did they come up with 9-26? They had to pick some age so they could develop a study. It has to do with "immuno-competency" and age, but regardless... what if you are 27? Will it not work on you? Officially, they do not know, but realistically, again with the consensus of major colleges of thought, yes! There should be no age limit to trying it if the circumstances exist where you are not in a mutually monogamous relationship (you both don't cheat) that is & will be longstanding. I think that if you are "out there" on the dating scene, you are a candidate for this vaccine. 3) If men are 1/2 the cause of this HPV STD, then why aren't they getting the vaccine? The studies are ongoing for FDA approval, but I think that, well I hope that, men (boys) will be getting the vaccine in the near future. 4) I think that this vaccine is going to dramatically change gynecology for the better. There will be fewer abnormal Pap Smears and fewer visits for genital warts. Time magazine named it one of the top inventions of 2006. A school district in Texas made it mandatory for its female students, and as you know, I practice what I preach so that I can tell you that my 11 yo daughter will be getting it at her next check-up! We are not sure if it will protect a life time or maybe just 15 years, but it should be somewhere in between. My e-mail should not be considered an exhaustive source of info. I have a number of links on my web page and here are 2 that stand out: http://hpv.com/tell-someone/ http://www.cdc.gov/std/HPV/STDFact-HPV.htm COST & INSURANCE: "So doc, what's it going to cost me?" The used-car salesman in me (actually I have nothing against used-car salesmen & I do not have one living inside of me) would start by telling you about the thousands of dollars spent per person on abnormal pap smears and genital warts, but I will refrain in going into the details on that. The vaccine is given in 3 injection doses (can cause a few days of sore shoulder); when you start, you return 2 months later for the 2nd shot and 4 months later (6 months after the 1st) for the 3rd dose. You can have some doses here and some doses "there" (maybe college or moved out of the area) as long as you stay on a similar time table. The cost is $175/shot ( $525 for the series of 3). The insurance companies have not "announced" who they will cover and what they will pay. We have found that the 9-26 yo will have a better shot (no pun intended) at coverage as the insurance companies will always find a way to weasel their way out of covering healthcare! In addition, the reimbursement is often lower than our costs (they think that everyone can have "Costco buying power")! We will ask for payment up front before we administer the shot. We will then submit the claim for reimbursement to your insurance company (typically if they do cover it they reimburse somewhere between $140-$175/shot). If they do cover it we will credit your account for the difference. As with the Flu vaccines that we administer in the fall, our hope is that if you are a candidate you get it somewhere, regardless if it is not with us. But unlike the flu shots, we will only be administering the vaccines to our patients (new or established) & only during patient appointments (you can make an appointment for the vaccine or you can have it done as part of another unrelated appointment); in case there is a "run" on this, call the day before to make sure we have it in stock. Please call Karla (front office), Lana (back office) or RaeAnne (office manager) for more details, but check out those links above 1st! How I selected a cord blood bank for my sonBy Tarrnie Williams Oct 4th, 2002 Disclaimer: This article is written solely to let others know about my experience in deciding which cord blood bank to use. I am not a medical professional, do not have any formal medical training, and I do not profess that any of the below knowledge is accurate beyond what I remember and experienced to be true. While I do recommend the cord blood bank we decided to use, I do not have any comment about any of the others beyond the reasons why I made my decision. So if you are looking, please select a cord blood bank as you see fit, I am sure they are all good choices. This information was gathered in the spring and summer of 2002. (IT HAS BEEN MODIFIED, IN CAPS., ON 2/3/4 BY DR. IAN TARAS)I first heard about cord blood banking via a pamphlet handed to us by our OB and I was immediately interested. I’ve always had more than a passing interest in advancing medical technology, especially in areas focused on combating diseases and increasing longevity, and the idea of cord blood fit right into this category. The idea that we could bank our child’s blood now, and then use that blood in the future to cure an otherwise incurable disease for him or possibly even us was very attractive. With my interest piqued, I immediately did what I always do when I want to know more about a subject – I hit the Internet. For me, the Internet is where I do all my preliminary research on any topic and there is a great deal of information about cord blood available online. I started with the company in the pamphlet, Cord Blood Registry, visited their site (www.cordblood.com), and found they have a great deal of good information not just about their services, but about cord blood banking in general. I then proceeded to look at some of the other competing companies including Viacord (www.viacord.com), Life Bank (www.lifebank.com), (CALIFORNIA CRYOBANK – WWW.CRYOBANK.COM), Cryo Cell (www.cryo-cell.com) and a few others. I also started reading some articles on cord blood in an attempt to determine which was the best company and why. Viacord and Cord Blood Registry certainly seem to do the most as we received a great deal of literature from each of them in the mail. One of the commonly posed questions about cord blood banking is whether you should bank your baby’s blood at all. The statistics say that the chance the blood will be used is somewhere between 1 in 5,000 to 1 in 200,000. The American Academy of Pediatrics (www.aap.com) currently does not recommend banking your cord blood due to the low chance it will be used - unless you currently have a family member with a possibly treatable condition. From my standpoint however, any chance to increase my son’s odds of conquering any potentially horrible disease was worth pursuing so my decision to bank my son’s blood was resolute. Whenever I shop for something, I always try to determine what the best choice is first, independent of cost. Then I’ll take a look at the cost and finally make a decision. For me, quality is worth the extra money. The question of course, was how to determine quality. At this point I had gained quite a bit of knowledge about cord blood banking, and from reading the information on each companies web site I had mostly determined what different factors each bank considered to be important. However, as each of the companies that banks cord blood essentially says they are the best, determining how to make a qualitative decision was difficult so I came up with a list of questions and the corresponding answers I decided I was looking for.
I started with Life Bank since they had a facility in my hometown of Vancouver, Canada. When I phoned them I got an answering machine that told me to leave a message. As far as I was concerned, this ruled them out. If my son needs medical help and needs his blood at some point in the future, there had better be a person on the other end of that line whenever I call. I dialed Viacord next, and after talking with them for a while, determined that they did not separate the stem cells from the red blood cells prior to storage. As mentioned above, I had decided that I preferred separation so I ruled Viacord out based on this factor. Additionally, Viacord doesn’t own their own storage facility, and this was another strike against them. I phoned Cord Blood Registry third, and they pretty much passed the questions with flying colors. They use a syringe for collection (or gravity bag), own their own storage facility, store the specimen in multiple containers, and seem to be a stable company. Their costs were $295 to enroll, $995 for processing and banking, and $95 per year thereafter. (NOW $1,740 TOTAL - INCLUDES SHIPPING AS WELL AS A $125 REBATE FOR DOCTOR’S COLLECTION FEES - & $95 PER YEAR STORAGE) (CALIFORNIA CRYOBANK, INC. $690 INITIAL - DOES NOT INCLUDE SHIPPING OR REBATE & $85 PER YEAR STORAGE) Last was Cryo-Cell. I almost didn’t phone Cryo-Cell as they were too inexpensive for my tastes, but I decided to call them anyway. They had the best customer service of the group and passed the set of questions with flying colors too, although they do use a Gravity Bag rather than a syringe. Their costs were $275 for processing and $50 per year thereafter – dramatically less expensive than any of the others. (NOW $595 INITIAL – DOES NOT INCLUDE SHIPPING OR REBATE - & $90 PER YEAR STORAGE) Around this time I asked our OB whether he knew which was best and he replied that he really didn’t. I received the same answer in our birthing class, and it appeared I had discovered at least as much information as was generally known about this new field. After conferring with my better half, we decided there really wasn’t any good reason to go with the more expensive services so we picked Cryo-Cell. I signed up the next day and received the kit shortly thereafter. Come the day of the birth we took the kit in with us, informed the duty nurse that we would be banking our son’s cord blood, and she informed us that she knew what to do. The birth was wonderful, the cord blood was collected, the courier came and picked up the package and sent it off to Cryo-Cell where they confirmed the arrival. The whole process was as simple as it could possibly have been and Cryo-Cell were helpful the whole way through – even when I phoned them to let them know I accidentally discarded the courier box I was meant to use. I can recommend Cryo-Cell without any reservations to anyone who has made the decision to bank their child’s cord blood as our experience was wholly positive. Good luck! Addendum (2/3/4) By Dr. Ian Taras: TO DATE CBR (CORD BLOOD REGISTRY) REMAINS THE FOUNDER AND LEADER IN THIS INDUSTRY. IT HAS MORE TRANSFUSIONS THAN THE ALL THE OTHERS COMBINED FROM ITS OWN – OWNED – LAB FACILITY. IT IS FINANCIALLY STABLE & SOLVENT. THESE ARE TWO MORE OF MANY ASPECTS TO LOOK AT. BANKING CORD BLOOD IS LIKE BUYING ANY OTHER PIECE OF INSURANCE; YOU HOPE YOU NEVER NEED IT, SHOULD NEVER COUNT IT AS A WASTE IF YOU DON’T, BUT ARE VERY RELIEVED IF YOU DO! IF YOU DO NEED A CBR COLLECTION KIT, I HAVE THEM IN THE OFFICE (I DO NOT HAVE KITS FROM THE OTHER COMPANIES) AND, IN FACT, IT IS EASIER FOR ME TO GIVE YOU THE KIT, EVEN IF YOU ARE YET NOT SURE THAT YOU WANT TO DO IT, THAN FOR YOU TO HAVE THEM MAIL YOU THE KIT. JUST ASK v
www.DrTaras.com - FAQ in Pregnancy - 818-887-0050 v
Headache Ø Tylenol & Tylenol Extra
Strength is safe for pregnancy as directed. Ø Make sure you are drinking
plenty of water. Ø Use cold washcloth on your
forehead and temples. Ø Rest! v
Sleep Ø Rest when you can. Ø Get things out of your mind
before you go to sleep. §
If
you are worried you are going to forget something, then write it down. Ø Tylenol PM 1-2 pills or
Benadryl Allergy 25-50 mg, as directed, is safe for pregnancy. §
A
side effect is drowsiness, which is okay, especially at night. v
Dizziness Ø Make sure you are drinking
plenty of water. Ø Eat small frequent snacks to
keep your blood sugar up. Ø Don’t change your position
too quickly (i.e. Lying or sitting to standing or walking). Ø After 7 months lie on your
side (right or left) rather than on your back for long periods of time. Ø If you feel faint, lie down
flat and elevate your feet with pillows so blood will rush to your head. §
Even
if you are in a store and embarrassed. v
Nasal Congestion Ø Use/Buy an inexpensive
humidifier. Ø Be patient. Colds in pregnancy tend to be worse and last
longer. Ø Make sure you are drinking
plenty of water. Ø Use Vitamin C and Zinc over
the counter as directed. Ø Benadryl Allergy 25-50 mg,
as directed, is safe for pregnancy. §
A
side effect is drowsiness, which is okay, especially at night. v
Cough Ø Use/Buy an inexpensive
humidifier. Ø Robitussin DM, over the
counter, is safe, as directed. Ø Gargle with salt water, or
buy over the counter cough drops. v
Breast Feeding / Nursing Ø Getting your milk to flow
before you put your baby to your breast can help. §
You
can do this with a warm shower or compress and nipple stimulation. Ø Frequent nursing and varying
the baby’s position on the breast can relieve engorgement. Ø Use a low-wattage (<40W)
light bulb as a heat lamp to aid in healing cracked nipples. §
Expose
your nipples to the heat for about 10 minutes, from about 18 inches away. ·
You
can do this several times a day. Ø If you are frustrated, you
can call the lactation consultant from the hospital. §
West
Hills Maternity: 818-676-4157 §
Tarzana
Maternity: 818-609-2200 v
Nausea Ø The smell of lemon squirted
on food or in drinks helps alleviate nausea. Ø Eat multiple small meals
instead of 3 large ones. §
Saltine
crackers and clear soups are easier to tolerate. Ø Increase your water intake
and worry less about your food intake. §
If
your vitamin makes you nauseous, ask to change it. Ø You can buy Emetrol liquid
& wristbands with pressure points (Sea Bands) over the counter. §
Ask
about www.ReliefBand.com or Bendectin if still no help. v
Heartburn / Indigestion Ø Sleep with your head
elevated with pillows. Ø Eliminate highly seasoned
foods, fatty foods, chocolate and other products with caffeine. Ø Over the counter products
are safe including: Tums, Maalox,
Mylanta, Pepcid AC and Zantac. v
Backache Ø Use proper lifting
technique. §
Bend
your knees!!! §
Epidural
does not give you a backache. Ø Maintain good posture and
buy over the counter insoles as needed. §
Wear
flat-healed shoes. Ø Sleep with pillow support
under and between your legs. Ø Apply warm heat to the lower
back as needed. Ø Swim and exercise. §
Ask
the office for specific, “Pregnant Back Exercises” work sheet. v
Pelvic Pain Ø Make sure you are drinking
plenty of water. Ø Rest often! Ø Tylenol & Tylenol Extra
Strength is safe for pregnancy as directed. §
Consult
the “Labor Precautions” sheet for more information. Ø Get regular exercise. §
The
Pregna-Gym (818-226-3656) is a great place! v
Urinary Frequency Ø Do not curtail your fluid
intake. Ø Lean forward while
urinating. This may get more of the
urine out of your bladder. v
Vaginal Infections Ø See Dr. Taras. These may not be yeast infections. §
Some
yeast / Candida species are resistant to over the counter anti-yeast
medications. v
Diarrhea Ø Make sure you are drinking
plenty of water. Ø Over the counter Imodium AD
is safe. §
Pepto-Bismol
is NOT safe! v
Hemorrhoids Ø Establish a good diet that
contains plenty of water, citrus fruits, and roughage. Ø Avoid straining when
defecating. Ø “Sitz Bath”= Sit in a
bathtub filled with approximately 4 inches of warm water. §
Allow
the water to continuously run as it flows out. Ø Use Preparation H or Anusol,
over the counter creams or suppositories.
They are safe. v
Still have questions? Ø Write them down and bring
the list with you to your appointment. Ø Leave a general message on
the voice mail. Ø Fax or e-mail me your
question. |
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