Author: Jeanne Sager

Categories
Health x Body Wellbeing

Symptoms Of Crohn's Disease That Should Not Be Ignored

When Heather Sliwinski is out in public, people don’t see her as sick. The Crohn’s disease symptoms and side effects that can make living with the chronic condition debilitating at times are largely invisible.
“I’ve been sitting on the bus before on a bad day—in pain and sick—and told by a stranger that I shouldn’t be sitting, that I should give up my seat to someone else who needs it because I’m a younger, seemingly healthy individual,” the PR professional from San Francisco says. “What they couldn’t see is that I was in pain, sick, and terrified that I may have an accident. Who wants to tell a stranger that they have diarrhea to justify taking up a seat on the bus?”
An estimated 1.6 million Americans are walking around with some type of inflammatory bowel diseases (IBD), a classification that includes both Crohn’s and colitis. These diseases are typically diagnosed before someone hits their thirties, and they’re chronic. There is no cure for Crohn’s.
And yet, myths about Crohn’s disease, its symptoms, and what will happen to those diagnosed run rampant. Here’s what the experts say is really going on in the gastrointestinal tract of people like Sliwinski and what to do if you think you might be experiencing symptoms of Crohn’s disease.

What is Crohn’s disease?

Before you can consider whether or not you have Crohn’s disease, you need to know what Crohn’s disease is, right?
Ramona Rajapakse, MD, a gastroenterologist and director of the Inflammatory Bowel Disease Center (IBD) at Stony Brook Medicine, describes Crohn’s as an inflammatory condition of the gastrointestinal (GI) tract, the system of organs that stretches from the mouth all the way to the anus.
Although sometimes confused with colitis, which refers to an inflammation of the inner lining of the colon, Crohn’s disease is its own separate condition. Setting it apart from colitis are a number of factors, including the fact that Crohn’s can affect all layers of the bowel wall and can appear anywhere along the GI tract. What’s more, Crohn’s disease can do something doctors call “skip,” meaning there may be sections of the bowel affected by Crohn’s with perfectly healthy, normal tissue in between them.

What causes Crohn’s disease?

Despite the large numbers of Crohn’s sufferers in America, the cause of the disease still stumps doctors, says Meenakshi Bewtra, MD, a gastroenterologist and assistant professor of medicine at the Hospital of the University of Pennsylvania.
“We really don’t understand what causes Crohn’s disease (CD), but we currently believe it is an interplay between some unidentified environmental factor, a dysregulated immune system, a change in the gut microbiome, and some genetic factors,” Bewtra says. “Unfortunately, we haven’t figured out what any one of these are, let alone what combination causes CD.  So I try and also make sure that [patients know they] did nothing to cause this—either to themselves or to their children. They are not responsible for this.”
The one and only risk factor that doctors can point to is heredity: There’s a higher incidence of Crohn’s for people who have a family member with the disease. And yet, even having a parent, grandparent, or sibling with the disease is no guarantee that you’ll end up with a Crohn’s diagnosis, nor does everyone with Crohn’s have a family history to report to their doctor.
People with Crohn’s disease often ask Bewtra if the disease can be passed on to their children, and to that she says absolutely not.
“While there does seem to be some genetics at play, I caution against not having children if that is something a patient wants simply because they fear passing on CD,” she says. “There are plenty of children with CD who do not have parents with CD, and there are plenty of parents with CD who do not have children with CD.”

What are the Crohn’s disease symptoms to look for?

Crohn’s disease can be silent for a long time before someone, or their doctors, make the connection and reach a diagnosis. This is in part because symptoms vary from patient to patient, Rajapakse says.
When Amanda Semenoff was finally diagnosed with Crohn’s disease more than a decade ago, she realized the symptoms had been present and slowly creeping up for a long time.
“Diagnosis took more than two years, and my symptoms were pretty extreme by the time they figured it out,” the mediator from New Westminster, British Columbia, tells HealthyWay. In that time, Semenoff had lost more than 100 pounds and found herself too weak to climb stairs without lying down about halfway up to rebuild her strength.
Even now, she has fuzzy memories of those two years due to a perpetual brain fog, coupled with stomach ulcers, bleeding rectal fissures, and near constant vomiting.
For Sliwinski, the path to diagnosis was even longer and likewise fraught with complications.
“The onset of my symptoms was in 2010. I was managing, and I had been told by my primary care physician that I had irritable bowel syndrome (IBS), so I was used to having multiple bowel movements a day,” she recalls. “But it got to the point where I couldn’t finish a meal without having to run to the bathroom.”
A year after the onset of symptoms, she landed in the hospital with high fever, extreme abdominal pain, and diarrhea. When she noticed blood in her stool, Sliwinski says she knew there was something more than IBS going on. Still, it wasn’t until 2013 that she finally got the answer: Crohn’s disease.
While the effects of Crohn’s do vary from person to person, the Crohn’s & Colitis Foundation suggests keeping an eye out for the following Crohn’s symptoms:

  • Persistent diarrhea
  • Rectal bleeding
  • Urgent need to move bowels
  • Abdominal cramps and pain
  • Sensation of incomplete evacuation (of your bowels)
  • Constipation (can lead to bowel obstruction)
  • Fever
  • Loss of appetite
  • Weight loss
  • Fatigue
  • Night sweats
  • Loss of normal menstrual cycle

Although it’s typically diagnosed in one’s twenties or thirties, Crohn’s can show up in younger kids as well, and failure to grow is a major indicator, says Ashkan Farhadi, MD, a gastroenterologist at MemorialCare Orange Coast Medical Center and director of MemorialCare Medical Group’s Digestive Disease Project in Fountain Valley, California.

How is Crohn’s disease diagnosed?

Crohn’s can take months or even years to diagnose in part because it manifests itself differently from patient to patient. But it’s also a complex condition to diagnose, Farhadi says.
Crohn’s disease is diagnosed based on a series of tests. First, Farhadi says, there are clinical findings—basically examination by a doctor and review of your medical history. Next a potential Crohn’s patient will undergo imaging, be it CT scan or MRI. Typically an endoscopy—a procedure in which the digestive tract is viewed via a miniscule camera inserted into the tract (or sometimes swallowed by a patient)—will be done to give doctors a look at what’s going on in the GI tract. Finally, biopsies may be taken, and the tissues will be reviewed to determine if there’s inflammation or other issues.
In addition to the GI tract itself, a doctor may look at other parts of the body. That’s because Crohn’s disease is what Bewtra calls a full-body disease. “There are other parts of the body such as the eyes, liver, bones, etc. that can also be affected, sometimes even if the patient feels otherwise well,” she notes.

What happens if you’re diagnosed with Crohn’s disease?

A Crohn’s diagnosis is a major step to feeling better, but just how quickly you will get there depends on the severity of the disease.
Typically the first step is medication, Farhadi says. Short-acting steroids may be used in order to get the inflammation of the GI tract to calm down, offering relief from pain. Other medications prescribed, called immuno-modulators, may be focused on getting the body’s immune system in check.
“It’s an autoimmune disease; the immune system is acting against its own GI tract,” Farhadi explains.
For some patients, diet and other lifestyle changes will be necessary to help the gut heal. Those changes could be temporary or long-term.
Surgery is typically kept as a last resort, but it’s also on the table for some patients with Crohn’s disease. Sometimes that means taking out an inflamed section of the GI tract, Farhadi says. Other times it means going in to perform a stricturoplasty, a procedure that removes scar tissue in the intestinal tract that has built up due to chronic inflammation. Removing that tissue can help waste flow more smoothly through the bowels and reduce a patient’s pain.
The most common surgery for Crohn’s disease is the treatment of a fistula, a tunnel created when inflammation works its way through the walls of the intestines.  
For Semenoff, treatment was long and extreme.
“It took three years for me to get to functioning at all,” she recalls. “Hospitalizations, procedures, all kinds of crazy medications and weird diets, journaling, massage therapy, supplements, and many doctors. Some of it worked, but in some spaces it isn’t as obvious. My Crohn’s is now mostly in remission and controlled by avoiding my trigger foods, some fasting, and basic self-care.”
Remission is exactly what doctors shoot for when they treat people with Crohn’s disease. “We don’t cure it,” Rajapaske says. “We control it.”
It’s a disease that waxes and wanes, she adds. Weeks, months, or even years with no pain or intestinal issues can be followed by what’s called a flare-up, a sudden reactivation of symptoms. Sometimes patients can go for lengthy periods of times living medicine-free or eating what they want, but they’ll need to return to their doctor for treatment if Crohn’s rears its ugly head again.
[pullquote align=”center”]“Despite all of this—and it is scary and overwhelming—our primary goal in IBD care is to make sure that the patient can live the life they want to live.”
—Meenakshi Bewtra[/pullquote]
“When someone is in a flare … they can have terrible abdominal pain—it’s hard to describe how it feels, but it is relentless,” Bewtra says. “Sometimes it feels better temporarily after going to the bathroom, but it always comes back. They can go to the bathroom every hour—even though sometimes they only pass a little mucus or maybe some blood. They are fatigued and may even have a low grade fever. They cannot participate in normal activities—they simply do not feel well enough.”
It’s a fact that Slewinski knows all too well, but she’s found power in taking charge of her own health. Being diagnosed with Crohn’s has given her the tools she needed to go the next step and find the treatments that work for her body.
“I still have bad days here and there, but the good days greatly outweigh the bad. I can’t guarantee these therapies will work for everyone, in whole or in part, but I’ve learned to become the CEO of my own health, so to speak, and that has helped me figure out a mix of treatments that work for me,” she says. “So eight years into my IBD, I’m managing with diet and lifestyle changes, as well as keeping my anxiety in check, since we know the gut/brain connection is strong. I’m always looking at other alternative therapies that could improve my quality of life.”

How can you get help with Crohn’s disease?

Diagnosis of Crohn’s disease is typically made by a gastroenterologist, so if you think you have Crohn’s disease symptoms, it’s best to talk to your general practitioner about a referral.
Bewtra not only treats the disease but also battles Crohn’s herself, and she encourages her patients to be open and honest with their doctors.
“Despite all of this—and it is scary and overwhelming—our primary goal in IBD care is to make sure that the patient can live the life they want to live,” she says. “I really try to emphasize that there may be times of greater challenge, times when goals may need to be put on hold, but every physician I know tries to emphasize that our goal is that they live the life they want, be it volunteering in a [developing] country, working in a hospital, teaching preschool, running a business, etc.”
If you are diagnosed, the road ahead doesn’t have to be walked alone. The Crohn’s & Colitis Foundation offers online support groups as well as information on how to find in-person groups in your area. The foundation also runs a program called Team Challenge, a fundraising effort to not only help provide services to people with Crohn’s disease but also to fund research.
“The program has become more than just a fundraising and advocacy effort for me, but an extended family for a shoulder to lean on when times get tough,” Slewinski says. “I’m sure anyone else who has found the organization would say the same thing.”

Categories
More Than Mom Motherhood

How To Find A Babysitter Your Kids Will Love (And You Will Too)

If there’s one thing just about every parent on the playground will agree on, it’s this: If you can find a babysitter who you trust and your kids love, you hold on to that sitter’s number harder than your kid holds on to his favorite stuffie when you say it’s time for the toy to take bath.
No matter how easygoing you are, it can be tough to find a good babysitter who makes you feel like you can actually relax when you’re out of the house. And you’re not alone in this struggle: A recent American Red Cross survey determined at least 55 percent of parents have had to stay home from an event because they couldn’t find a sitter when they needed one, and 30 percent said they’ve rejected a potential babysitter because of safety concerns.
But you don’t have to give up on chasing down that rare unicorn non-parents call “date night” or ever holding down a job just because you can’t find someone you can trust to spend time with your kids. The right sitter is out there! Here’s how to find one.

How to Find a Babysitter: Where to Start

Before you can start scheduling sitter interviews (yup, they’re a thing), you need to figure out what you’re looking for!
Some questions to ask yourself:

How often will I need a babysitter?

A neighborhood teen may be able to pop over one night a month so you can sneak out for dinner with your partner. But if you need someone who can pick your kids up from school, help them with their homework, and get dinner started before you get home from work, you may want to look for a college student or someone who is retired and looking for something to do in the afternoons.

What do my kids need?

If you’ve got a small infant, you’ll likely want to steer clear of young teens and find a babysitter with experience caring for small children, such as a childhood development student at the local college or another parent who happens to stay at home. If your child is in elementary school and already able to make a PB&J sandwich and wipe their own heinie, a local teen may be the perfect person to hang out with them for a few hours on a Saturday afternoon.

What will I need a babysitter to do?

If you’ll need a sitter who can drive your kids home from school, you can automatically cross that 14-year-old across the street off your list!
[pullquote align=”center”]Figuring out the what is a big first step in helping you find the who in your babysitting search.[/pullquote] 
If you’re hoping that your sitter will be up for teaching your child a skill such as swimming, you might decide to hit the local pool to see if the lifeguards are looking for extra work.
Figuring out the what is a big first step in helping you find the who in your babysitting search.

Where to Find a Babysitter

The Banks family had it made when Mary Poppins flew into town just when they needed a nanny. Unfortunately babysitters with magical umbrellas are in short supply these days, so you’ll have to stick to these tricks to find a babysitter.

Use a babysitting agency.

Whether it’s an online service such as SitterCity or Care.com or a more traditional agency that exists in a brick-and-mortar location, babysitter agencies are like matchmakers for parents. They recruit qualified babysitters and match them with parents who need their services.
They can be a quick way to find someone you love, but you should still do your own due diligence, says Florence Ann Romano, a former nanny and founder of The Windy City Nanny.
“Make sure you are doing your own research on whomever they are matching you with; in other words, stalk them on social media!” Romano says. “See what they have on their Facebook, Instagram, Twitter, etc.”
You can also have a professional background check run on your potential sitter or ask the agency to provide details of how deep their checks went.
“Don’t rely just on the agency to do a background check that is surface level,” Romano advises. “Some of these agencies don’t dive deep enough, and I have seen it happen before that they won’t catch, for instance, a DUI on someone’s record but will clear them for service!”

Ask your friends about their babysitters.

They may be willing to share the numbers of trusted sitters who they’ve already vetted, or they may offer up names of their own kids (who you like and trust) who’ve taken babysitter certification courses.
If none of your friends have sitter names to offer up, they may be willing to do the job themselves. A local parent in your area might be able to use a little extra cash, making her the perfect choice. Or you could offer to set up a sitter swap situation: One parent or set of parents watches all the kids one night, and you return the favor a few days later so they can get their own night out. The kids get playdates and the parents get real dates—everyone wins!

Try a babysitting app.

Sites like Care.com and SitterCity have apps, and they’ve got the more traditional agency model behind them, but they’re not the only game in town these days.
Sitting Around, for example, can hook you up with other parents in your community who are interested in creating a babysitting co-op. Although there’s a fee for membership, the babysitting itself is free.
Sitter and Bubble let you view the sitters of other friends (so long as they also use the app), so you can find sitters that your friends like without having to actually…well…talk to your friends.
TaskRabbit, on the other hand, was designed as an app to connect folks with people who need help on a variety of errands, not just babysitting. That said, babysitting makes the list, and you may find your perfect sitter with a few swipes.  
Kango, meanwhile, offers not just babysitting but ridesharing too, so you can find someone who will do that daycare or preschool drop-off.

Hit your local college campus.

Whether you go the old-fashioned flier route or call the childhood development department to see if they can suggest any students looking for jobs, a college in your area may be prime pickings for babysitters.

Ask coaches and teachers.

Your daughter’s karate sensei, your son’s hip hop teacher, their soccer coach—they all work with kids, and they’ve likely got a few good names up their sleeves. Whether it’s current or former students or maybe even someone on their staff, you get the added bonus of knowing that someone you already trust with your child has vouched for your potential babysitter.

What to Look for in a Babysitter

Once you’ve gotten a few names, it’s time for a job interview. Hey, you’re going to pay this person to babysit your kids, so why shouldn’t they have to undergo an interview process?
Romano suggests at least two in-person meetings, one that involves just you and the babysitter, then (if they pass muster) another with your kids involved.
“The first time, meet them for coffee outside your home and get to know them,” Romano suggests. “Then, if you like them, bring them into the home to meet your kids; do a trial morning/afternoon. Observe him or her with your kids.”
Sara Schaer, co-founder and CEO of Kango, suggests asking your potential sitter a round of questions, including:

  • Do they have experience and affinity for a particular age group? If you have an infant or a toddler, make sure you specifically ask if they have experience with that age group, Schaer advises.  
  • What is their motivation for babysitting? Some babysitters are just in it for the cash, but you’ll want to find someone who genuinely likes spending time with kids.
  • What is their safety training? Ask if your sitter is CPR certified and if they’ve taken any other babysitting courses, such as those offered by the American Red Cross.
  • How would they handle an emergency? Schaer recommends that you provide an example of an emergency that might crop up and ask them to provide a solution on the fly.
  • Do they have a clean criminal record, and are they willing to be background checked (including fingerprinting)? “Candidates who have an issue on their record will often remove themselves from consideration if they know this is a potential requirement,” Schaer says.
  • Do they drive, and if so do they have a clean driving record? This may not apply to all sitters, such as a young teen, but it’s a must if you’re hoping to find a babysitter who will drive your kids around town.
  • Do you have any references? It’s not enough to just ask for references; you need to follow up! Checking references is a must, Schaer says.

What to Pay a Babysitter

Once you’ve lined up the perfect sitter, let’s face it, you’re going to have to figure out how much to pay the babysitter who’s spending time with your kids.
You certainly want to pay them enough to make the job worthwhile (and keep them coming back), but how do you know if you’re underpaying or overpaying?
According to the American Red Cross survey, about half (51 percent) of Americans rely on unpaid babysitters, and nearly a quarter (24 percent) pay between $6 and $10 an hour for someone to watch their children. Ten percent pay between $11 and $15 an hour, while 4 percent pay between $16 and $20 an hour.

Babysitting Pay Rates Around the Country

When HealthyWay asked parents across the country to share just how much they’re laying out every time a babysitter shows up on their doorstep, the numbers were just as varied…but so were family situations. Some folks pay teenagers significantly less than they do adults, while others paid teens more than they would the grandmotherly lady down the street.
Stamford, Connecticut: $20 per hour to watch a 3½-year-old, including school pickups.
Atlanta, Georgia: $12 to $14 per hour to watch four kids ages 3 to 7.
Cleveland, Ohio: $10 an hour to watch a 9-year-old.
Chicago, Illinois: $15 an hour for an older lady to watch two kids, ages 2½ and 6 months. $12 an hour for a teenager to watch the same kids.
North Charleston, South Carolina: $10 per hour to watch one 4-year-old.
Western Washington State: $10 to $15 an hour for a preschool teacher who babysits on the side.
Los Angeles, California: $22 an hour for an experienced nanny to watch one kid regardless of age.
Still struggling to come up with a good rate? Care.com offers a babysitting rate guide based on zip code and experience of the sitter.

How to Help Your Babysitter

Of course, you want to find a babysitter who can help you with your kids, but if you want to really make sure your kids have a good experience, it’s on you to help your sitter.
Part of that is how you greet your sitter when they walk in the door, says Rachel Charlupski, founder of The Babysitting Company.
“Parents should also not expect their children to warm up to the sitter if the parent is cold and not friendly with the sitter,” she says. “We always recommend parents being very animated and welcoming to the sitter.”
Sitters also need to be prepped, Charlupski says. You can’t expect them to come into your house and know the rules of your home or read your mind about your expectations.
Schaer suggests being up front with your babysitter about what you expect out of them, and be aware of what’s not considered “normal” duties for a sitter.
[pullquote align=”center”]“Predictability and familiarity are reassuring to kids … so parents should make every effort to ensure that.”
—Sara Schaer[/pullquote]
“Quality, engaging, and age-appropriate childcare; safety; courtesy; compliance with parent instructions and household rules; good judgment; and honest, proactive, and professional communication with parents can all be expected,” Schaer says.
But any of the following are not considered typical “job expectations” of a babysitter, and you’ll need to make a deal with your sitter if you want them done as well:

  • Stand-alone extensive housecleaning beyond tidying up and cleaning any areas used during the sitter job
  • Caring for a different number of children than originally stated or an unreasonably large group of unattended kids
  • Babysitting for a completely different duration than requested (e.g., several hours past the initially stated end time)
  • Excessive medical responsibility (parents/guardians need to authorize medical treatment)
  • Tutoring or academic work if not explicitly included and agreed on first
  • Pet care if not explicitly mentioned and agreed on in advance

Before leaving your children alone with a sitter, you’ll also need to write out a complete list of information that they might need during their time with your kids, including:

  • Guidelines and limits for outings, screen time, and homework
  • Meal information
  • Bedtime rules
  • Allergy information and/or other medical conditions
  • Behavioral triggers or routines
  • Likes and dislikes
  • Contact numbers for parents, as well as pediatrician and other emergency numbers

“Predictability and familiarity are reassuring to kids (in addition to quality care and safety), so parents should make every effort to ensure that,” Schaer notes.
Romano offers up this final piece of advice: “Don’t compete with the sitter. Remember that they are another person to love and guide your child. It’s another person to shape them and inspire them. Choose wisely! If you do, it will be a beautiful thing.”

Categories
Healthy Pregnancy Motherhood

Early Signs Of Labor That Might Mean Baby Is Coming

Being pregnant—especially if it’s your first pregnancy—is like wandering into a whole new frontier with your phone’s map app open only to find out you’ve got spotty service. You’ll get all the information eventually, but it feels like it comes at you in bits and pieces. Case in point: the signs of labor.
Maybe your best friend told you she knew she was in labor the second she spotted some blood in her undies. But what about that woman in your prenatal yoga class who said she always knows she’s ready to deliver when she starts vomiting? And aren’t pregnant women in the movies always going into labor with dramatic gushes of amniotic fluid?
If all those stories (and over-the-top dramatic scenes) have you confused about what really happens when you go into labor, you’re not alone.
The truth is, everyone experiences labor differently, says Mary Fleming, MD, an OB-GYN and attending physician at Einstein Medical Center Montgomery in East Norriton, Pennsylvania.
“For some it is a gradual process that occurs over weeks; others may not perceive any discomfort until active labor ensues,” Fleming says.  
So how will you know when you’re in labor? And what signs of labor mean it’s time to call the doctor? Here’s what the experts have to say.

Signs Your Body Is Getting Ready for Labor

The goal of every pregnancy is to reach labor, that time when your body is readying for delivery, or the actual arrival of baby. For most folks, that happens sometime after the 37th week of pregnancy, which is what doctors call term labor or sometimes full-term labor.
That said, labor can happen any time after 20 weeks of pregnancy, says Jimmy Belotte, MD, PhD, interim medical director in the division of general OB-GYN at Montefiore Health System in New York. “When it occurs between 20 weeks and 36 weeks + 6 days, it is referred to as preterm labor.”
Just when it will happen is hard to say, Belotte explains, as every pregnancy is as different as the parent and baby involved.
But there are signs that your body is getting ready to go into labor.

Signs of Labor: When Baby Drops

With most pregnancies, especially those considered full-term, a baby will “drop” in the uterus. Typically this will happen near the end of the third trimester, Fleming says, as the fetus prepares for the labor process.
“The head will begin descending into the pelvis,” Fleming says. “Women will usually feel more fullness and pressure in the pelvis and sometimes in the vaginal area. This process helps to apply pressure to the cervix and is part of the early stages of the labor process.”
As a baby drops, the height of the fundus, which is a term a doctor uses to refer to the top of the uterus, will also shift downward, away from the chest. Depending on your body, that “drop” may be visibly apparent to friends and family.

Signs of Labor: Mucus Plug

Another sign your body is readying for labor? You might pass the mucus plug, which is literally a thick chunk (or plug) of mucus that dislodges from the cervix shortly before labor. The plug may be accompanied by pinkish vaginal discharge or spotting, akin to the breakthrough bleeding that can happen when you’re ovulating.
Just how long it will take from the time a baby drops or the mucus plug drops into the toilet is hard for doctors to say because these processes can vary widely. But they’re both things to mention to your OB-GYN or midwife, as they’re signs that something is beginning to happen!

Signs of Labor: Cervix Dilation

Your medical practitioner will likely check to see if your cervix has dilated or started to open up, which is yet another sign that the body is preparing for labor, Fleming says.
[pullquote align=”center”]You can walk around with a cervix that’s dilated an inch or two for days or even weeks without feeling it or going into full blown labor.[/pullquote]
This is not something that can typically be felt—in fact, you can walk around with a cervix that’s dilated an inch or two for days or even weeks without feeling it or going into full blown labor—but a cervical exam will allow your doctor or midwife to get a gauge of whether the cervix is readying for labor and just how much.
After 39 weeks, some providers may suggest stripping the membranes of the cervix. The optional process is considered a safe and simple way to induce the body to kickstart labor, if not always effective.
“If possible, the provider will use her/his finger to sweep along the inside of the cervix where the cervix and the bag of water/membranes meet,” Fleming says of membrane stripping. “The process may be uncomfortable but usually lasts for 20 seconds or less.”
It’s an optional procedure, Fleming says, and it’s one that should only be performed late in the third trimester by a medical professional.

The Sign That Labor Has Started: Contractions

While your body can start prepping for labor weeks (or sometimes months) in advance of the real thing, you won’t be in actual labor until you’ve started contractions, Fleming says.
“The definition of labor is consistent contractions that cause cervical change,” she explains. “We instruct women to contact their provider when they start having contractions that they can time, every 5 to 10 minutes over a two-hour time span.”
During that phone call, your healthcare provider can assess if it’s time to make a trip to their office or a hospital or whether it’s time for them to come to your home if you’re having a home birth.
[pullquote align=”center”]“The contractions have to be strong enough and consistent enough to cause the cervix to open before the diagnosis of labor can be given.”
—Mary Fleming, MD[/pullquote]
If it’s “go time,” a cervical exam will come next to determine whether the contractions are actually causing cervical dilation, meaning you’re in true labor, or if you’re having Braxton Hicks, a term for false contractions that don’t have any effect on the cervix.
“We know it is often frustrating for first-time mothers who have contractions to be told they are not in labor,” Fleming says, “but the contractions have to be strong enough and consistent enough to cause the cervix to open before the diagnosis of labor can be given.”

Wait, what’s a contraction?

Hey, if you’ve never given birth before, you’ve probably never felt a contraction either, so it’s no surprise most people don’t know the difference between a Braxton Hicks contraction and a “real” one.
Braxton Hicks contractions can start as early as the first trimester but may only be felt late in the second trimester, according to Belotte. “They are different from the labor contractions because they are sporadic, last longer than regular labor contractions, and tend to not be so painful,” he adds.
As for the “real” contractions, there is no one right way to experience contractions. They vary depending on the person feeling them.
“Some women will describe contractions as back pain and others as pelvic pressure,” Fleming explains. “Most will feel a tightening across their abdomen that intensifies for 30 seconds and up to one minute and then relaxes.”
Mild contractions are typically uncomfortable enough to be noticeable but don’t necessarily interrupt normal activities, while intense contractions can make it difficult to walk or carry on a conversation.
“Again, because all women experience pain in a different way, it is normal for some women to experience intense contractions in early labor and for others not to feel much intensity until closer to delivery,” Fleming says.

Isn’t water breaking a sign of labor?

Forget what you’ve seen on TV. Most women do not experience a giant gush of water flowing out between their knees, signaling that they’re suddenly in labor and need to get to the hospital stat.
It’s not typical for your water to break at the beginning of labor. In fact, “for most women, their water breaks during labor,” Fleming says.
Water can break spontaneously (on its own) or because your healthcare provider breaks it for you with a procedure called artificial rupture of membranes (AROM).
If your water does break before labor begins, it may be a big gush. Then again you may simply notice your clothes are wet or wake up to find a clear puddle of fluid in the bed. Water may “break” and leak out slowly over time as well, Fleming says, as the membranes of the amniotic sac do not reseal.
“For this reason, liquid will continue to drain from the vagina in small amounts until delivery,” she says.

Early Labor vs. Active Labor

Once your body is revved up and “in labor,” your provider still may say you’re not quite ready to be rolled into the delivery room. Sigh. That’s because labor is broken down into two parts: early labor and active labor.
“Early labor starts when regularly recurring, painful labor contractions are felt by the mother, leading to cervical changes including progressive shortening, thinning, and opening (dilatation) of the cervix up to a point of rapid acceleration of the rate of cervical dilatation,” Belotte says.
Typically, early labor is the longest phase. It can be just a few hours for some folks. Then again it can go on for days (literally) for others.
A mom-to-be is monitored during early labor to determine whether dilation is progressing; the baby’s heartbeat is monitored also to ensure that the baby is healthy and handling the pressure of getting ready for delivery well. It’s during early labor that practitioners typically decide whether a delivery may be done vaginally or require surgical intervention.
If the answer is the former, at around 6 centimeters of dilation, active labor typically begins. It’s shorter and faster than early labor, Belotte says, and is associated with the fetus moving lower and lower, while the cervix continues to dilate to 10 centimeters, which is the size needed for vaginal delivery. Active labor is what turns into delivery!

Categories
Mom x Body Motherhood

The Signs of Ectopic Pregnancy That Women Should Never Ignore

Rebecca was a trained wilderness first responder. She knew about ectopic pregnancies. Still, when an embryo implanted in her Fallopian tube, Rebecca (who’s asked that we not use her last name) missed the signs of an ectopic pregnancy completely.
“I didn’t even know I was pregnant,” Rebecca recalls. “I had suspicions, but a test came out negative, then I traveled to Hawaii for several weeks.”
It was while she was in Hawaii that the bleeding started, along with painful cramps, two classic signs of ectopic pregnancy. But since her [linkbuilder id=”6463″ text=”pregnancy test”] was negative, Rebecca shook them off for days, then a week. Finally, nine days after it all started, she mentioned she’d been bleeding to a friend who happened to be a nurse. Suddenly, two and two came together to make four.
“She sent me straight to the hospital, where I found out I was pregnant, miscarrying, and ectopic all at once,” Rebecca recalls.
Rebecca’s life was saved by that trip to the hospital. An estimated 2 percent of pregnancies are ectopic pregnancies, and for women living in North America, this condition is the leading cause of death in the first trimester of pregnancy and accounts for anywhere from 10 to 15 percent of all maternity-related deaths.
But what is an ectopic pregnancy? And are the signs really that easy to ignore? We talked to the experts about how ectopic pregnancy is defined, what they do to treat the condition, and how you can stay safe.

What is an ectopic pregnancy, anyway?

When someone gets pregnant, the embryo that’s created when sperm meets ovum is supposed to travel up the Fallopian tube and find its way to the uterus where it will hang out until birth, developing, growing, and turning into a human being.
But when a pregnancy is ectopic, the embryo gets lost on its way to the uterus. Technically, an ectopic pregnancy is “any pregnancy that implants outside the uterine cavity,” says G. Thomas Ruiz, an OB-GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, California.
In almost every case of an ectopic pregnancy—about 95 percent of the time—the embryo will implant itself in the Fallopian tube. In about 2.5 percent of ectopic pregnancies, the fertilized ovum can settle in at the cornua of the uterus (essentially the spot where the uterus and Fallopian tube meet). The other 2.5 percent are found in the ovary, cervix, or abdominal cavity.

What’s the problem here?

So the embryo didn’t go where it was supposed to. Why is that a problem? Well, every part of the female reproductive system has its own job. The uterus, of course, has the job of providing a growing fetus a safe place for development.
The Fallopian tube, cornua of the uterus, ovary, cervix, and abdominal cavity, on the other hand, are not suited for a developing fetus. There simply isn’t room in those structures for what has to happen to get a baby from conception to birth.
According to Cindy Basinski, an OB-GYN from Newburgh, Indiana, “Pregnancies that develop outside the uterus are dangerous because as the pregnancy grows it can rupture and cause life-threatening bleeding inside the abdomen.”
Sometimes the body will figure out something is wrong, and essentially “fix” an ectopic pregnancy, stimulating a miscarriage early on. Sometimes a woman won’t even know she was pregnant, let alone that her body was dealing with an ectopic pregnancy.
It’s when an ectopic pregnancy continues to grow, however, that the condition becomes something serious, Basinski says. Until the condition is treated—or if it ruptures—you might notice signs and symptoms like Rebecca’s.

Signs of an Ectopic Pregnancy

Notice Basinski said might.
“Unfortunately, for some women, ectopic pregnancy may have very little to no symptoms until it ruptures, causing bleeding in the abdominal cavity—leading a woman to seek emergency care,” Basinski says. “It is unpredictable during growth of an ectopic pregnancy—[whether it’s] weeks or months—when this event may happen.”
On the other hand, for many women, there are noticeable symptoms of experiencing ectopic pregnancy.
Some women report bloating, nausea, or vomiting, although these symptoms are common in [linkbuilder id=”6462″ text=”early pregnancy”] and can easily be confused for garden-variety morning sickness. Pelvic pain that can’t be explained by period cramps or another source or vaginal bleeding in the early stages of a pregnancy, on the other hand, are reasons to call your OB-GYN immediately. Once you’re in their office, you may well be diagnosed with an ectopic pregnancy.

“Pain may be related to stretching of the Fallopian tube as the ectopic grows within it or small amounts of bleeding leaking into the abdominal cavity from the growing pregnancy,” Basinski explains. “Vaginal bleeding may occur as pregnancy hormones are often not produced normally, causing bleeding.”

How is an ectopic pregnancy diagnosed?

Even after you tell your doctor that you’re feeling any of the signs of ectopic pregnancy, diagnosis can be tricky. In fact, according to a 2002 study published in the journal Obstetrics and Gynecology, almost 40 percent of ectopic pregnancy diagnoses are incorrect and are later revealed to be normal, intrauterine pregnancies.
Avoiding this confusion comes down to talking to your doctor about what tests they’re performing.
“If a person is truly diagnosed with an ectopic pregnancy by a physician, this is generally a very accurate diagnosis,” Basinski says. “Physicians are very careful to proceed to treatment of ectopic until they are certain because they do not want to harm a pregnancy if it is a normal one.”
That’s why they require a number of tests before diagnosis or treatment.
“If a physician is concerned that a patient may have an ectopic pregnancy, they will often follow a patient’s levels of beta-human chorionic gonadotropin (BHCG, a pregnancy hormone) to see if it is rising normally,” Basinski says. “If it is not rising normally, this can indicate either an impending miscarriage or ectopic pregnancy.”
An ultrasound is the next step, allowing doctors to take a look inside to see if the embryo is located inside the uterus (where it belongs) or outside of the uterine cavity (making it ectopic). This is where things can get tricky.
“It is difficult to see any pregnancy in any location until the pregnancy has grown enough to be seen—about four to five weeks,” Basinski notes. “If pregnancy levels reach a certain level but no pregnancy is seen in the uterus, this may be an indication of an ectopic pregnancy. If a pregnancy is seen outside the uterus, a definitive diagnosis of ectopic is made.”

Treating an Ectopic Pregnancy

After a definitive diagnosis of ectopic pregnancy, the first treatment most doctors reach for is methotrexate, Ruiz says. The medicine is used in other medical settings to treat everything from rheumatoid arthritis to certain cancers, and it’s contraindicated for most pregnant women because of potential harm to the fetus.
However, in cases of an ectopic pregnancy, there is no saving the fetus, Ruiz says.
“If the embryo is an ectopic, it will not survive,” he notes. “The risk to the mother can be loss of life, loss of the uterus, loss of the tube, or impairment to future fertility.”
Prescribing methotrexate in cases of pregnancy (whether ectopic or intrauterine) stops the growth of the cells in the embryo, and the body will typically miscarry the pregnancy.
“Methotrexate is used in early diagnosed ectopic pregnancies and basically prevents DNA replication in rapidly dividing tissue,” Ruiz explains.
There’s a strict criterion before it’s prescribed, he adds, including a BHCG level that’s less than 5,000 milli-international units per milliliter and no fetal cardiac activity, to ensure the fetus is not viable.
For some women, however, methotrexate doesn’t work. Rebecca’s ectopic pregnancy remained in her Fallopian tube even after she was treated with the drug, and her doctor had to go in surgically to remove the embryo and save her Fallopian tube, enabling her to get pregnant again in the future.
Other women may have to have the affected tube removed completely, Ruiz says, if the methotrexate doesn’t work or if the diagnosis is not made soon enough. Typically this can be done laparoscopically, but if the tube has already ruptured, an ectopic pregnancy becomes a surgical emergency, requiring an abdominal incision.
Although a D&C, short for dilation and curettage, may have once been a means to treat ectopic pregnancy, the procedure is rarely used today, Ruiz says.
“Twenty-five years ago, if we were really stumped, we would do a D&C and send it for rapid frozen section,” Ruiz says. “If the rapid frozen section returned negative for chorionic villi we would proceed to laparotomy [a surgery where the surgeon cuts through the abdominal wall] for a presumed ectopic.”
These days, Ruiz says, highly sensitive ultrasounds and blood testing have rendered the D&C essentially obsolete.

How does this all happen?

Ectopic pregnancies are not a woman’s fault. There’s nothing you do that makes the embryo implant in the wrong part of the body.
But that doesn’t mean there aren’t risk factors at play, Basinski says.
Those with a higher risk of ectopic pregnancy include women with a history of:

  • Pelvic inflammatory disease due to a sexually transmitted disease
  • Endometriosis causing damage to fallopian tubes
  • Previous pelvic surgery for any reason, including appendectomy, tubal ligation, or tubal ligation reversal surgery.

A previous ectopic pregnancy can also increase your chances of having another one, as can smoking and the use of an IUD as a form of contraception.

Ectopic pregnancy prevention is possible (sort of).

There’s no way to tell whether or not a pregnancy will turn out to be ectopic. You can’t tell the embryo where to go, nor can you will it into the uterus.
But if you aren’t specifically trying to have a baby anyway, condom usage can go a long way toward preventing ectopic pregnancy, Basinski says. After all, it’s one of the most effective means of preventing any pregnancy!
If you do want to get pregnant and you have any of the aforementioned risk factors, hope is not lost.
“Women with risk factors should let their physicians know so that together they can closely monitor future pregnancies to enable an early diagnosis and treatment,” Basinski says.
In Rebecca’s case, ectopic pregnancy was not the end of her fertility journey. After two ectopic pregnancies, both of which ended in surgery, she tells HealthyWay, “I’m the mom of two beautiful boys, both conceived with IVF.”

Categories
Mom x Body Motherhood

Diastasis Recti Is The Post-Pregnancy Condition Nobody Talks About

Danna Lorch had never heard of diastasis recti when she was pregnant, but even if she had, the new mom didn’t have time to think about her stomach muscles after she gave birth. Back and forth she went from her hospital room—where she was recovering from an emergency c-section—to the neonatal intensive care unit, where her newborn son needed her to hold him and feed him.
No one told her then that the muscles at the core of her body might have been stretched apart during her pregnancy. In fact, it wasn’t Lorch’s physician who diagnosed her with diastasis recti. And it wasn’t the first physical therapist she saw about the agonizing pain in her hip—or the second. It took three physical therapists before the problem with Lorch’s abdominal muscles finally had a name and she could get some help.
The number of people who experience diastasis recti after [linkbuilder id=”6506″ text=”pregnancy is hard”] for researchers to quantify. Diastasis recti—a separation of the rectus abdominis muscles in your abdomen that leaves a gap that allows your belly to pooch out—isn’t always diagnosed.
Some people with diastasis recti simply assume they’re having a hard time losing weight after giving birth or having back pain because they’ve been hunched over a baby while breastfeeding or feeling the strain of carting a bulky infant carrier. They may not be wrong, but then again, there may be another underlying condition that’s exacerbating that sore back and unrecognizable tummy.
In one study of 300 first-time pregnant women who were followed from pregnancy till 12 months postpartum, the prevalence of diastasis recti was 33.1 percent, 60 percent, 45.4 percent, and 32.6 percent at gestation week 21, 6 weeks, 6 months, and 12 months postpartum, respectively. In other words, a whole lot of pregnant people. In the study, which was published in the British Journal of Sports Medicine, the researchers found no difference in risk factors between those who had diastasis recti and those who didn’t. No one did anything “wrong” to create this painful condition. It simply happened.
So how can you tell if you might end up with diastasis recti after giving birth? And what exactly is it?

Deciphering Diastasis Recti

Diastasis recti is the separation of the rectus abdominal muscles. But does that mean the muscles in the abdomen suddenly decide to go walkabout? And if yes, why?
According to Mary Fleming, MD, an OB-GYN and attending physician at Einstein Medical Center Montgomery in East Norriton, Pennsylvania, pregnancy is often to blame. As the uterus expands to accommodate a growing fetus, it puts pressure on the abdominal wall and stretches these muscles. In part, that’s a necessity of pregnancy. Our hormones ebb and flow, softening and stretching the muscles of the abdomen to accommodate the baby as it develops.
For most, that stretching is simply a way for the abdomen to round out as the uterus grows. But for others, that stretching will push the muscles apart, and the muscles won’t quite spring back into place. That’s diastasis recti.
This can happen to anyone who is pregnant, but if you have a c-section, the risk increases because the muscles have to be surgically separated during the procedure to allow doctors access to the uterus to deliver the baby.
“For most women, these muscles will return to the normal place after delivery (of either type),” Fleming says, “However, for some women they do not, leaving a separation or gap, which can be seen as a midline bulge below the umbilicus (belly button). Diastasis recti is the clinical term for this condition.”

Do I have diastasis recti?

Let’s face it: The state of the abdominal area after giving birth can really vary. Some women seem to have magical powers that pop everything back from whence they came just minutes after birth. (Or so it feels anyway…we’re looking at you, Duchess Catherine!) For others, nothing in the abdominal region will ever look quite the same as it did before they earned their tiger stripes.
[pullquote align=”center”]According to one study, diastasis was present among all women at 36 weeks of pregnancy and decreased to 39 percent at 6 months postpartum.[/pullquote]
How it looks doesn’t (or shouldn’t) matter. But how it feels does, and the pain and discomfort that can come with diastasis recti shouldn’t be ignored.
Of course, it’s hard to say just how many women find that their abdominal region is affected by diastasis recti. There is limited research on the condition. But according to one study, diastasis was present among all women at 36 weeks of pregnancy and decreased to 39 percent at 6 months postpartum, says Nichole Mahnert, an OB-GYN at Banner – University Medical Center Phoenix in Arizona.
What makes it hard to judge just how often the condition crops up is that for some people, diastasis recti will resolve on its own without medical intervention. This can happen in as little as six months, Fleming says, leaving a new mother largely unaware that her abdominal muscles decided to start wandering away from one another.
What’s more, the stigma of dealing with post-pregnancy weight can keep some parents from talking to their doctors and finding out they have diastasis recti. Even reporting on the topic of diastasis recti has been met with debate over society’s health and beauty standards and the damaging effect they can have on a new parent’s psyche. But again, it’s important to note that diastasis recti treatment isn’t about creating a “perfect mom bod.” It’s about healing the muscles of the abdomen and helping you regain core strength, which connects to overall body health.  
As Lorch says, “[Diastasis recti] kept me from feeling strong for a long time and also made me wonder why I wasn’t conforming to the pervasive ‘bounce back baby body’ nonsense that celebrity gossip magazines pump out at us.”
When someone is grappling with angst over why their body just isn’t “bouncing back” the way the tabloids tell us it should, an actual medical condition that’s split their abdominal muscles is often the last thing that comes to mind.

Diagnosis: Recti

While some folks never get help (or put it off), for others, diastasis recti can be debilitating enough to send them running to their doctor, begging for help.
That’s what happened to Grace Everett. The mom of two sons, ages 5 years and 20 months, felt what she calls “pretty acute back pain” after her second child was born, and it became untenable somewhere around the six- to eight-week mark.
“At that point, the rest of my body had recovered from the c-section, but I realized my back was not doing well at all; in fact, it seemed to be getting worse,” Everett recalls. “I wasn’t able to do normal things, like pick up my preschooler or clean (without pain) and had trouble sleeping.”
When she mentioned the pain to her doctor, they referred her to a physical therapist, where she was officially diagnosed with diastasis recti.
“[It] was essentially making my back work way too hard, because my core was totally out of commission,” Everett says. “‘My physical therapist was amazing from the start. She used an ultrasound machine so we could actually see what my muscles were doing. And then we started off small, with very specific exercises that were invisible to watch, where I was laying down prone just trying to get my abs to wake up. I had to retrain my core to engage and convince my back it wasn’t needed.”
Aside from back pain, another sign that you might have diastasis recti is a bulge right in the center of your abdominal area. This bulge will be vertical and is most apparent when sitting up from a lying-flat position, Mahnert says.
This can happen just days after giving birth, and it’s typically not an emergency situation. But it’s not normal for significant or severe pain to be associated with the separation, so that would warrant an immediate call to your doctor, Mahnert cautions.
Whether it’s pain, a bulge, or things just don’t feel right, it’s worth mentioning to your OB-GYN how your abdomen is feeling after birth. After all, this is why follow-up obstetrical care is recommended post birth—so the OB-GYN can catch conditions that relate to pregnancy or birth.
A diagnosis of diastasis recti will usually be made by measuring the length between the two muscles at rest and again when the muscles are contracted. From there, treatment will begin.

Rectifying the Recti: Healing Diastasis Recti

The good news? Surgery is very rarely needed to heal diastasis recti. Although an abdominoplasty can bring the walls of the abdomen together, this operation is considered elective, Mahnert says, meaning it’s often not covered by insurance. What’s more, it’s not recommended until after someone is finished with childbearing.
Instead, physical therapy—like the course that helped Everett get back on track—is the most common path for treatment because it’s both less invasive and more likely to be covered by insurance.
A physical therapist will examine you and begin developing an exercise routine that will target the abdominal muscles without exacerbating your symptoms.
For example, Megan Eggleton, a physical therapist at Grover M. Hermann Hospital in Callicoon, New York, says you’ll want to avoid exercises that increase that bulge, like full sit-ups.
“So very gentle abdominal activation to start, like pelvic tilts, very small crunches, pulling in your stomach like you’re sucking it in and holding for 10 seconds 10 times, and also on hands in knees doing alternating arms and legs,” she says.
Another popular diastasis recti treatment is sitting on an exercise ball and marching in place, Eggleton says, as it will help tighten the core abdominal muscles without worsening the diastasis recti.
Slow and steady can feel frustrating when you just want to feel better, but Lorch found that her physical therapist helped her feel strong and in control of her body again.
“My teacher, Hened, tailored exercises just for my diastasis and even taught me how to check my own stomach as I exercised to make sure I wasn’t straining the gap but strengthening it,” she says. “I saw results in about three months, and in about six the gap had nearly closed. It’s still not perfect by any means, but it’s no longer something that makes me feel weak or self-conscious. I used to love running before the baby and that’s something that I’m finally slowly getting back into.”
[pullquote align=”center”]”Life won’t get less crazy. So take care of yourself now, so you can keep up once they’re zooming all over the house!”[/pullquote]
The process was similar for Everett, who advises other parents in her situation make the call to their doctor as soon as possible, so treatment can begin right away.
“Don’t wait until life gets less crazy,” she says. “We moms have a way of putting off self-care, but honestly, taking an infant to my appointments, where he would just snooze in his car seat, was a heck of a lot easier than when he became mobile and I had to line up a sitter every time. Life won’t get less crazy. So take care of yourself now, so you can keep up once they’re zooming all over the house!”

Why Diastasis Recti Happens

Everett and Lorch both underwent c-sections, which can increase a risk of diastasis recti because of the work a doctor has to do to pull apart the abdominal wall to access the uterus.
But it isn’t only c-section deliveries that can result in the condition, Eggleton says. In fact, pregnancy isn’t the only cause, and it can happen to anyone—women, men, non-binary folks … whoever.
“The most common cause of diastasis recti is pregnancy in women. However, less commonly, it can also be caused by obesity (carrying a lot of weight in the abdominal area), lifting heavy weights incorrectly, and performing excessive and often incorrect abdominal exercises,” Eggleton says.
Few other risk factors for the condition have been identified, which makes it harder for a parent-to-be to prevent diastasis recti. Instead, doctors suggest patients simply follow the same healthy measures they’re recommended to follow anyway: Eat a healthy diet and exercise regularly.
And if diastasis recti does happen, find someone who is qualified to help get you on the path to treatment. The better acquainted they are with diastasis recti, the better chances they have of helping you!

Categories
Healthy Pregnancy Motherhood

How To Choose An Obstetrician For The Best Delivery Possible

On paper, the obstetrician was perfect. She took Kate’s insurance. She had graduated from a prestigious medical school. She was well regarded in the medical community.
In fact, the obstetrician seemed so perfect that Kate (who has asked that her last name not be used) was willing to ignore her rushed manner on her first visit. “It was a red flag, but not a deal breaker,” Kate said of the doctor’s flurried manner and lack of conversation with Kate’s husband.
“But then when I miscarried at 13 weeks—a really devastating loss when you’re 40—her manner was so cold and she actually referred to the fetus as ‘shriveled up,’ which just felt unkind,” Kate recalls.
It wasn’t long before Kate and her husband “fired” the obstetrician they had so carefully chosen and decided to entrust their next pregnancy to a physician who was in many ways her total opposite—an older man who was both kind and warm.
For many women who are trying to conceive or are already pregnant, choosing an obstetrician doesn’t require a whole lot of trial and error: They call up their health insurance company or pull up the company’s provider list and they choose a name of a provider who is located somewhere near their home.
But some are lucky to find a provider at all. An estimated 11 percent of women between the ages of 19 and 64 don’t even have health insurance.
But for those who do—and for those who have a choice in the matter—the decision of who should serve as your obstetrician is one that can’t be taken lightly. After all, an obstetrician does a lot, specializing “the care of pregnant patients, labor, and birth,” explains Lisa Valle, DO, an obstetrician and gynecologist from Providence Saint John’s Health Center in Santa Monica, California.
While some moms prefer a midwife to deliver their baby, obstetricians still deliver more than three-quarters of the babies in America. These are the physicians in whose hands we literally place our babies.

Questions to Ask an Obstetrician

Whether we pay them out of our own pockets or our health insurance picks up the tab, obstetricians are like any other physician: They work for us.
Now imagine hiring someone to work for you without asking them a few basic questions before you hand them a keycard and offer them access to your computer system. You wouldn’t do it, would you?
Of course, some women already have a gynecologist, a physician who specializes in the care of a women’s reproductive system, whom they love and trust.
“In the United States, our training for obstetrics and gynecology is combined into one four-year residency,” Valle says. “As a result, many elect to practice both, however, not all gynecologists elect to practice obstetrics.”
If you feel safe and comfortable with your current gyno, ask them if they’re an OB-GYN, meaning they practice obstetrics as well as gynecology. On the other hand, if you’re starting fresh in a new town or just want to see a new provider, setting up an interview to learn if they’re the right fit for your health needs (and those of your baby) is A-OK.
But what should you be asking your future obstetrician? Here are a few questions to help you make heads or tails of this big decision.

Will my obstetrician be there when I deliver?

Sure, you may want this one doctor to be there for every single appointment and there on the day you give birth, but obstetricians are human beings too! Instead of asking if they will be there on the day you deliver, ask what their procedure is for delivery.
Do they recommend that you see a range of physicians in their practice so you know everyone and therefore have a familiar face in the delivery room? Do they guarantee there’s always someone in their practice who will be on call?
Obstetricians want the best for their patients, but they also want patients to know that if they’re not right there the minute they pick up the phone, it’s nothing personal.
“I wish patients knew that it is not possible for one doctor to be available all the time and to handle all issues that come up,” OB-GYN Janelle Cooper, MD, tells HealthyWay. “I wish patients knew that although we are dedicated to our careers we also have lives outside of medicine and we cannot be available 24 hours a day.  
“Many pregnant women have a hard time with that when they have only seen you their entire pregnancy but they have to be delivered by one of your partners. Often this is because we have been working all night the day before and went home to rest or are seeing other patients in the office.”

Where does this obstetrician deliver?

Where you plan to give birth will play a big role in who you choose to deliver your child. After all, if you want to give birth at home, you’re probably not going to find an obstetrician who will show up at your door with a doctor’s bag in hand.
These days most home births are attended by midwives, so if you’ve got your heart set on birthing in your bedroom, you may want to find an OB who works with a midwife, or you could go to a midwife directly.
If giving birth at a hospital or birth center is more your speed, you’ll still need to find out where your obstetrician has privileges, a special relationship that allows doctors in private practice to provide care in a hospital.
Keep in mind how far that hospital is from your home and how difficult it might be to get there when you’re ready to give birth. You probably don’t want to choose an obstetrician whose privileges are at a hospital that’s four hours from home!

What’s an obstetrician’s c-section rate?

C-sections happen, and sometimes there’s no avoiding it. But if you have your heart set on natural childbirth, taking a look at an obstetrician’s c-section rate can help determine whether they’ll be likely to support you if you plan to give birth vaginally.
“C-section rate is the number of c-sections a doctor or institution does over a specific time period,” explains Nichole Mahnert, an OB-GYN at Banner – University Medical Center Phoenix in Arizona.
Determining whether your possible doctor has a “low” rate or a “high” one comes down to doing a little compare and contrast. The World Health Organization, for example, recommends a c-section rate of no more than 15 percent of births, while actual rates in the U.S. range from 23 percent to 38 percent, depending on your state.
“Generally we like to see c-sections below 30 percent,” Mahnert says. “Most hospitals should have information available to patients about their [c-section] rate because this is something they should be tracking.”
Keep in mind that there are all sorts of reasons that a doctor might perform a c-section, from fetal distress to an issue with mom’s health to patient preference. And a particular obstetrician’s c-section rate may be affected by their clientele.
Are you talking to an obstetrician who primarily sees high-risk patients, for example? That may jack up their c-section rate, so be prepared to ask follow-up questions on why their rate is what it is.
Mahnert also suggests asking an obstetrician to differentiate between their first-time patient c-section rate and their repeat c-section rate, as it’s more common for a patient to have subsequent c-sections due to medical necessity.

Do you perform VBACs?

While giving birth via a c-section may necessitate another surgical birth down the line, for many folks, it doesn’t. That’s where the VBAC or “vaginal birth after a cesarean” comes in. And an obstetrician’s opinion on VBACs can be the difference between living the dream of trying a vaginal birth or being sent back into the operating room.
“If you have had one to two [c-section deliveries] and want to try for a vaginal delivery this is something very important to discuss with your OB,” Mahnert says. “They can tell you your chance of a successful vaginal delivery based on your characteristics and history. You also want to make sure your OB feels comfortable with the plan.”
Some obstetricians will not offer VBACs at all, but that’s not always within their control. Some hospitals simply won’t support the practice. It’s worthwhile to work this into your questions about where the obstetrician delivers and how they feel about c-sections overall.

What’s your take on the birth plan?

A birth plan is exactly what the name implies: a plan you put together about what you want to happen during delivery. Studies have found that mapping out a birth plan can help make the person giving birth feel more empowered, and a birth plan can ensure that you walk away from birth feeling like it was a positive experience.  
But that birth plan is unlikely to be successful if the practitioner who’s helping you bring your child into the world isn’t on board.
“All OBs should discuss your birth plan with you to make sure we are all on the same page and to make sure the items are doable,” Mahnert says. “It is important to have a realistic birth plan and understand that labor and delivery is sometimes out of our control and we need to be flexible. OB doctors want mom and baby to be healthy and happy and have your best interests in mind!”
Many obstetricians have birth plan templates, so don’t be afraid to ask your potential obstetrician if they have one that they recommend. Review it and ask questions.
“Your OB should be willing to talk this over with you and answer your questions or concerns,” Mahnert says.

What are the obstetrician’s fees?

The cost of delivery will likely come down to a mix of your health insurance company (if you have one) and your decisions on where to give birth and who you want at your side. For example, some health insurance companies will cover the costs for pre-approved doctors, which they call “in-network,” whereas you may only see part of the fees of another doctor or “out-of-network” provider covered.
Although you can ask the obstetrician about their fees, most of those questions should be directed to the front office staff, Mahnert says, as they are more familiar with the ins and outs of insurance billing.
You may also want to call your health insurance company directly, as they can outline other delivery-related fees such as the cost of anesthesia or the fee for a private room—bills that don’t come from the obstetrician’s office.
If you don’t have health insurance, be sure to mention that to the billing department. Some doctors offer sliding scale fees for patients who are paying their own way.

Categories
Health x Body Wellbeing

Can You Get Pregnant On Your Period? You Asked, We Answered

Can I get pregnant on my period? If you’ve ever asked yourself that question, don’t worry: You’re not the only one wondering.
Whether you’re trying to conceive or actively trying to avoid conception, knowing when you’re fertile enough for sperm to meet egg and make a baby can be confusing. Even if you got an A+ in health class, our bodies are all different, and that means the cycle of one woman, transgender man, or non-binary person can be ever-so-slightly off from their peers, making that exact moment when you might experience a pregnancy different from your best friend.
The short answer? Yes, it is entirely possible to get pregnant on your period.
If you are flashing back to health class and thinking hey, wait a second, we hear you. The longer answer is yes, but…

Can you get pregnant on your period?

No matter what your high school best friend always said, there is no one time of the month when it’s 100 percent guaranteed that you can have unprotected sex with no repercussions. The risk of sexually transmitted infections aside, there is a risk of pregnancy—albeit a slight one—that comes with period sex.
If you’re wondering how it can happen, it all has to do with the timing of your menstrual cycle.
A “normal” (meaning typical of most folks) cycle lasts anywhere from 27 to 35 days, says Mary Fleming, OB-GYN and attending physician at Einstein Medical Center Montgomery in East Norriton, Pennsylvania. Day one of a menstrual cycle is considered the first day of your period (or the day you start bleeding). Your cycle then continues for that 27 to 35 days until a new cycle begins with the arrival of your next period.
For most people, a period lasts about three to seven days, Fleming says. Counting ahead, in most folks, ovulation occurs about two weeks later (anywhere from 10 to 17 days into the cycle). “Ovulation is the process of the ovary releasing the egg and its migration through the fallopian tubes,” Fleming explains.
Of course, it takes an egg for someone to get pregnant, as conception happens when a sperm and egg come together and form an embryo. That period of ovulation is also referred to as your fertile window, the one time in your cycle when you are most likely to get pregnant.
Do a little math, and it seems hard to imagine how someone could possibly get pregnant during their period, right? Ten days, which marks the early end of a fertile window for the average person, is at least three full days after the seven-day mark, which again marks the outset for most women’s cycles! Well, this is why it’s rare to get pregnant on your period.
But rare doesn’t mean it never happens, Fleming says. The most likely reason for someone to get pregnant during their period? A menstrual cycle that’s different from the norm.
“The most likely explanation for those women who conceive when they are on their period is that those women are not having regular ovulatory cycles,” Fleming says. “These women may bleed sporadically, have intermittent spotting, or bleed for long periods of time. This typically means they are not ovulating or ovulating unpredictably.”
Even in women who do have regular menstrual cycles, studies have found that estimating your fertile window may not be as easy as counting ahead 10 days after the menstrual cycle begins. According to one study performed by the Biostatistics Branch of the National Institute of Environmental Health Sciences, “In only about 30 percent of women is the fertile window entirely within the days of the menstrual cycle identified by clinical guidelines—that is, between days 10 and 17.”
In other words, it can fall earlier, putting fertility closer to the period when someone is still bleeding.
Getting pregnant “during your period” may also happen when you confuse your period with bleeding from some other condition.
For example, Fleming says, cervical or endometrial polyps may cause bleeding from the vagina, as can cervicitis (an infection of the cervix) or vaginitis (an infection of the vagina such as yeast or bacterial vaginosis) or even micro-tears in the vagina due to vaginal dryness.
If someone assumes that they’re bleeding because of their period but has not actually reached that point in their menstrual cycle, the risk of pregnancy from unprotected sex goes up.

How to Avoid Pregnancy on Your Period

If your goal is to prevent pregnancy, there are a number of birth control options to consider, all of which should be used straight through your period.
The IUD, birth control pill, and other contraceptives can all make period sex safer—at least when it comes to pregnancy risk. To protect against STIs, always use a condom.

What if you want to get pregnant?

If you are trying to conceive, skipping birth control is a big start, but don’t depend on period sex to get you there, Fleming says. Because it’s rare, she still recommends determining your fertility window and having sex more often during that time.
“You will need to determine when you ovulate by keeping a menstrual calendar with a mobile app, basal body temperature charting, or a commercial ovulation predictor kit,” she suggests. “The first day of bleeding is day one. Once you know the length of your cycles (day one to day one), count backwards 14 days.”
Have fun!

Categories
Healthy Relationships Wellbeing

Setting Boundaries With Your Partner, Friends, And Family Will Change Your Life

The way Tina Tessina sees it, all personal relationships from marriages to families and friendships require setting boundaries.
“Boundaries are the limits you place on how much others can ask of you, verbally or otherwise,” says Tessina, a psychotherapist and author of It Ends With You: Grow Up and Out of Dysfunction. “If a friendship or relationship is between two people who both have solid boundaries, the subject may never come up, because neither person will encroach without permission—but the boundaries are there.”
You might have been in a relationship where you’re unable to say “no,” especially when it’s with someone you value so much that you want to give them everything they’ll ever need. But we all need that line between “I like/love you,” and “I will willingly take anything you throw at me—literally anything you throw at me.” And in a perfect world, there would be no need to set boundaries at all, right?
Sure. But this isn’t a perfect world, and in reality, we live in a society where as much as 15 percent of women feel tired very often, where at least 65 percent of people feel work is stressing them out, and 57 percent say they’re stressed out by their family obligations.
We are not terribly good at saying “no, this is my line in the sand,” and it’s given rise to countless self-help seminars where we pay good money to learn to say “sorry” less and “no” a whole lot more. But is setting healthy boundaries really as simple as learning to add one word to your vocabulary? Well…maybe!
We asked the experts what the key to setting boundaries is and how to differentiate between laying down the law and being demanding. Here’s how to draw that line in the sand…in a healthy way.

Setting boundaries is uncomfortable.

If setting boundaries were as easy as binge-watching a season of Shameless, we all would have set a whole lot more of them a long time ago. But setting boundaries takes work, says Fran Walfish, PsyD, Beverly Hills family and relationship psychotherapist and author of The Self-Aware Parent.
“You can’t set boundaries and expect ‘all of us to be happy,’” Walfish says. “Someone is likely to not be happy.”
That person who’s unhappy might be you. As Walfish explains, “When you sign up for boundary setting, you must agree to tolerate increased anxiety. Here’s what I mean: You are likely to get flak from your boyfriend, partner, husband, parents […] when you say no to something they want. Everyone is given the blessing and gift of one life. That does not entitle them to control other people, spouses, and especially their children.”

In other words, while setting boundaries is important, we can’t exactly depend on everyone we know to be comfortable with us doing it. And they likely won’t say, “Hey, my line that’s not okay to cross is the exact same as yours, so I am on exactly the same page.” We need to be open, if not loud, about communicating what we think is okay and what isn’t. That applies not only to the people we love, our family, and our friends, but also to the random strangers we run into in the grocery store and in line at the post office. Our voices matter, and we need to use them.
Not convinced? Consider this: The fear that setting boundaries is selfish can hold us back, and not just at home. It can affect our jobs, our friendships, and even our health.
“Setting boundaries is simply asking for respect and insisting on it if necessary,” Tessina says. “There is nothing selfish about that, although a person with no respect for self may not understand it.”
So how do you set boundaries?

Setting Boundaries With Your Partner

You may not even realize you have boundaries that can’t be broached until they’ve been violated, even by someone you are in a serious relationship with!
What are some commonly violated or broached boundaries? “Reading personal mail or rummaging in personal space or demanding time, affection, or consideration without considering the other person’s wishes or feelings,” Tessina says. “Showing up unannounced is another classic breach of boundaries. Expecting someone to always pay for things. Talking behind backs, changing appointments because something more fun came up.”
If these things are cropping up in your relationships, be it with a friend or someone you love, step back and think about how you feel. If you feel “crazy” or are using similarly stigmatizing language about yourself, that’s a red flag.
“[You need] better boundaries if [you’re] feeling taken advantage of, not respected, not valued and that it’s never [your] turn,” Tessina advises. “Anyone can be subjected to rudeness and inconsideration. How you handle it determines whether you are setting boundaries or not. Most situations can be handled with polite firmness. People pleasers usually just don’t know how to say ‘no, thank you’ and make it stick.”
Every relationship is different, but one common example of boundaries that crop up in many relationships is the definition of the relationship itself.
“Specifically, if a woman is not available for an open relationship or a lack of commitment after a certain amount of time and, for example, her boundary is committed monogamy after three months, this is a conversation she may need and want to have,” says Annie Wright, a licensed psychotherapist and the owner and clinical director of Evergreen Counseling, a therapy center in Berkeley, California.
That conversation isn’t selfish. It’s not unreasonable. And the best way to present it is to be clear and concise.
“As obvious as this seems, not all of us are in touch with our boundaries, let alone our feelings,” Wright says, “So getting in touch with your boundaries may take self-reflection, maybe paying attention to any uncomfortable feelings or body-based signals a woman has that contain clues about what it is she truly wants, or perhaps it will take dialogue with herself, her friends, or her therapist—anything to help her get clearer on what she actually needs and wants from the situation.”
Use language that’s specific, such as “I am not open to an open relationship,” so you’re clearly communicating your boundaries. You should also ask specific questions of your partner, such as “Are we in a monogamous relationship?” Again, this language is specific and does not allow a partner to skirt the questions.
“Another example of a boundary may be the amount of time she is willing and able to give her partner versus investing that time in friends, family, and her own hobbies and pursuits,” Wright says. “Again, if a woman realizes her time boundaries are being encroached on by the relationship or by her partner and she feels uncomfortable about this, she may need to have a conversation and set a boundary about how much time she is able to spend with her partner on any given week/weekend.”
The key, once again, is being specific, clear, and concise.
“And then, once she gets clear on her boundaries, she may need to have a conversation with her romantic partner to explain her feelings about the situation she’s facing and to ask for what she needs and wants instead,” Wright suggests.
If you’re uneasy about setting boundaries with a partner, consider this: It could end up making the relationship better.
“Boundaries are essential to healthy intimacy,” Tessina says. “Boundaries are evidence of respect, and it’s not possible to really love someone if we don’t respect them. Setting boundaries creates mutual respect and consideration. These qualities allow people to be close without emotional harm.’”

Setting Boundaries With Parents

Of course, your partner isn’t the only person who can be crossing that boundary line. Society is slowly but surely adjusting to the notion that parents can also be a toxic influence in a person’s life, and with that comes the issue of determining whether you need to establish boundaries with your own family.
So how do you determine when you have a typical (albeit annoying) parent and when you have to set healthy boundaries with your parents?
“If [someone] is filled with thoughts about her parents and family of origin, and they take up the majority of her mental thinking space, then she needs to establish reasonable separation from her parents in order to be an independent adult as a prerequisite for coupling up,” says Walfish. “This is a crucial milestone in adult development.”
Saying no to our parents can be difficult, regardless of your upbringing, but it’s particularly difficult for kids who grew up in so-called “dysfunctional families,” where researchers have noted a tendency for children to develop anxiety and other mental health disorders.
But consider an upcoming holiday: Your parents want you at their place. Your siblings are pushing you to agree because it would be easier for them if everyone just showed up at the old homestead. But you want to stay home with your kids.
Is it okay to set boundaries here on behalf of your partner and your kids as well as yourself? Absolutely, Wright says.
“It’s important … to, again, self-reflect and to understand what she is and is not available for in terms of which holidays she does or does not spend with her family, how long she’s willing to spend when she does go there, and to also reflect on why and how it doesn’t always feel good for her to do so,” Wright says.
The next step?
“Usually, a conversation needs to happen with parents and siblings to reset expectations about what the adult woman is willing and able to do in terms of visiting or not, plus any additional requests she has about how she would like to be treated (for example, she would like her mother to stop bringing up her divorce and shaming her about it),” Wright notes. “These kinds of conversations are not necessarily easy, but I do think they are critical for healthy boundary setting with our families.”

Setting Boundaries With Your Kids

Of course, our parents and siblings aren’t the only people who can push, push, push. If you have kids, you know they test their limits. And setting firm boundaries can be even harder when you take one look at their darling faces with their puppy dog eyes.
But while you clearly have to give more to a helpless infant than you do to your 30-something sister who can’t seem to stop blowing up your text messages, even setting boundaries with children is possible…and necessary.
Setting those, however, often starts with you. Yes: you.
Are your kids trying to set boundaries with you that you waltz right over? It happens, even with the best, most well-intentioned parents, Tessina says.
“You can breach boundaries with your children by snooping in their private affairs without good reason, not allowing them to grow up, treating them like babies,” she says.
Other sins: “Doing too much for them—for example, getting too involved with their homework and doing it yourself instead of just helping them think it through—and expecting them to live up to your expectations and aspirations without considering their own dreams,” Tessina notes.
How often have you heard that kids learn by example? That’s especially true when it comes to setting boundaries.  
“To give them boundaries with you, insist that they treat you with respect, and set the example by respecting them,” Tessina says.
Walfish likes to use this common parent “mistake” as an example of how setting boundaries helps not just us but our kids: “Many teens and young adults have become anxiously attached to their electronics including [the] computer, iPhone, smartphone, iPad, and so on. The more you check your device, the more fuel you are feeding this addictive behavior and revving up versus winding down to go to sleep.”

As a solution, Walfish suggests, “Create your own reasonable curfew/bedtime. Make a solemn commitment to turn off all electronic devices at curfew time, then turn them back on in the morning. You will begin to develop confidence and security knowing your messages, texts, and emails are there, secure, and waiting for you to retrieve the next day.”

Setting Boundaries With Friends

Dinner’s over, and the check shows up. Your three friends want to split the check four ways, but you scooted in after work, meaning you missed the pre-dinner cocktails…and you’re driving, so you skipped the after-dinner drinks, too.
What do you do?
Financial boundaries are a common issue for friends, Wright says.
“For instance, when you have two girlfriends, one with a lot of disposable income and preferences for girls’ weekends away and fancy meals out, and another girlfriend who really enjoys spending time with her friend but who is on a stricter budget, often a need will arise for the friend who is on the stricter budget to set reasonable expectations with her other friend about what she can spend, how often they can go out together, and maybe negotiate finding low-cost or no-cost things to do together,” she notes.
Again, self-reflection matters here. You have to determine where and how you feel like your boundaries are being crossed and what you’d prefer happen instead.
Then speak up!
“If you say ‘no, thank you’ several times, then gently tell the person you don’t like what they’re doing, that it makes you uncomfortable, and they still don’t get it, then you need to sit them down and tell them you will not allow them to do that to you,” Tessina suggests. “For example, if a friend borrows money or lets you pay for lunch all the time, you can say, gently, ‘I think it’s your turn to buy lunch today’ or ‘I really need you to pay back the money you borrowed.’”
It it doesn’t work, you may have to be blunt.
“Say, ‘I think you’re taking advantage of me financially, and I can’t be your friend if the situation doesn’t improve,’” Tessina says. “‘So, I’m sorry, but I’m not going to lunch with you anymore unless you buy, and/or I’m not lending you any money.’”
It may sound scary to throw out an ultimatum, but this comes back to the self-reflection: Is this boundary important to you?
“Hopefully, your friendship is strong enough to tolerate you setting a boundary and having your own needs and wants, and hopefully, your friend will be able to honor that,” Wright says.
At the end of the day, that’s what all boundaries come down to. You deserve to be treated well, and you deserve people in your life who are willing to respect that.
[related article_ids=1000278]

Categories
Health x Body Wellbeing

How Pressure Points For Migraines Can Help Us Find Relief

When you’ve got a headache that just won’t go away, what’s your go-to fix? If you’ve been diagnosed with migraines and throw out a Facebook query to your family and friends, pressure points for migraines are sure to come up.
But let’s face it … the majority of migraine remedy suggestions tend to fall into two camps: old wives’ tales and science-backed options that you really need to follow up on. So can figuring out pressure points for migraines really help?
Here’s the good news: There’s actual science behind the idea that manipulating pressure points or trigger points can help manage your migraines. In America, 28 million people over the age of 12 suffer from migraines, and studies have been launched to find everything from nausea relief to pain relief.
Although you may be able to find some relief at home using pressure points on your body, trying to use them without proper knowledge could just irritate your muscles. So what do you need to know about pressure points before you start poking around?

What causes migraines?

Before you start digging in, you need to know what you’re working with.
The word migraine gets thrown around a lot, but from a medical perspective, the National Library of Medicine defines a migraine as a type of headache that typically occurs with other symptoms such as nausea, vomiting, or sensitivity to light and sound. A throbbing pain is felt on only one side of the head in typical cases.
“It is not uncommon for some people to concentrate stress in one part of the body,” explains Nada Milosavljevic, MD, a physician and faculty member at Harvard Medical School and founder of Sage Tonic. “One typical area is the head, and the symptom is the all-too-familiar headache. For some people, headaches are easily triggered and recurring, causing distraction, irritability, and the tendency to rely on medications to feel normal. For others, intermittent migraines can drive them to distraction, blocking out other activities for several hours or even whole days.”
Treatments for migraines vary from daily medications to pharmaceuticals that can be taken orally when someone senses the headache coming on.
But pills aren’t the only options out there. More natural remedies can be helpful for some patients, Milosavljevic says.
“Behavioral, stress reduction, and integrative therapies like acupressure, biofeedback, CBT (cognitive behavioral therapy), and physical therapy can be beneficial,” she notes.
One of the most popular of those natural remedies is pressure point massage, sometimes known as pressure point manipulation or acupressure.

Pressure Points for Migraines

This form of massage treatment focuses on myofascial trigger points in the muscles, says Michele Macomber, a certified myofascial trigger point therapist at Pain Free Maryland.
“Myofascial trigger points form in muscles that have become too tight, are injured, or are in spasm,” Macomber explains. “There can be any number of them in any individual person, depending on the events of their life. Trigger points can form at birth, every time a child gets a bump, any time an adult gets a repetitive strain injury or has an accident, any time someone spends countless work hours in a posture of poor ergonomics.”
“A migraine sufferer may need medication, changes in habits or foods, and to avoid perfumes, smoke, and chemicals as well, but the tension aspect of the headache, whether true migraine or not, is easily and effectively treated with myofascial trigger point therapy and stretch,” she adds.
That usually means calling someone like Macomber to help relieve those tight muscles causing a headache. Medical practitioners have developed cold lasers, for example, a relatively painless procedure that can be used only in a medical setting to tackle pressure points and relieve migraine symptoms. There are also compression techniques that can be done in an office setting to quiet the muscle pain that can lead to a migraine.
Sometimes a practitioner will use a needle in the spot (think acupuncture) or compression via massage, putting pressure on the pressure point, which triggers the body to send blood to that area and signals the body to release the pain. The goal is to eventually signal the body to relax the pressure point, creating relief for both the muscles and the headaches.

Pressure Point Treatment at Home

But that doesn’t mean you can’t get some migraine relief at home using pressure points.
With some 400 acupressure or trigger points in the body, there are spots that may supply relief if you can find them.
“With a bit of practice and some initial guidance, a migraine sufferer can readily stimulate acupressure points on their own,” Milosavljevic says, “especially those on the face and arms, which allow for easy access.”
In addition to providing migraine relief, pressure point massage can help relieve the stress associated with a migraine attack. Milosavljevic recommends these two to get you started:

LI 4

This trigger point is located on the top side of the hand in the web between thumb and index finger. “To find the point, squeeze the thumb against the base of the index finger,” Milosavljevic says. “The point is located on the highest point of the bulge (fleshy prominence) of the muscle, level with the end of the crease.”

Yintang

Sometimes called the “third eye point,” this trigger point is located on the face. You can find it midway between the medial ends of your eyebrows, right in the center of your forehead.
To get relief from at-home manipulation of the pressure points for your migraines, William Charschan, a chiropractor and owner of Charschan Chiropractic and Sports Injury Associates in North Brunswick, New Jersey, suggests pushing firmly on the pressure point for about a minute, using the index finger or index and middle fingers together.
The pain should slowly ebb, but the pressure can be repeated as needed. The amount of pressure you exert on the trigger point is up to you, although the feeling should be a “good hurt” rather than an excruciating pain. If it’s the latter, stop!
If pressure point massage alone doesn’t work, Macomber suggests incorporating heat and stretching.
“These are not a sufficient substitute for treatment, but until and after they get treatment, stretches may help reduce tension and pain,” she explains, but she quickly adds one note of warning. “Stretching far enough to feel pain makes muscles reflexively tighten up and can exacerbate the problem.”
To avoid this, don’t stretch if it is painful, and never stretch as far as the joint will allow.
“You should feel a comfortable, pleasant stretchy feeling, but never an extreme stretch sensation or pain,” Macomber says. Heat can also be added via a heating pad placed directly on the neck, shoulders, or other pressure points to soothe the irritated muscles.

Post-Pressure Procedure

It’s important to follow up with your physician, even if at-home treatment alleviates the migraine pain. “The problem with treatment is that without understanding or relieving the common triggers, migraines will continue to occur and may be frequent,” Charschan says. “Also, there is often a genetic link to those who get migraines, which may be linked to body style.”
“We not only look like our parents but walk like them and hold ourselves like them,” Charschan continues. “In other words, our mechanical signatures are often quite similar.”
For example, you may have your dad’s feet, which predispose you to back issues or asymmetrical body mechanics that create stress, which pulls on one side of the neck. That can be a migraine trigger and is often a main reason that patients who receive chiropractic treatment for migraines see improvement,” Charschan sys.
“Medically, they look at the mechanism of the migraine and treat it with medicine but ignore the mechanical causes which can often be eliminated or improved with chiropractic manipulation and soft tissue treatment,” he says.
The good news? Regardless of the cause of migraines, science points to the possibility of long-term relief with the help of appropriate treatment.
[related article_ids=1001219]

Categories
Health x Body Wellbeing

Potential Causes Of Sudden Weight Gain According To Weight Management Experts

Sudden weight gain. Three words few people want to hear. And yet, there you are. You’ve stepped on the scale, and seemingly out of nowhere, your weight has skyrocketed.
If you haven’t eaten a Thanksgiving-sized meal or recently found out you’re pregnant, a sudden weight gain can send you into a tailspin, wondering exactly what the heck is going on with your body. Are you getting sick? Is your thyroid acting up? Is it cancer? Or are you absolutely fine and just need to refocus on your fitness?
That depends on how much weight you’ve gained and how fast, says Susan Besser, MD, a primary care physician with Overlea Personal Physicians and a physician certified in treatment of obesity through the American Board of Obesity Medicine. Most of us gain a few pounds every now and then, whether it’s because we’ve been spending a lot more time sitting or we’ve been under the weather.
Weight gain isn’t typically a problem unless it’s sudden, Besser says, but even then, a pound or two is considered well within the range of normal.
It’s when you’ve gained at least 10 pounds in as little as a week that Besser says she starts to get concerned. She’s quick to point out that it’s not just the weight gain itself but other symptoms that tend to coincide with sudden weight gain, such as obvious swelling of the legs, sudden shortness of breath, or chest pain.
“These things all suggest a systemic illness,” Besser explains. “Alternatively, many chronic health problems don’t cause sudden weight gain but slow, steady unexplained gain.”
If you’ve had sudden weight gain like the type Besser has described, here’s what the experts say could be going on (and what to do about it).

Causes of Sudden Weight Gain

Medicine

If you’ve had a change in medicine recently, and your weight has increased suddenly, a call to your pharmacist might be in order.
There are a range of drugs that can cause varying degrees of weight gain, says Julie Cantrell, MD, lead physician at OhioHealth Medical Weight Management. Some may cause sudden weight gain, while some may cause the body to pack on weight more slowly, albeit still significantly.
One of the worst offenders is prednisone, a steroid used to fight inflammation in patients with everything from asthma to lupus to psoriasis. Known for giving patients a “moon face” because of swelling, prednisone and similar steroids cause both fluid retention and an increased appetite, Cantrell says. Together, these symptoms can cause the numbers on the scale to climb, and for folks who have a chronic disease that requires extended steroid usage, weight management can be a significant challenge.
Antidepressants make the list too, in large part because they affect many of the different hunger hormones, Cantrell says. In particular, Paxil is known for its effect on hunger and resulting weight gain.
Other drugs that can cause a fluctuation in weight include anticonvulsants, beta blockers, diabetes medications, antipsychotics, and heart medications, although Cantrell notes that typically gains are slow rather than sudden.

Heart and/or Kidney Disease

The medications used to treat heart disease aren’t the only trigger of weight gain. Heart disease itself, along with kidney disease, can also cause a spike when you step on the scale.
That’s because congestive heart failure and renal failure both result in “significant water retention,” Besser says.
If you don’t have a medication to blame, and you’ve noted sudden weight gain, the risk of heart or kidney disease is a reason to call your doctor ASAP.
“Increased weight due to heart or kidney disease could be life threatening,” Besser warns, not because of the weight itself but because of the underlying disease.

Thyroid

When patients show up in Cantrell’s office complaining of weight gain, they often hope it’s a malfunctioning thyroid, she says, “because then we can fix it!”
Some 12 percent of Americans will develop a thyroid disorder during their lifetime, according to the American Thyroid Association, but up to 60 percent of Americans with a malfunctioning thyroid never know it.
For those who have hypothyroidism, meaning the thyroid gland is not producing enough hormones, weight gain can be a problem, along with fatigue, depression, and forgetfulness.
“The thyroid is like the body’s gas pedal, determining how many calories we burn at rest,” explains Jacob Teitelbaum, MD, author of the Beat Sugar Addiction NOW! series. “For most of us, that plays a much larger effect than exercise on weight.”
Treatment of hypothyroidism with synthetic hormones will typically help reverse weight gain.

Cushing’s Disease

Although it’s considered a rare condition, Cushing’s disease, or Cushing’s syndrome, can sometimes be the culprit of sudden weight gain. Most common in adults aged anywhere from 20 to 50, Cushing’s is an illness that results in excessive levels of cortisol, an adrenal stress hormone.
“This triggers insulin resistance and marked fat deposition,” Teitelbaum explains. That means fat won’t be spread evenly across the body; instead it’s often deposited in spots on the upper body such as around the neck, while legs and arms may remain thin.
Treatment for Cushing’s disease is dependent on the cause, as some cases of the condition are familial (meaning it was passed down through your genes), while others can actually be caused by medications such as the steroids described earlier.

Cancer

It may be a major fear for most of us when we note body changes, but this is one that can typically be written off when it comes to a sudden weight gain, says Avram Abramowitz, MD, a board-certified oncologist and hematologist with Queens Medical Associates.
Typically, cancer will cause weight loss rather than weight gain.
“The way cancer works is that tumors produce their own chemistry, which interferes with the body’s ability to use the nutrition intake. Whether people eat a lot or a little, well or poorly, is almost irrelevant when cancer takes over the body,” Abramowitz notes. “Their ability to use nutrients is subsumed by the behavior of the cancer.”
The only time cancer may cause weight gain, he adds, is at the end stage. Called ascites, this weight gain is actually a filling of the body with fluid, but other symptoms are apparent long before this point.

Pregnancy Complications

Most women gain steady weight while pregnant, and according to Nancy P. Rahnama, MD, a bariatric physician, as long as the weight gain isn’t sudden, it’s normal.
“General progression of weight gain will vary, but an average of four pounds a month is considered normal as long as the mother stays within the appropriate range,” Rahnama says.
It’s when you see sudden weight gain that you should have a talk with your doctor or midwife.  
“Any more weight gain may be suggestive of gestational diabetes, which can be detrimental to the baby and the mother,” Rahnama says.
Preeclampsia, HELLP syndrome, and other hypertensive disorders that are singular to pregnancy can also cause sudden weight gain in much the same way that kidney and heart disease can cause a weight spike in a non-pregnant woman. According to the Preeclampsia Foundation, “Damaged blood vessels allow more water to leak into and stay in your body’s tissue and not to pass through the kidneys to be excreted.”

Mental Health Issues

Although typically people suffering from depression or a binge eating disorder see slow weight gain rather than sudden weight gain, as lack of energy and increased appetite cause the body to build fat, stepping on the scale and seeing a big jump can be a sign of a mental health issue.
Sometimes, Cantrell says, the weight gain was gradual but seems sudden because “we put our heads in the sand.”

When to Call the Doctor

Whatever may be to blame for sudden weight gain, doctors advise against self-diagnosing in favor of a call to your physician.
“Inappropriate weight gain without an obvious cause that is consecutive should be evaluated,” Rahnama stresses. “When this weight gain is associated with other symptoms, such as fatigue, depression, hair loss, change in skin texture, or a lack of menstruation, the evaluation should be done sooner than later.”