Emotional stress sets off a series of reactions that helps you survive if you were to run into a bear in the woods. But unfortunately many of us today experience this kind of emotional stress constantly, and it’s not because we’re being chased by a bear!

To avoid being in a chronic state of emotional stress in today’s hectic world, you have to actively take steps to effectively manage your stress. Some quick tips? Breathe deeply, meditate, learn to visualize, express your feelings, eat clean, and exercise. All of these things will help. If you’d like to know more about how I can help you manage your stress, email me.

Implantation bleeding. You may experience some normal spotting within the first six to 12 days after you conceive as the fertilized egg implants itself in the lining of the uterus. Some women don’t realize they are pregnant because they mistake this bleeding for a light period. Usually the bleeding is very light and lasts from a few hours to a few days.

Miscarriage. Because miscarriage is most common during the first 12 weeks of pregnancy, it tends to be one of the biggest concerns with first trimester bleeding. About 15% of recognized pregnancies will end in a miscarriage and more than 80% of miscarriages occur within the first three months of pregnancy.. About half of women who bleed in pregnancy eventually miscarry, but that doesn’t necessarily mean that if you’re bleeding you’ve lost the baby, especially if you don’t have any other symptoms.
Other symptoms of miscarriage are strong cramps in the lower abdomen and tissue passing through the vagina.

Ectopic pregnancy. In an ectopic pregnancy, the fertilized embryo implants outside of the uterus, usually in the fallopian tube. If the embryo keeps growing, it can cause the fallopian tube to burst, which can be life-threatening to the mother. Although ectopic pregnancy is potentially dangerous, it only occurs in about 2% of pregnancies.
Other symptoms of ectopic pregnancy are strong cramps or pain in the lower abdomen, and lightheadedness.

Molar pregnancy (also called gestational trophoblastic disease). This is a very rare condition in which abnormal tissue grows inside the uterus instead of a baby. In rare cases, the tissue is cancerous and can spread to other parts of the body. Other symptoms of molar pregnancy are severe nausea and vomiting, and rapid enlargement of the uterus.

Subchorionic hemorrage. This is a fancy way of saying there is bleeding inside the uterus next to the pregnancy. This is diagnosed by ultrasound and does not mean you will miscarry. The blood from this area will start out bright red but become brown as time goes on, and eventually stop.

Additional causes of bleeding in early pregnancy include:

• Cervical changes. During pregnancy, extra blood flows to the cervix. Intercourse or a Pap test, which cause contact with the cervix, can trigger bleeding. This type of bleeding isn’t cause for concern.

• Infection. Any infection of the cervix, vagina, or a sexually transmitted infection (such as chlamydia, gonorrhea, or herpes) can cause bleeding in the first trimester.

Adapted from Web MD Medical Reference

Exercise is a great way to prevent the winter blues. Getting your endorphins firing is sure to increase your general sense of well-being as well as your energy. Try walking, jogging, biking, or swimming. Whenever possible, exercise in the sun or near a sunny window.

Getting enough vitamin D is also critical. Without it our moods shift, our sleep cycles get disrupted and our appetites increase. That equals a sad, sluggish and hungrier person. Not a good combination for feeling optimal! To counter a lack of Vitamin D from the sun, try spending 30 minutes per day in front of a specially designed light box to naturally improve mood and energy levels. Also, if you aren’t already taking vitamin D supplements, you should begin taking it in order to help keep you healthy throughout the chilly winter season.

Whenever possible let the natural light shine in. And lastly, resist the urge to bail on your friends and plans. Surrounding yourself with light and people you enjoy is a great way to elevate your mood.

This translates into:
· less postoperative pain
· much smaller incisions
· less risk of infections
· less blood loss
· shorter hospital stays
· shorter recovery time for the patient

The most common surgery a Gynecologist will perform with the robot to assist is a hysterectomy, although the robot may also be used for several other types of surgery as well.

General Information about Hysterectomy
Hysterectomy means removal of the Uterus. It is a way to treat many types of problems involving the uterus and/or cervix. Hysterectomy often, but not always, cures the condition being treated. Sometimes the cure is only partial. No matter how the Hysterectomy is performed, it is still major surgery and requires sufficient recovery time. Many conditions may respond to other treatments that are less invasive and often just as effective. For those conditions that have not responded to alternative treatments, hysterectomy may be the best choice for treatment.

Reasons for Hysterectomy:
1. Uterine Fibroids
2. Chronic Pelvic Pain, including Endometriosis
3. Uterine Prolapse
4. Abnormal Uterine Bleeding
5. Cancer of the Uterus or Cervix

Types of Hysterectomy:
1. Total Hysterectomy- Removal of Uterus and Cervix only. Ovaries are NOT automatically included.

2. Subtotal (Supracervical) Hysterectomy- Removal of upper Uterus only and leaving the Cervix in place.

3.Radical Hysterectomy- Removal of Uterus, Cervix and Surrounding Tissues. This is usually done for removal of Cancer.

Associated Surgeries:
1. Salpingo-oophorectomy- Removal of both fallopian tubes and ovaries
2. Oophorectomy- Removal of one or both ovaries
3. Salpingectomy- Removal of one or both fallopian tubes

Surgical Approaches to Hysterectomy:

1. Abdominal Hysterectomy – Removal of the Uterus through a “bikini” cut (a horizontal incision just above the pubic bone) or through a midline, vertical incision. These incisions are usually several inches long. They allow excellent access to the pelvic organs and this approach may be needed for more complicated surgeries. There is more postoperative pain, longer hospital stays, more blood loss, higher chance of infection and longer recovery with this approach.

2. Vaginal Hysterectomy – Removal of the Uterus and Cervix through the vagina. There is usually no abdominal incision with this approach. The patient may have less pain and slightly shorter hospital stay and recovery with this type of hysterectomy compared to an abdominal incision. A vaginal hysterectomy is not always possible given the anatomy of the patient if there are lots of scars (adhesions) or a large uterus. Laparoscopy may also be combined with a vaginal hysterectomy in some cases to increase the chances of a successful vaginal hysterectomy.

3. Laparoscopic Hysterectomy – Removal of the Uterus through several small abdominal incisions. These incisions are usually about one quarter to one half inch in length and are less painful than much larger incisions. A camera is used in one of the incisions to view the pelvis and the other incisions are for surgical instruments. There is less bleeding, pain and infection with this surgical approach. Hospital stays and recovery time are also significantly shorter than Abdominal Hysterectomy. There is a slightly higher chance of injury to the urinary tract compared to Vaginal Hysterectomy however Laparoscopy allows the surgeon better visualization and access to the anatomy in the pelvis. Surgical time is generally longer for Laparoscopy than for Vaginal and most Abdominal Hysterectomies.

4. Robotic Assisted Hysterectomy – Takes what is good about Laparoscopic surgery and improves on it dramatically with better visualization than any surgical approach and with greatly improved handling of the anatomy compared to other surgical methods. Recovery times and hospital stays are the shortest with this surgical approach; however time in the operating room is the longest due to the more technical nature of this surgery. Robotic-Assisted Hysterectomy also allows the surgeon to deal with more complicated problems and anatomy that, in the past, would have made Abdominal Hysterectomy a necessity.

The need for Hysterectomy, type of Hysterectomy and surgical approach is something that you should discuss with your Gynecologist. If you are considering the need for Hysterectomy for your Gynecological problem, please call our office to make an appointment.

For more information about Robotic-Assisted Hysterectomy, please visit www.daVinciHysterectomy.com.

Short Term Insomnia (3 months or less) is usually caused by stressors including non-ideal sleeping environment, stress in family or with job, pain or recent illness, time changes or jet lag, and medications (use of, or stopping a medication). This type of insomnia is usually resolved with removal of the stressor.

Long Term Insomnia lasts longer than one month. Its causes are often more complicated such as mental health problems; menopausal night sweats; medical illnesses causing pain, stress or breathing problems; medical illnesses such as Parkinson’s or Alzheimer’s Diseases, sleep apnea, restless leg syndrome; medication or illegal drug usage; or may be unknown in cause.

If you think that you have a problem sleeping and have tried the suggestions below without much relief, you should see your doctor for a basic evaluation. Often a review of your medical history and lifestyle can reveal the causes of insomnia and often the solutions are somewhat simple. Most people don’t need medication. We call these suggestions “Sleep Hygiene”.

Good Sleep Hygiene
1. Maintain a regular bedtime and awakening time schedule including weekends. Get up and go to bed at the same time each day regardless of how much sleep you actually got at night.

2. Establish a regular, relaxing bedtime routine. Relaxing rituals prior to bedtime may include a warm bath or shower, aroma therapy, reading or listening to soothing music.

3. Sleep in a room that is dark, quiet, comfortable and slightly cool. Sleep on comfortable mattress and pillows.

4. Use your bedroom only for sleep or sex. Have work materials, computers and TVs in another room. Darken your room as much as possible. This includes all those little power lights from electronic equipment.

5. Finish eating at least 2-3 hours prior to your bedtime.

6. Avoid caffeine within 6 hours of bedtime. Avoid alcohol and smoking within 2 hours of bedtime.

7. Exercise regularly. Finish a few hours before bedtime.

8. Avoid napping during the day.

9. Go to bed only when sleepy. Lay in bed only for sleeping, not for work or watching TV.

10. Designate another time to write down problems and possible solutions rather than right before bedtime. Late afternoon or early evening is better.

11. After 10-15 minutes of not being able to get to sleep, go to another room and read or watch TV until sleepy. Do not watch the clock.

12. See your doctor if you think that you have gastric reflux (heartburn) or severe snoring (sleep apnea) as these conditions may interfere with your sleep.

13. If you think that you may have Anxiety or Depression. This can interfere with sleep. See your doctor.

14. If you take prescription medications or supplements, review these with your doctor to make sure that they are not causing insomnia.
Most people will sleep much better if they use good Sleep Hygiene. Some people may require a little more help and may wish to turn to herbal or other natural remedies. Remember, more is not always better, so take only what is recommended on the package.

Sleep Aids That May Help.

Melatonin: This sleep hormone helps to make you sleepy when it is dark and awake when it is light.

Valerian Root: Increases GABA (sedating neurotransmitter) levels in the brain.

Lemon Balm: Increases GABA (sedating neurotransmitter) levels in the brain.

Chamomile: Noted for relaxing and antispasmodic properties.

Passion Flower: Noted for relaxing and anxiety reduction properties.

5-HTP: This Serotonin precursor may also help with hot flashes and mood. May prevent early AM waking.

Tylenol PM, Benadryl or Unisom: These over the counter aids often help.

With the exception of Melatonin, most of these aids should only be for occasional use. They may lose their ability to help if used too frequently.

“But Doc, nothing has worked.”
If your sleep does not improve with the above suggestions or medications, it is time to visit your doctor to evaluate the possible causes. Your primary care doctor is a good place to start. They may either wish to try a medication for insomnia or they may suggest further studies or referral to a sleep specialist for more in-depth evaluation. A description of that evaluation is beyond the scope of this article.

So, if you are having trouble getting enough sleep, try the sleep hygiene first and sleep aids second. If they don’t help much, then see your doctor. Sweet dreams!

For more information, please consult www.uptodate.com/patients and search “insomnia”.

For more information on Seattle Health Coaches visit seattlehealthcoaches.com. Like this health tip? Subscribe to our newsletter by clicking here.

Much of the abnormal vaginal bleeding during pregnancy occurs so early in the pregnancy that the woman doesn’t realize she is pregnant. Therefore, irregular bleeding that is new may be a sign of very early pregnancy, even before a woman is aware of her condition. Vaginal bleeding during pregnancy can also be associated with complications of pregnancy, such as miscarriage or ectopic pregnancy. I’ll cover this topic more in a future article.

Heavy, excessive, or frequent bleeding (menorrhagia) needs to be evaluated due to risk of anemia, which can lead to dizziness and fainting. But abnormal bleeding, sometimes not heavy at all, can also just interfere with life, and cause emotional distress or severe cramping.

Benign (noncancerous) causes of heavy or frequent bleeding include:

• uterine fibroids (benign tumors of smooth muscle tissue),
• endometrial polyps (tiny benign growths that protrude into the womb),
• adenomyosis (a condition in which the uterine muscle becomes spongy),
• intrauterine devices (IUD’s)
• underactive thyroid function (hypothyroidism),
• an autoimmune disorder called systemic lupus erythematosus
• blood clotting disorders such as inherited bleeding disorders, and
• certain medications, especially those that interfere with blood clotting.
• Pelvic infection
• Endometriosis
• Polycystic Ovary Syndrome
• Postmenopausal hormone therapy
• Stress

Though not common, menorrhagia can be a sign of endometrial cancer. A potentially precancerous condition known as endometrial hyperplasia can also result in abnormal vaginal bleeding. This situation is more frequent in women who are over the age of 40.

Although there are many causes of menorrhagia, in many women, the specific cause of menorrhagia is not found even after a full medical evaluation. These women are said to have dysfunctional uterine bleeding. Although no specific cause of the abnormal vaginal bleeding is found in women with dysfunctional uterine bleeding, there are treatments available to reduce the severity of the condition.

What tests do you need then? Pelvic exam, pap smear if overdue, cultures for infection, blood work to check hormones and blood levels, and an ultrasound are usually needed to figure out what’s going on.

Treatments to stop this problem range from stress relief, weight loss, antibiotics, hormones, to surgery. Hormones could be something as mild as a progesterone cream to possibly a birth control pill. Surgery does not necessarily mean major surgery. If the problem is a small one, then small surgery may be needed. Keep in mind that the treatment options always depend on the patient, where she’s coming from, her age, other health conditions, whether she wants to get pregnant or she’s done with child bearing.

So give us a call if you are having bleeding issues. Don’t be afraid. You don’t have to live with this problem. We can help.

Spotting! What a pain! I feel for you. Unfortunately, it is completely normal and very common to spot or have breakthrough bleeding the first 3 months on any new hormonal birth control. That means it’s common and normal with the birth control pill, the OrthoEvra patch, the Nuvaring, Depoprovera, and the Mirena IUD. So there is nothing wrong with you or the birth control method you are using. It may be more likely to happen with a generic pill, the cheaper versions of the brand name pills. However, if the bleeding continues beyond the first 3 months then give us a call. We may just change your pill, or you may need further testing.

- Dr. Orly “Don’t worry unless I’m worried” Steinberg

First: Stop the activity, stand or sit quietly and take some deep breaths, do some mental distraction techniques such as preparing your grocery list in your head.

Second: Do some quick pelvic floor contractions by squeezing and letting go 5 or 6 times and continue to distract yourself. A rolled up towel or your hand pressure in your perineal area helps control the urge as well.

Third: Relax and do not rush to the toilet. Rushing causes the “flight or fight” response which is difficult to overcome. Think positive thoughts

Finally: when the urge has subsided, walk calmly to the toilet and continue to focus on control.

Sponsored by:
North Sound Physical Therapy

Probiotics are living microorganisms that live all over our body. They are supposed to be on us! They don’t cause us any symptoms and protect us from invading bacteria, funguses and viruses that cause illness. We have trillions of probiotic bacteria on our bodies, mostly in our intestines.

What can probiotics do for you?

1. They promote healthy digestion.
They can keep you from getting both constipation and/or diarrhea. They can benefit those with Irritable Bowel Syndrome and those with Ulcerative Colitis and Crohn’s disease.

2. They can boost immunity.
Much of our immune system is located in our gut. Many bacteria, fungi and viruses (including the cold virus) attack us from the food we eat. Having probiotics in our gut to support our immune system is important to fight off disease.

3. They can prevent a secondary infection in those who have just taken antibiotics.
Antibiotics kill off many good and bad bacteria. Probiotic supplements can repopulate your body with harmless, beneficial bacteria instead of bad, disease causing bacteria.

4. They can promote vaginal health.
Our vaginas have bacteria and yeasts present all the time. There is no way to get rid of all the microorganisms in the vagina, nor would we want to get rid of them.

In the healthy vagina there are many probiotic organisms, “the good neighbors”. We want plenty of them. They don’t cause symptoms and crowd out “the bad neighbors”, which consists of yeasts and those bacteria that cause odor and irritation if they grow out of control. The more good bacteria there are, the less of the symptom causing microorganisms there are. In women who get 2 or more vaginal infections per year that may either be Bacterial Vaginosis (BV) or Yeast infections, I recommend taking a probiotic supplement daily, just like a vitamin, to prevent getting such frequent infections. It works!

5. There are some studies suggesting that probiotics can affect our health in several other ways such as preventing gum disease, preventing seasonal allergies, preventing upper respiratory infections, colon cancer, and might even help with our metabolism.

How do I get probiotics? Which one should I take? How should I take them?

Probiotics are available in food such as yogurt, kefir, sauerkraut and fermented soy products. These may have only limited amounts of probiotics compared to the calories you may be consuming.

To get the “most bang for your buck” you may want to consider a probiotic supplement. There are many, many supplements on the market. Some are cheap and some are expensive. Some are in capsules, some in powders. Some are room temperature and some are refrigerated. Some have one species of organism, some have many.

In general, you want to choose one that has at least 10 billion organisms per dose, has more than one species of organism, is not too expensive, and that you will remember to take daily.

I take one that has 14 billion organisms, 8 different species, is in capsules, that isn’t refrigerated (who can remember to take a pill that has to be stored in the fridge?) and costs about $12 per month. It seems to work well for me. I used to get 4-5 colds per year and since starting regular probiotics, I just got my first cold in 2 years and it only lasted for one week instead of my typical 2 week cold. I am a believer!

In my patients, I see women with several yeast infections per year go down to one or less per year. Does it work for everyone? No, there may be other factors at play, but I usually do see a measurable improvement in frequency of infections.

Can probiotics help me? Try them for 6 months and see!