December 2001, Volume 1, Issue 3
Special Points of Interest
Tiffany Athey, M.S.N, W.H.C.N.P., Joins WHP Staff
Are Elected Repeat Cesarean Sections Necessary?
True or False – A Patient Quiz
Birth Control Pills and Ovarian Cancer Prevention
Avoid Holiday "Feast"ivities Weight Gain
Currently Enrolling Clinical Research Studies
__________________________
Suzanne Trupin, MD, FACOG
2125 South Neil Street, Champaign, IL 61820
PHONE (217)356-3736
FAX (217) 356-5849
www.womenshealthpractice.com
Tiffany Athey, M.S.N., W.H.C.N.P., Joins WHP Staff
Women's Health Practice welcomes Tiffany Athey, M.S.N., W.H.C.N.P., to our staff.
Tiffany is a women's health care nurse practitioner who trained at and obtained her Masters of Science in Nursing at Vanderbilt School of Nursing in Nashville, Tennessee. She received her Bachelors of Science in Biology from the University of Nebraska. Tiffany is nationally certified as a Women's Health Care Nurse Practitioner by the National Certification Corporation for Obstetric, Gynecologic, and Neonatal Nursing Specialties. Her special interests in women's health include adolescent medicine, lactation, prenatal care, menopausal assessment, and issues of sexuality.
Nurse practitioners are registered nurses with advanced education, which prepares them to deliver primary health care in specialty areas in collaboration with physicians and other health care providers. They maintain communication with all members of the health care team, including the patient.
Nurse practitioners care for your health in a variety of ways:
• Perform physical examinations;
• Diagnose and treat common health problems, such as infections;
• Treat and manage chronic health care problems;
• Facilitate illness prevention to decrease health care costs;
• Provide health and education to improve or maintain health;
• Teach, advise, and provide family planning and pregnancy care;
• Conduct health screening procedures, such as Pap smears, breast exams, sport and employment physicals;
• Order and interpret selected studies;
• Perform procedures, such as colposcopies and endometrial biopsies; and
• Prescribe medications.
Consumer studies cite the personal interest shown by nurse practitioners and their ability to decrease the mystery surrounding health care as reasons consumers seek health care with Nurse Practitioners.
Join us in welcoming Tiffany to Women's Health Practice-we are excited and fortunate to have her as a member of the WHP healthcare team!
Are Elected Repeat Cesarean Sections Necessary?
Women who have delivered a child via Ceasrean section (C/S) are three times more likely to suffer a uterine rupture if allowed to labor at a second delivery than women who elect repeat Cesarean section (N Engl J Med 2001;345:3-8)
Researchers from the University of Washington in Seattle found that uterine rupture occurred in 1.6 of 1,000 women with repeat C/S delivery without trial of labor; in 5.2 of every 1,000 women with spontaneous onset of labor was induced without prostaglandins; and in 24.5 of every 1,000 women whose second labor was induced with a prostaglandin.
An editorial in the same journal points out that the uterine rupture is of clinical significance not only to the mother, but to the infant. The incidence of infant death among the women with uteri ruptured was 10 times as high as in those without rupture. In addition, the women with ruptured uteri were twice as likely to have infants with Apgar scores of less than 7 at 5 minutes postbirth.
To many women, the risks associated with a trial of labor after a C/S, which are significant to many clinicians, seem small in comparison to the prospect of a successful vaginal birth. The pros and cons, therefore, must be discussed with each individual patient so that each woman can make an informed decision for herself.
True or False — A Patient Quiz
Genital warts are caused by a virus.
TRUE. Warts are caused by the human papillomomavrius (HPV), There are more than 100 types of this virus-more than 30 of those types cause infection in the genital area.
The virus can be caught from a toilet seat.
FALSE. HPV infection is transmitted from one person to another during sexual activity.
HPV does not always cause warts.
TRUE. A person can have the virus but not have warts or may not know the virus is there.
Using a condom during intercourse can prevent HPV from spreading.
FALSE. HPV can infect any tissue in the genital region, so it can spread from areas that are not covered by a condom. It is important to use a condom, though, to decrease HPV transmission and help prevent transmission of other diseases.
Genital warts may sometimes go away on their own without treatment.
TRUE. The body's immune system can make the warts go away.
Once warts are removed, they never come back.
FALSE. Sometimes warts do not return, but sometimes they do because HPV infection remains in the body.
Genital warts can cause cancer.
FALSE. It is really the HPV virus that causes cancer-some types of HPV cause warts and some do not. Some types of HPV can cause cancer and some do not. The types of HPV that cause genital warts are not the same types that cause genital cancer. If certain types of the virus stay in the body for a long time, the risk of cancer is higher.
Birth Control Pills and Ovarian Cancer Prevention
The ovary is a small organ in the pelvis that makes female hormones and releases eggs, which, when fertilized with sperm, can develop into a baby. A woman has two ovaries, one on either side of the uterus or womb.
Cancer can occur in the ovary, as sometimes happens with other organs. About 23,000 women in the U.S. are diagnosed with ovarian cancer each year. It is the sixth most common cancer in women and, causes more deaths than any other reproductive organ cancer. More than 14,000 women die from the disease annually.
The most common type of ovarian cancer develops in the outside lining of the ovary. The cancer cells can grow and spread to other parts of the body. Ovarian cancer should not be confused with ovarian cysts, which are fluid-filled sacs, like a blister, that form on the surface of an ovary. Ovarian cysts are not cancer and usually go away without treatment.
The chances for survival are greater if ovarian cancer is found early. For example, 95% of women diagnosed and treated early will live 5 or more years. Unfortunately, only one quarter of ovarian cancer cases are discovered at this stage. Although women with ovarian cancer sometimes have symptoms, such as upset stomach or a feeling of pressure or pain in the pelvis, more often they have no noticeable signs. By the time symptoms are noticeable, the cancer usually has spread outside the abdomen.
RISK FACTORS
The exact causes of ovarian cancer are not known. However, studies have shown that certain factors increase the chances of developing this disease.
• Family history. Some women are at higher risk of developing ovarian cancer because at least one close relative (mother, sister, or daughter) has had the disease. A woman with a family history of ovarian cancer has a 5% lifetime risk of getting it. This compares with a 1.8% lifetime risk of ovarian cancer in a woman with no affected relatives.
• Age. The chance of developing ovarian cancer increases as a woman gets older. Most ovarian cancers occur in women over the age of 50 years, with the highest risk in women over age 60 years.
• Childbearing. Women who have never had children are more likely to develop ovarian cancer than women who have had children. In fact, the more children a woman has had, the less likely she is to develop ovarian cancer.
BIRTH CONTROL PILLS
Many studies have found that women who use or have used birth control pills are about half as likely to get ovarian cancer compared with those who have never used the pill. Researchers are not sure how oral contraceptives protect against ovarian cancer, but this benefit is well documented.
The Centers for Disease Control and Prevention's Cancer and Steroid Hormone (CASH) Study, along with other research conducted over the past 20 years, shows that the longer a woman uses birth control pills, the lower her chance of getting ovarian cancer. Importantly, this benefit continues long after she stops taking the pill.
The Longer A Woman Takes the Pill, The Lower Her Risk of Ovarian Cancer
Source: Centers for Disease Control and Prevention: Cancer and Steroid Hormone Study
The CASH Study found that the reduced risk of ovarian cancer is seen in women who have used oral contraceptives for as little as 3 to 6 months and continues for 15 years after stopping. Other studies show the protection lasts for at least 20 to 30 years.
Recent research has also has confirmed that today's low-dose oral contraceptives give just as much protection as older, high-dose pills. Even high-risk women (those with a higher genetic likelihood of getting ovarian cancer) can lower their risk by using birth control pills.
For further information regarding birth control pills and the prevention of ovarian cancer, please speak with Dr. Suzanne Trupin, Tiffany Athey, M.S.N., W.H.C.N.P., or one of our nursing staff.
Avoid Holiday "Feast"ivities Weight Gain
During the holiday season the typical person gains 5-7 pounds. To keep you and your diet from straying too far during the holidays:
1. Plan Ahead: Remember the "calorie break" concept- save calories the week prior to holiday parties.
2. Never Go To A Party Hungry: To avoid overindulgence, snack on low-fat foods before the party.
3. Take Control of Your Environment: Never engage in conversation while sitting next to a platter of your favoriate snack.
4. Bring A Low-Fat Dish to the Party. Concentracte on low-fat foods-bring a dish to share with others.
5. Fill Your Plate With Veggies and Lean Protein Foods. Add only small "tastes" of high-fat dishes.
6. Eat Slowly and Savor Every Bite. It takes 20 minutes for the stomach to signal your brain that you are full.
7. Decide in Advance How To Handle Gifts of Cookies and Candies. Avoid temptation- don't leave cookies out in the open. Take one or two and give the rest away.
8. Limit Alcohol Consumption. Alcohol is high in calories and stimulates your appetite and reduces your willpower.
9. Stay Active. Exercise to burn extra calories.
10. Moderation Is The Key To Weight Maintenance. An occasional indulgence will not destroy your weight-loss attempts.
Choosing an OB/GYN is an important decision. You'll want to select an OB/GYN who is qualified and with whom you feel comfortable. All OB/GYNs have earned their undergraduate college degree and completed an additional four years of medical school. After receiving their medical degree, OB/GYNs complete four years of residency training in obstetrics and gynecology.
Look for an OB/GYN who is certified by the American Board of Obstetrics and Gynecology (ABOG). This distinction is only obtained after successful completion of two separate tests, a written test and oral exam, given by a panel of experts to determine the doctor's skill, knowledge, and ability to treat many conditions.
The letters F.A.C.O.G. appearing after an OB/GYN's name designates that he or she is a Fellow of the American College of Obstetricians and Gynecologists (ACOG), and is Board Certified, a requirement of becoming an ACOG Fellow.
By choosing an ACOG Fellow as your physician, you can feel confident that you will receive the highest quality health care. Choosing an ACOG Fellow as your physician ensures that your OB/GYN is keeping abreast of the latest medical guidelines, treatments, and techniques in women's health care today. If your OB/GYN is a Junior ACOG Fellow, it means he or she has met all ACOG standards but still needs to complete the Board examinations.
Suzanne Trupin, M.D., F.A.C.O.G., has been Board Certfied and an ACOG Fellow since 1984. She was recertified by the American Board of Obstetrics and Gynecology in 1994, 2000, and 2001.
If you are relocating and need to determine if an OB/GYN is an ACOG Fellow, go to www.acog.org/member-lookup.
Contraceptive Update-Emergency Contraceptive Pills
Emergency contraceptive pills (combination estrogen/progestin) are approximately half as effective 72 to 120 hours after unprotected sex as they are in a period up to 72 hours, but still significantly reduce the risk of pregnancy. Canadian researchers who studied approximately 300 women calculated the pregnancy rate for women taking emergency contraceptives up to 72 hours after unprotected sex to be 0.8%; 72 to 120 hours after unprotected sex the pregnancy rate was 1.8%.
While researchers agree that women who do not wish to become pregnant after unprotected sex should seek medical consultation as soon as possible, the emergency contraceptive pill may provide an alternative in the period after 72 hours, when few other alternatives remain.
Emergency contraception is one of many contraceptive options offered at Women's Health Practice.
Currently Enrolling Clinical Research Studies
WHP is currently enrolling patients in clinical research studies in the following areas: urinary tract infections, osteoporosis, migraine headaches, STAR (prevention of breast cancer), yeast infection, endometriosis, and stress urinary incontinence. For inclusion and exclusion criteria and to see if you qualify, contact Louise Adam, Research Coordinator, at 217-356-3736, ext. 118.