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Doctor’s Orders

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Find an ob/gyn you like and trust so you’ll keep going back for important yearly exams

mammogramMay is women’s health month. One of the greatest gifts you can give yourself is an ongoing, open relationship with an obstetrician/gynecologist to discuss care and concerns over time. As a woman, you have many responsibilities that require you to be well and strong. Plus, others depend on you.

The American College of Obstetricians and Gynecologists recommends that you schedule a visit annually, to get what is often referred to as a well-woman checkup. “It is not only for gynecologic reasons but also for a blood-pressure check, review of vital signs and weight. We review whether there were any new medical or surgical problems in the past year, review systems such as cardiovascular, pulmonary, gastroenterological, genital, urinary and then do a physical exam,” explains Dr. Quinn Peeper, an obstetrician/gynecologist at Touro Infirmary Hospital, in New Orleans.

The pelvic exam, Pap smear and sexually transmitted disease screening are integral parts of the visit. “The whole point is to keep someone comfortable and disease-free,” says Dr. Stephen Champlain, obstetrician/gynecologist at East Jefferson General Hospital, in Metairie. For most women, the Pap smear should be a mandatory part of the visit. “It screens for changes in the cervical cells, which potentially could lead to cancer or what we call cervical dysplasia, which is a precursor to cancer,” says Champlain. Cervical cultures are sometimes done to pick up asymptomatic infections like chlamydia, which is making a resurgence in the country. “At the end of the exam, we palpate, or feel, the ovaries and uterus to make sure they are not tender and fall within the normal size limits that we expect. We try to make sure that someone does not have a big, painful cyst on their ovary, a tender uterus or a fibroid tumor,” explains Champlain.

If you are worried about coming in because of the screenings, have a talk with your doctor about what is necessary for you. “Women at any age should have a pelvic exam at least at intervals,” suggests Dr. Sherri Godbey of Crescent City Physicians. “Your pelvic organs need to be checked just like your heart and lungs, but I come up with a plan that is tailored to the woman.”

Sexually transmitted diseases are largely preventable. “Condom use is the best thing and not being promiscuous is good too. Unprotected sex with multiple sexual partners is the prescription for getting an infection and there is no medicine or vaccine that is going to prevent getting an infection. It comes down to behavior,” says Champlain.

The breast exam is critical along with the patient education that takes place in the office about how to perform a breast self-exam at home. You should examine your breasts at least twice each month, right after menstruation—if you are still menstruating—and in the middle of the cycle. “Check above the breast all the way to where the collarbone is, checking out the armpit bilaterally on both sides, below the armpit to the level of where the breast comes down to. You check above and to the side of the breast and then you check the breast in a circular or up and down fashion using two to three fingertips trying to feel for something that feels like a hard Mardi Gras–sized bead or a frozen pea,” advises Champlain. If you feel anything hard or nodular, you should get it checked.

Mammograms matter. “Mammogram screenings start at age 35. We do yearly screenings starting at age 40 or 41,” says Champlain. This gives you a baseline of what is normal for you, so the doctor is able to recognize any changes. The visit is comprehensive but quick and easy.

Screenings are not limited to gynecologic issues, says Godbey. “I do a thyroid screen test, talk about cholesterol and include a lipid panel for women who may be at risk or have a history of cholesterol problems, be overweight or have diabetes. I usually check the abdomen, listen to the heart and lungs, assess the pulse, do a basic musculoskeletal exam and try to spot anything that is physically or visibly wrong.”

Do not overlook the importance of good nutrition as well. “Every woman over the age of 18 should get at least 1,000 milligrams of calcium every single day. Eating well and exercising regularly prevents a lot of diseases that come up,” says Champlain. Sometimes a little assistance can be helpful, especially if you are pre-conceptual, pregnant or have a chronic disease. “I usually recommend my patients take a good, brand-labeled, over-the-counter multivitamin,” says Godbey.

It is advised to stay away from most enhancers or supplements. “I recommend vitamin C, calcium and vitamin D,” says Godbey. If you are using any product, it is recommended to inform your doctor and seek an expert opinion. “A lot of times, just because a product is touted as helpful or beneficial and sold over-the-counter or over the Internet, it does not mean it is 100 percent safe. I usually have patients bring the product in or send me a label in the mail, so I can give my 2 cents worth,” says Godbey.

An open dialogue is essential to a productive visit. You should take advantage of the time you spend with your doctor. “It is a good time for the woman to bring up a variety of health concerns such as sexual health issues, menopausal symptoms or postmenopausal issues like osteoporosis, frequent urinary tract infections or urinary incontinence,” says Godbey.

Sometimes girls as young as 9 come in with developmental issues or problems with menstruation. “If the pediatrician cannot help out or feels something is beyond their knowledge or resources, they will send young women or children to us,” says Champlain. Dysmenorrhea, or pain with menstruation, often associated with women going through early periods, is one common condition. Doctors emphasize that they are supportive of their patients and proud of the role they have played in maintaining optimal health. “Most patients that come in to the office, thank goodness, are coming in for routine care and are not pursuing a bad problem,” says Champlain.

Teens should not be hesitant to visit, regardless of whether they are sexually active. “You should come in just to build a relationship and confidence. It helps young girls get over the fear and anxiety they can sometimes have going to the gynecologist for the first time,” says Peeper. A pelvic exam is not always necessary and important topics are discussed, such as sexual issues and menstrual problems. “A lot of women and teenagers get nausea, vomiting, palpitations and sweating to where it interferes with school and study habits, so it is important to address,” comments Peeper.

Many young women are asking questions about Gardasil, a vaccine for those between 9 and 26 years of age. “Gardasil is proven to be very safe and is cutting down the risk of HPV, cancer, dysplasia and warts,” says Champlain. Other women are interested in getting in better shape. Godbey, for one, recommends doing some kind of physical activity most days of the week. What works for one person may not be the best idea for someone else. “I try to give advice that fits [the patient] and addresses [her] goals, physical capabilities and personal interests,” she says.

Doctors want teens to know that what happens in the office stays in the office. “If it is something we need to discuss with parents, we encourage the patient to bring them in as an emotional backup, but they need to give us their approval,” explains Champlain.

If you are uncomfortable with your current ob/gyn, it is time to find a new one. “We consider ourselves patient advocates, and there should never be any reason someone cannot come to a physician or needs to go through a nurse. There should be nothing between being open and honest with your physician,” affirms Champlain. All visits are confidential. “The patient’s chart is a sacred document, and we treat it, along with the patients’ confidence, with a lot of respect,” says Champlain.

Being postmenopausal is not an excuse for skipping out on a well-woman exam. “It is important to come in after menopause for a blood pressure, thyroid and cholesterol check. Even if the patient has had a hysterectomy, she still needs to come because the risk of vulvar, vaginal and other gynecologic cancers increases with age,” says Peeper. Other issues can still be burdensome. “Urinary incontinence is a problem that affects millions of people,” he emphasizes. Dedicating one day a year to seeing your ob/gyn can be empowering, informative and, in some cases, lifesaving. “It is definitely a lifelong relationship,” says Peeper.