Dr Smith is now a guest contributor to WebMd’s “Trying to Conceive “online discussion community. Over the coming weeks, Dr. Smith will be offering insights on the topic of fertility and also moderating the discussion that results from her submission.  Her first two topics were: “When is the best time to conceive?” and “Did my contraception affect my fertility?”

Please join her and feel free to participate!

To see more of Dr Smith’s insights, go to follow this link: http://http://exchanges.webmd.com/infertility-and-reproduction-exchange/groupstory/15141723

Atlanta Women’s Specialists offers a unique class for expectant fathers. If you are expecting a baby (and are one of our patients), please encourage your baby’s dad to join us for this event.

The Fathers’ Only class is designed for you to learn from other dads who understand and have been in your shoes recently. Ask questions and learn the need-to-know basics before your baby arrives and enjoy pizza at the same time.

This class is expecially helpful for first-time dads. Even if you have been down this road before, we encourage you to join us.

Where: Meridian Mark Office
5445 Meridian Mark Rd
Ste 350
Atlanta, Georgia 30342

When: Tuesday, August 24, 2010

Time: 6:00pm until 7:00pm
Cost: FREE!

A Sign up sheet is on the table in the main waiting room at each office. You can also register (and get additional information about the class) by sending an email to Mary Alice Hedden, mhedden@awsphysicians.com.

We hope you’ll join us.

There is no question that women with Osteoporosis should be on some form of therapy to lower their risk for fractures.  But what about those of us with low bone mass that doesn’t meet criteria for Osteoporosis?  Up to now, clinicians have not had great guidance on making decisions about an individual patient’s need for treatment.   Fortunately, the National Osteoporosis Foundation and more recently the North American Menopause Society (NAMS) have established  user- friendly guidelines that clinicians can use.

The guidelines recommend that women begin screening for bone mineral density at age 65.    Consideration of doing testing in women at age 50 should only occur if they have 1 or more of the following risk factors:  a fracture after menopause, weight less than 127 pounds, current smoking, rheumatoid arthritis, excessive alcohol intake (3 or more units a day), or a parental history of fracture.  Chronic steroid use is also a risk factor.  Based on these recommendations, it is clear that we are currently overusing the DEXA scan that measures bone density.

A calculation tool called the FRAX calculator is now available to help your doctor decide whether or not a prescription is indicated.    It calculates your 10 year fracture risk.  Your clinician may recommend prescription therapy if your risk for a hip fracture is greater than or equal to 3%  OR  if your overall osteoporotic fracture risk is greater or equal to 20%.

Although it is appropriate to repeat the bone density scan after 1-2 years of treatment, there is little benefit of repetative scanning in women who have stable bone density measurements.

I for one, am happy to have better guidelines to follow.  I’ve had the overall impression for years that we were over-treating people and indeed, most women with low bone mineral density (Osteopenia) will not require prescription therapy. 

The next question I would like to have adressed is:  how long should we be taking these medications once started? 

                                                                                                                 Maria Arias, MD

Atlanta Women’s Specialists offers a unique class for expectant fathers. If you are expecting a baby (and are one of our patients), please encourage your baby’s dad to join us for this event.

The Fathers’ Only class is designed for you to learn from other dads who understand and have been in your shoes recently. Ask questions and learn the need-to-know basics before your baby arrives and enjoy pizza at the same time.

This class is expecially helpful for first-time dads. Even if you have been down this road before, we encourage you to join us.

Where: Meridian Mark Office
5445 Meridian Mark Rd
Ste 350
Atlanta, Georgia 30342

When: 4/27/2010

Time: 6:00pm until 7:00pm
Cost: FREE!

A Sign up sheet is on the table in the main waiting room at each office. You can also register (and get additional information about the class) by sending an email to Mary Alice Hedden, mhedden@awsphysicians.com.

We hope you’ll join us.

Atlanta Women’s Specialists has adopted the new guidelines for cervical cancer screening established by the American College of Obstetricians and Gynecologists (ACOG). These guidelines were released and published in the December 2009 issue of Obstetrics & Gynecology.

According to the new guidelines, women should have their first cervical cancer screening at age 21 and can be rescreened less frequently than previously recommended.  Most women younger than 30 should undergo cervical screening once every two years instead of annually, and those age 30 and older can be rescreened once every three years. We’ve posted more detailed information on these new guidelines here.

Annual Visits and Pap Smears

Many women equate the annual “well woman” visit with getting a PAP smear.  These new guidelines do not change the recommendation for an annual visit.  A breast and pelvic exam should be obtained annually, but the laboratory test for cervical cancer screening (the PAP) does not need to be obtained annually in most cases.  In addition, the Centers for Disease Control (CDC) recommends yearly screening of all sexually active women 25 and under for Gonorrhea and Chlamydia.

Cervical cancer rates have fallen by more than 50% in the past 30 years in the US due to the widespread use of the Pap test. The incidence of cervical cancer fell from 14.8 per 100,000 women in 1975 to 6.5 per 100,000 women in 2006. The American Cancer Society estimates that there will be 11,270 new cases of cervical cancer and 4,070 deaths from it in the US in 2009. The majority of deaths from cervical cancer in the US are among women who are screened infrequently or not at all. Cervical cancer is a slow growing cancer caused by certain strains of the human papillomavirus (HPV), an extremely common sexually transmitted disease among women and men. HPV also causes genital and anal warts, as well as oral and anal cancer.

Today’s news is incredible.  Not only are women shocked and concerned but so are their physicians!  As most women have probably heard, the USPSTF (US Preventative Services Task Force) has changed the guidelines for routine screening mammography.  The 2009 USPSTF judged that although women in their 40s and women in their 50s benefit equally from routine screening mammography, women in their 40s experience greater harms from screening than do women in their 50s. Therefore, the USPSTF recommended routine screening for women aged 50-74 years but recommended against routine screening for women in their 40s.

It’s important to know that the current USPSTF panel is not made up of women haters, nor did they make their recommendations based totally on the bottom line: $$$.  While it is true that there are many false positives with routine screening for women in their 4os,  it  is also true is that more lives are saved by early intervention.  The bottom line is that many questions have yet to be answered.

For now,  ACOG (American  College of Obstetrics and Gynecology) has not changed their  screening recommendations.  For women 40-49, a screening mammography is recommended every 1-2 years.  Women 50  and older should have yearly screening.  There is no change to the recommendation that women continue self breast examination.

What effect this all will have on insurance coverage remains to be seen.   At Atlanta Women’s Specialists,  the American College of Obstetrics and Gynecology recommendations will continue to be followed.

 Maria Arias MD

We are now offering both the H1N1 and Season Flu vaccines to our pregnant patients.  If you are pregnant, you can get these shots at your next regularly scheduled OB visit, by scheduling an injection-only appointment or by attending one of our Flu Clinics.  They will be held between the hours of 9:00 am and 3:00 pm on the following days: Meridian Mark Office: November 12 and 19; Alpharetta Office:November 10 and 17.  On Flu Clinic days no appointment is necessary; just show up and we’ll give you the shot.

Starting November 5, we are offering the H1N1 vaccine to our pregnant patients.  If you are pregnant, you can get this shot at your next regularly scheduled OB visit, by scheduling an injection-only appointment or by attending one of our H1N1 Flu Clinics.  They will be held between the hours of 9:00 am and 3:00 pm on the following days: Meridian Mark Office: November 12 and 19; Alpharetta Office:November 10 and 17.  On Flu Clinic days no appointment is necessary; just show up and we’ll give you the shot.

Due to the anticipated demand from patients who are not pregnant, we have asked for additional vaccine supplies. When we receive the additional supply we will offer the vaccine to all patients and to the spouses of pregnant patients.  Please watch our blog or Facebook Fanpage for future announcements.

Infants are thought to be at higher risk for severe illness from 2009 H1N1 infection and very little is known about prevention of 2009 H1N1 flu infection in infants. If you are breastfeeding or giving your baby infant formula, a cautious approach would be to protect your baby from exposure to the flu virus in the following ways:

·         Ask for help from someone who is not sick to feed and care for your baby, if possible.

·         If there is no one else who can take care of your baby while you are sick, try to wear a face mask at all times when you are feeding or caring for your baby. You should also be very careful about washing your hands and taking everyday precautions to prevent your baby from getting flu. Using a cloth blanket between you and your baby during feedings might also help.

·         If you are breastfeeding, someone who is not sick can give your baby your expressed milk. Ideally babies less than about 6 months of age should get their feedings from breast milk. It is OK to take medicines to treat the flu while you are breastfeeding.

About 7% of all breast cancers are inherited. Some of the risk factors for breast cancer include; female gender, increasing age, increased alcohol consumption, prolonged estrogenic exposure, Ashkenazi or Eastern Jewish descent and family history of breast cancer.  Studies show that the inheritance of germ-line mutations (alterations) of the tumor-suppressor genes known as BRCA-1 and BRCA-2 increases the lifetime risk of breast cancer by 65-70%.  BRCA-1 and BRCA-2 mutations are located on chromosomes 17 and 13 respectively. There are over 1,200 BRCA-1 mutations and greater than 1,300 BRCA-2 mutations. 

If you have a personal or family history of breast and/or ovarian cancer you might benefit from a thorough hereditary cancer risk assessment.  If possible, the testing should start with a family member—you, if applicable—who has been diagnosed with breast or ovarian cancer. Testing someone diagnosed with cancer enables geneticists to specifically target chromosomal mutation sites.  The information gathered via this genetic testing may help customize prevention strategies to further reduce risks of recurrence or primary malignancies. If this is not possible, then the unaffected, at-risk individual will have all of the potential genetic mutation sites tested for the BRCA 1 and 2.

Screening should include a complete personal and family history, extensive genetic counseling with testing, and healthcare planning. If the testing reveals the presence of any of these gene mutations, you will be considered “at increased risk” for breast cancer.  You also will have some prevention strategies to consider, including: closer surveillance, chemoprevention or prophylactic surgical procedures. 

If you have a family history of breast cancer, we recommend you find out more about genetic testing.  For assistance evaluating your genetic testing options, schedule appointment with one of our physicians or nurse practitioners.

You can also get more information about Northside Hospital’s Hereditary Cancer Program from their website www.northside.com.

Juanita Wyatt-Hathaway, MD