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

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.

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

Here’s a story that may ring true for you like it does for many of us.  A girlfriend was diagnosed with breast cancer almost 2 years ago. In the beginning, her friends spent a lot of time focusing on the cancer–what stage is the cancer?… is her cancer treatable?…is the cancer in remission? Without realizing it, they were ignoring the most important detail:  how is our friend coping?  It is easy to get wrapped up in the diagnosis and treatment of this disease. It is so much more important to focus on the person who is dealing with this diagnosis.  Some of us learned this the hard way, unfortunately. We know better now.  And recently, we learned about a local facility that knows better, too!

TurningPoint Women’s Healthcare in Alpharetta is dedicated to the well-being of women who are dealing with breast cancer and its treatment effects. TurningPoint provides survivorship support for women in all stages and treatment phases of breast cancer. Several of their staff members are breast cancer survivors.

TurningPoint is a non-profit organization. Many of their educational and support programs are provided free of charge. There is a financial assistance program available to those that may need it. 

They currently provide the following services to Breast Cancer Survivors:

• Physical Therapy
• Exercise Consultation
• Massage Therapy
• Nutrition Services
• Counseling

If you are currently dealing with breast cancer, have a loved one dealing with this disease, or would like to make a donation, visit their website at www.myturningpoint.org.

Our shipment of seasonal flu vaccine has been delayed. As a result, we are delaying the start of our vaccination program.  We anticipate receiving our supply in the next couple of weeks, (although a November arrival date is a possibility).  Once we have a sufficient supply, we will begin offering flu vaccine shots to our pregnant patients.  You will be offered a flu shot when you come in for a regular OB appointment.  We’ll also be offering several flu clinic days at each office. You won’t need an appoinment on these days; just show up and we’ll give you a shot (if you are one of our pregnant patients).  We’ll provide more details in the coming days. We also anticipate offering the H1N1 (Swine) flu vaccine. Once we receive notification that we will be receiving a supply, we will let you know.

October is Breast Cancer Awareness Month!

Did you know that 1 woman out of 8 in the United States will be diagnosed with breast cancer?

Breast self-exam (BSE) is a tool that may help you become familiar with the way your breasts normally look and feel. BSE may help you find tumors in the time between your annual mammogram and/or clinical breast exam. It may also help you learn what changes in your breasts should be reported to your health care provider. If you notice any changes such as thickening, lumps, spontaneous nipple discharge or skin changes, such as dimpling or puckering see your health care provider right away.

Find a buddy and encourage each other to do monthly Self Breast Exams. You can also encourage each other to get a mammogram.

To support Breast Cancer Awareness Month, AWS will be having “Pretty in Pink Fridays!” We’re encouraging our employees to wear pink or a Race for the Cure t-shirt along with scrubs each Friday throughout this month! Also, don’t forget to wear your pink ribbon pin each day to show your support!

For more information on breast cancer, you can go to the following links:
www.komen.org
www.cdc.gov/cancer/breast

As the media blitz continues regarding the H1N1 influenza virus, otherwise known as the swine flu, I continue to receive questions from patients  anxious to take the appropriate steps to prevent or treat  the flu.  We at Atlanta Women’s Specialists understand these fears, and have taken steps to help give you the most up to date information possible and to aid you in disease treatment and prevention.  Please browse through the information that is listed under our  Health Topics  section regarding the H1N1 Flu.  The Centers for Disease Control (CDC) also has continually evolving information that is listed on their website at www.cdc.gov or you can check at www.flu.gov.  The information is extremely helpful and answers most questions that  my patients have been asking.  If you have further questions, or would prefer to talk about this in more detail, feel free to inquire through our office or discuss with your physician at your next appointment.

As a large number of our patients are pregnant, and therefore have been classified as a “high risk population” by the Centers for Disease Control, I would like to give some answers to the most commonly asked questions that I receive.  Again, I believe that you will find these answers supported by the information provided by the CDC.

What should I do to prevent the flu?  Pregnant women are considered a high risk population.  Secondary to some of the underlying physical changes that happen with pregnancy, pregnant women have been shown to have a more difficult time in handling the flu.  For that reason, it becomes of ultimate importance to try and prevent infection with either of the seasonal flu or the H1N1 Flu.  To that end, practicing the appropriate techniques of hand washing, hand sanitizer, coughing into your sleeve and avoidance of others suspected of being ill is our first line of defense.  

Should I be vaccinated against the flu?   Vaccinations for both the seasonal flu and the H1N1 flu are extremely important.  The seasonal flu vaccine has been considered crucial for pregnant women for many years.  Now, the recommendation naturally extends out to the H1N1 flu.  Although this is a “new” vaccine, it is constructed along the same lines that the seasonal flu has been previously.  They have just included the new H1N1 virus strain into the same type of transport media as the seasonal flu.  My patients have been extremely concerned regarding its safety with pregnancy.  However, it is considered more dangerous to actually contract the flu while pregnant, than the theoretical risk of the vaccine.  Also, this vaccine, like the seasonal flu vaccine, is a killed virus and therefore there is not a risk of “catching the flu” from the vaccine itself.  As for the timing of the vaccine,  it will be possible to get both vaccines on the same day.  However, we do recommend that you get the flu vaccine as soon as possible, and then get the H1N1 vaccine once it is available (currently scheduled for release in mid October).

What do I  do if I am  exposed to someone who is diagnosed with the flu?   The current recommendations are to start antiviral medications as soon as you are informed of the exposure and take a once-daily dose for 10 days to help prevent developement of the flu.  We would ask, as the CDC recommends, that you call the office for a prescription.  We will then forward this to your pharmacy without requiring a visit in the office.  Again, the antiviral medications are a category C medication which means that there are no human studies that have been done on pregnant women.  However, as stated previously, the limited information on animal studies that have been done, show no effects to offspring.  Although this information is limited, the risk of the disease is still considered much more significant than any risk from the medication.

What happens if I develop signs or symptoms of the flu?   Again, as per the CDC, please notify our office with these symptoms so that we may direct the next appropriate steps.  It is recommended that we NOT have patients come into the office for confirmation of infection, but rather start a twice daily medication regimen for 5 days.  As this infection has been shown to spread easily, the authorities have recommended that we keep people out of the physicians offices to try and prevent further transmission.  However, if anyone develops symptoms of  significant shortness of breath or signs of respiratory compromise, they will be directed to the hospital for further evaluation so that they can be treated most effectively and quickly. 

What should I do if I become ill  and am breastfeeding?  The current recommendations are to continue breast feeding, but try to avoid coughing or breathing directly on the baby.  If you become too sick to nurse yourself, it is recommended to continue with pumping and then have the breast milk fed by bottle by another family member.

These are just a few of the questions that I have received recently.  This is by no means an exhaustive list.  I am sure that there are more questions that will arise.  Please feel free to contact us for more information.   We will continue to follow the ever-evolving information, and will attempt to forward this to you as we receive it.

Take care, and remember….wash your hands!!!

Michael A. Dawson, MD

First let me start by saying that menopause is  a “natural”,  “normal”,  and inevitable part of all women’s lives.   To that end, we should all accept that we may have some symptoms along the way.  Typically, there is a constellation of symptoms that may occur.   They include : changes in menstrual cycles (cycle length, amount of menstrual flow and even skipping periods);  hot flashes and/or night sweats;  vaginal dryness or  a  “burning” sensation with intercourse; sleep disturbances; possible mood changes (depression, anxiety or just plain old irritability!).  Any of these symptoms can occur even if we’re still having regular periods!  PMS symptoms may also worsen in the 40 something crowd.  This really gives us something to look forward to!

Suffice it to say…there is no single pill or treatment that addresses ALL of these potential issues.   Deciding whether or not to intervene or “treat” a symptom is an individual choice  that each woman must make.  If menopausal symptoms are interfering with your quality of life, talk with your clinician.   Together you can put your symptoms in perspective and decide what’s best for YOU.  Remember to keep an open mind, what’s best for your sister or friend, may not be best for you.

Maria Arias, MD