Tuesday, 26 July 2016

Understanding Cesarean Section

The rate of cesarean section in this country has never been higher. Reasons for the drastic increase (50 percent in the past decade) are: greater monitoring in the delivery room (which increased the cesarean rate 40 percent with no significant drop in delivery-rated problems); higher medical malpractice premiums and higher rates of obesity. It seems that physicians are quicker to suggest and perform a cesarean, particularly in fist-time mothers. Since the trend these days is for women who have had one cesarean to deliver all subsequent babies the same way, the rate will likely continue climbing.

Overall estimates are that up to 18 percent of cesarean deliveries in the United States are elective—that is, performed without a clear medical need. It’s important to know the facts about elective cesareans: Women and their babies are more likely to have birth-related complications than women who have vaginal births. They are also more likely to deliver babies too early. Regardless, there are times when a cesarean is necessary for women experiencing complications that make a vaginal birth unlikely or dangerous.

During a cesarean, the baby is delivered through an incision in the abdominal wall and uterus. Other things you should know:

Anesthesia. Unless there is no time, you are usually given an epidural or spinal as anesthesia for a cesarean. That means you can stay awake for the delivery, although the doctor will screen the surgical field from view. If things are going too fast for an epidural, you may need general anesthesia.
Recovery. A cesarean section is major surgery; expect a longer hospital stay and recovery time.

Blood loss. You lose more blood during a cesarean section than with a vaginal delivery. You may require a transfusion, although the risk that you’ll need one is approximately 2 percent. At the very least, the blood loss may leave you tireder than if you’d had a vaginal delivery.

Scar tissue. You may have scar tissue form in the pelvic region from the surgery that may affect future pregnancies and deliveries.

The baby. The baby may have some breathing problems because it did not come through the birth canal. It may also have low APGAR scores (a way of evaluating its health right after birth) because of anesthesia or problems during labor and delivery. But don’t worry; the delivery room staff will rub the baby to restore color and movement and/or provide some supplemental oxygen to help it pink up.

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Adopting a Child: Ensuring That You’re Ready

As you likely know, deciding whether to adopt a child is not an easy decision. You may have considered adoption as an attractive option, whether you believe you’ll be doing something good for a child in need or have found it difficult to conceive or carry a baby to full term.

There are some specific things that you and your partner should think about before making any serious commitment to adopt a child.

Try to put yourself in the shoes of your future self and imagine what it would be like to have a child who is not genetically related to you. Your son or daughter may not have your features or even share the same ethnicity. Take into consideration that this could potentially affect the child in the future, too. Other hereditary issues, such as mental or physical conditions, are also things you should consider.

You’ll want to give a lot of thought to how you will talk to your son or daughter about their family background. This may be especially difficult for you to decide if your child was abandoned or abused or in cases where little information is available to you. Know that your child’s emotional issues stemming from his or her adoption may be something that you will need to address and perhaps even seek counseling for in the future.

If your potential adoptive child will be of a different race or nationality, think about how you will help them keep a positive identity with their background. Your first instinct may be to raise them as an American, but it’s also important for them to have a sense of where they came from. This may help your future son or daughter become a well-rounded, confident individual as they age. As such, you should become well-educated on your potential adoptive child’s country of origin so that you are able to begin teaching them at a young age.

One important factor you will need to consider is whether you are willing to handle any issues that may arise with a child’s birth parents. This may include keeping them in your son’s or daughter’s life, which could entail simple correspondence or complicated yearly visits. Additionally, be prepared to handle any legal problems that may occur in case the parents decide to renege on an adoption.

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The Hormones of Desire

While hormones play an important part when it comes to sex and desire, their role is complex, intertwined and, despite years of research, still difficult to pin down.
Here’s what we do know: While numerous hormones are involved in sexual desire and sex itself, two of the main ones appear to be estrogen and testosterone.
Estrogen. You know this hormone primarily for the role it plays in fertility and reproduction (and staving off those hot flashes). But estrogen is to your vulva and vagina what moisturizer is to your face—critical for keeping things moist, flexible and healthy down there.

With less estrogen comes vulvar and vaginal changes, some of them significant. The genital tissue can become dry and less acidic, increasing the risk of infection. It takes longer to get lubricated for sex, even if you’re full of desire. Over time, estrogen deficiency can lead to more significant changes in the entire urinary and genital area, including reduced blood flow to the vagina. The result: dryness, irritation and pain upon intercourse, also called “dyspareunia.”

Estrogen loss can also lead to changes in the size and sensitivity of the vulva, vagina and clitoris as well as reducing blood flow to these areas.

Testosterone. You might think of testosterone as a male only hormone, but all women produce some testosterone, just as all men produce some estrogen. Much of our testosterone is produced by the ovaries.

Unlike estrogen, testosterone levels don’t suddenly plummet at menopause, but, rather, decline gradually beginning in your mid-20s. By the time you reach menopause, your body is producing about half as much as it did when you were in your 20s.

Researchers are still debating testosterone’s role in women’s sexuality. They think it contributes to blood flow and arousal of the clitoris and labia (the tissue around the vagina) which, in turn, contributes to arousability and orgasm. Hormone receptors are prevalent in the hypothalamus, the part of the brain that controls sexual function and mood. So, it appears that both estrogen and testosterone may influence getting a woman “in the mood.”
The exact role that testosterone plays in female sexual desire is still being determined. Some studies connect abnormally low levels of testosterone with lack of desire; others don’t. More research is needed to define the significance of testosterone levels in women and what constitutes “normal” testosterone levels in postmenopausal women.

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Intimacy After a Diagnosis

The diagnosis of a neurological condition or a stroke turns your life upside down. Suddenly, you’re spending more time visiting doctors and therapists than working, may be unable to participate in activities you love and may find yourself coping with a baffling array of medications and other treatments. But have you ever considered the effect such conditions may have on your sexual life?
Well, if you consider that sex starts in the brain—the center of any neurological illness—it can have quite an impact. Add to that the multiplier effects of fatigue, physical disability, depression and loss of independence, and you can imagine how total the loss might be.

Neurological conditions can affect how you process sexual stimulus, whether it’s touch or visual. That can affect your level of desire, your ability to become aroused and your ability to reach orgasm. For instance, studies suggest that as many as 72 percent of women with multiple sclerosis have sexual dysfunction. And women with may experience involuntary sexual gestures, such as touching themselves, grabbing their genitals, even having unintended orgasms, even as antiepileptic drugs tend to reduce libido.

No matter what condition you’ve been diagnosed with, you don’t have to resign yourself to a life without sex or intimacy.

Talk to your doctor. Tell your doctor how important your sexual life is to you. I know this might be difficult, particularly if you’re not used to talking about such issues with “strangers,” but it’s worth it. In many instances, the medications you’re taking may be interfering with your libido; in other instances, your doctor may be able to prescribe certain medications to improve libido, such as supplemental testosterone and even sildenafil (Viagra).

Talk to your physical and occupational therapist. These health care professionals often spend hours a week with their patients. They get to know them—and their problems—well. And they often have unique strategies—emotional and physical—to help you retain the intimacy you desire.

Educate yourself. The more you know about the possible effects your condition or your partner’s condition may have on intimacy, the better prepared you are to face the challenge. Knowledge is power.

Talk to your partner. If you’ve had a stroke, for instance, and you don’t have as much sensation on one side of your body, ask your partner to focus on areas that can still feel sensation. Also have an honest conversation with your partner about the importance of intimacy in your life. And listen to what your partner says without judging. For instance, your partner may tell you that the drooling that is a result of your Parkinson’s turns him off. If this is the case, talk to your doctor about options for reducing this symptom.

Rediscover intimacy. Who says intimacy is all about intercourse? Intimacy could be taking a bath together in candlelight or giving each other massages with scented body oil.

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Since You’ve Been Gone: Making Big Plans Once Your Chick Has Flown the Coop

Now that you have an empty nest, life may seem a little quieter than it used to be. There is no longer a parade of your kids and their friends tromping through the house, asking for food and needing to be cleaned up after. Is this really something to be sad over? You’ve done your job as a parent: you’ve raised your children right and now they’re off to college or work. Why not reward yourself?

First, think about the space that isn’t being occupied anymore. Oh, the possibilities! If you’ve always wanted a gym, now’s your time to invest in a treadmill and a weight set. Perhaps a home office has been a pipe dream of yours. Well, it doesn’t have to be anymore. That antique roll-top desk would look awfully nice once you clear out the posters and debris left behind by your son or daughter. Or maybe you just want a fancy guest room to host friends and family members. Make it your own special project that will provide you with the space you previously thought was just too pie-in-the-sky.

Don’t feel guilty about using the space for your own personal wants or needs. This is your house, and you’ve spent the last 18 or more years catering to your son or daughter. If it helps you feel better about them going off on their own, then it’s what you should do. You can always leave a bed in the room for when they come home to visit.

Now is also a good time to see the rest of the world. Your travel expenses are much lower, considering that you won’t need to tote around the kids. Additionally, you and your partner don’t need to take their desires into account. Never got to backpack through Europe in college? Now’s your chance! Was scuba diving in the Great Barrier Reef too expensive in years past? Look for travel deals and take a trip with your partner or a friend.

Also, a great way to occupy free time and maybe meet new people is to take a class. Whether you choose to learn a new form of exercise or a new language, you’ll feel better using your time to improve yourself.

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Fitness: An Empty Nest Can Be the Perfect Setting to Get in Shape

Mothers sometimes say that it’s hard for them to get in their daily 30 minutes of exercise because they spend the majority of their time juggling a career and taking care of a house full of kids. Well, now that the chicks have flown the coop, you have the space and time to get fit right in your own home.

Expensive gym memberships are hardly necessary, and you don’t even need to buy extensive amounts of equipment to perform certain activities at home. Moreover, exercise need not be boring.
For example, there are no teenagers around to roll their eyes at you if they come home to see you dancing in the living room, right? Take advantage of this! Dancing burns tons of calories, keeps you flexible and can benefit the heart and the brain with its mood-enhancing effects. You can even multitask by putting on some good music—as loud as you want—and shimmying and shaking while you clean the house.

Yoga has been touted for centuries as an effective way to build strength and flexibility. The mind-body practice is also perfect for minimalists, because all you need is some snug but not tight clothing, a mat for stability and perhaps a few props, like foam blocks or straps. There are a number of instructional programs both on television and DVD. However, it may be a good idea to take a couple of beginner’s courses before trying yoga at home, because the guidance you get from a teacher can help you avoid strain or injury.

Going back to the basics of strength training—think push-ups, sit-ups and pull-ups—is a great way to stay fit because you probably already know how to practice good form, because these were often the cornerstone of physical education classes in the 1960s and ’70s. There are also modern variations you can use with these.

For example, this twist—literally!—on the sit-up works the oblique abdominal muscles as well as those located centrally. Get in your starting position, with your back on the floor, knees bent in front of you and arms wide behind your head. (Remember to keep your elbows out, otherwise you’re cheating.) As you bring yourself up, gently twist to one side, bringing your right elbow toward your left knee, and alternating sides each time you sit up.

And remember that regular exercise can help prevent bone loss, especially weight-bearing exercises like weight training, walking, hiking, jogging, stair climbing, tennis and dancing. Now that the children are gone and the house is yours to use as you’d like, get moving and take care of your health.

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How to Care for Someone Living With Breast Cancer

A breast cancer diagnosis doesn‘t affect just one life. It can flip the lives of family and friends upside down, so it‘s important to guide not only the patient but also loved ones through this difficult time. 
The patient‘s friends and family play a crucial role in recovery and beyond. It‘s up to them to create a circle a care, which will provide a sense of optimism and comfort for the patient, and it‘s up to health care providers to guide them through this process. 

Use these tips from Constance Roche, NP, as a reference. CLICK HERE for the printable tip sheet.
Creating a Breast Cancer Circle of Care: Steps to Share With Patient‘s Friends and Family
Step 1: Designate a Care Leader

Have someone take the lead in organizing support. A friend or family member who is naturally organized can be the go-to person to delegate helpful tasks. Likewise, one person can offer to help communicate status updates to friends and family.

Step 2: Touch Base Regularly

Plan to stay in touch throughout recovery and beyond. Daily calls, weekly visits or regular emails will give the patient something to look forward to.

Step 3: Whip Up Some Recipes for Love

Food is fuel, and the patient will need the proper nutrients during this process. To help coordinate meal prep, you can use a service like Meal Train LLC, a free solution that simplifies the organization of giving and receiving meals. The site allows the giving party to take into account the recipient‘s preferred meal times, food preferences and available days. This helps ensure that the recipient gets the meals they enjoy on the days that are most helpful.

Step 4: Treat This Diagnosis Separate From Others

Friends and family should refrain from telling stories about others with what they assume is a similar diagnosis. Every cancer diagnosis is different, and there are specifics that direct course of care. So often, newly diagnosed patients get overwhelmed with information and frightened by others‘ stories. This diagnosis is unique for the patient in that it‘s happening to them.

Step 5: Don‘t Turn to Dr. Google

If you‘re looking for more information on breast cancer and recovery, ask the oncology team for trusted resources. Some websites give inaccurate information and can steer you down a confusing road. HealthyWomen‘s breast cancer center is a great place to start. 

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