Year: 2016

I get a lot of questions from friends and family about my job. The most frequent question I get when I tell people my chosen profession is “Why would you choose that?” The second is “Did you deliver your own babies?”

My answer to the first usually depends on where I am, who I am with, and (most importantly) what kind of a mood I’m in. If I’m well rested, and I think you are actually interested in my response, I’ll tell you about the first baby I delivered; how it was one of the most awe-inspiring moments of my life, and what a privilege it is to help women welcome a new life into the world. If I’m tired (or at a dinner party), I’ll tell you “I thought it would be a good way to meet chicks” or “the proctologists weren’t hiring.”

My answer to the second, however, is always the same. “No. I just wanted to be the dad.”

I’d probably delivered close to six or seven hundred babies by the time my wife brought our first child and only son Jack into the world. While I will tell you assisting in the birth of a child is never routine, and I am always amazed every time I get to do it today, most of the time there is a anticipated routine that is going to play out. I coach pushing the same way, deliver the baby the same way, and make the same bad jokes about the not charging you if you cut your own baby’s umbilical cord. So as the due date approached and the overnight bag for the hospital sat patiently by the backdoor, I waited, with much overconfidence and arrogance I might add, for her water to break, or for contractions to start, so we could get on doing the same thing I had done hundreds of times before.

Then it started. Somewhere between the screams of pain (peppered with some of the most colorful profanity I have ever heard coming from my sweet Southern Bell of a wife) and the not-so-great fetal heart rate tracing, it became abundantly clear I was in way over my head. I had a head full of knowledge. I knew where L&D was, I knew how to diagnose labor, and I even knew when a C-Section would be indicated. I was technically proficient, but lacked true experience. I was prepared for the what, the when, the where and the how. What I wasn’t ready for was the who. What I wasn’t ready for was to see what labor looked like for MY WIFE.

I knew the definition of labor and how frequent someone needs to contract, but I didn’t know the look of pain on my wife’s face during a really bad set of contractions. I knew sometimes the baby’s heart rate dropped as the cervix was changing, but I didn’t know how it would feel to hear MY baby’s heart rate go to the 60s and sit there (it was really scary, by the way). I certainly have counted to 10 hundreds of times, but I was completely unprepared for how momentous it was to see the woman I love bring another human being into this world with a startling combination of determination, courage and love. I knew how to help deliver a baby, but I never really understood what it meant until I watched my wife make me a dad.

Dad’s, if you feel unprepared for your wife’s upcoming labor, you are. If you are nervous about what’s going to happen, you should be. If you’re scared about all the stuff that could go wrong, that’s OK. And if you think there is anything I can tell you that can get you ready, there isn’t. My wife has given me so much over the years (except my fair share of the comforter… she takes way more of that than she is entitled). But the gift of fatherhood is second to none. I thought I married a strong woman before she gave me Jack and Katherine. Turns out I didn’t know what strong was.

So fellas, be prepared for the unexpected. Trust the amazing staff at Greenville Women’s Clinic and Vidant to take excellent care of your wife and to bring your healthy child into this world. And enjoy every second of being “just dad.”

David Ryan

P.S. Tell the proctologists I’m all set.

At the age of 4, according to my mother, I decided I wanted to be a nurse.  With 5 siblings, I kept myself busy taking care of everyone when they were sick or injured or taking care of the sick dogs, chickens, or cows.  Being a softie at heart, it was difficult to see anyone or anything suffer.  When I got to be a little older, my diabetic grandmother would let me give her insulin injections and I found that to be quite exciting.  At the age of 13 my brother was born and had a cleft lip and cleft palate.  He was quite sickly and required 10 surgeries.  I spent many hours helping take care of him and this was the “decision maker” for me. 

I attended ECU School of Nursing graduating in 1979.  Immediately after graduating, I started working at Pitt County Memorial Hospital in Labor and Delivery.  I have participated in many deliveries and have delivered quite a few myself.  It was an awesome job and I loved almost every minute of it.  It was adrenaline pumping, exciting, sometimes sad but rarely boring.  I retired in 2012 after 33 years in L&D to come to Greenville Women’s Clinic.  Being very passionate about women’s health, it has truly been a learning experience because GYN was something I knew very little about.  I have learned so much in the short three years I have been here about many different things.  Coming from a tertiary care center to an office setting has also been quite an adjustment.  The stressors are of a  different  magnitude but are as equally critical in the office setting as in the hospital setting.

Nursing continues to be an ever changing and challenging career.  My career has been wrought with many demands, victories, trials and tribulations but I would not trade any part of it.  I cannot imagine spending my life doing anything else!  I have met some awesome people and have had experiences I will never forget.  I could write a book about some of the things I have seen and heard and I imagine it could make the best seller list for a week or two.

Happy Nurses’ Week to all the nurses out there and to those that are toying with the idea of nursing as a career.  It is an awesome profession with many rewards – you won’t regret it!

Dawn Arnold, RN
Clinical Supervisor
Greenville Women’s Clinic

In my world as an Obstetrician Gynecologist, I find myself in a variety of situations.  I often smile when someone says, “Oh you are an OB/GYN…it must be great delivering babies!”  A medical colleague will often comment, “I don’t know how you do what you do…pelvic exams and pap smears all day!..No thank you!” I would beg to differ with any stereotype you may imagine; I feel we have the best of ALL worlds.  Yes, we are trained to deliver babies, but also to meet most medical and surgical needs for a woman at just about any life stage.  I may see Patients for their annual physical, then go over to deliver someone’s precious baby, and finish my day completing a hysterectomy or urinary incontinence surgery that very same day.  What a specialty, you never know what we are up to!  It is an amazing calling and I am so blessed to be a part of this wonderful specialty.  I do wish to share with you however, some very important points to ponder and consider in your health care needs.  As an OB/GYN, we refer to your physicals as the “well woman’s exam.”  It is not just about you getting your Pap smear, birth control or mammogram; it is about so much more.  A well woman’s exam is as rich and variable as our field can be; it evaluates whether or not you are indeed well.  How is your form?  How do you function?  Sounds like an anatomy lesson, right?  I see the well woman’s exam as an opportunity to look at the prism of a woman’s life, where every facet is equally important.

Depending on your age, lifestyle or family history, a well woman’s exam evolves based on your life stages and needs.  The journey is ever changing, and the path we follow is unique to each of us.  In the most general sense, let’s imagine some paths you may find familiar.   Can you remember your first gynecology visit?  You of course, likely discussed your menstrual cycle, but before you realized it, you were thrown into a conversation about sexual activity, birth control, peer pressure and even sexually transmitted infections.  Upon turning the age of 21, we develop a love-hate relationship with the speculum and the Pap smear.  We are relieved to know we have a normal pap, however getting to that result is a daunting task for many.  During your reproductive years, pregnancy and fertility issues weave in and out of your visits.  As time passes you may then confront potential pelvic concerns like pelvic pain or urinary incontinence.  Although we are taught to develop a lifelong discipline of self-breast awareness, it is at 40, we assume the position to undergo mammogram screening to catch breast cancer as we cannot see or feel it in the early stages.  As if our adolescence and for some motherhood haven’t been exciting enough, we then look to the perimenopausal years where one may experience hot flashes, night sweats, mood changes, vaginal dryness or all of the above!  From this, our journey through menopause brings about concerns for falls, osteoporosis and heart disease.  You see for a woman, the journey can be wandering and for some a winding path.  The reality is, even though I have given you broad generalizations, life is complex and unique to each person.  You may go down one or all of life’s pathways.  I must consider every path for any age as I get to know someone.  There is so much more to discuss as well.  We have not mentioned screening someone who may be on the path to issues with depression or who is in a domestic violence situation that could include intimate partner violence or elder abuse.   You see as an OB/GYN, we may walk out of one room discussing one’s pregnancy needs to another who desires to never get pregnant!  Sexuality is also something I talk about at any given age as it is an important part of our health.  Sexuality does not imply sexual intercourse.  It may be a discussion on so many levels, ranging from peer pressure, intercourse, pain with intercourse, desire issues we refer to as libido to masturbation, gender attraction or identity issues.  And the discussion doesn’t stop here; there is so much to our world as women. 

You see, I open the discussion to show you our world and if you have a path you have never felt comfortable discussing with your Health Care Provider, do it now.  In the world of women’s health, we all hope to serve and assist you to achieve all your well woman’s needs no matter the need or the nature of the discussion.

As girls grow into teens, it’s important that they receive appropriate medical care. The American College of Obstetrics and Gynecology (ACOG) recommends that young women have their first visit with an obstetrician-gynecologist (OB/GYN) between the ages of 13 and 15. It’s important to take cues from your daughter to decide when the time is right. If she is having extreme discomfort with periods, has a lot of questions, or is becoming sexually active, it is never too early to make an appointment.

The idea of seeing a gynecologist or having a pelvic exam can be intimidating for any girl. You can ease your daughter’s worries and fears by explaining why the visit is necessary, giving her an idea of what to expect and addressing any questions she might have.

Choosing a Gynecologist for Your Daughter
For a decision as significant as choosing a gynecologist, it is imperative to get input from your daughter about what type of doctor she would be most comfortable with. Would she prefer a male or female doctor? Would she like to see the same doctor as you? These are just a couple examples of questions you should ask your daughter about choosing a gynecologist for her.

Explaining the Importance of the Visit
Before your daughter’s gynecology visit, it is important to set expectations for her about what the visit entails and explain why it is necessary that your daughter begins going to the doctor on a regular basis. You should explain to your daughter why she needs to see a gynecologist and how they can help her stay healthy.

A few reasons the visit is important:

1. She can get accurate information and confidential answers to questions she has concerning sex, sexuality, her changing body, and menstruation.
2. She can learn how to prevent pregnancy, sexually transmitted diseases and how to live a healthy lifestyle.
3. For girls who experience missed periods, pain, or other reproductive problems, the doctor can assess the problems and offer treatment.

Reassure your daughter that even though there are a lot of different parts of the gynecological visit, the actual physical exam, the part she might feel most nervous about, doesn’t take long.

What to Expect During the Visit
During your daughter’s first visit, there is usually no internal examination and no PAP smear obtained. According to new guidelines for women regarding PAP smears, the first screening occurs at age 21. However, there will be a breast exam and an external examination of the genital area during the first visit.

Your daughter may be asked the following questions related to her medical and reproductive history:

1. 1. When was your last period?
2. 2. Are you sexually active? If so, are you using protection?
3. 3. Are you experiencing any problems with your period, such as pain or heavy bleeding?
4. 4. Do you have any discharge, sores or discomfort in the vaginal area?
5. 5. Do you think you could be pregnant?

Encourage your daughter to answer these questions honestly. Her time with the gynecologist is completely confidential. Assure her that there is nothing the doctor hasn’t heard before and they are there to help.

Brief your daughter on family history, especially if you are not going to be in the room with her. Make sure to include any important medical information about siblings, parents, grandparents, aunts or uncles. One helpful way to make sure your teen remembers everything is to type up a family history for her to take into the room.

Prepare your daughter as much as possible by explaining, from your own experience, what these examinations are like. An encouraging experience can ease a young woman’s nerves and motivate her to schedule regular appointments to better manage her own health.

Please contact us if you have any questions regarding your daughter’s first gynecology visit or call Greenville Women’s Clinic at 252-757-3131.

Weight loss.  This is an ongoing conversation throughout our Society.  It has become quite the industry not just in Medicine, but in our retail environment.  There are many weight loss programs, some focusing on nutrition, some on exercise and in the medical world, those involving medications or even surgery.  This plethora of options have led us to feel that the Science of weight loss is a bit of a mystery.  All the information out there can put you into a tailspin! So you may ask, which choice is right for me?  Patients ask me, “I don’t know where to start, how do you do it?  What can I take that is safe or is surgery right for me?”  Millions of dollars and hours are spent on this topic.  It is a topic best searched not alone but with the help of your Health Care Provider, friends and family.  There is power in the numbers when it comes to weight loss.  No matter the choice however, the final conclusion and solution is that which is right for you.  No one method or medicine is good for all. 

There are several schools of thought when it comes to weight loss.  There are some who say that weight loss is purely the practice of accounting, “calories in versus calories out.”  I would argue that this is only partly true.  There are others who would say, “add exercise -period.”  Again, I would argue that this is also partly true.  Then there are those who claim, “those Patients will never be able to do it on their own! #Surgery!”  In certain circumstances, this is partly true as well.  The bottom line…weight loss is not so much about Science; it is not a singular event.  Weight loss is about changing one’s lifestyle.  If we are overweight, obese or just not happy with our current physical state and well-being, then something about our current lifestyle is prohibitive to feeling our best.  This lifestyle must change. 

We hear a lot about diet and exercise, but not so much about the medical and surgical therapies available.  Medical versus surgical therapy depends on your medical history and personal circumstances.  Surgical therapy includes those that limit the size of your stomach or bypassing most of your stomach decreasing your absorption ability.  As for medical therapy, there are many options.  First, let me make clear that no one pill will lose weight for you.  The goal for weight loss medications is to help you overcome your barriers to weight loss beyond optimal diet and exercise.  Barriers include appetite or craving control, energy issues to maintain an exercise program or combination of all of the above.  The typical Patient is one who has a BMI greater than 30 who have failed to lose weight with regular diet and exercise or if they have a BMI of 27 or greater and have already developed diabetes and heart disease.  If you are considering weight loss surgery such as a gastric sleeve or bypass, this therapy may be helpful in preparation for it.  They are not indicators for all Patients so talk with your Health Care Provider about your concerns and challenges. 

Below is a list of medications to consider in your weight loss journey if you are determined to be a good candidate for medical therapy.  I do not endorse any specific one, but provide this for your information.  This is also not all inclusive but the most commonly used and available. 

• Orlistat – Works by decreasing your fat absorption which helps with weight reduction and may improve your cholesterol levels.  Side effects may include loose stool or diarrhea.   
• Metformin – if you are known to be pre-diabetic, may help improve your glycemic control and therefore lower insulin levels that would help with weight loss.  Side effects include loose stools however should improve with time.
• Phentermine – a generic and widely available option, but not to be confused with the infamous Fen-Phen which was said to cause heart disease.  Phentermine is a stimulant and works to decrease your appetite and does increase your energy levels.  It does have addiction potential and is only advised to use for 12-weeks at a time.  Side effects may include dry mouth, difficulty sleeping, but more importantly may increase your heart rate and blood pressure, and therefore must be followed carefully by your Health Care Provider. 
• Belviq – a serotonin-acting agent that may help regulate the control center for appetite, thereby helping you feel full sooner.  It is FDA approved to take for long term weight loss.  Side effects may include headache, nausea or fatigue. 

Lastly there are combination therapies available and include,

• Qsymia – a long acting version of Phentermine and Topiramate which works to decrease appetite and cravings.  It is FDA approved to take for long term weight loss.  Topiramate has been used in the treatment of seizure disorder and migraines.  Side effects may include dry mouth, constipation or nerve disturbances. 
• Contrave – combination of Buproprion and naltrexone that works to decrease your appetite and cravings.  This is not recommended as a first line medication but may be best for the person who is not only trying to lose weight but quit smoking as well. Buproprion has been used in the treatment of Depression or to help you quit smoking. We believe it works by helping regulate one of the brain’s hormones – epinephrine, which affect appetite control as well.  This medication cannot be used in someone with a seizure disorder or uncontrolled hypertension. 

Bottom line, you have options in your weight loss journey.  The best option is based upon many factors and best discussed and determined by working with your Health Care Provider. 

February is American Heart Month – a time for all of us to refocus on preventing cardiovascular disease. If you’re not already taking good care of your heart, now is the time to start. Heart disease is the top killer among women in the United States. Many risk factors increase your chances of developing heart disease, including high blood pressure, high cholesterol, diabetes and being overweight.

One of the best ways to protect your heart and reduce your risk of disease is by eating a heart-healthy diet. Here are five steps to get you on the right track:

1. Load up on fruits, vegetables and whole grains.
These three factors are the keys to a heart-healthy diet. Balance your meals with a mix of high-fiber foods. Fiber helps regulate blood pressure and keeps you feeling full longer. Aim for four and a half cups of fruits and veggies a day and at least three ounces of whole grains.

2. Watch unhealthy fat and cholesterol.
Limiting the amount of saturated and trans fats you consume can lower your cholesterol levels and reduce your risk of coronary artery disease. Choose healthy fats like those found in olive oil, canola oil and trans fat-free margarine instead of the ones in butter, creamy sauces, hydrogenated margarine and shortening. Look for monounsaturated fats and polyunsaturated fats, like the ones found in healthy oils, nuts, seeds, soy and seafood.

3. Reduce your sodium intake.
Too much sodium can result in high blood pressure. Start by reducing the amount of salt you use as a seasoning when you cook, then begin paying attention to how much sodium is in the prepared foods you eat, like canned soup.

4. Go with low-fat protein.
Protein is an important part of your diet, but some types are better than others. Stay away from full-fat dairy products, egg yolks, fatty meats and cold cuts. Instead, opt for low-fat dairy, egg whites, lean meat, poultry, fish and legumes. Try substituting plant protein for animal protein to reduce your fat and cholesterol intake.

5. Make a meal schedule.
Knowing what to eat and what to avoid is just the beginning of maintaining a heart-healthy diet. To ensure that you stick to the plan, create a meal schedule for your household once a week. Choose heart-healthy recipes and add the ingredients to your shopping list. Not only can this help ensure a healthy diet, but it could also lower your grocery bills.

Studies show that healthy choices have resulted in fewer women dying from heart disease per day. Learn how to lower your chance for heart disease, ask your health provider questions about heart health and make sure you know the symptoms of a heart attack. There’s much more work to be done before heart disease becomes a thing of the past, but together we can do it. You can make a difference during American Heart Month!

January is a time to reflect on the changes we want to make in the upcoming year. One resolution anyone can benefit from would be making a goal to stress less. Stress can affect many aspects of physical and mental health, whether you realize it or not. Common symptoms of stress include:

Hair Loss
It’s normal for strands of hair to fall out over time and get replaced by new ones. When you’re under physical or emotional stress, the shedding of hair can speed up to the point where half to three-quarters of your hair can fall out.

Forgetfulness
We all have our moments of not being able to find our car keys. Research shows that the more stress we are under, the more often these mental lapses happen. Take a step back and consider whether any stress in your life may be playing a role in memory loss.

Dental Health
During the day and even while sleeping, people under stress may clench or grind their teeth. This action can wear down and damage teeth, causing joint problems leading to severe jaw and neck pain.

Skin Problems
One of the effects of stress is skin that’s more sensitive to irritants. Stress can worsen pre-existing conditions including rosacea, psoriasis and acne, as well as dehydrate the skin, permitting allergens, bacteria and pollutants to irritate it.

Substance Abuse
For individuals struggling with alcohol or drugs, stress can disrupt efforts to remain substance-free. Even for people who have abstained for a long time, stress can play a significant role in contributing to a relapse.

Sexual Problems
The effects of stress can extend to the bedroom. Cortisol is one of the hormones produced by stress. If elevated levels of Cortisol are being produced for a prolonged period of time, they suppress our sexual desire.

Irregular Menstrual Cycle
Your monthly flow is showing up early, late or not at all. When stressed,
your brain sends out signals that can alter or disrupt ovulation.

Inability to Concentrate
Being under pressure can affect how well our brains work. The good news? A month after the stressful period is over, your mental skills should return to normal.

Reduced Immunity
Excessive stress and anxiety can lead to an increased chance of getting sick. Keep daily stress under control as much as possible to offset the effects of past stress and encourage good health in the present.

Insomnia
While insomnia can stem from a variety of sources, one to consider is stress. Stress can cause a number of sleep-related issues including trouble falling asleep, difficulty staying asleep and poor-quality sleep.

Stress that’s left unchecked can contribute to health problems, such as high blood pressure, heart disease, obesity and diabetes. Stress relief can lead to improvements in your overall well-being. Try to get relief through regular exercise, enjoyable hobbies and spending time with loved ones. Take control of your symptoms and ring in the New Year with less stress.