SEATTLE, Oct. 15, 2012 - If you’re pregnant or thinking about having a baby, finding the right provider is a pretty good place to start this incredible journey. When you come to OB Speed Dating, you’ll get the chance to meet several Obstetricians and Certified Nurse Midwives (CNMs) who deliver at Swedish/Ballard's Family Childbirth Center and get to know them in a fun, low-key environment.
'Women's Health' posts
Self breast exams: to do or not to do?
Remember when there were monthly emails you could sign up for to remind you and your friends to do your self breast exams at home? Remember seeing the news anchors talking about their monthly self breast exams in an attempt to remind you to do your breast “due diligence?” What happened to self breast exams and are they still important?
Initially, self breast exams were recommended as a screening tool to help early detection of breast cancer. Unfortunately long-term studies have not confirmed that they actually live up to their hype. Two large studies looking at over 200,000 women in both Russia and China didn’t show any difference in breast cancer mortality after 15 years between the women who were performing routine self exams and those who were not. In fact, the women that were practicing self exams found more lumps and underwent more biopsies for benign reasons. Reviews of several other studies failed to show a benefit of regular breast self-examinations including no benefit of early diagnosis, or reductions in deaths or stage at diagnosis. Hence in 2009, the US Preventative Services Task Force advised that clinicians no longer recommend routine self breast examination as a screening tool for breast cancer detection.
Even though you don’t need to be doing a monthly self exam, you should...
I often get asked why can’t a woman just get a breast MRI rather than a mammogram. The imaging tests that we do for breast cancer screening and evaluation of abnormalities have different strengths and weaknesses.
Mammograms are very useful as a screening tool. They can be done quickly and read efficiently by the breast radiologist. They have minimal radiation exposure. They can be done by a mobile coach in locations that are more convenient to patients. They are excellent for identifying abnormal calcium deposits within the breast tissue and for seeing disrupted tissue and masses. They may be less effective in women who have dense breast tissue but the digital techniques have helped some with that.
Ultrasound is a great tool for evaluating a mass or tissue asymmetry found on mammograms. It can distinguish between a benign appearing solid mass, a fluid filled cyst, a mass that is suspicious for cancer, or normal appearing breast tissue. There is no radiation exposure. It is less reliable as a screening tool because it can be dependent on the skill of the physician or technologist doing the procedure. It is possible to miss abnormalities or to mis-interpret normal findings as abnormal. There are studies underway evaluating using an automated version of ultrasound as a screening test but the results are not conclusive and this is not considered ready for standard practice.
Breast MRI is a highly sensitive test that is very dependent on...
You may have many questions when you find out that you are pregnant, but some of the most common concerns revolve around nutrition and food safety. These are some basic guidelines from the American College of Obstetricians and Gynecologists to get you started. As always, your situation may be different and so always discuss specifics with your provider.
How much weight should I gain?
This depends on your pre-pregnancy BMI (body mass index - a calculation from your height and weight). In general, however, if your pre-pregnancy weight is normal you should gain between 25 to 35 pounds. Most women stay within this goal with an increase of only 300 extra calories a day (equal to about 2 tablespoons of peanut butter and one slice of whole wheat bread). If you are underweight, however, you may need to gain more weight, and if you are overweight, less. Your doctor can help you to come up with a specific weight goal.
What foods can't I eat?
Alcohol, of course, is not recommended in pregnancy, but there are other restrictions. Other foods can put you at risk for listeriosis, a bacterial infection that causes miscarriage and stillbirth. Unpasteurized milk and cheese can put you at risk, as can raw or undercooked shellfish, meat, or poultry. Deli meats and hotdogs are okay if they are heated until they are steaming hot.
What about fish?
That depends on the fish! Certain large fish may contain too much mercury to be safely eaten in pregnancy. High levels of mercury exposure in pregnancy may lead to nervous system damage in the unborn child. If you are pregnant you should avoid eating Shark, Tilefish, Swordfish, and King Mackerel and limit your intake of albacore tuna to 6 ounces a week.
You may eat fish and shellfish that are lower in mercury, but no more than 12 ounces a week. If you want to eat fish caught by family or friends from local waterways check for local advisories first, and do not eat more than 6 ounces.
Do I need to take extra vitamins or supplements?
It is important to take ...
Frequently women will ask me: Where should I get my mammograms? There are several things to think about.
First, you want to go to a Center that is accredited by the American College of Radiology. This means that they have high quality images and well-trained radiologists. It is preferable to have a digital mammogram but if that technology is not available, then film mammograms are better than not having one done. While it is not clear that digital mammograms improve survival, they do allow the radiologist to examine the images more clearly and to use computer assisted diagnostic tools.
The radiologists’ experience is also important. Dedicated breast centers usually have radiologists who are specialized in breast imaging. These sub-specialized radiologists are very experienced in using mammograms, ultrasound, and breast MRI to diagnose breast disorders and are less likely to miss abnormalities.
Convenience is also a consideration. You want to make it easy to get your mammograms. Some Breast Centers will have mobile mammography programs that will bring mammogram screening to your place of work, local community or senior center, or even your church or synagogue. If possible, it is a good idea to get your mammograms at the same Center or within the same hospital system every year. That way the radiologists have easy access to your prior studies and can compare them to the current ones.
Here are some other things to know about getting mammograms:
SEATTLE – May 29, 2012 – Swedish Cancer Institute (SCI) is set to open its new True Family Women’s Cancer Center to patients on Tuesday, June 5. Carefully designed with the female cancer patient in mind, the new 23,600-square-foot women’s cancer center gives Swedish Cancer Institute the ability to consolidate most of its services for treating women’s cancers into one facility. The new center acts as a treatment hub where women are guided through personalized and coordinated multidisciplinary treatment of their cancer, including disease-specific education and holistic support activities.
Symptoms associated with menopause have been treated with estrogen and progesterone for many years. When I went into private practice in 1986, we had been taught that hormones given to postmenopausal women were protective. We prescribed them widely, like they were vitamins. If menses stopped, the next thing to do was to take hormone replacement therapy. We asked patients to let us know when their menses stopped so that we could administer hormone therapy promptly.
Today we have concerns about hormone therapy. The Women’s Health Initiative was a large study that collected data on the incidence of heart disease, stroke, cancer and bone fracture in women taking hormones as compared with women who did not take hormones in menopause. In 2002, a large portion of the study was discontinued because it appeared that women taking estrogen and progesterone were at increased risk for heart disease, stroke and breast cancer.
In 2002 many women went off of hormone therapy and many physicians stopped prescribing it. In the months that followed, many women found that they had symptoms of menopause that interfered with their lives. The consumer media began reporting on natural and bio-identical hormones. Claims surfaced of superior safety.