Thankful & Happy

A large number of research studies have observed the habits of happy people. In each of these, a reoccurring thread appears in each of the researchers’ conclusions: the happiest participants regularly express gratitude.

When saying “thank you” or expressing gratitude by other means, researchers found we interrupt negative thinking, which triggers anxiety or anger. By shifting the focus from this detrimental, negative thinking, a positive, constructive thought pattern is achieved. The result, people become happy.

Also, the effect of gratitude on mood and outlook is almost immediate. When subjects considered what they were grateful for, the average participant felt their mood and outlook shift within minutes.

Here are a few easy tips to help you use gratitude to create more happiness in your life:

• Smile and say thank you to everyone who performs a small service or courtesy: the cashier, a busboy, the mailman, the person who held the door for you. 
• Find a reason every day to say thank you to your family.
• Start your day by considering three things you are grateful for in your life.
• When negative thoughts creep in, find three things about yourself for which you are thankful.

If you find that you struggle with anxiety, depression and anger, talk to your doctor. We are here to listen. Together we can help you cope with mood swings, depression, anxiety and anger.

And always remember, we are grateful for you, our patients, staff and readers.

Pregnancy Stretch Marks

Ninety percent of women will start seeing stretch marks around the sixth or seventh month of pregnancy. Stretch marks occur when your body grows faster than your skin and the fibrous layer under your skin breaks.

They can appear on the breasts, belly, upper arms, buttocks and thighs. When stretch marks first appear, they are purple or red. Luckily, they fade to white or gray over time.

Unfortunately, there is no proven way to treat or prevent stretch marks; however, gradually gaining the appropriate amount of weight rather than gaining too much too quickly can help reduce stretch marks. Here are some things you can do to help make them less noticeable:

  • Eat a healthy diet. Choose foods packed with anti-oxidants, vitamin E, and Omega 3 & 6.
  • Drink eight glasses of water a day and avoid caffeine.
  • Exercise. Choose low-impact activities like yoga.

Try to keep your skin supple by hydrating your skin with thicker creams or lotions. Moisturize every morning and night, and pay particular attention to areas that are stretched and feel “itchy.”

Always consult your doctor before beginning any new exercise program, and ask for nutritional advice during your office visits. Your doctor can supply more information specific to the condition of your skin and your stretch marks.

After the birth of your child, stretch marks will fade; but if you continue to be bothered by them, consult a dermatologist. A dermatologist has several treatment options for stretch marks and will share with you appropriate treatment for your condition.

Prenatal Diet

Your prenatal diet is important to you and your baby’s health.

You may need additional vitamins and minerals to not only help your baby but to also support the changes occurring with your body.

Your doctor may recommend that you take a prenatal vitamin and mineral supplement. Remember that vitamin and mineral supplements do not replace a healthy diet. It is important to follow the nutritional guidelines your doctor shares with you. Also, supplements like folic acid and iron are good for your baby in moderation. Exercise caution, though. Too much can be harmful. You and your obstetrician will determine your specific dosage.

The term “you are what you eat” also applies to the foods you are passing on to your baby. Make choices that limit empty calories from added sugars and saturated fats. These non-nutritive ingredients are found in soft drinks, desserts, fried foods and fatty meats. Always choose water over soda. Also, share with your provider if you are going to breastfeed your child. If so, your nutritional needs will be even more important and over a longer period of time!

It is imperative that pregnant women never drink alcohol. This includes any beverage containing beer, wine or liquor. Research has shown that even moderate drinking during pregnancy can cause behavioral or developmental conditions with the child, including malformation and developmental delays.

Your care team is ready to answer any questions you may have about your prenatal diet and nutritional needs. Together we can make certain that you are eating the right foods and taking the right supplements to give your baby a healthy start.

Breast Cancer Awareness

Other than skin cancer, breast cancer is the most common cancer among women in the U.S., but it can be successfully treated. Screening tests can find cancer early, when chances for survival are highest.

1. Know your risk:

  • Learn about your family health history.
  • Talk to your doctor about your risk of breast cancer.
  • Use the Know:BRCA tool at to help you assess your risk of having a BRCA mutation.

2. Get screened:

  • Talk with your provider about when to start mammograms and how often to have them. Generally, the average risk for women starts between ages 40-45.
  • Have a clinical breast exam at least every three years starting at age 20 and every year starting at age 40.
  • Setup reminders for your screening exam and monthly self-breast checks.

3. Know what is normal for you:

See a doctor if you notice any of the following breast changes:

  • A lump, hard knot or thickening inside the breast or underarm area;
  • Swelling, warmth, redness or darkening of the breast;
  • Change in the size or shape of the breast;
  • Dimpling or puckering of the skin;
  • Itchy, scaly, sore or rash on the nipple;
  • Pulling in of your nipple or other parts of the breast;
  • New pain in one spot that doesn’t go away.

4. Make healthy lifestyle choices:

  • Maintain a healthy weight.
  • Exercise daily.
  • Limit alcohol intake.
  • Breastfeed if you can.

Fast Facts About Breast Cancer

  • Each year in the U.S., more than 246,660 women will be diagnosed with breast cancer.
  • One in eight women in the U.S. will be diagnosed with breast cancer in her lifetime.
  • Breast cancer is the second leading cause of cancer death among women.
  • More than 2.8 million breast cancer survivors are alive in the U.S. today.
  • Most breast cancers are found in women who are 50 years or older, but breast cancer also affects younger women.
  • About 10% of all new cases of breast cancer in the U.S. are found in women younger than 45 years old.

Wondering if you or your child should get the HPV vaccine?

Human papillomavirus (HPV) is a common viral infection that has potentially serious consequences such as genital warts and cervical, vaginal, vulvar, penile, anal, mouth and throat cancer. HPV is the most common sexually transmitted virus in the United States. More than half of the sexually active men and women are infected with HPV at some time in their lives. Most HPV infections don’t cause any symptoms and go away on their own. Still, several types of HPV can be prevented by vaccination.

  • HPV vaccines prevent infection but cannot treat infection.
  • The ideal age for HPV vaccination is 11 or 12 years in girls and boys; however, they can be given as young as age 9 and up to age 26.
  • HPV vaccine is given in a 3-dose series within a 6-month period. It is important to have all 3 doses.
  • Three types of HPV vaccines are licensed by the FDA.  They all are effective in protecting against the two HPV types that cause most cervical cancer.
  • The vaccine can prevent most cases of cervical cancer in females, especially if it is given before exposure to the virus.
  • The vaccine can prevent other HPV-associated diseases such as anal, oral and throat cancers, especially when administered before sexual activity begins.
  • It is best to give the vaccine before sexual activity begins, but it can be given at any time up to age 26.
  • The vaccine can be given if you have already tested positive for HPV or had genital warts.
  • Protection from HPV vaccine is expected to be long lasting, but vaccination is not a substitute for cervical cancer screening.
  • Studies show that the vaccines are very safe and effective. They do not contain live viruses, so they cannot cause an HPV infection.

According to The American College of Obstetricians and Gynecologists (ACOG) the HPV vaccine is a crucial part of ensuring your and your family’s health.

Genital HPV

Genital human papillomavirus (HPV) is the most common sexually transmitted virus in the United States. HPV is primarily spread through vaginal, anal, or oral sex, but sexual intercourse is not required for infection to occur. Most people who have genital HPV don’t know they have it because there are often no symptoms, and it can go away on its own-without any serious health problems. There is no cure for HPV, but there are treatments. Anyone who has ever had genital contact with another person can have genital HPV. Both men and women can get it and pass it on without realizing it. There is no reason to be tested just to find out if you have genital HPV.

The surest way to prevent HPV is not to have sex. If you decide to be sexually active, limit the number of partners you have. Condoms may lower chances of getting HPV however HPV can infect areas that are not covered by a condom. You cannot prevent any sexually transmitted disease by washing the genitals, urinating, or douching after sex. Women and men can get vaccinated to protect against the types of HPV that most commonly cause health problems. The vaccines are given in 3 doses over 6 months. The vaccines are most effective when all doses are received before a person has had sexual contact with his or her partner.

There are many types of HPV. All HPV infections are either low-risk or high-risk. Low-risk HPV infections can cause genital warts, which can be treated with medication applied to the area or surgery to remove them. High-risk HPV infections can sometimes develop into cancer of the cervix. These infections may also lead to other cancers, such as anal cancer. In some people, high-risk HPV infections can persist and cause cell changes. If these cell changes are not treated, they may lead to cancer over time. It is important to know about the link between HPV and cervical cancer and about the steps you can take to prevent the disease. Most types of HPV do not lead to cancer. Women can protect themselves from cervical cancer by getting regular Pap test. The Pap test is the best way to screen for cervical cancer. Changes that are caught early can be treated before they lead to cancer.

Most people who have sex will have HPV at some time in their lives. There is no blame, no shame about having genital HPV. The virus is very common. If you have HPV, don’t blame your current partner or assume your partner is cheating. People can have genital HPV for a very long time before it is detected. Talk openly and honestly with your partner about HPV and other STDs.

Pelvic Organ Prolapse

by Pleas Copas, MD

Pelvic organ prolapse (P.O.P.) affects up to 25% of adult females in the United States, with 11% seeking surgical therapy. P.O.P. includes cystocele (dropped bladder), rectocele (where the wall between the rectum and the vagina drops), and dropped uterus (where the uterus drops onto the top of the vagina).

Symptoms reported by patients include:

  • Pelvic pressure
  • Low back pain
  • Bulging or protruding vaginal tissue, especially when the patient has been lifting, straining or active for long hours
  • Difficulty voiding or having bowel movements
  • Painful sex and tenderness afterward

The most common predisposing factor for P.O.P. is childbirth, even though some women who have P.O.P. have never been pregnant. Normal labor and delivery can damage nerves, muscles, and connective tissues that support the uterus and vagina. Patients may notice prolapse early after delivery, but it is more commonly felt as time passes. Menopause and the resulting estrogen deficiency may contribute to prolapse as well.

The need for treatment mainly depends on the severity of symptoms and the disruption to your lifestyle. If the prolapse is extremely severe or recurrent urinary tract infections are common, your gynecologist may have to recommend treatment.

Treatments may be surgical or non-surgical. The non-surgical route mainly involves the use of a pessary. A pessary is similar to a diaphragm and comes in many different shapes and designs depending on the type of prolapse being treated. It can be worn continuously or only when extremely active, and it must be removed for sexual intercourse. However, most patients chose surgical treatment. The surgical procedures for P.O.P. date back to the late 1800s. Since P.O.P. is essentially a pelvic hernia, many procedures use the same principles to improve symptoms. The surgical procedures can be performed vaginally or through an abdominal incision. More recently, laparoscopic and robotic procedures have been employed.

As with abdominal hernias, mesh has been used in repairing P.O.P. Commercials on TV, ads in newspapers, and billboard designs are prolific in urging patients to take part in class action lawsuits regarding these surgeries; however, the mesh itself is not the main factor behind the controversy. Many inexperienced and insufficiently trained surgeons were enticed to use these valuable products, which resulted in unacceptable complication rates. Several companies have stopped offering the mesh products due to these lawsuits, but they have yet to be removed from the market by the FDA.

As a fellowship-trained physician in Women’s Care Group, I offer my patients a choice of many different approaches to P.O.P. repair. My preference is vaginal surgery. The abdominal wall is not affected, which helps ensure a faster recovery time. Also, I will perform mesh repairs to patients who request them, especially when they have already tried traditional surgeries without success.

With careful selection of procedures, adequate post-operation recovery, and physical and medical therapy when necessary, a satisfactory cure rate of 80-90% can be attained.

Stress Urinary Incontinence

by Pleas Copas, MD

If you leak urine at inappropriate times, you are not alone. More than a third of U.S. women report urinary incontinence. Urinary incontinence can have many causes, but one of the more common causes is stress or strain.

Stress urinary incontinence is urine leakage with activities. Activities can include coughing, sneezing, lifting, exercising, during sex, or even getting up from a sitting position. The amount of leakage may be small, just a squirt, but may happen frequently during the day. The most common cause for stress incontinence is loss of support of the vagina that holds up the urethra or bladder neck. This is commonly the result of pregnancy. When the symptoms are severe enough and conservative treatments such as physical therapy of pelvic muscles (Kegel exercises) or weight loss have not given the desired results, surgery is available.

In the distant past, many of the surgeries required an abdominal incision to achieve the best results. This is no longer necessary. Newer procedures that are done through a small vaginal incision are available for many patients. These can be done in the outpatient setting with much less pain and discomfort. The success is as high as older surgeries (80-85%) but with a lower complication rate. Even though the discomfort is much less, heavy physical activities must be avoided for about a month to allow healing. Small incisions take as long to heal as larger incisions. Sexual intercourse must also be avoided during this time.

Several different procedures are available for “minimally invasive” treatment of stress incontinence. The doctors at Women’s Care Group mainly use the TVT procedure from the Gynecare division of Johnson & Johnson. This has been used for more than 15 years in millions of patients around the world with a low complication rate. In fact, most large studies by experienced surgeons report major complications in less than 1% of patients with a success rate of 80-85%. The long-term results are available and reveal that 97% of the patients initially cured remain dry after 11 years of follow-up. This procedure uses a small, permanent sling made from polypropylene mesh. The mesh is made of the same material as sutures used in most heart surgeries.

Some patients require lab evaluations to check their bladder and urethra before surgeries, but many only need a regular consult office visit to schedule the surgery.