Fatigue and Sleep

Every week I talk to someone about fatigue. There are physical and emotional causes: but the most common cause is lack of sleep.

I have struggled with sleep myself. I have a job where I often get up in the middle of the night with phone calls or emergencies and I use to find it difficult to fall back asleep, especially after difficult or stressful situations.

Science shows that sleep is extremely important to emotional and physical well-being. Lack of sleep has a variety of side effects including, anxiety, depression, weight gain, and even cancer.

Science indicates that the following play a role in our sleep.

Blue Light:
1. Avoid computers, phones, and TVs 1 hour before bed.
2. Our bodies’ circadian rhythms can get thrown off with bright lights, but just as important is these devices can increase anxiety or even excitement and that can prevent us from falling asleep.
Exercising:
1. 30 minutes of elevated heart rate helps your body rest at night.
2. Exercising within 1 hour of bed can make it difficult to fall asleep.
Meditation:
1. if you are like me and have a “Monkey Mind” it is especially useful
2. Even 2 minutes has been shown to help
3. The more you practice the more it helps. It likely won’t help the first few times you try.
Noises:
1. Many of us don’t want to be without our phones, but even light buzzing/clicking can prevent us from falling into a deep sleep.
Sleeping Aids:
1. Can be habit-forming and make the situation worse
2. Melatonin can help in adults, but most studies show it is a placebo in kids.
Caffeine:
1. Duration of action is individualized, but a good rule of thumb is Caffeine takes 6-10 hours to leave our system.
Alcohol:
1. Can prevent you from falling into a deep sleep.
2. For sleep purposes, don’t drink within 3 hours of wanting a good night sleep.

May 2, 2021May 2, 2021

Heavy Bleeding

I often have trouble summarizing “heavy bleeding” in a 30 minute appointment. This is going to be a very short summary, about a very complicated topic. Hopefully you find it helpful to start simple and we can build from there.

Often times we do not find specific reasons for heavy/irregular bleeding. We will make sure it is nothing serious (cancer, infection, ect); everything else can be treated as stated below.

Causes:

Hormone imbalance
Anovulation (often from hormone imbalance)
Infection
Unknown
Structural problems
1. Polyps
2. Fibroids
3. Thick endometrium
4. Hyperplasia
5. Endometriosis/Adenomyosis
6. Cancer/precancer

Periods can change over a life time, sometimes we find the reason, sometimes we don’t. These things have been shown to cause changes in our mensural cycles: stress, change in what we are eating, weight loss, weight gain, increase in activity, decrease in activity, new sexual activity, new relationships, pregnancy, age.

Treatment:

Once we rule out hormonal problems, infection, and cancer we can start treatment. Treatment is simple.

Hormones
1. Oral birth control
2. IUD, Nexplanon
3. Patches, Nuvaring
4. Shot-Depo-provera
Antihormones
1. Lysteada: helps your uterus clot.
2. Lupron: medication that puts you into a fake/temporary menopause.
Surgery
1. Ablation
2. Hysterectomy
3. Uterine artery ablation (we don’t do this in Tillamook, this is something interventional radiology does not gynecologists)

May 2, 2021May 2, 2021

Vaginal Hysterectomy

This post was made by the Mayo Clinic and it is just general information:

Overview

Female reproductive organs Female reproductive systemOpen pop-up dialog box

Vaginal hysterectomy is a surgical procedure to remove the uterus through the vagina.

During a vaginal hysterectomy, the surgeon detaches the uterus from the ovaries, fallopian tubes and upper vagina, as well as from the blood vessels and connective tissue that support it, before removing the uterus.

Vaginal hysterectomy involves a shorter time in the hospital, lower cost and faster recovery than an abdominal hysterectomy, which requires an incision in your lower abdomen. However, depending on the size and shape of your uterus or the reason for the surgery, vaginal hysterectomy might not be possible. Your doctor will talk to you about other surgical options, such as an abdominal hysterectomy.

Hysterectomy often includes removal of the cervix as well as the uterus. When the surgeon also removes one or both ovaries and fallopian tubes, it’s called a total hysterectomy with salpingo-oophorectomy (sal-ping-go-o-of-uh-REK-tuh-me). All of these organs are part of your reproductive system and are situated in your pelvis.

Why it’s done

Vaginal hysterectomy treats various gynecological problems, including:

Fibroids. Many hysterectomies are done to permanently treat these benign tumors in your uterus that can cause persistent bleeding, anemia, pelvic pain, pain during intercourse and bladder pressure. For large fibroids, you might need surgery that removes your uterus through an incision in your lower abdomen (abdominal hysterectomy).
Endometriosis. This occurs when the tissue lining your uterus (endometrium) grows outside the uterus, involving the ovaries, fallopian tubes or other organs. Most women with endometriosis have a laparoscopic or robotic hysterectomy or abdominal hysterectomy, but sometimes a vaginal hysterectomy is possible.
Adenomyosis. This occurs when the tissue that normally lines the uterus grows into the uterine wall. An enlarged uterus and painful, heavy periods result.
Gynecological cancer. If you have cancer of the uterus, cervix, endometrium or ovaries, or precancerous changes, your doctor might recommend a hysterectomy. Most often, treatment for ovarian cancer involves an abdominal hysterectomy, but sometimes vaginal hysterectomy is appropriate for women with cervical or endometrial cancer.
Uterine prolapse. When pelvic supporting tissues and ligaments weaken or stretch out, the uterus can sag into the vagina, causing urine leakage, pelvic pressure or difficulty with bowel movements. Removing the uterus and repairing supportive tissues might relieve those symptoms.
Abnormal uterine bleeding. When medication or a less invasive surgical procedure doesn’t control irregular, heavy or very long periods, hysterectomy may be needed.
Chronic pelvic pain. If your pain is clearly caused by a uterine condition, hysterectomy might help, but only as a last resort. Chronic pelvic pain can have several causes, so an accurate diagnosis of the cause is critical before having a hysterectomy.

For most of these conditions — with the possible exception of cancer — hysterectomy is just one of several treatment options. You might not need to consider hysterectomy if medications or less invasive gynecological procedures manage your symptoms.

You cannot become pregnant after a hysterectomy. If you’re not sure that you’re ready to give up your fertility, explore other treatments.

Risks

Although vaginal hysterectomy is generally safe, any surgery has risks. Risks of vaginal hysterectomy include:

Heavy bleeding
Blood clots in the legs or lungs
Infection
Damage to surrounding organs
Adverse reaction to anesthetic

Severe endometriosis or scar tissue (pelvic adhesions) might force your surgeon to switch from vaginal hysterectomy to laparoscopic or abdominal hysterectomy during the surgery.

How you prepare

As with any surgery, it’s normal to feel nervous about having a hysterectomy. Here’s what you can do to prepare:

Gather information. Before the surgery, get all the information you need to feel confident about it. Ask your doctor and surgeon questions.
Follow your doctor’s instructions about medication. Find out whether you should take your usual medications in the days before your hysterectomy. Be sure to tell your doctor about over-the-counter medications, dietary supplements or herbal preparations that you take.
Discuss anesthesia. You might prefer general anesthesia, which makes you unconscious during surgery, but regional anesthesia — also called spinal block or epidural block — might be an option. During a vaginal hysterectomy, regional anesthesia will block the feelings in the lower half of your body. With general anesthesia, you’ll be asleep.
Arrange for help. Although you’re likely to recover sooner after a vaginal hysterectomy than after an abdominal one, it still takes time. Ask someone to help you out at home for the first week or so.

What you can expect

Talk with your doctor about what to expect during and after a vaginal hysterectomy, including physical and emotional effects.

During the procedure

You’ll lie on your back, in a position similar to the one you’re in for a Pap test. You might have a urinary catheter inserted to empty your bladder. A member of your surgical team will clean the surgical area with a sterile solution before surgery.

To perform the hysterectomy:

Your surgeon makes an incision inside your vagina to get to the uterus
Using long instruments, your surgeon clamps the uterine blood vessels and separates your uterus from the connective tissue, ovaries and fallopian tubes
Your uterus is removed through the vaginal opening, and absorbable stitches are used to control any bleeding inside the pelvis

Except in cases of suspected uterine cancer, the surgeon might cut an enlarged uterus into smaller pieces and remove it in sections (morcellation).

Laparoscopic or robotic hysterectomy

You might be a candidate for a laparoscopically assisted vaginal hysterectomy (LAVH) or robotic hysterectomy. Both procedures allow your surgeon to remove the uterus vaginally while being able to see your pelvic organs through a slender viewing instrument called a laparoscope.

Your surgeon performs most of the procedure through small abdominal incisions aided by long, thin surgical instruments inserted through the incisions. Your surgeon then removes the uterus through an incision made in your vagina.

Your surgeon might recommend LAVH or robotic hysterectomy if you have scar tissue on your pelvic organs from prior surgeries or from endometriosis.

After the procedure

After surgery, you’ll be in a recovery room for one to two hours and in the hospital overnight. Some women are able to go home the day of the surgery.

You’ll take medication for pain. Your health care team will encourage you to get up and move as soon as you’re able.

It’s normal to have bloody vaginal discharge for several days to weeks after a hysterectomy, so you’ll need to wear sanitary pads.

How you’ll feel physically

Recovery after vaginal hysterectomy is shorter and less painful than it is after an abdominal hysterectomy. A full recovery might take three to four weeks.

Even if you feel recovered, don’t lift anything heavy — more than 20 pounds (9.1 kilograms) — or have vaginal intercourse until six weeks after surgery.

Contact your doctor if pain worsens or if you develop nausea, vomiting or bleeding that’s heavier than a menstrual period.

How you’ll feel emotionally

After a hysterectomy, you might feel relief because you no longer have heavy bleeding or pelvic pain.

For most women, there’s no change in sexual function after hysterectomy. But for some women, heightened sexual satisfaction occurs after hysterectomy — perhaps because they no longer have pain during intercourse.

You might feel a sense of loss and grief after hysterectomy, which is normal. Or you might have depression related to the loss of your fertility, especially if you’re young and hoped for a future pregnancy. If sadness or negative feelings interfere with your enjoyment of everyday life, talk to your doctor.

Results

After a hysterectomy, you’ll no longer have periods or be able to get pregnant.

If you had your ovaries removed but hadn’t reached menopause, you’ll begin menopause immediately after surgery. You might have symptoms such as vaginal dryness, hot flashes and night sweats. Your doctor can recommend medications for these symptoms. Your doctor might recommend hormone therapy even if you don’t have symptoms.

If your ovaries weren’t removed during surgery — and you still had periods before your surgery — your ovaries continue producing hormones and eggs until you reach natural menopause.

January 2, 2021January 2, 2021

Vaginal pH

I see people every day that are worried about vaginal irritation/odor/discharge. These people may have yeast infections or an increase in bacteria. Often times we can treat those things with the appropriate medications, only to have the same symptoms return or other ones emerge to take their place. When the vagina keeps getting infections, discharge, or irritation it is often a PH problem. The vagina likes to be very acidic, like vinegar. Blood (from menstruation) and semen (from sex) both increase the PH in the vagina and can change bacteria in the vagina. Maintaining the pH balance of the vagina is essential to keeping the vagina smelling and feeling healthy. A normal vaginal pH is usually less than 4.5.

In the vagina, a change in pH may cause infections as it can allow bacteria and yeast to thrive and once you get one of these infections, you can get rid of it with appropriate medications, but if the PH is still elevated, those infections can easily return one after another. This is incredibly frustrating, but hopefully, I can offer some suggestions to eliminate the problem.

Are bacteria normal in the vagina?

Yes, the vagina has many good bacteria. Lactobacilli bacteria are healthy vaginal bacteria and secrete lactic acid and hydrogen peroxide, which give the vagina its acidic pH level.

Bacterial vaginosis is an increase in bacteria that normally live around the vagina, but not in it. These bacteria can overpopulate the vagina. This occurs when some types of bacteria multiply and increase the vaginal pH levels and kill the good bacteria. A person with bacterial vaginosis may experience itching, burning, pain, discharge and/or odor.

Other vaginal infections The presence of infections may also increase the vaginal pH. Examples include trichomonas vaginalis, yeast and group Streptococcus (GBS), and e. coli. Sometimes we get rid of one of these infections, only to find another take its place. This is when its time to start thinking about pH.

What can I do to treat the problem on my own?

Washing or cleaning the vagina using particular solutions, such as those containing vinegar, soaps, lubricants, oils or water can help or make things worse. Some solutions claim to reduce vaginal odor, but may make the problem worse because they wash out good bacteria, which affects the vaginal balance and can make some more prone to other infections. If you use any product in the vagina make sure it is “pH balanced” FOR the vagina. This product should have a pH of 4.5 or lower.

If a person’s vaginal pH levels are routinely high without any symptoms of an infection, they can take several steps at home to reduce their pH levels. These include: Avoiding soaps and washes, but use moisturizers and lubricants: Soaps typically have a high pH, and using them to clean the vaginal area may increase vaginal pH. It is best to use warm water and a gentle cleanser to clean the vulva but to refrain from using soap inside the vagina. Moisturizers that are made for the vagina and are pH balanced, may help neutralize alkaline products.

Probiotics? Oral probiotics have not been shown to help with vaginal bacteria. Yogurt in the vagina has not been shown to help with vaginal bacteria. There are vaginal probiotics that you put in the vagina. These products have not been studied well, but you could give them a try. Natural remedies do help some people.

Changing tampons regularly. Leaving a tampon in for too long can increase the vaginal pH because the pH of blood is slightly basic. Changing tampons frequently also reduces the risk of bacterial infections, including toxic shock syndrome (TSS).

Using barrier protection during sex. Using barrier protection, such as condoms or dental dams, not only helps to prevent pregnancy and STIs but can prevent semen and other fluids from affecting pH levels in the vagina.

Apple cider vinegar. Tampons allowed to absorb some Apple Cider vinegar may help. Vinegar has a pH of 4.5, so it may help make the vagina a more welcoming place for those good bacteria. Tampons may also help clear semen, and blood out of the vagina.

Summary

Understanding normal vaginal pH can help you avoid irritating bacteria infections. If you seem to have a vaginal odor, itching, discharge that comes and goes, especially if it comes and goes around the time of your menstrual cycle or after sex, it is very likely it is a pH problem. Try some over the counter pH correctors or apple cider vinegar. This may solve the problem. Even if you correct the pH, remember that you may need yeast medication or an antibiotic to help get rid of the bad bacteria. It is important to see a doctor to rule out sexually transmitted infections as they can cause long term problems if not identified quickly.

November 16, 2020November 18, 2020

Low Sexual Desire

This is a hard topic, but one most people can relate to. In relationships, we either have a high sex drive or low sex drive. Most couples don’t match 100% of the time.

Decrease sexual desire can be problematic, especially if it causes stress or anxiety and continues for more than 6 months. Decrease desire can also be problematic because there are SO MANY different causes. This is a problem that can be improved, or fixed, but there are no magic pills. -OK there are a few, but well get to that.

To start with, read this list and think about things that might be affecting your sex drive. Start changing some basic components of your life that aren’t working for you.

It probably isn’t one thing causing your desire to be elusive.

An incomplete list of possible culprits

Sexual problems If you have pain during sex or don’t orgasm, that makes sex less exciting and can lead to long term decrease desire.
Medical Problems If you are in pain, fatigued, or worried about your health, sex may be something you are not interested in.
Medications Certain medications, especially antidepressants are known to decrease ones desire.
Lifestyle habits Smoking marijuana or nicotine decreases blood flow, which may decrease arosal. A little alcohol may seem like a good idea to start, but to much will make sex less appealing for a variety of reasons.
Fatigue If you are tired after your daily activities, you will likely not want to add one more thing onto your day.
Menopause Hormone levels drop as we grow older. This can make you less interested in sex and cause vaginal dryness or other pain.
Pregnancy If your feel fat and ugly during pregnancy, no wonder you don’t want to have sex. If you feel maternal, sex may also be unappealing. If your in pain every time you move, you probably don’t feel like sex.
Emotional issues Stress, anxiety or depression definitely play a role in desire.
Poor self image either about yourself or your partner, if you have gained weight the last thing you want to do is look at yourself naked. If your partner isn’t your ideal image, it may be leading to decrease desire.
Low self-esteem
Guilt
History of physical or sexual abuse sex is only fun and enjoyable, when its fun and enjoyable.
Previous negative sexual experiences If your partners have never really cared about your sexual experience, its hard to get excited about theirs.
Lack of connection with your partner
Relationship Conflicts In relationships this can be an issue for one person and not the other. We are two different beings after all.
Trust issues
Fear

Where to start

Women need more foreplay to lubricate the vagina and relax the muscles. If you try and “push” through it might be self-defeating. You need to take a few extra minutes at the beginning. Don’t force yourself, but start over. Making sure your comfortable, or your desire will be less in the future.
Use lubrication, It feels nice, smells good, and tastes good.
Try to figure out your “ turn offs” and explain them to your partner. If your turn off is your partners turn on you will need to let them know. This may be hard, but if you are honest it will work in both of your best interest in the long run.
Keep in mind your turn offs may not be an action. You need to dig deep on this one.
1. Maybe you have pictures of your kids on your nightstand
1. Perhaps that is the quilt your grandmother gave you for your wedding
1. Maybe your nervous your dog is going to walk in on you and try and join
Don’t let someone push you past your boundaries, but be open to suggestions.
You need a vibrator. Even if you aren’t using it for enjoyment, it will help relax muscles, get blood flowing. You can use it on your own to try and get yourself ready or use it with your partner to increase the foreplay. Vibrators are a must especially if you find you are feeling dry or have pain of any kind.
Pick a day so you don’t feel pushed at other times. This will free up some space and allow you to mentally have control. You can still change your mind, but you shouldn’t have to worry about sexual encounters. Sex doesn’t have to be spontaneous.
Make it a mission to find something that sexually interest you, books or movies, that new vibrator…. If nothing does, its time to start over and find out what else may be playing a role in your lack of desire.

Less than magic – pills

Wellburtrin: This is an antidepressant that has been shown to help with sexual desire in some studies. This may be especially useful if you have some depression or anxiety.

Testosterone: If your menopausal estra-test is a great hormone replacement medication. If you are interested, talk to your doctor about the benefits and problems with this medication.

ADDYI: FDA has recently approved a medication for low sexual desire. As of 2021 it is a new drug and as such it is expensive. We have a hard time getting insurances to pay for it, but if you want to give it a try go to the website and talk directly with there doctors. This will be an online consult and they will send you a sample to see if Addyi is a good fix for you.

https://addyi.com/