Gestational Diabetes: Do I HAVE to drink that?

 

Short Answer:  Yes.

Long Answer:  You actually don’t HAVE to do anything you don’t want to do.  We won’t MAKE you do anything you don’t want to do.  This concept supports your autonomy as a patient.

However, you trust us to be the lifeguard of your pregnancy.  Throughout your pregnancy, we will monitor your blood work, vital signs, and the baby’s growth and development by using ultrasound, drawing your blood, listening to your baby’s heartbeat, and measuring the size of the uterus.  Trust us when we say that the second trimester glucose screen is very important to the health of both you and your baby.  We might even recommend it earlier in the first trimester if we are concerned about impaired glucose tolerance.

One complication of pregnancy that we screen for and treat is called gestational diabetes.  Gestational diabetes can occur in women of any size, even without a personal history of family history of diabetes.  Insulin is a hormone produced by the pancreas, and the body uses insulin to help transport blood glucose (sugar) from the bloodstream into the cells of the body.  The hormones of pregnancy can cause you to be resistant to insulin.  If you become resistant to insulin, your blood glucose levels become elevated and the glucose easily transports across the placenta to your baby.  This can cause the baby to grow very large, and at the same time it impairs the development of the baby’s lungs.  You can end up with a very large baby who, at the same time, has very immature lungs and needs help breathing after birth.

Maternal Complications of Gestational Diabetes:

  • You have a 70% chance of developing Type 2 Diabetes within 10 years
  • You are at a higher risk of high blood pressure or preeclampsia in pregnancy
  • You might require medication to help manage your blood glucose
  • You are at higher risk of miscarriage or stillbirth

 

Fetal Complications of Gestational Diabetes:

  • Your baby can grow very large
  • Your baby might experience a shoulder dystocia at delivery, which is an emergency situation where the head delivers but the large body is stuck behind your pelvic bones.  We might have to break the baby’s collar bone to help your baby deliver.
  • Your baby might require assistance breathing at delivery or in the first few days
  • Your baby might need to be observed or treated in the special care nursery for low blood glucose.

What happens if your one hour glucose screen comes back elevated? 

We will ask you to take a three hour glucose screen.  If the three hour glucose screen comes back elevated, you will have the diagnosis of Gestational Diabetes.  At that time, we will send you for a consultation with a Maternal Fetal Medicine physician called a Perinatologist.  These physicians are specially trained in high-risk pregnancy and obstetric ultrasound.  They can help us monitor the growth of your baby.  In addition, a diabetic educator will teach you how to test your blood glucose daily.  They will also teach you how to eat well to keep your blood glucose as stable as possible.  You will also be asked to increase your daily exercise, which will help your body be more sensitive to insulin and help you regular your blood glucose.

 

The glucose screen is usually done at the 24-28 week visit.  We ask that you eat normally that day, with good protein and not a heavy carbohydrate load.  Plan for the visit to take at least an hour because we have to draw your blood one hour after you finish drinking the liquid.  Pack a healthy snack with protein for the ride home.

 

So… yes.  Your midwives are aware that the glucose screen can cause nausea and discomfort.  You may not like the taste of the drink.  However, it is an important screening test that can help us provide the very best care for you and your baby.

 

For more information:

http://www.diabetes.org/diabetes-basics/gestational/

http://www2c.cdc.gov/podcasts/player.asp?f=11504&loc=WhatIsGestational

By: Kirsten Johnson | Certified Nurse Midwife

Who needs sleep?

What is the one thing we spend the most time doing?  Sleeping!  Sleeping is a very important part of our life and contributes to our health.  Getting a good amount of sleep gives our body time to rest, and our brain time to make new connections.  When we don’t get enough sleep we can see the effects in many areas of our lives:  difficulty concentrating, poor attention, poor judgment, decreased ability to learn, depressed mood, and even obesity, heart disease, and a depressed immune system.

Do you think your children are getting the sleep that they need to be successful in school and in relationships with friends and family?  A National Sleep Foundation study recently found that 85% of teens do not get adequate sleep!  Adequate sleep means 8-10 hours every night for a teenager and 9-11 hours a night for a school age child.

Poor sleep has become a larger problem over the last 20 years.  What can you do to help ensure your child gets enough sleep?  Here are a few sleep tips to try:

  1. Maintain a consistent bedtime.  It is important for your body to always get up and go to bed around the same time, trying to limit fluctuations to 1 hour or less.  This includes the weekends, holidays, and summer break.  For older kids, avoid naps.  Naps make it more difficult to fall asleep at bedtime.
  2. Make sure the room is cool, dark, and quiet. Use your bed only for sleep, not for playing or punishment.
  3. Eliminate caffeine or nicotine from your diet, especially after noon. The effects of caffeine on sleep can last for 8 hours!
  4. Try to spend some time outside in the sun during the day. Spending time in a dark house confuses the brain into thinking it is nighttime.  Natural light during daytime is the best way to make sure your circadian rhythms are on track.
  5. Make up a relaxing bedtime routine. Try to always follow the same schedule so your kids know what to expect.  Some good ideas are a shower, story time, listening to calm music, or writing in a journal.
  6. Eliminate one of the biggest enemies of sleep from the bedroom: The Screen!  Looking at screens, especially screens from phones or tablets actually make your brain believe it is day and not night so your brain doesn’t release the sleep inducing hormone melatonin.  Studies have shown people who have tvs in their bedroom get less sleep on average each night.  It takes longer to fall asleep and you are less likely to stay sleep when there is a TV in your bedroom.  Remove technology from the bedroom!

Try the above tips and see if you and your children start getting better sleep.

Sleeping_angel

BE A CHAMPION! PLEASE IMMUNIZE!

Community Health Association of Spokane Valley Clinic

It is National Vaccine Awareness Month and that means… it’s time to talk about immunizations.

I will keep this short and sweet as we want to stay focused. Please come in and talk to a provider at any time if you have any questions or concerns about vaccination so we can discuss why they are safe and so important for you, your family and your community.

 

  1. Starting in September CHAS will have flu shots available for anyone who comes to any of our clinics. We will be here and ready to go to help keep you healthy thus If you have an appointment prior to the start of September you can come back in at anytime for a nurse visit to get your annual flu vaccination. If you are wondering “Do I need a flu shot” this post from a nurse who questioned her need for the vaccine while pregnant  may be just for you. http://www.voicesforvaccines.org/nurses-vaccinate-to-protect-families-and-patients/

 

  1. Please ask our medical staff at every visit if you need any vaccines. We should check every time you come in so we take every opportunity to keep you protected and healthy. If you don’t ask, who will? One question and 30 seconds of your time could save your life or the life of someone you love.

 

  1. For Teens- In 2014, nationally, 4 out of 10 teen girls and 6 out of 10 teen boys had not even started the HPV vaccine (Gardisil) series making them vulnerable to cancers caused by HPV. Your teenager also needs to shots to protect them from meningitis and a TDaP to protect them from tetanus and Pertussis (whooping cough). Please start asking about HPV and if your teen starts this vaccine series, please remind them to finish it.

 

  1. Be a Champion! This month, I encourage everyone to be a champion for vaccine Please look up just one vaccine, any one of your choice and become passionate about it for your community. Be familiar with the results of getting such an infection and how not getting immunized can impact your community. Please go to http://www.immunize.org/vaccines/ this site will give you discussion points about each illness, pictures of what the illness looks like, and tons of resources to access so you can learn everything you need to know about vaccination. Let’s work together to make our community as safe as it can be. Please look at this resource  http://www.voicesforvaccines.org/ too as it helps you see each illness through the eyes of families and individuals affected by each preventable illness.

Healthy Choices for Kids.

Do you know why there’s so much talk these days about obesity in children?

Children who are overweight when they are young have a much harder time losing weight when they are older than adults who were not overweight as kids. If you make improvements in your child’s diet and increase the amount of physical activity he gets now, you will have a much better chance of keeping him healthy as an adult.

Here are a few ideas to make changes in your family’s diet:

  •   Drink water!  (no juice, no soda)
  •   Eat at home!  (don’t eat out more than once or twice a week)
  •   Keep cut up fruits or vegetables around so your kids will snack on them instead of chips
  •   Eat together! Keep the TV off!
  •   Make sure you have 20-30 minutes to eat together (eating too fast makes it easy to over- do it)
  •   Eat 3 meals a day! (skipping leads to overeating )
  •   Keep junk food out of your house!
  •   Make salads with vegetables, not eggs, meat or cheese
  •   Toss your salad to use less dressing
  •   Treat yourselves sometimes!

Here’s some suggestions to increase physical activity in your family:

bike-helmet-child

  •   Ride a bike
  •   Go for a walk after dinner
  •   Dance
  •   Swim
  •   Play sports
  •   Walk when you talk on the phone
  •   Take a martial arts class
  •   Limit TV and video games to 1-2 hours per day

 

Good luck and enjoy the rest of your summer.

Meet your provider: Deena Solomon

CHAS Dr. Solomon

I recently sat down with Perry St. Clinic’s pediatrician, Deena Solomon to get to know a little bit more about what makes her so great to work with.

Tell us about yourself…

My name is Deena Solomon, Pediatrician at the new Perry St. clinic! I am originally from New York, I grew up in Staten Island, went to medical school in Tel Aviv University in Israel, and did my residency in the pediatric department at King’s County hospital and University Medical center of Brooklyn, New York. After that, I worked as a pediatrician for 3 years in an outpatient clinic Staten Island Hospital. We moved to Spokane 6 years ago and have been a stay at home mom up until I started working at CHAS, about 6 months ago.

What initially drew you to Pediatrics vs any other branch of medicine?

CHILDREN! I love kids, I think that kids are extremely honest, which makes them so fun to work with. They always tell the truth the way they see it, and I always appreciate that about them.

Do you have children yourself?

I have 3 kids, a 7 year old son, and 2 daughters, 5 and 4 years old.

Do you have any special connection to the Perry District?

I live on the South Hill and I frequently visit the Perry District. I am excited to be in a place close to where my kids are attending school, I’m familiar with District 81 schools, sports available at those schools, parks to play at nearby, and things to do in nearby. I’m excited to relate to families in Perry and to be more conversational about what’s going on in their neighborhood. I’m especially excited to start building more relationships with families in the area.

When you aren’t taking care of kids, what are you doing?

(Laughs) When I’m not taking care of kids at CHAS, I’m taking care of my own kids at home! So, lots of outside play time. Right now, it’s all about basketball. My two oldest are involved playing at the YMCA, so most weekends are spent practicing and playing in games. But, now that the weather is getting good, it’s also going to be more about riding bikes and being out at the playgrounds. It’s basically all kids all the time.

What do you listen to get you excited for the day?

I listen to comedy talk shows, but I also enjoy quiet drives to work, since I’m always around kids at work and at home. The 10-15 minute car ride on the way here is the best way to get me prepped for the day.

What do patients/co-workers like about you?

I am pretty easy to speak to, and I think I am a good listener and people appreciate that about me. Especially parents with concerns about their children.

What’s the best advice you’ve ever received?

That’s a really easy one, one of my mentors during my rotations was a big inspiration to me, he always made a point of reminding me, “less is more when it comes to pediatrics.” When there is a question of whether you should do an invasive test, intervention, blood test or x-ray, it’s usually best to avoid it. Typically best for kids not to go through the trauma of excessive testing. He always said a children’s place is at home, if there is any way you can get a kid at home vs. in the emergency room or in the hospital for an extended time, that’s where they should be.

Doc McStuffins or Jake and the Neverland Pirates?

I love Doc McStuffins! The show promotes all the values I would want to promote in my own kids. They show that both male and female roles aren’t predetermined and you can do anything you put your mind to! I also appreciate the diversity of the show…plus she’s a doctor!

What makes you unique?

I think my life experience, growing up in New York, my parents emigrating from Eastern Europe, living in Israel, traveling a ton in my life, and marrying someone with a very different background than my own (because my husband is Middle Eastern). My take on everything is a little unique because of all the different experiences and backgrounds influencing my life and it gives me a unique perspective.

What do you enjoy most about working at CHAS?

I really like that everyone is really working towards the mission of CHAS, (The mission of CHAS is to improve the overall health of the communities we serve by expanding access to quality health and wellness services), and it’s really been a pleasure for me to see that everybody I have met has a really positive outlook on what they are doing and working towards that mission. I love the fact that CHAS has been around for 20 years and we are making a big difference in our community and we are continuing to expand to all areas of our community. I’m really happy to be part of that.

Deena can’t wait for the Perry St. opening on March 23rd!

 

By Matt Grebe

Talking with baby

Community Health Association of Spokane Valley Clinic

 

Did you know something as simple as talking to your baby can help them be more successful in school?  75% of your baby’s brain development occurs in the first 2 years of life.  You are your baby’s first teacher!  The more words they are exposed to during this time the better.  Simple things like telling your child what you are doing, “Mommy is making your bottle now,” and pointing out things you see, “Look at the big red ball,” help their language develop.  You may be tempted to turn the TV on and let your baby be exposed to language that way.  Unfortunately, studies have shown this actually makes their language development worse.  Instead, turn the tv off and talk directly to your baby throughout the day, making eye contact with them, and giving them a chance to respond.  This helps with language and communication skills that are needed throughout life.

Books and songs are another way to help develop their language skills.  Sing simple songs over and over again, and you will quickly see that they will begin to recognize the song.  Exposing them to books is a great opportunity.  You might find your 6 month old baby has no interest in sitting down and reading a book, but let them explore books.  They will probably start by sticking it in their mouth, but soon they will start looking at the pictures, and before you know it they will have their own favorite book.  Your baby may not want to sit on your lap and read the entire book.  That’s ok!  Flip through the book with them.  Point out different pictures.  Practice animal sounds.  Your baby will enjoy the time spent cuddling with you, while also building a foundation for their developing language and a love for reading.

By Ashlee Mickelson, Physician