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

Birth Plans!

Should I write a Birth Plan?

Many women want to write out a birth plan to clarify the care they hope to receive while they are in labor.  A birth plan can be a short wish list or a long explanation of your circumstance, such as if you are adopting the child out or if there are known anomalies incompatible with life.

Is a Birth Plan required?  No.  The nurses, midwives, and physicians are highly trained professionals who will take care of you to the best of their abilities.  We have not performed routine shaves, enemas, or episiotomies for over 25 years, so you do not need to request that we refrain from these procedures.  We have many tools in our bag of tricks to help your labor progress well and hopefully avoid complications.

In addition, every woman and every labor is different.  It is a good idea for you to relax, let go, and accept the labor that comes to you.  There really is no other choice but to deal with the reality of the moment.  Your care providers will help you.  Honest.  That’s what we have chosen to do for our career.  We want the best outcome for you and your family.

I do recommend that my mammas write up a short, one-page wish list that gives the labor team a frame of reference of what experience you are hoping for in labor and delivery.  It is a good idea to designate one person to speak for you if you are unable to speak for yourself due to an intense labor.  It tells us if you have specific requests, such as dad cutting the umbilical cord or your desire to avoid an epidural or even GIVE ME THE EPIDURAL THE MOMENT I WALK IN THE DOOR!

Bring your birth plan to one of your prenatal visits to discuss with your midwife or physician.  Then when you have a final draft, bring a printed copy for the nurse caring for you in labor and delivery.  That way, your entire team is on board with the plan and works with you!  Remember to keep it short and flexible.

Some ideas of what women specify in a birth plan:

  • Who will be present for the birth?
  • Are you bringing a doula?
  • Will there be siblings present?
  • Do you want mobility or do you want to stay in bed?
  • What activities or positions do you plan to use (walking, birthing ball, standing, tub, squatting, etc)?
  • What is your plan for pain relief (massage, hot packs, position changes, hypnobirthing, Lamaze breathing, jacousi tub, medication)?
  • How do you feel about fetal monitoring?
  • Who will care for the baby?
  • What is your plan to feed your baby?
  • Do you want to wear your own clothing and listen to music?

 

You can always google “birth plans” on the internet for more ideas, remembering to keep your wish list to one page!

-Kirstin Johnson, Certified Nurse Midwife

Preventing Pertussis or “Whooping Cough” in the newborn.

whopping-cough-babies-2160x1200

 

Pertussis, also called “Whooping Cough” is a bacterial infection that you or your baby can catch when an infected person coughs or sneezes.  Infected droplets can travel through the air, and if you inhale the droplets you can become infected with pertussis.  Whooping cough begins like a cold, with a mild fever and runny nose.  Most adults do not have severe symptoms, but they can pass pertussis on to a newborn very easily without realizing it.

Whooping cough is especially dangerous for a newborn because their immune system is not fully mature and they cannot fight this infection.  Babies cannot get the vaccine for pertussis until they are two months old.  Even after they start the vaccinations, they are not fully protected by the vaccines until they are a year old and have had three vaccinations for pertussis.  Whooping cough in a newborn is a very serious illness, and it often requires that the baby be admitted to the hospital for breathing problems or pneumonia.  Some babies who get whooping cough do not cough at all – they just stop breathing.  Newborns can die from whooping cough.

The entire family can help protect your newborn from whooping cough.  All teenagers and adults who are around your baby should get a pertussis booster, called Tdap.  The Tdap shot is a tetanus vaccine that includes pertussis.  If you are pregnant, the best time to get the Tdap vaccine is between 27-36 weeks of pregnancy.  Your body will have time to make antibodies against pertussis.  These antibodies are passed through the placenta to protect your baby.  You can protect your baby with antibodies long before your baby is old enough to get the pertussis vaccine.  After the baby is born, the antibodies are passed through your breast milk.

For more information:  http://www.cdc.gov/features/pertussis

-Kirstin Johnson, Certified Nurse Midwife

The Force (for health) Awakens!

May the force be with you this winter, here are some great tips on staying healthy from our Jedi Knights on the dental team and our fun loving Darth Moorman. Be sure that these are not “a trap” and this is the advice “you’re looking for” this holiday season.

CHAS_KidsNews_Dec2015_DocTalk_PRINT1

-Written by Darth Moorman and team

Football Season is Here!!! Let’s Play…

Spokane Football

Fall sports have started and it’s time to get those kids in for their annual Well-child exams/sports physicals (please call their doctors office today if this hasn’t happened yet). We want to make sure all kids and adolescents are healthy enough to play sports and that they continue to stay healthy throughout the school year.

Injuries can happen to any child at any time and a concussion can happen in just about all sports. Statistically, girls are at a higher risk of suffering concussions in their chosen sports than boys are; however, concussions can impact any student athlete. Striving for scholarships, championships, and social acceptance drives kids to make a choice about continuing to play when injured, despite their lack of readiness. It is your job as a parent, and our job as your child’s Doctor, to convince our kids that if they have not recovered 100% from a head injury then they are not ready to jump back into the game. Going back early places them at increased risk for severe bodily injury, permanent brain injury, or, in rare cases, even death. If your child has had a head injury and is having any symptoms at all, please get them in to their doctor for an assessment.

Concussion is a clinical diagnosis and you do not have to be KNOCKED OUT to have a concussion…this only happens 10% of the time. The most common symptoms to develop after injury to the head are headaches, dizziness, nausea or vomiting, disorientation, confusion, and loss of coordination. Severe symptoms can result in changes to your child’s personality, grades or academic effort, and their friendships.

There are 4 R’s for concussion to consider:

  1. Recognition- You have to recognize that a concussion has occurred.
  2. Remove- You need to remove that athlete from the risk of repeat injury.
  3. Recovery- Athletes need time to be symptom free before going back to activity.
  4. Return- To cognitive activity as well as return to play.

Diagnosis after injury should be done by your child’s primary care provider so they can follow up during and after the recovery period. There are many tools and tests people use to diagnose a concussion, but the symptoms should be followed closely by a medical provider to help prevent re-injury as well as to educate the athlete about risks of a second concussion. This typically results in worse symptoms, much longer recovery times and potential removal from the activity entirely. Missing a week for 100% recovery is certainly better than missing the entire season due to repeat injury.

With a single concussion, 85% of high school athletes have full symptom recovery within 2-3 weeks. When an athlete is highly symptomatic they should take a couple of days (48 hours) off from school. Their doctor can help make a plan as to the speed of their return to school and sports based in the extent of the concussion and symptoms. Returning to light aerobic activity that does not put the athlete at risk for repeat injury can help maintain fitness and mental health during the recovery period. In the past, athletes were strongly advised to avoid all physical activity until recovery had reached 100%. But new evidence shows that physical activity can help with brain growth and repair while doing nothing may prolong the recovery time.

So when should your child stop their activity or be disqualified from sports?

Three concussions in a lifetime requires having a serious conversation about risks associated with repeat head injury. Things that should disqualify your child from continued activity are increasing length of or severity of symptoms, concussions caused by less trauma then the first or second, decreased time in between concussion or prolonged post-concussive symptoms.

Remembering to help your child place their overall health and wellness above their sports performance may just help keep them playing sports for years to come.

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.

Wildfires and Children’s Lungs

With recent wildfires in the area you may be wondering what this means for your children. The smoke from wildfires contains a mixture of gasses as well as fine particles of burnt material. These can irritate your eyes, nasal passage, as well as your lungs.

Children’s airways are still developing and are much smaller than adults, and therefore are at a higher risk to be affected by poor air quality. Children breathe in more air per pound of body weight and they also tend to be more active which also leads them to breath in more air.

via Krem

via Krem

When the air quality is poor it is important to avoid going outside. If this is not possible, limit the amount of activity that is done outside. Anytime your child runs and plays, they begin to breathe faster, leading to more exposure of the dirty air to their sensitive developing airways.

Keep windows and doors shut. Make sure to run the air conditioner on the recirculate setting to prevent the dirty air from coming inside. A simple mask is not helpful. The small particulates that are present in the smoke are small enough to be allowed through a paper mask. It is also important to keep track of the air quality index where you live. You can check this out at www.spokanecleanair.org to find out the current air quality.

Symptoms of exposure to wildfire smoke can include runny nose, burning eyes, cough, shortness of breath, and nausea. If your child has asthma make sure to have their rescue inhaler available at all times since the smoke can trigger an asthma exacerbation. If any of these symptoms persist or don’t improve after going inside and resting, please seek medical care.

by Ashlee Mickelson, Physician

The Itch of a biting insect: How do I protect my child from them?

With the hot wet days and nights of summer come the biting insects, especially in those early evening hours when eating outdoors and enjoying the gentle weather of a summer evening.

Children are at risk for multiple types of insect bites; biting flies,  mosquitoes, and ticks to name a few. The best way to protect your child from these pesky critters is to apply a repellent containing DEET.

According to the AAP (American Academy of Pediatrics) DEET remains themost effective in repelling these biting insects. It can safely be applied by an adult to the children’s clothing and exposed skin.

Application of the product is best done in an open area. DO NOT spray this directly onto the child’s head and face, instead spray into the adult’s hand and rub onto the face/ears/neck avoiding contact with the eyes.  Follow directions on timing for re-application typically anywhere from 2 to 5 hours depending on the concentration of DEET in the repellant being used.

A common question heard can be: Is it safe for my young child?

The answer is simply:  Yes.  A repellent containing DEET of no more than 30% is safe for application to an infant older than 2 months of age when safely applied by a responsible adult.  Remember to always wash the child’s skin at the end of the day to remove the product to avoid irritation and wash their clothing.

Avoid use of scented lotions/fabric softeners/detergents as these can attract those pests more.  Dressing a child in floral prints and bright colors also can attract the pests.  It’s a good idea to protect the child’s head/ears by having them wear a hat with a wide brim.  Using mosquito netting around strollers and those portable cribs also can help protect the child from those pesky flying insects.   Avoiding stagnant water is a good idea as these are frequently breeding grounds for mosquitoes.

BugBite_0

Despite your best efforts your child ends up with an itchy bite, what next?

There are many over the counter products designed for this. Some good options to use are: a topical cream such as Calamine Lotion, Hydrocortisone Cream, or Benadryl Cream.  Another simple product is to mix baking soda and water into a paste and apply to the bite.

Remember if ever there is a question your Pediatrician is just a phone call away.  🙂

Enjoy your summer stay safe and protected!!

Daniel Moorman, MD

Adolescent Suicide on the Rise in Spokane

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A recent article in the Spokesman Review states, “Five teen suicides this school year – including three in the past month – have jolted the community. It’s the highest number in the history of Spokane Public Schools, prompting parents, students and community members to ask what they can do to help.”

As a Pediatrician here at CHAS I have noticed since mid –March an increased number of teenagers coming into my office for significant suicidal concerns with several reporting that they don’t feel safe going home from the clinic. This is very alarming and hard to manage if our Mental Health Staff has a full schedule. Periodically, the only option we may have available is to ask the family to go to the Sacred Heart Children’s Hospital Emergency Room for safety and to get prompt access to a mental health professional or other services.

Another article from the Inlander just three years ago, covers this local topic as well. They report, “experts say the region needs to start talking about the problem. Spokane has a rate of suicide higher than the state average. It’s the city’s second-leading cause of death for people ages 10-24.” Suicide isn’t just an issue for Spokane, but the entire Inland Northwest. Coeur d’Alene has the highest suicide rate in Idaho, and Idaho consistently has one of the highest rates in the nation, according to a report by Suicide Prevention Action Network of Idaho.

Both articles go on to discuss the need to work on being open and frank with all adolescents. As a medical care team we need to remember to do annual mental health screenings for all teenagers and the PHQ (Patient Health Questionnaire) is a validated test and a reasonable way to open the conversation with any teenagers in your office. The biggest obstacle is getting over the awkwardness of discussing this topic which is hard for many individuals to do. Teenagers tend to be more open and honest when they feel you are open with them and showing them that you actually care about their personal story.

Scientifically we know the adolescent brain works differently than the adult brain as teenagers seem to be pre-programmed to take greater risks and have less inhibition of impulse behaviors. This makes them appear to live more in their current emotions and less in their analytical/reasoning brain where adults tend to spend more of their time. This can lead to behavior that seems uncharacteristic and reckless to others but does not seem strange or out of the ordinary to teens in my office when they bring up the topic.

To try and keep this commentary to a minimum, I have provided links to both of the recent articles which I feel are informative for our community. They do go on to provide resources which I have attached below.

What Causes Suicide?

According to the National Alliance on Mental Illness (NAMI), “90 percent of youth suicide victims have at least one major psychiatric disorder, although younger adolescent suicide victims have lower rates of psychopathology.” Overall, NAMI asserts that 90 percent of people who complete suicide could have been treated for a mental or substance-abuse disorder.

Suicide Prevention Meetings

Prevent Suicide Spokane is hosting a meeting about what can be done in the community to help. The event is 1 to 3 p.m. Friday at Spokane Regional Health District, 1101 W College Ave. For more information contact Sabrina Votava at (509)475-7334 or sabrina@yspp.org.

Prevention Resources

First Call for Help Crisis Hotline: 509-838-4428

National Suicide Prevention Lifeline: 1-800-273-TALK (8255)

suicidepreventionlifeline.org

LGBTQ Crisis Hotline: 1-866-4-U-TREVOR

American Foundation for Suicide Prevention: afsp.org

QPR Institute: qprinstitute.com

Youth Suicide Prevention Program: yspp.org

Some Warning Signs

  • Talking or writing about death, dying or suicide when these actions are out of the ordinary for the person
  • Acting reckless or engaging in risky activities — seemingly without thinking
  • Increasing alcohol or drug use
  • Withdrawing from friends, family and society
  • Feeling anxious or agitated, being unable to sleep, or sleeping all the time
  • Experiencing dramatic mood changes
  • Changes in eating and sleeping habits
  • Unusual neglect of personal appearance
  • Marked personality changes
  • Frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc.
  • SOURCES: National Suicide Prevention Lifeline (suicidepreventionlifeline.org); National Alliance on Mental Illness (nami.org)

By Dan Moorman, Physician