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SANDWICH GENERATION: Dementia and the Caregiver

Sandwich Generation, Dementia, & Caregivers

You may be part of the Sandwich Generation. Do you or someone you know provide care or assistance to an elderly person with dementia?

For those of us who find ourselves  attending to the needs of our children (even young adult children) and our elderly parents, it is easy to feel sandwiched between them in ways that can be stressful. According to Pew Research, there are an estimated 43.5 million Americans providing unpaid care to others who are over the age of fifty. My husband , my brother, and I have been among those 43.5 million and to some degree even as our daughters moved into their young adult years we are still finding ourselves part of what has come to be known as the sandwich generation.

 

If you or somone you know is sandwiched like I have been, I wanted to offer some insights, advice from experts I have encountered, and most of all hope to help you navigate these turbulent waters.

 

The statistics provide a good overview of the scope and extent of the problems facing the sandwich generation, but they do little to address the physical, emotional, and spiritual costs of caring for an elderly parent. For many unpaid caregivers just being able to look through a new lens or to have small ideas about how to manage an elderly parent’s behavior can feel like a lifeline; I know that occasionally as I watched first my father and  then my mother succumb to the ravages of dementia it was sometimes the smallest suggestion that not only made a big difference but felt like I’d been thrown a lifeline. Those instances often opened an avenue that renewed my hope and made it a little easier to press on.

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A New Provider and More Offerings

We are adding a new provider and developing more offerings.

NEWS & ANNOUNCEMENTS

 New Provider Coming

Summer Huntley-Dale, PhD, NP-C will be joining Asheville Gynecology & Wellness in a few months. Summer is a nurse practitioner with a PhD who will be coming aboard in a few months. She will be available to see GYN patients for routine and problem oriented visits. She shares Asheville Gynecology & Wellness’s commitment to health and wellness. Summer has done additional training through Apeiron in the use of genomic testing to help design more precise plans for health improvement.

(Stay tuned for news regarding when she will begin scheduling appointments.)

Teaching Kitchen News

 

 

Dr. Scott was accepted to the Food-For-Life Instructor Training that will certify her kitchen to continue offering classes.

 

REFLECTIONS ON HEALTH INSURANCE

This year, more than many other years, public attention focused on the importance of healthcare and what can happen if health insurance becomes too expensive to afford. While the national debate about health insurances rages on, I want to offer another perspective on how we can all insure our health.

Many illnesses occurring in the USA are related to personal lifestyle choices. These lifestyle choices include one’s nutrition, physical activity and exercise, stress management, spiritual practices, and the degree to which one feels connected in community with others. Each of these items exerts powerful effects on health and disease

We are a culture who are driven by incessant interaction with computers, tablets, Kindles, and cell phones. This high-paced, stress-filled pattern leaves little time for community building, relationships with others, or cultivating a physical and emotional connections to animals and the earth. In addition, our foods are often laden with fats and sugars. Manufacturers seem to know that when consumers are stressed they will reach for calorically-dense foods packed with fats, sugars, and salt. These factors in combination with an increasingly sedentary lifestyle are known to contribute to many health problems. Many people wonder how they can change their current habits so that they can insure good health in the future.

 

I have been committed to raising patient’s awareness about what they can do that will have appositive impact on health. It is important to find ways to empower others to make the changes they desire to make. At Asheville Gynecology & Wellness, we emphasize Whole Food, Plant-based approaches because this approach consistently lowers cholesterol, regulates blood sugar and blood pressure, and reduces inflammatory processes. Our goal is to empower others to make lasting changes

I am excited to be going to our nation’s capitol in May to complete the Food-For-Life Instructor Training. This is an intensive program that will help me translate nutrition research into community education. We plan to soon be accepting enrollment for classes beginning in mid-August 2017.

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Child Meditation Class March 18 & 19

Child Meditation Facilitators Training

with optional certification

March 18 & 19, 2017 Held At

Asheville Gynecology & Wellness

Suite E-106

Gerber Village Asheville, NC

Download the Flyer: Child Meditation Facilitators Training Flyer

Enjoy a weekend workshop complete with practical skills and supporting philosophy for teaching guided imagery and mindfulness to children. Since this workshop is also broadcast live globally, you will also have access to the recorded training for six months.

Certification options:
Certified Mindfulness Instructor for Children

Certified Guided Imagery Specialist for Children

$295 (Includes lunch) Scholarships are available

Topics Covered During Child Meditation Facilitators Training

The Basics

•Creating safe spaces.
• What to expected your first time teaching meditation to children & tips. • Research supporting meditation.
• Creating original meditations.
• Working with school- aged vs. teens.

Mindfulness

• What children should become mindful of.
• Mindfulness activities appropriate for all age groups.
• Brain science and mindfulness.
• Establishing and enhancing your own mindfulness practice.

Guided Imagery

• Waldorf-style storytelling for teaching meditation. • Meditation based on the five senses.
•Using art to enhance meditation.
• Auras, chakras and understanding subtle energy

Workshop facilitator Sarah Wood Vallely, author of

Sensational Meditation for Children www.sarahwood.com

828.242.0680 text or call

 

Child Meditation Facilitators Training Flyer

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CONTRACEPTIVE OPTIONS

Contraceptive Options

There are many available contraceptive options.  Their effectiveness in preventing pregnancy has improved with the Long Acting Reversible Contraception (LARC).

The contraceptives categorized as LARC have the lowest failure rates of all the methods available including combined birth control pills, barrier methods, and natural family planning. These types of contraceptives either have a progesterone  only agent or “no”  hormones (Paragard IUD). They are administered via injection, insertion under the skin, or insertion inside the uterus. The failure rate of Long Acting Reversible Contraception is less than 1%. The failure rate for birth control pills for all users is 9% which is improved with consistent use and condom failure rate is 12%.

In any given year 5% of unintended pregnancies among women of all ages occured  while using contraception consistently and 95% occur in women who were either not using contraception at all or using it inconsistently. The most recent data for North Carolina reveals that the rate of teen pregnancy  (ages 15-19) was 53 per 1000 in 2011. This represents a 57% decrease since 1988.  Some evidence suggest that the decrease in the teen pregnancy rate is due in part to the use of Long Acting Reversible Contraception (LARC).

 

Nexplanon® (etonogestrel) Subdermal Implant

NexplanonNexplanon® is a progestin-only, soft flexible implant pre-loaded in a sterile, disposable applicator. It measures 4 cm (about 1.6 inches) in length and 2 mm (7/100th of an inch) in diameter.  It releases progesterone for 3 years .It is inserted and removed in an office setting. 

Nexplanon® does not contain latex.

Side Effects

The most common side effect with Nexplanon® is changes in menstrual cycles, causing irregular periods.

Mechanism of action is achieved by suppression of ovulation, increase thickness of cervical mucus and changes in the endometrium. 

Efficacy: 0.05% failure rate

 

Mirena® IUD (levonorgetrel)  Intrauterine device

 

 MirenaMirena® is a progestin-only IUD which is inserted into the uterus. It is T-shaped and latex free.   It measures 32 mm (about 1.26 inches) horizontal and 32mm vertical. Mirena® prevents pregnancy by thickening the cervical mucus and thereby preventing sperm from reaching the egg and thins the lining of the uterus and partially suppresses ovulation. It is effective for 5 years after insertion. 

Mirena® is recommended for women who have had a child.

 

You should not have the Mirena® IUD inserted until 6 weeks postpartum, or if:

  • you have an untreated pelvic infection,
  • you have unexplained bleeding,
  • you have problems with your immune system,
  • you have multiple sexual partners or your partner has multiple partners,
  • you have allergies to silicone, polyethylene, silver, silica, barium sulfate and iron oxide.

Side effects

The most common side effect is irregular cycles.

There is a risk of perforation which may require surgery for removal.

There is a risk of expulsion as well.

Efficacy: 0.2% failure rate.

 

Skyla® (levonorgestrel) Intrauterine device

 Mirena2

Skyla® is a progestin-only IUD which is inserted into the uterus. It is T-shaped and latex free. It measures 28 mm (1.1 inches) horizontal and 30 mm (about 1.2 inches) vertical. It has less hormone and is smaller than the Mirena®. It is designed for women who have not had a baby. It is effective for 3 years after insertion.  Skyla® prevents pregnancy by thickening the cervical mucus preventing and thereby sperm from reaching the egg and thins the lining of the uterus and partially suppresses ovulation 

Side Effects

It causes irregular periods and may cause menstrual cycles to stop after one year.

There is a risk of perforation which may require surgery for removal. There is a risk of expulsion as well.

You should not use Skyla® or any IUD if:

  • you have an untreated pelvic infection,
  • you have unexplained bleeding,
  • you have problems with your immune system,
  • you have multiple sexual partners or your partner has multiple partners,
  • you have allergies to silicone, polyethylene, silver, silica, barium sulfate and iron oxide.

 

Efficacy: 0.2% failure rate.

 

Depo-Provera (medroxyprogesterone acetate) Injection

Depo-Provera

 

Depo-Provera Injection is administered every 3 months.

Depo-Provera is a progestin-only injection. It works by preventing ovulation and by thickening cervical mucus making it hard for the sperm to reach the uterus.

 

Side Effects

Depo-Provera causes irregular cycles.

You should not use Depo-Provera for more than 2 years. It can potentially cause bone loss if used for more than 2 years.

Efficacy: 1% failure rate

 

Paragard® (copper) Intrauterine device

Paragrd

Paragard® is a T-shaped device that contains copper which is inserted into the uterus. Size measures 32 mm  (1.26 inches) horizontal 36 mm (about 1.42 inches) vertically.  Paragard® prevents pregnancy by releasing copper which produces an inflammatory reaction in the uterus that is toxic to sperm and which prevents fertilization. It can be used for up to 10 years. 

 

Side Effects

The Paragard® typically causes menstrual cycles to last longer and to be more painful and heavier. There is a risk of perforation which may require surgery for removal. There is a risk of expulsion as well.

Efficacy: 0.8% failure rate

 

Combined Estrogen and Progesterone Contraception

Most combined hormonal contraception have the same estrogen (ethinyl estradiol) at different doses and combined with a variety of progesterones.

Side effects

Combined estrogen and progesterone contraception taken regularly tend to improve menstrual cycle pain and flow. The birth control pills generally improve complexion and used to treat heavy menstrual flow. Taking birth control pills may increase your risk for blood clot, stroke or heart attack if there are risk factors in your medical history or your families.

Contraindications

Migraines with aura, previous DVT, smoker over 35 yrs old, uncontrolled hypertension under 35, hypertension over 35 yrs of age

If taken consistently the efficacy is 1-2 % failure while if taken inconsistently would be closer to 9% failure rate.

 

Pills  

Most birth control pills contain a combination of ethinyl estradiol with a number of progesterones including but not exclusive to levonorgesterol, norethindrone, ethynodiol acetate, drospertenone, and norgestimate. There are a variety of oral contraceptives which are well tolerated.

 

Nuvaring® (etonogestrel/ethinyl estradiol)

Nuvaring

 

Nuvaring is a combination contraception which the individual can insert in the vagina and remove and insert new Nuvaring on a monthly basis.  This is ideal for women who have trouble remembering to take their birth control pills daily. It is low dose and by passes the liver.

 

Side effects

Combined estrogen and progesterone contraception taken regularly tend to improve menstrual cycle pain and flow. The birth control pills generally improve complexion and used to treat heavy menstrual flow. Taking birth control pills may increase your risk for blood clot, stroke or heart attack if there are risk factors in your medical history or your families.

Contraindications

Migraines with aura, previous DVT, smoker over 35 yrs old, uncontrolled hypertension under 35, hypertension over 35 yrs of age.

Efficacy: If taken consistently the efficacy is 1-2 % failure while if taken inconsistently would be closer to 9% failure rate.

 

Othro Evra® patch (norelgestromin/ ethinyl estradiol)

Ortho Evra

 

 

Ortho Evra patch is a patch that is applied to the skin and changed weekly.  It is a combination contraception.

 

Side effects

Combined estrogen and progesterone contraception taken regularly tend to improve menstrual cycle pain and flow. The birth control pills generally improve complexion and used to treat heavy menstrual flow. Taking birth control pills may increase your risk for blood clot, stroke or heart attack if there are risk factors in your medical history or your families.

Contraindications

Migraines with aura, previous DVT, smoker over 35 yrs old, uncontrolled hypertension under 35, hypertension over 35 yrs of age

Efficacy: If taken consistently the efficacy is 1-2 % failure while if taken inconsistently would be closer to 9% failure rate.

 

Barrier Methods

  • Diaphragm (holds spermicide close to cervix) 12 % failure rate
  • Male condoms 18 % failure rate (according to CDC data)
  • Female condom 21% failure rate
  • Withdrawal 22% failure rate
  • Fertility awareness 24 % failure rate

 

Permanent methods

Permanent methods of contraception are appropriate options when a woman or couplele has no further desire to have children. These methods are essentially  irreversible.

  • Vasectomy  0.15% failure rate
  • Tubal ligation  0.5% failure rate  IVF could be done after tubal ligation
  • Essure®  1% failure rate  IVF cannot be done with Essure®

Conclusion

Today there are many available methods for preventing pregnancy. This guide provides basic information about numerous options, their effectiveness, and the associated risks. You are encouraged to talk to your provider to determine what option might be best for you.

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Confused About Mammogram Screening For Breast Cancer?

Are You Confused About Mammogram Screening For Breast Cancer?

Breast cancer screening guidelines have become a bit confusing. There are quite a few organizations who have established guidelines but at present there are differing opinions.

The groups all agree that mammogram screening helps reduce deaths from breast cancer in women. However, the controversy involves the issue of when women should begin having screening mammogram and the frequency with which mammograms should be done. The experts from the various organizations have reviewed various published studies and have reached different conclusions. 

Mammogram showing small cancerous lesion  from www.nibib.noh.:gov:sicence-education:science-topics:mammography

Mammogram with small cancer

The fact is that screening mammograms can detect breast abnormalities. Clinical trials have demonstrated that for women in the 40s and 50s screening mammograms can reduce cancer deaths by as much as 15 to 29 percent. However, one study reported that despite early diagnosis resulting from screening mammograms, the number of women being diagnosed with advanced breast cancer hasn’t changed.  One conclusion that this suggested was that some women will be diagnosed with early breast cancer that would never have affected their health or lifespan.

The problem arises from the the fact that doctors cannot distinguish “dangerous” breast cancers that will eventually progress to advanced disease from those that will not become life-threatening. Therefore, annual mammograms remain the best alternative for detecting early disease and reducing the risk of death.

There is a legitimate concern that mammogram screening can lead to false positive results. A false positive occurs when an abnormality is detected that eventually proves to be benign—not cancer. A woman receiving a false positive result on screening mammogram may be asked to obtain additional mammogram images and other testing like an ultrasound. The problem of false positives is particularly difficult for younger women who may be more likely to receive a false positive results.

MammoGram Seriesshow

Images of various findings on mammogram

Presently, the decision on timing (and frequency) of mammogram screening is best decided based on each individual’s risk in  discussion with her health care provider.

Breast cancer screening guidelines

(Chart from www.FacingOurRisk.org “Mammogram Update by Lisa Schlager)

Comparison Breast Cancer Screening (1)(To download a copy of this chart Comparison Breast Cancer Screening (1).)

  • ACR, SBI, ACOG — annual mammogram starting at age 40, with no upper age limit 

  • ACS — start at age 45, annual 45-54, biennial starting at 55, continue if life expectancy >10 years 

  • Canada & most European countries start biennial screening at age 50 & stop at age 69 

  • USPSTF, CDC, AAFP –every 2 years from age 50-74 

  • USPSTF & ACS do not recommend Clinical Breast Exam (performed by healthcare provider) 


For clarification, I will provide the names of the above mentioned organizations.

ACR American College of Radiology

SBI Society of Breast Imaging

ACOG American College of Obstetrics and Gynecology

USPSTF US Prevention Service Task Force

AAFP American Academy of Family Physicians

ACS American Cancer Society

CDC Center for Disease Control

 

The density of the breast tissue as described on the mammogram can shape the decision as to what sort of mammogram study is preferred. Dense breast tissue is more difficult to assess on mammogram and the 3D mammogram  is better suited for women with dense breast tissue. The absolute guidelines have not been formulated for 3D mammograms. 3D mammograms are not offered everywhere and not all insurance companies cover the additional cost.

dna

DNA Double Helix

 

If you have a strong family history of breast cancer please review this with your provider to determine if you may be a candidate for genetic screening.

 

Also keep in mind risk reduction starts with lifestyle including avoiding smoking cigarettes and drinking alcohol.

Remaining physically active and eating a diet high in fresh vegetables, fruits and whole foods does decrease risk of breast cancer and important for heart health as well.

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