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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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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Acupuncture at Asheville Gynecology & Wellness

Acupuncture  at Asheville Gynecology & Wellness 

Did you know that Asheville Gynecology & Wellness offers Acupuncture Services? Please join us in welcoming Natasha Kubis, L.Ac. 

Natasha Kubis, L.AC,, s and her husband Alex relocated to the mountains of Western North Carolina.  Natasha left a busy Acupuncture practice of 7 years to move to Asheville.  She is steadily building her practice and I am delighted that she affiliated with Asheville Gynecology & Wellness. She is compassionate, gentle, and she listens carefully to each patient’s needs. Her unique style of integrating the various aspects of acupuncture practices with soft tissue work is a truly integrated and whole approach to care. Natasha has an interest in treating pain, anxiety and women’s health.

Acupuncture is a natural form of healing that has many potential benefits that include: drug-free pain relief, treatment of a wide range of acute and chronic ailments with an approach that seeks to restore health and balance that may address underlying causes of illness, and prevention of illness and maintenance of well-being.

How it Works; Meridians

A meridian is an ‘energy highway’ in the human body that connects different areas.
 Energy, or Chi in Chinese, flows throughout the body along these meridian or energy highway, accessing all parts of the body.

There are 12 main channels and 8 extra channels that are named according to the organ and area of the body they eventually flow through.  The meridians are distinguished as either Yin or Yang which reflects a foundational idea in Chinese medicine related to the balancing and connectedness of seemingly opposing forces. Acupuncture points are located along the meridians and different techniques can be used to affect the flow of Chi/energy traversing the meridians.  There are over 2,000 points on the body.

Natasha Head Shot

Natasha Kubis, L.Ac. Acupuncture

Natasha is an astute clinician who integrates soft tissue treatment into her hour-long, one-on-one sessions. Her method of treatment combines Chinese and Japanese techniques and her results have been impressive.  I highly recommend her services to anyone who’s been having health issues that have not responded well to traditional medical care. She can be reached at:

Essential Acupuncture Wellness

828 407 1651

natasha@essential-well.com

www.essential-well.com

 

Asheville Gynecology & Wellness

828 585 6655

info@ashevillegynecologywellness.com

www.ashevillegynecologywellness.com

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NEWSLETTER Spring 2016

NEWSLETTER Spring 2016

Asheville Gynecology & Wellness strives to transform women’s health care one patient at a time. We provide personalized, gynecological care to women at every stage of life, taking the time to listen and build partnerships in health. We are a gynecology practice that is reaching beyond convention to find innovative ways to improve women’s health and well-being.

(Space is available for Tomorrow’s KICKSTART, Tomorrow April 5th)

(See Below)

ACUPUNCTURE NOW AVAILABLE

Acupuncture

Image from www.theage.com.au 10/2/11

Natasha Kubis is a Licensed Acupuncturist in North Carolina & New York. She is Board Certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). In 2009, she graduated from Eastern School of Acupuncture and Traditional Medicine in Montclair, NJ where she received a Masters Diploma and graduated with honors. The program was three years in length and involved 3,000 hours. Natasha practices a combination of traditional Chinese as well as Japanese styles of acupuncture in her treatments. She studied with world-renowned pioneer in Japanese acupuncture, Kiiko Matsumoto. She implements both theories in her diagnostic principles but utilizes Japanese needling techniques for a pain free acupuncture experience.

Some key differences between Japanese Style acupuncture and Traditional Chinese style acupuncture are the needle size, depths of insertion, insertion technique as well as needle stimulation. Natasha uses Japanese style needling techniques which involve smaller needles, more shallow needling, the use of a guide tube which allows for quick and precise insertion, and less manipulation of the needle after it has been inserted. Patients find this technique to be painless compared to Traditional Chinese style.

Japanese Acupuncture involves a great deal of palpation of the acupuncture point before insertion of the needle. In Japan, acupuncture was traditionally an occupation for the blind. Acupuncture has been practiced in China for over 2,500 years. It involves the insertion of small, thin, sterile needles into the skin at acupuncture points to treat a wide range of disorders, most commonly chronic pain.

Today, stainless steel is used to make needles and needles are discarded after a single use. As a natural form of healing, acupuncture has the following benefits:

  • It provides drug-free pain relief.
  • It effectively treats a wide range of acute and chronic ailments.
  • It treats the underlying cause of disease and illness as well as the symptoms.
  • It provides a holistic approach to the treatment of disease and illness, linking body, mind and emotions.
  • It assists in the prevention against disease and illness as well as the maintenance of general well-being.

Acupuncture is based on the Meridian Theory. A meridian is an ‘energy highway’ in the human body that connects different areas. Energy (Chi) flows through 12 main channels and 8 extra secondary channels. There are over 2,000 points on the body. Stimulating the points along the meridian system allows different parts of the body to communicate. This is important to move blockages when there are traffic jams along the meridian pathways. Blockages can lead to acute or chronic illness whether it is physical or emotional. Stimulating acupuncture points triggers the release of opioid peptides, naturally occurring chemicals that have an analgesic effect, enhance our sense of well-being, and possibly improve immune function..

Natasha believes in educating her patients and creating an environment in which they feel involved and connected to their own particular curative process. She creates cooperative partnerships with her patients in their process of self-healing. She is a general practitioner with special interests in pain management, emotional well-being, immune system support and reproductive health.

FOOD FOR LIFE

Food For Life Small logoFood For Life: Kickstart

(Nutrition Education and cooking demo)  

Begins: April 5th at 5:30 PM to 7:30 PM

6-week Class

Instructor: Terri Edwards

Registration at http://tiny.cc/9a7z9x

The Food for Life: Kickstart Your Health classes opportunities to discover which foods are optimal for weight management, learn about various health topics including blood pressure and digestion, and get empowered with the practical cooking skills needed to help you on your journey to better health.In the classes, attendees do all of this while enjoying a cooking demonstration of healthful dishes in a supportive setting.

 

Food for Life: Diabetes Initiative NOW Enrolling for MAY 17th This class offers many of the same principles of plant-based eating with a special focus on diabetes, pre-diabetes. Adult onset diabetes (Type 2) has become an enormous public health burden that is directly related to the foods we eat. http://www.eatplant-based.com/food-for-life-classes.html

 

REFER A FRIEND Asheville Gynecology & Wellness is grateful when our patients refer friends or family members. When you refer someone, we know that you are giving us a vote of confidence. It is always helpful when a new patient lets us know that they were referred by one of our patients.

 

LiveWell Expo logo

Our Booth was a big success. We had more than 1,000 visitors and our staff was available to answer questions, pass out gifts, and serve smoothie samples.                          

WINNER ANNOUNCED

Congratulations to Kathryn Bailey.

Kathryn won the Raffle for the gift basket from Gerber Village valued at nearly $500

LIKE US ON FACEBOOK & TWITTER

Facebook logo        Twitter logo         Facebook logo

Dr. Vicky Scott                           @DrVickyScott               AshevilleGynecologyWellness

 

DID YOU KNOW?

  • Heart disease is the leading cause of death for women in the United States.
  • Exercise spread out during the week in smaller chunks of time during the day provides many of the same benefits as continuous exercise. Adults are encouraged to exercise for 2 hours and 30 minutes (or 150 minutes total) each week.
  • Vitamin D has important roles in heart health, immune and nervous system function, and of course bone health. Vitamin K, found in green leafy vegetables, has also been shown to reduce the risk of bone fractures.
  • The new U.S. Dietary Guidelines, which are updated every 5 years, may not go far enough according to some experts. The recommendations for reducing refined sugar to 10% of a daily 2000-calorie diet and the unclear recommendation to reduce red meat and processed meats for men and boys fails to address the proven role of these foods in heart disease, inflammation, and cancer.   For more information go to https://www.drmcdougall.com/misc/2010other/guidelines.htm
  • What influences our chances of living to be 100 years old? You may be interested in watching a very intriguing TED Talk by Dan Buettner, who teamed up with National Geographic, to investigate 4 “Blue Zones” across the world with a higher proportion of the population who live to 100. Watch the TED Talk at https://www.ted.com/talks/dan_buettner_how_to_live_to_be_100


Asheville Gynecology & Wellness

11 Crispin Ct, E-106

Asheville, NC 28803

PH (828) 585-6655 FAX (828) 585-6656

Email: info@ashevillegynecologywellness.com

Website: www.ashevillegynecologywellness.com

 

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Do I Need STD/STI Testing?

DO I NEED STD/STI TESTING?

  • If you have had unprotected sex
  • If you have a new partner (or more than one partner)

Then the answer is YES! The recent move to rename Sexually Transmitted Disease (STD) with the term Sexually Transmitted Infections (STI)is intended to broaden the concept to include curable diseases that often show few symptoms.

RECOMMENDATIONS FOR STD/STI AND HIV SCREENING (CDC)

  • All adults and adolescents from ages 13 to 64 should be tested once for HIV
  • Annual chlamydia screening of all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.
  • Annual gonorrhea screening of all sexually active women younger than 25 years, as well as older women with risk factors such as new or multiple sex partners, or a sex partner who has a sexually transmitted infection.
  • Screening at least once a year for syphilis, chlamydia and gonorrhea for all sexually active gay, bisexual, and other men who have sex with men (MSM) MSM who have multiple or anonymous partners should be screened more frequently for STDs/STI’s (3-6 months intervals)
  • Anyone who has unsafe sex or who shares injection drug equipment should be tested for HIV at least once a year
  • Syphilis, HIV, chlamydia, and hepatitis B screening for all pregnant women and gonorrhea screening for at-risk pregnant women starting in early pregnancy and repeat testing as needed
  • Hepatitis C testing for Women born 1945-1965 and women with other risk factors like IV drug use
  • Herpes type specific testing should be considered for women presenting for STD/STI screening
  • Trichomonas should be considered for women with multiple sexual partners

SYMPTOMS OF STD/STI

Most of the time there are either minimal symptoms and signs or no symptoms and signs at all of the STD (sexually transmitted disease). This is why the name is being replaced by STI (sexually transmitted infection) to encompass the idea that some STIs will not present with signs and symptoms of a disease. If you have had unprotected sex, you have a new partner, you have more than one partner, or if for any reason are worried you have been exposed to an STD/STI talk to your healthcare provider about getting tested.

HOW DO STI TESTS WORK?

Getting tested can be quick and easy. Depending on what test is being performed  your provider may take a blood sample, a swab, or ask for you a urine sample. Below is a list describing how what is done to test for each STI.

CHLAMYDIA

Swab or urine sample

More info @ http://www.cdc.gov/std/chlamydia/chlamydia-factsheet-june-2014.pdf

GONORRHEA

gono

 

Swab or urine sample

More info @ http://www.cdc.gov/std/gonorrhea/gon-factsheet-july-2014.pdf 

 

HIV

HIV virus

 

Blood specimen

More info @ http://www.cdc.gov/std/hiv/hiv-std-factsheet-dec-2014.pdf 

 

HERPES WITHOUT SYMPTOMS

Blood sample for type IgG test

More info @ http://www.cdc.gov/std/herpes/herpes-factsheet-july-2014.pdf

HERPES WITH SYMPTOMS

Swab

SYPHILIS

Treponema

 

Blood sample or swab from a sore

More info at http://www.cdc.gov/std/syphilis/syphilis-factsheet-july-2014.pdf

 

TRICHOMONAS

trich-228

 

Swab 

More info @ http://www.cdc.gov/std/trichomonas/trich-fact-sheet-aug-2012.pdf

 

 

HPV GENITAL WARTS

Visual inspection and at times biopsy

HPV

Testing can be done during routine Pap 

Other STIs

More info @ http://www.cdc.gov/std/general/other.htm

ADOLESCENTS

 

youth-sti-infographic

From the Centers for Disease Control Website @ 

http://www.cdc.gov/std/products/youth-sti-infographic.pdf

PREVENTION

One of the most important aspects of prevention of STIs is the use of safe sex practices. Women under 26 are encouraged to be vaccinated against HPV types 16 and 18 which are often seen in cervical cancers

NOTIFICATION

The Centers for Disease Control and Prevention (CDC) are notified of positive test results for HIV, Syphilis, Gonorrhea, and Chlamydia tests. These are public health concerns and it is the function of the CDC to maintain accurate records that permit effective disease surveillance and the CDC is also responsible for helping develop policy and guidelines for managing communicable diseases. 

 

ALL images were retrieved from the CDC website. http://www.cdc.gov/

 

 

 

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