Category: Women’s Health

By: Haley Robuck, CNP

Pap tests, also known as pap smears, are used to help identify cancerous or precancerous cells within the cervix. Pap smears are usually conducted by a gynecologist or primary care provider who takes a swab of cells from your cervix to test them for abnormalities that could lead to or develop into cancer.

Cervical cancer is caused by the human papillomavirus, commonly known as HPV. HPV is the most common sexually transmitted disease and most people who are sexually active have, had, or will have it at some point in their lives. Normally, the body will clear the virus, including those that cause cancer, within two years; however, some types of HPV present a higher risk of developing into cancer than others. Most people with HPV do not exhibit any symptoms and can spread it without knowing they have it. Indications of cancer may include pain or discomfort in the area, bleeding, vaginal discharge with a foul odor or containing blood. It is recommended that you get vaccinated and practice safe sex by using condoms and other barriers to lessen the risk of getting HPV.

Early detection gives the best chance of treatment and recovery, so it is recommended that you have a pap test every 3 years from age 21-65. Sometimes, a pap test will be given alongside an HPV test, in which some doctors will allow you to wait five years between them upon receiving a normal result. After age 65, talk to your provider about whether further screenings are necessary. If you have had a complete hysterectomy for non-cancerous reasons, you may not need a pap test. Having regular pap tests will allow you to remain on top of your reproductive and pelvic health, as well as increase the likelihood of recovery if you do end up with HPV or cervical cancer. If you have certain health risks, such as an HIV infection, weakened immune system, having been exposed to diethylstilbestrol (DES) before birth, or a previous history of abnormal pap tests, your provider may recommend you have them more frequently.

To schedule a pap test, please contact your primary care provider. Primary care providers with Fisher-Titus are offering pap tests to patients during their regular wellness visits. For more information, go to FisherTitus.org.

Haley Robuck, CNP is a nurse practitioner with Fisher-Titus Family Medicine in New London. Haley became a Registered Nurse in 2011 following coursework at Firelands Regional Medical Center School of Nursing in Sandusky. She earned a Bachelor of Science in Nursing at Bowling Green State University the following year and a Masters in Nursing as a Family Nurse Practitioner in 2015 from Ohio University. She is a member of the American Association of Nurse Practitioners

August is Breastfeeding Awareness Month. Breastfeeding provides many benefits for both mom and baby. Deciding how to feed your baby is a personal choice. Our Birthing Center team at Fisher-Titus is here to support you on your breastfeeding journey.

What Are the Benefits of Breastfeeding?

In addition to being a special way to bond, breastfeeding reduces the risk of many diseases for both mother and baby.

The cells, hormones, and antibodies in breastmilk help keep your baby healthy. This protection is unique to your baby and will change to meet your babies needs as they grow. Research shows that breastfed babies have lower risks of:

• Childhood leukemia
• Asthma
• Childhood obesity
• Ear infections
• Eczema
• Diarrhea and vomiting
• Lower respiratory infections
• Necrotizing enterocolitis (a disease that affects the gastrointestinal tract in premature babies)
• Sudden infant death syndrome (SIDS)
• Type 2 diabetes

Babies aren’t the only ones who benefit from breastfeeding. Breastfeeding can help mom’s health and healing after childbirth as well. It leads to a lower risk of the following health problems in mothers:

• Type 2 diabetes
• Certain types of breast cancer
• Ovarian cancer

Supporting Breastfeeding Mothers

While breastfeeding is a great way to feed your baby, it’s not always easy. It takes some learning for both mom and baby and it may take time before you get into a comfortable routine. As you embark on your journey, a good support system is important.

At Fisher-Titus, we have a caring team of Birthing Center staff that support moms in our community with their breastfeeding questions and concerns. Five of our Birthing Center nurses are Certified Breastfeeding Counselors. We have three nurses that are also Certified Lactation Counselors, the premier national certification in lactation management in the U.S. We also have an International Board Certified Lactation Consultant (IBCLC) on staff.

All of these staff members are able to support breastfeeding moms in assessing the latching and feeding process, helping with corrective interventions, counseling mothers, and understanding and applying knowledge of milk production. Most importantly, they are a caring source of support for moms as they navigate their new journey in feeding their newborn.

In 2019, Fisher-Titus earned recognition from Ohio’s First Steps for Healthy Babies and was awarded Maternity Care Best Practice Award 2018 for our efforts to encourage and support breastfeeding mothers. This month, we were also honored to be recognized be Newsweek as a Best Maternity Care Hospital for the exceptional care we provide to mothers, newborns, and their families.

While our education programs are currently on hold due to COVID-19, we normally offer several options for both prenatal and postnatal mothers including one-on-one lactation support. These include Baby Boot Camp, Childbirth Education Express, and Breastfeeding Support Group.

About Alisha

Alisha Nims, RN is the manager of Obstetrics at Fisher-Titus. For more information about the Fisher-Titus Birthing Center, visit fishertitus.org/birthing-center.

New mammogram guidance surrounding the COVID-19 vaccine has been in the news and on social media lately. That’s because the Society of Breast Imaging (SBI), one of the leading breast imaging organizations in the country, has issued guidelines for breast imaging and the COVID-19 vaccine.

The reason for these guidelines is axillary adenopathy, or the swelling of lymph nodes in the armpits. This swelling is rare in women with an otherwise normal screening mammogram occurring in 0.02-0.04% of screening mammograms.

Studies around the COVID-19 vaccine have found that a possible side effect can be swelling and tenderness of the lymph nodes, particularly those in the armpit. Approximately 11.6% of patients who received the Moderna vaccine had swelling or tenderness following the second shot. The side effect was less prevalent in the Pfizer-BioNTech vaccine but it did happen. The SBI noted that the incidence of this side effect could possibly be higher but has gone unnoticed by vaccine recipients.

This side effect is not a surprising one. Your body has a network of lymph vessels and lymph nodes that are part of your immune system. They collect fluid, waste, and other things like viruses and bacteria that are in your tissues and bloodstream. Lymph vessels carry lymph fluid through your body like blood vessels. Lymph fluid does a few things but one important function is the ability to fight infections through the white blood cells it carries.

When your body is working to fight infection and build immunity to a virus or bacteria, the node in a particular area may swell or enlarge as it tries to filter out bad cells. While the swelling is usually indicative of your body fighting infection, it can be a sign of cancer in an area.

The swelling/tenderness in the armpit from a COVID-19 vaccine could cause a woman to worry about breast cancer. The swelling could cause a false reading on her breast imaging or make her worry that she’s developed a lump. Not only can this cause a lot of stress for women, it can also mean unnecessary follow-up testing.

So what should you do if you are eligible for the COVID-19 vaccine but also need a screening mammogram or breast MRI?

If at all possible, the SBI recommends considering scheduling your mammogram or breast MRI before your first dose of the COVID-19 vaccine or 4-6 weeks after your second dose. However, screening mammograms and breast MRIs are important so if scheduling imaging around vaccination would unduly delay care, you can still get your mammogram or breast MRI. Talk to your doctor if you have concerns about getting or delaying your imaging due to the vaccine.

If you choose to go forward with your screening mammogram or breast MRI after your vaccine, let the technologist know that you have had the vaccine. They can make a note on your intake form so the physician reading it can take that into consideration when they review your imaging.

Most of all, women should know that this side effect is normal with the COVID-19 and does not necessarily indicate a problem in your breasts. If you notice swelling or tenderness after the vaccine, monitor to see if it subsides and contact your doctor if you have any concerns.

About Karen

Karen Darr is the Director of Imaging Services at Fisher-Titus. Fisher-Titus offers 3-D mammography and curved paddles. Talk to your doctor to see if you should be getting a regular screening mammogram. For more information, visit fisher-titus.org/breast-health.

Prenatal care is the health care you receive during your pregnancy. For your health and the health of your baby, it’s important that you start prenatal care early and continue it regularly through the duration of your pregnancy. Babies whose moms do not receive prenatal care are three times more likely to have a low birth weight than those whose moms receive care.

For first time moms, prenatal care can be somewhat of a mystery. You may ask yourself questions like, “Do I go to the doctor the day after a positive home test?” or “How often will I be seeing my doctor?” Although it is confusing, prenatal care is very important, and your doctor is there to guide you through the process from start to finish.

When doctors see pregnant moms regularly, they are better able to detect any problems that might arise. When they can catch them early, they are able to treat them early. Early detection of complications in pregnancy can cure some problems and prevent others. Each appointment is also an opportunity for you to discuss any questions or concerns that may come up throughout the pregnancy.

How Often Will I See My Doctor During Prenatal Care?

Once you have a positive pregnancy test, you can call your doctor to schedule your first appointment. The office staff will likely ask you some questions including when your last period was. This will help them determine your due date and therefore how far along you are. Your first appointment may not be for a few weeks, but if you have any concerns, you can always call the office with your questions. The office staff and your doctor will be happy to help.

Your doctor will likely recommend the following schedule for visits. This is the schedule recommended by most experts and unless you are older than 35 or your pregnancy is high risk, your visits will probably closely follow this recommendation.

Prenatal Care Schedule

• Once a month for weeks 4 through 28
• Twice a month for weeks 28 through 36
• Weekly from week 36 to birth

What Happens During Your Prenatal Care Visits?

During your first prenatal visit, you can likely expect the following:

• Review your health history including diseases, operations, or prior pregnancies
• Review your family’s health history
• A complete physical exam including a pelvic exam and a Pap test (if indicated)
• A blood draw and urine sample for lab work
• Blood pressure, height, and weight checks
• Due date calculation
• Ask any questions you might have about pregnancy and birth
• Review prenatal care recommendations from your doctor such as prenatal vitamins, food restrictions, etc.

As your pregnancy goes on, your visits will change and may include:

• Measuring your weight gain
• Measuring your abdomen to check your baby’s growth
• Checking baby’s heart rate

There will also be other routine tests throughout pregnancy. Some are recommended for all pregnant women and others will be recommended based on your age, personal or family history, or the results of other tests. These may include:

• Blood work to check for anemia, your blood type, HIV, and more
• Urine samples
• Amniocentesis, chorionic villus sampling, or maternal serum screen to diagnose or detect a higher risk certain birth defects
• Ultrasounds
• Glucose screenings to determine your risk of or diagnose gestational diabetes
• Group B strep test
• Biophysical profile
• Nonstress test

Dr. Kristin Kruse is an Obstetrician/Gynecologist with Fisher-Titus Women’s Health in Norwalk. She is board certified by the American Board of Obstetrics and Gynecology and has advanced training and certification in robotic-assisted surgery. Fisher-Titus Women’s Health is currently accepting new patients with same-day or next-day appointment availability in Norwalk and Milan. For appointments, call 419-660-2980.

Female urinary incontinence is a common concern, especially as people get older. However, it can be embarrassing and can affect women earlier in life than men due to pregnancy and childbirth. But incontinence does not have to be inevitable. If it is affecting your daily life, you can talk to your doctor about things you can do to reduce urinary incontinence.

What is Urinary Incontinence?

Urinary incontinence is the loss of bladder control. It can range in severity from occasional leaking urine when you cough, sneeze, or exercise to having an urge to urinate that is very sudden and strong and maybe doesn’t allow you to get to a bathroom in time.

There are several types of incontinence

• Stress incontinence occurs when you cough, sneeze, laugh, exercise, lift something heavy, or do anything that puts pressure on your bladder.
• Urge incontinence is a sudden, intense feeling of having to urinate that leads to the loss of urine or the need to urinate often even throughout the night.
• Overflow incontinence is when you have frequent or constant urine leakage due to a bladder that doesn’t empty completely.
• Functional incontinence is a physical or mental impairment preventing you from making it to the bathroom in time such as arthritis keeping you from being able to unbutton your pants in time.
• Mixed incontinence is the presence of more than one of these types of incontinence.

What causes female urinary incontinence?

Urinary incontinence is twice as common in women as it is in men and is more common as women age. Pregnancy and childbirth, menopause, and the structure of the female urinary tract are all factors that lead to these higher rates of incontinence for women. Other causes of persistent incontinence include:

• Aging of the bladder muscle causing a decrease in the capacity to store urine and involuntary bladder contractions
• Hysterectomy
• An obstruction along the urinary tract such as a tumor or urinary stones
• Neurological disorders

There are also certain foods, drinks, medications, and medical conditions that can cause temporary incontinence such as:

• Alcohol
• Caffeine
• Carbonated drinks
• Artificial sweeteners
• Chocolate
• Chili peppers
• Foods high in spice, sugar, or acid
• Heart and blood pressure medications, sedatives, and muscle relaxers
• Large doses of vitamin C
• Urinary tract infections
• Constipation

Treating Female Incontinence

The good news is, there are lots of treatment options for incontinence. Your doctor will likely recommend treatment based on the type of incontinence you have and your specific situation and may include behavioral techniques, strengthening muscles, medications, or surgery.

The behavioral techniques will likely be the first step as they are the simplest and least invasive options.

• Bladder training where you try to hold off when you feel an urge to urinate so that you can lengthen the time between trips to 2.5 to 3.5 hours.
• Double voiding helps you learn to completely empty your bladder by urinating, waiting a few minutes, and going again.
• Scheduled bathroom trips instead of waiting for the urge to go.
• Fluid and diet management.

There are a few ways your doctor may suggest strengthening bladder muscles:

• Kegel exercises
• Electrical stimulation
• Biofeedback
• Physical Therapy

If those techniques are not working well, your doctor may suggest medication, minimally invasive procedures, or surgery which may include:

• Botox
• Sling procedures
• Bladder neck suspension
• Prolapse surgery
• Artificial urinary sphincter

Dr. Donald Smith Jr. is a Urologist with Fisher-Titus Executive Urology Specialists in Norwalk, Sandusky, and Bellevue. Dr. Smith and the Fisher-Titus Urology Team will be at the Fisher-Titus Women’s Health Fair on October 26. For more information about this event, follow @FisherTitusHealth on Facebook or visit fishertitus.org/upcoming-events.

Mammography is imaging of the breast tissue designed to detect tumors and other abnormalities. There are two purposes for a woman getting a mammogram: screening or diagnostic.

If you are a woman over age 40 you are probably very familiar with the word “mammogram.” But, if you’re not, you may have heard the word without knowing what it’s all about. Either way, mammograms are important for everyone, especially women, to understand.

Screening and Diagnostic Mammograms

A screening mammogram is used in the early detection of breast abnormalities in women that have no symptoms. The goal is to detect breast cancer before there are any noticeable signs. When detected early, breast cancer is 99-100 percent curable within 5 years of diagnosis.

You will usually receive results within a few weeks. If your screening mammogram comes back normal, you will continue to get regular mammograms. This will allow your doctor to compare them as time goes on and look for subtle changes in your breast tissue.

If your mammogram is “abnormal” that does not necessarily mean you have cancer. Your doctor will likely recommend additional mammograms, tests, and exams to help determine what may be going on. They may also refer you to a specialist or surgeon, not because you have cancer or need surgery, but because they are experts in diagnosing breast problems.

The other purpose of a mammogram is to diagnose a breast change such as a new breast lump, breast pain, and unusual skin appearance, nipple thickening, or nipple discharge.

Who Should Get a Mammogram?

While guidelines for starting regular mammograms vary, most experts agree that women with average risk can choose to be screened starting at age 40. Many women begin them at age 40 and continue having them every year or every two years.

Women with a higher risk of breast cancer may benefit from starting screening mammograms before age 40. Risk factors such as family history of breast cancer or precancerous breast lesions may indicate a benefit to getting screening mammograms earlier. If you have an increased risk for breast cancer, your doctor may recommend breast MRIs in addition to screening mammograms.

Have a conversation with your doctor about your own risk factors, your preference, and the benefits and risks of screening. Together you can decide the screening mammography schedule that is best for you. You should also check with your insurance provider to determine your coverage for screening mammograms.

What to Expect During a Mammogram

When you arrive for your regular screening mammogram, you will be asked to remove your shirt and put on a gown that opens at the front. You will stand in front of a special X-ray machine and the technologist will place your breast on the plate.

Another plate will move down from above and flatten the breast, holding it still while the image is taken. You will feel some pressure in the breast and it may be uncomfortable for a few seconds. These steps will be repeated to take a side image and images of the opposite breast.

After all four images have been taken, you will wait while the technologist checks them to make sure they don’t need to be re-taken. Remember, the technologist cannot tell you your results so they will be sent to your doctor who will review them and call you.

It can be scary to think about breast cancer, but a regular screening mammogram can be your best defense, and learning more about mammograms can help ease your fears.

Karen Darr is the Director of Imaging Services at Fisher-Titus Medical Center. Fisher-Titus now offers walk-in screening mammograms from 3 to 6 p.m. Monday through Friday and from 7 to 11 a.m. Saturday. For more information, visit fisher-titus.org/breast-health.