Archive for the ‘Sarieah Macdonald, CNM, NMNP’ Category

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10 Warning Signs of Endometriosis

Monday, October 12th, 2015

Endometriosis is a painful, chronic disease that affects at least 6.3 million women and girls in the U.S.  Many women suffer from endometriosis throughout their lives, often misdiagnosed as simply suffering from ‘painful menses’, or with their symptoms ignored completely.

One recent study of several hundred women diagnosed with endometriosis revealed that they had suffered since adolescence, but were undiagnosed until their 40’s.

Endometriosis is a common, painful and for some, debilitating condition. But it CAN be treated.

For more information, please give us a call at 503-287-4970 to schedule a complimentary consult to see how we can assist you.

 

10 Common signs of Endometriosis: 

1)   Monthly menstrual cramping- Cramping that begins before, continues during, and lasts after your menses is the most common symptom of endometriosis.

2)   Pelvic pain Pain that is diffuse, located deep in the pelvis, dull and aching is suggestive of endometriosis. In women with pelvic pain, the rate of endometriosis is 40%-50%. You should never ignore pelvic pain!  

3)   Back and thigh pain- Pain that begins in the back, radiates to the thighs and may be associated with rectal pressure is suggestive of endometriosis, particularly if associated with #1 and #2.

4)   Painful sex and/or pain with deep penetration- Dyspareunia (painful sex) that occurs immediately prior to onset of menses is associated with endometriosis. Endometriosis associated dyspareunia is most intense with deep penetration.

5)    Pain with bowel movements-  Painful defecation is associated with endometriosis that involves the area behind and between the uterus and large intestine.                                          

 6)   Pain with urination, urgency or increased frequency– Are associated with a variety of concerns, including endometriosis involving the bladder. Such symptoms should be assessed by a healthcare provider without delay. 

7)   Abnormal monthly bleeding- Persistent heavy flow, menstrual bleeding lasting longer than 7 days, passing large clots, and/or spotting/bleeding between expected menses are all suggestive of disordered uterine bleeding. There are a variety of potential causes, including endometriosis.

8)   Infertility- Often the first (maybe the only) sign of endometriosis is difficulty getting pregnant. Almost 40% of women with infertility have endometriosis. Although many women overcome endometriosis related infertility.

9)  Onset in Adolescence- Endometriosis pain can begin with the very first menstrual period. 50% of adolescents with chronic pelvic pain and painful menses have endometriosis. Yet, it is most often diagnosed in women in their 30s and 40s .

10)  Irritable Bowel Diagnosis- Endometriosis can coexist with, or be misdiagnosed as, irritable bowel syndrome or pelvic inflammatory disease (Fritz &Speroff, 2011).

American College of Obstetrics and Gynecologists. 2012. Gynecologic Problems: Endometriosis.

Fritz, M., and Speroff, L. Clinical Gynecologic Endocrinology and Infertility 8th ed. 2011. Lippincott Williams & Wilkins.

Tharpe, N., Farley, C., Jordan, R.. Clinical practice guidelins for midwifery & women’s health. 4th ed. 2013. Jones & Bartlett Learning.

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PCOS

Sunday, September 21st, 2014

As frightening as it might first seem, it can be empowering for a woman to learn that she has Polycystic ovarian syndrome (PCOS). Discovered sooner rather than later, there are many opportunities for intervention.

While there are many medications and even natural remedies to treat PCOS, taking charge of lifestyle changes will often have a profound impact, and for many, can reverse the presentation of PCOS symptoms. Including infertility.

Any treatment focused on reducing insulin levels in both lean and obese women with PCOS may be beneficial.

Exercise is key to this.

Increasing muscle mass improves glucose regulation (and reduces insulin levels), which in turn can stimulate ovulation.

So, through increasing activity level from sedentary to moderate daily activity, women may see a fall in ovarian androgen secretion and an improvement in cyclic pituitary-ovarian function, which may reduce hair growth and restore menstrual regularity, and presumably fertility.

Exercise and a whole-foods diet can also improve cardiovascular function by lowering high LDL and triglycerides and raising protective HDL. By increasing cardiovascular and weight bearing exercises, choosing whole foods rich in fruits, veggies,and whole grains over processed foods high in fat, sugar, and processed foods, a woman can not only lose weight, but may also improve hormone regulation and longevity.

For overweight or obese women with PCOS, weight loss alone can be the biggest catalyst for change in symptoms like infertility.  A healthy BMI is associated with a reduction in serum testosterone concentration, improved glucose regulation, ovulation, and optimally increases one’s ability to achieve spontaneous pregnancy.

With support, a woman with a PCOS diagnosis has many tools available to increase her chances for conception. While weight loss is only one of those tools, with appropriate support it is often a key tool to help regulate cycles and improve ovulation.

If you think you may have PCOS, or already have a diagnosis, give us a call today to schedule an appointment with our women’s healthcare specialist to talk through the tools right for supporting YOUR health needs.

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Adolescent Transitions

Thursday, April 17th, 2014

When it comes to supporting adolescent girls during life’s transitions,  we- as a culture-have a lot of work to do.

Most women I know (myself included) stumbled through their adolescent transitions feeling awkward, unsupported and more than a little confused.

Between a changing body (hips, breasts, pimples and cramps!), roller-coaster of hormonally-fueled emotions, and a large dose of culturally fueled embarrassment/shame about these changes, the female adolescent experience is one most of us wish to improve for our own daughters.

As a midwife, I see a lot of that work beginning with the care and information that I provide. Not just to adolescent girls directly, but to their families as well.

Together, we can support our daughters in embracing life’s transitions, celebrating milestones,  encouraging their empowerment and self awareness in the process.

In that vein, I am sharing this video – I’m not sure how many young women have such a positive experience, but I believe that together we can raise our female children to feel confidence, trust and love in their bodies.

While this may startle some viewers, and is not an endorsement for any product sold, I appreciate the sense of ownership and comfort-with-self that it demonstrates, such a contrast to the experiences of most women’s first menstrual experiences.

Often as a parent,  it is easier to know what to talk about than it is to know how to talk about it. If your daughter or adolescent-loved one is on the cusp of this life transition, give us a call and schedule for both of you to come in for a visit to talk with our midwife.

503-287-4970

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Preventative Health

Monday, March 24th, 2014

Detecting Health Issues and Preventing Disease

Preventing disease and detecting health issues at an early stage is essential to living a healthy life- Have you scheduled your preventative health visits for 2014?

Our purpose at Nature Cures Clinic is to support you in achieving optimal wellness through patient centered care. Preventative health visits are perfect opportunities for us to do that while being ‘pro-active’ in health, rather than ‘reactive’ to disease.
In support of your health, all of us at Nature Cures Clinic are providing recommended preventative health visits per the affordable care act for Women, Children AND Men (did you know men can get preventative health visits too?)

Here are just a few of the preventative health visits we offer (As always, check with your insurance plan to see what visits they cover and the frequency they cover them):

Yearly preventative care visit for adult men & women
Well-woman visits including preconception counseling
Mammography screening (film referral and digital exam) for all adult women
Genetic screening and evaluation for the BRCA breast cancer gene
Cervical cancer screening including Pap smears
Human papillomavirus DNA testing for all women 30 years and older
Breast-feeding support and counseling
Domestic violence screening and counseling
Contraception methods and contraceptive counseling
Sexually transmitted diseases screening including gonorrhea, Chlamydia, syphilis and HIV
HIV counseling and screening for all sexually active women
Sexually transmitted infection counseling for all sexually active women annually
Iron-deficiency anemia, bacteriuria, hepatitis B virus and Rh incompatibility screening in pregnant women
Screening for gestational diabetes
Colorectal cancer screening (including fecal occult blood testing)
Cholesterol and lipid screening
High blood pressure screening
Diabetes screening
Depression screening
Diet and nutrition screening and counseling
Screening and counseling for alcohol or substance abuse, tobacco use, obesity,
Prostate cancer screening for men (age 40 and older)

For a complete list of visits now recommended under the Affordable Care Act, we encourage you to check out our recent blog as well as the healthcare.gov website under “prevention and getting care”.

Schedule today for a preventative health visit at 503-287-4970, we look forward to supporting you in health! 

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Have you scheduled your preventative health visits for this year?

Wednesday, March 12th, 2014

Preventing disease and detecting health issues at an early stage is essential to living a healthy life- Have you scheduled your preventative health visits for 2014?

Our purpose at Nature Cures Clinic is to support you in achieving optimal wellness through patient centered care. Preventative health visits are perfect opportunities for us to do that while being ‘pro-active’ in health, rather than ‘reactive’ to disease.

In support of your health, all of us at Nature Cures Clinic are providing recommended preventative health visits per the affordable care act for Women, Children AND Men (did you know men can get preventative health visits too?)

Here are just a few of the preventative health visits we offer (As always, check with your insurance plan to see what visits they cover and the frequency they cover them):
Yearly preventative care visit for adult men & women
Well-woman visits including preconception counseling
Mammography screening (film referral and digital exam) for all adult women
Genetic screening and evaluation for the BRCA breast cancer gene
Cervical cancer screening including Pap smears
Human papillomavirus DNA testing for all women 30 years and older
Breast-feeding support and counseling
Domestic violence screening and counseling
Contraception methods and contraceptive counseling
Sexually transmitted diseases screening including gonorrhea, Chlamydia, syphilis and HIV
HIV counseling and screening for all sexually active women
Sexually transmitted infection counseling for all sexually active women annually
Iron-deficiency anemia, bacteriuria, hepatitis B virus and Rh incompatibility screening in pregnant women
Screening for gestational diabetes
Colorectal cancer screening (including fecal occult blood testing)
Cholesterol and lipid screening
High blood pressure screening
Diabetes screening
Depression screening
Diet and nutrition screening and counseling
Screening and counseling for alcohol or substance abuse, tobacco use, obesity,
Prostate cancer screening for men (age 40 and older)
For a complete list of visits now recommended under the Affordable Care Act, we encourage you to check out our recent blog as well as the healthcare.gov website under “prevention and getting care”.

Schedule today for a preventative health visit at 503-287-4970, we look forward to supporting you in health!

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Birth Control, Risk, and Understanding your options

Monday, January 13th, 2014

Birth control, contraception, fertility management… Who hasn’t thought about it in some way?

There are so many different types & methods available these days-  but not all of them are right for every woman.

And trying to find the ‘right’ one can be a tremendous challenge.

Because finding the ‘right’ one means something different to every woman.

‘Right’ could be most effective- or least invasive; with hormones- or without; with monthly bleeding-or no bleeding for months; easiest to start- or easiest to stop; most secure against STIs- or safe while breastfeeding …. Or all of these!

There is a host of interwoven elements that make the process so personal.

Which is why having a provider to talk about what you WANT out of a birth control method is so important.

Because the truth is, not every woman can use every method.

Sometimes this is because of a current medical condition.

And sometimes it is because of a past medical history or family medical history.

Because every woman is so unique, her individual RISK profile  is unique too.

So what does that mean?

When I talk about a ‘risk profile’ I mean the risk of being on a certain type of method given a woman’s unique history and her health risks should she become pregnant.

While it is true that pregnancy is a natural and healthy state for most, it is also true that there are inherently increased risks associated with it.

This may sound unpopular to some, but the truth is, simply in terms of what we call ‘risk ratio’ many times the risk of a contraceptive method is less risky than the risk of a pregnancy for an individual woman based on her health status.

Certainly, this isn’t true for every woman, but it’s important to consider when you hear news stories about catastrophic events associated with birth control methods.  Rarely (if ever) is any background on the woman’s risk profile- or health history, mentioned.

Recently, there has been a lot in the news about the risks of Nuva Ring, a type of birth control that works like birth control pills but is a vaginal suppository.  It has been widely popular since it doesn’t require a daily pill, the hormones don’t go through the entire system the way a pill does, and it involves only once a month insertion so a woman is able to control its monthly placement and removal.

Hearing of bad outcomes associated with the Nuva Ring certainly gives me some pause, however without knowing anything about the underlying health status of someone that had a bad outcome- it is important not to become too reactive.

This is one reason it’s important to know and feel comfortable with the healthcare provider that supports you in your contraceptive choices.

By having a provider who takes the time to know you, your personal & family history, your health preferences, your health & lifestyle concerns, you have someone working on your health team that is willing to help you find the right method(s) for you.

By using a provider who as the most current information, recommendations and guidelines on contraception options & use, that information can be shared with you in a way you understand, and you have all your questions answered.

When I hear of tragedies related to birth control, I often wonder if the person involved felt confident in her choices, options and decision on what to use.  Did she know her options? Her risks? Did she feel comfortable with her provider to ask the questions she had? Did she have all of her questions answered?

For all too many in this health system of ours, birth control visits have turned into the healthcare world’s version of fast food.  I know, I’ve seen it first hand- a woman typically walks in and out of such visits in 15 minutes—or less.

During that time many women barely have a chance to get comfortable talking about the fact they have sex, let alone have the time to feel supported in knowing the options given their unique health status.

Or providers put up hurdles that limit the availability of options. Like the largely antiquated requirements of having a Pap and STI screening weeks in advance of IUD placement,  or a vaginal exam for birth control pills. (Current research is clear that neither of these are generally needed, although in certain situations your unique health care needs may suggest otherwise.

Unfortunately what that means to a lot of women is a delay in access to the method that is right for them OR- for many women- having to endure an invasive procedure unnecessarily.

It is hard given such scenarios to imagine every woman is able to make the best decision for her needs.

That’s one reason I believe so strongly in doing things differently.

When a woman comes in to see me about contraception, we talk about a lot of things- including what she wants out of a birth control method- and what she doesn’t. We evaluate her risk profile together and collaboratively formulate a plan.

We formulate a plan together because there are a lot  of options for women to manage their fertility. From the gentle, non-pharmacological monthly fertility awareness methods, to the highly effective pharmacological methods of implants I want women to get their needs met.

If you are in need of contraception, have questions or concerns about your current contraception method or would like to establish care with a provider who does things differently than the standard 15-minute visit (All New Patient visits are scheduled for a full hour), please schedule an appointment with Sarieah Macdonald, CNM today.

 

 

 

 

 

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New Campaign Challenges Portland, Or Women to Get the Best Care from Their Health Providers

Tuesday, November 12th, 2013

Nature Cures Clinic Launches Our Moment of Truth™ to Improve Women’s Health Conversations, Outcomes

 [Portland, OR] – A recent study of more than 1200 women in the United States found that despite expressing satisfaction with the health care services they receive, many women, including here in Portland are not getting what they say they want from their health care team, or having important conversations that may help ensure their health and wellness.

To combat these potentially harmful gaps in women’s health care, Nature Cures Clinic has launched Our Moment of Truth (OMOT), a local initiative encouraging women to become active participants in managing their health and learning more about the full range of options available for their needs.

As part of the campaign, Nature Cures Clinic is urging women to examine the type of health care they are receiving, evaluate what they want from their health care experience, and ensure important conversations with their provider take place. The initiative also encourages women to become aware of all their health care options by highlighting the woman-centered, evidence-based model of care provided by midwives during important health events throughout women’s lives, including puberty, family planning, pregnancy, birth, and menopause.

“Women can play a critical role in getting the optimal health outcomes they want by ensuring they are well informed on all of the types of providers available to them, including midwives here in our community,” said Sarieah Macdonald, CNM.  “But women can only succeed in getting the best care possible when they have the best possible information available to them. No one should settle on care that doesn’t meet their needs or give them exactly what they want.”

The OMOT campaign was created based on the results of a 2012 survey conducted by the American College of Nurse-Midwives (ACNM), which found that when women visit their health providers, a number of conversations that are critical to ensuring sound, comprehensive care simply aren’t happening.

According to the survey of women between the ages of 18 and 45, a number of major health issues are being overlooked during provider visits, and women may be leaving appointments without vital health information they need.

Despite 85% of women saying they were somewhat to very satisfied with their care, when the same women were asked about the types of services they wanted and were receiving, their responses painted a much different picture, and showed that many women aren’t actually getting the services they want.

In particular, while 65% of women said they want a health provider who offers family planning advice after a previous birth, only 13% received this information. Additionally, while half of respondents said they wanted a provider who offers a choice of birth settings, not just a hospital birth, less than a quarter of women were given these options.

The survey also found that areas women’s providers were not addressing or discussing with them included how to maintain health and wellness during pregnancy (62%), preparing for motherhood (80%), and birth control and family planning (87%).

Midwives are a solution to these gaps in health discussions and services, and OMOT aims to ensure women are given a complete picture of midwife-led care to prevent misunderstandings associated with midwifery that have stopped women from seeking out their services.

“A lack of information about midwives prevents women from seeing a provider who can give them a comprehensive, personalized range of services during critical health events throughout their lives, not just centered around maternity care and birth, but also during adolescence and through menopause” said Macdonald.  “Women deserve a health provider who presents a spectrum of care options. Understanding all available care options will allow women to play a more active role in their own health decisions and outcomes.”

Visit www.ourmomentoftruth.com to learn more about how the high-quality care of a midwife can address women’s needs, and www.naturecuresclinic.com to learn about midwifery resources in Portland, OR.

About Our Moment of Truth™: A New Understanding of Midwifery Care

Our Moment of Truth™: A New Understanding of Midwifery Care presents midwifery as a solution for many women who are looking for more out of their care. Recognizing that many women are not receiving the care they desire, Our Moment of Truth™ challenges women to evaluate what they want from their health care experience and become aware of their full range of options. Our Moment of Truth™ offers women the information and tools they need to ask the right questions of their provider and have an important dialogue on critical health issues before moving forward with a care plan. Explore Our Moment of Truth™ tools and resources for finding desired health care at www.ourmomentoftruth.com.

About Midwifery care at Nature Cures Clinic: http://www.naturecuresclinic.com/practitioners/sarieah-macdonald-mn-nmnp-cnm/

About the American College of Nurse-Midwives
The American College of Nurse-Midwives (ACNM) is the professional association that represents certified nurse-midwives (CNMs) and certified midwives (CMs) in the United States. ACNM promotes excellence in midwifery education, clinical practice, and research. With roots dating to 1929, our members are primary care providers for women throughout the lifespan, with a special emphasis on pregnancy, childbirth, and gynecologic and reproductive health. ACNM provides research, administers and promotes continuing education programs, establishes clinical practice standards, and creates liaisons with state and federal agencies and members of Congress to increase the visibility and recognition of midwifery care. Visit www.midwife.org for more information.

 

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What do you mean I don’t need a Pap? Understanding this test and the changing guidelines

Wednesday, October 23rd, 2013

In the last few years, there have been a lot of changes in the medical world around the need for Pap exams. For many women, the phrase ‘You don’t need a pap’ is met with both relief that the oft-uncomfortable procedure is not needed, as well as confusion about what that means in terms of accessing a health care provider for an annual exam.

While I cover the difference in the October Newsletter article “Pap or Annual: Know the Difference”  I feel it is important for women to fully understand what a Pap exam actually is/does and why not everyone needs one every year.

The Pap smear/exam (The Papanicolaou test) looks for unhealthy changes to the cells of the cervix, which is the lowest part of the uterus.

The test is useful in finding cell changes associated with precancer–cell changes on the cervix that might become cervical cancer if not treated appropriately. It can also detect cell changes associated with cervical cancer as well as infection from common sexually transmitted infections.

What we have learned in the last few years is that there are more than 40 types of HPV and it is the most common sexually transmitted infection in the United States. It is also one that most people never know they have or even that they have been exposed to it. As an aside, unlike some sexually transmitted infections a new HPV diagnosis doesn’t mean a new exposure. This virus can be asymptomatic, unrecognized and subclinical for a long time. The CDC estimates more than 50% of sexually active people have become infected with HPV at least once in their lifetime- most without ever being aware of it.

Some types of HPV cause warts on genital areas of men and women, including the skin of the penis, vulva (area outside the vagina), and anus, and the linings of the vagina, cervix, and rectum. These types can also infect the lining of the mouth and throat. These types of HPV do NOT cause cancer.

Other types of HPV, types that do NOT cause warts, can cause cell changes that result in cancer. These are called ‘high risk’ HPV types.

These are the types of HPV that are associated with –and tested for- in a Pap test.

So why would anyone tell you to wait several years between Pap exams, why not test every year?

The answer is that usually, the body’s immune system clears the HPV infection on its own within a few years.  This is true for the HPV types causing warts (but not cancer) AND the types causing cancer (but not warts).

When the body’s immune system doesn’t clear the ‘high risk’ HPV infection, it can linger and cause normal cells to become abnormal and potentially cancerous. These types of HPV have no other outward sign or symptom.

However, that process of turning normal cells to precancerous cells or cancerous cells is generally very slow.

Research supports the slowness of this process and in the absence of any abnormal Pap or HPV results, it suggests that routine annual pap exams are unnecessary and may cause high rates of intervention when, given some time, the body may well clear the virus on its own.

I like to explain the process using a twist on the Aesop’s fable of the tortoise and the hare.   The body’s immune system is like the hare, quick and fast it most often clears the ‘high risk’ HPV virus from the body- with the body never showing sign it was even there.  Only occasionally is the ‘high risk’ HPV type like the tortoise- slow and steady enough to outmaneuver the immune system to make cell changes.

While that is a rather simple analogy (and maybe not a great one, at that), it gets to the point of why Pap exams- in the absence of anything abnormal- are not needed for every woman, every year.

BUT, that does NOT mean women shouldn’t come in for- at a very minimum- an annual exam each year.

Pap exams are a useful tool to evaluate cervical cell health, but women’s health care should NOT be reduced to simply these exams, something that has happened far too frequently over the years.

 

 

 

 

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Pap or Annual Exam? Why Women Need to Know the Difference

Wednesday, October 23rd, 2013

By Sarieah Macdonald, MN, NMNP, CNM

You may have gone to a women’s health care provider recently and heard some startling news: “Your Pap was fine and now you don’t need to have an annual for several years.”  There’s some good news to this announcement (read more about PAP exams here) and then there’s a part of that statement that, I believe, actually sells a woman’s health short. I am here to say, your reproductive health is MORE than a Pap exam and your annual visit should be, too!

Certainly, it is true that the new national guidelines on Pap smears/exams have changed how we think about and treat cervical cancer, caused by HPV (the human papillomavirus).   However, how women are hearing about these changes and incorporating them into their ongoing health care, concerns me.

In my practice I believe EVERY woman should have at least an annual wellness exam with a women’s healthcare specialist to discuss- if nothing more- the unique health concerns associated with being a woman.

Regardless of if you need a pap exam or not, you deserve to have access to a health care provider that specializes in the special health needs associated with being a woman. You are entitled to an ‘Annual Wellness Visit’- so much more than a Pap exam (and you may even be able to stay dressed)!

As women, where else do we have access to a trained specialist on women’s health issues, if not at the very least at an annual exam?

When a woman is told she ‘doesn’t need a pap for several years and therefore doesn’t need to come in’ to see her provider, I believe she is losing valuable access to someone known and trusted.

As a provider who listens and understands all about hormone changes, menstrual cycles, pregnancy and/or contraception issues,  sexual function/dysfunction/ concerns, pain, discharges, perimenopausal symptoms, sexual satisfaction, and relationships, I take the time to get to know you.

I do that- in part, because I believe relationships matter, and in part because I know that all women need someone knowledgeable to talk with.

I believe it is a tragedy of our healthcare system that women’s healthcare has been reduced to an annual single visit, for a single purpose- now reduced further for some women.

Largely gone from the system has been a safe, trusted resource to discuss health, sexuality and relationships with women-for women- as their bodies, their lives, and their needs change.

I hope to change that. So, pap or no pap- schedule a visit today!

For more information check out these resources:

Centers for Disease Control and Prevention. Basic information about hpv-associated cancers.  Last updated Sept. 5, 2013. Retrieved from http://www.cdc.gov/cancer/hpv/basic_info/

Office on Women’s Health, U.S. Department of Health and Human Services. Last updated Sept. 24,2013. Retrieved from: http://www.womenshealth.gov/publications/our-publications/fact-sheet/pap-test.html#h

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A midwife at NCC?

Tuesday, October 15th, 2013

As a new provider at Nature Cures Clinic, and the only non-naturopath or acupuncturist, one might wonder how exactly a certified nurse midwife nurse practitioner will fit in, after all is NCC going to be delivering babies now?

I love it when people ask me that, as it gives me the opportunity to explain that while some nurse midwife nurse practitioners only work with pregnant women and catch their babies, others- like me- do much, much more than that. And we do it very much aligned with naturopathic philosophy.

In fact, the two professions (nurse midwives and naturopaths) are the most aligned in all of the medical world with nurse midwives having as a core of their philosophy the importance of providing holistic health care to women!

In keeping with that model, I provide holistic primary (i.e. overall) and reproductive health care to women (and some men).

This means, I diagnose, treat and manage the primary health care needs of women, as well as any specific reproductive ones.

What does that mean, you may ask… It means that I provide care for:

Anything that would take a woman to any other provider (urgent care, physician, nurse practitioner, etc..):

– sore throat, cough, sinus pain, chest cold, difficulty sleeping/insomnia, strange rash, headache,  weight loss/gain, thyroid imbalance, muscle pains, etc..

AND/or anything you would take to a gynecologist:

– difficulty with your period, birth control needs/problems,  fertility    concerns, hot flashes, strange discharge, infection, irritation, vaginal pain, etc…

AND/or anything related to relational/sexual health:

– puberty changes, menopausal changes, difficulty with intercourse,    conception, questions about development, preventative health, sex education, relational concerns , sexuality, sex dysfunction, etc..

I provide care that supports the WHOLE person, because I believe true women’s health care is far more than a ‘once-a-year gyn’ visit.

When you schedule a visit, I talk with you, listen to you, take the time to get to know you to provide individualized care based on who you are and what you need.  I provide therapeutic and holistic care based on relationships, which makes me very much at home at NCC!

Schedule a free half-hour ‘meet and greet’ today to see if you are a good fit for midwifery care!

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What is a Nurse Midwife Nurse Practitioner and what does one do?

Saturday, September 21st, 2013

 5525048817_c71637e08d_z A Nurse Practitioner (NP) is a primary care provider that independently provides primary and specialty health care in their trained specialty.

There are many classifications of nurse practitioners, each with its own scope of practice, working environment and professional standards : Adult NP, Nurse Midwife NP, Family NP, Geriatric NP, Neonatal NP, Pediatric NP, Psychiatric/Mental Health NP, and Women’s Health Care NP.

Nurse Practitioners must have Masters level education within the specific scopes of practice for which they are licensed and go on to receive national board certification in that specialty.  A Nurse Midwife Nurse Practitioner must be board certified as a Certified Nurse Midwives (CNM) prior to obtaining an Oregon state license.

mother daughter picnic

The Nurse Midwife Nurse Practitioner (NMNP), CNM  independently provides health care to women throughout the lifespan.

With a scope of practice that encompasses the lifecycle of women from adolescent through menopause, the NMNP, CNM has a depth of care that spans primary care, gynecology, contraception, fertility, family planning, peri- and post- menopause, sexuality, pregnancy & childbirth, the postpartum period, newborn wellness (through 28 days), breastfeeding support, counseling related to sexuality, relationship, and reproductive issues, and treating male patients for reproductive health issues and sexually transmitted diseases.

As independent women’s primary care providers, the NMNP, CNM provides initial and ongoing comprehensive assessment, diagnosis and treatment through physical examinations. They prescribe medications including controlled substances and contraceptive methods; order and interpret laboratory and diagnostic tests and order the use of medical devices.

For more information on the specific skill-set of CNMs please see the article entitled Certified Nurse Midwives, the art of Being with Women.

American College of Nurse Midwives. 2004. Our Philosophy Of The American College Of Nurse-Midwives. www.midwife.org Retrieved September 12, 2013

American College of Nurse Midwives. 2004. Code of Ethics. www.midwife.org Retrieved September 12, 2013

American College of Nurse Midwives. 2012. Core Competencies. www.midwife.org Retrieved September 12, 2013

American College of Nurse Midwives. 2011. Standards for the Practice of Midwifery.  www.midwife.org Retrieved September 12, 2013

Oregon State Board of Nursing. 2013. Division 50. Nurse Practitioners. www.Oregon.gov Retrieved September 12, 2013

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Libido: Is this normal (or is something wrong)?

Wednesday, March 2nd, 2011

Common causes of low libido include fatigue, pain, hormone changes, stress, and raising a family. We invite you to come in and speak with our women’s health specialist about ways to bring your body back into balance and restore your sexual vibrancy (or maybe even find it for the first time).  Plus, a quick Q&A about birth control will also be appropriate, don’t ya think?

intimacy

Having low sexual desire is the most common sexual issue among women, reported by 10-51% of women surveyed. One large survey reported that 43% of women experience some type of sexual dysfunction.

Intercourse frequency – highly misrepresented in the media – may be high among 18-29 year olds, averaging 10-12 times per month in one study. But frequency drops among coupled women to 4-7 times per month in the 40-50 year old age range, and less than twice a month in over 70 couples. So what’s normal? If you or your partner feel that there is room for more intercourse/intimacy, then you should take time to discuss it.

What causes low libido?

There are many, many causes of decreased or low libido. To support you in determining what might be happening for you, we encourage you to schedule a visit with us today.

Common causes of libido changes:

Hormones: often a combination of hormonal shifts as opposed to one simple culprit. Frequent culprits of underlying disruption that can impact libido directly as well as mood, fatigue, and body changes: Estrogen, Progesterone, Cortisol, Thyroid Hormones, Prolactin, Androgens, Testosterone, Vitamin D

Fatigue: often a combination of life circumstances, feeling fatigued certainly impacts desire. But, being tired all the time may not be something you have to live with. Frequent culprits include:
Anemia – often an effect of heavy periods and fibroids
Hormone disruption- hormones are regulators of our basic human condition, when they are not functioning properly a side effect is often persistent fatigue

Lack of sleep: sleep is essential for helping us feel our best. When we suffer from persistent sleep disruption, general lack of sleep or unrestful sleep, the consequence can obviously be fatigue, but also disruption of our hormones. This may leave you feeling off, exhausted, with no energy and no libido. There are a variety of things that can be done to support more restful sleep and the impact can be transformative.

Life imbalance: work, family, kids, friends, events and activities add up quickly in many of our lives. When we don’t get “down time” to prioritize ourselves and our own needs, we suffer.

Body Changes: When anyone talks about weight, most people feel self-conscious and often, self-critical.  Yet, weight changes can be a signal that something is out of balance in the body. And, imbalance in the body can be the cause of weight changes.  BMI (weight evaluated in terms of height) that is too high or too low impair normal physiologic function, including hormone function and libido.

Pain: The signals that tell us something is painful flood the brain and “tell us” not to do that again- or they brace us in anticipation of the expected pain. Think about touching a hot pot, having done it once our brain learned to not do it again and we instinctively withdraw our hand to prevent (or minimize) any burn. We don’t even really have to ‘think’ about it, our body just responds. It is our pain response.  If we have experienced pain- for any reason, vaginally or during intercourse, it is common for the body to react in a way that ‘anticipates’ pain again. This can be in the form of muscle spasm, muscle contraction, vaginal dryness, and other responses. And there is a lot that can be done to support healing and reprograming those pain signals.
Common causes of pelvic floor/vaginal pain include: persistent vaginal dryness, endometriosis, interstitial cystitis, trauma, scarring, muscle spasms, infection, energetic discord, emotional and/or mental influences.

Medications: There are very real side effects from certain medications on libido. A frank conversation with one of our providers on the medications you are taking and the effects you are experiencing may provide you with possibilities you hadn’t considered. While for some individuals their medications are essential and any medication chafes inadvisable, for other individuals alternative medication options (or alternative healing modalities) with lower side-effect profiles may be good options. The key is to recognize that certain medications may be causing an effect on libido and come in to talk to our specialists about it. Medications that may effect libido: anti depressants, anti-anxiety medications, sleep aids, blood pressure medication, diabetes medications.

Where to begin?

Seek medical care from someone you can talk to honestly, that takes the time to listen and that specializes in women’s health to ensure there are no medical conditions that are contributing to the problem.

Image courtesy Miss Turner

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Polycystic Ovary Syndrome

Tuesday, March 16th, 2010

2646438199_b309cffd65In honor of Women’s Health Month, I felt it important to discuss a syndrome that, like women, is elusive, complex, and foolish to ignore. The syndrome is Polycystic Ovary Syndrome.

PCOS appears in between 4 and 12% of women seen in American clinics (1. 2) and in 20% of obese women (3). These numbers may be inaccurate, though, because of the variety and inconsistency of criteria for diagnosis in the past, and the myriad of subtle symptoms that go unreported or overlooked.

Symptoms such as acne, mild facial hair or nipple hair, irregular periods, heavy periods, difficulty conceiving, or intermittent pelvic pain may seem unremarkable or easily treatable by themselves, but collectively, they point to a very important diagnosis.

This is disturbing because not only are we at risk for missing the mark on its prevalence, but we may also be missing the diagnosis of PCOS all together.

The possibility of misdiagnosing or ignoring PCOS has significant implications.  There is increased risk for Type 2 diabetes, increased thickening of the endometrial lining and hyper-estrogen related cancers, and cardiovascular disease.

Treatments typically include pharmaceutical hormone regulators such as oral contraceptives and metformin, as well as a recommendation for weight loss in the overweight or obese PCOS patient. While medications have been beneficial for some, many women are opposed to the use of prescription medications unless absolutely necessary.  And women often do not like the side effects associated with these treatments.

More and more, women are asking the question, “Are there any alternative therapies?” The good news is that for many women the answer is yes.

We take an integrated approach to treating PCOS, we use the most effective treatments for your health needs. These can include  lifestyle changes, nutritional therapy, herbs, acupuncture, Chinese medicine, as well as conventional therapies.

Our goal is to get you the best possible outcome.

Regardless of the approach, the goals for treatment are; decreasing circulating insulin and androgens, restoring ovulation and menstrual regularity, weight loss, improving cardiovascular profiles, supporting liver function, and improving the hypothalamic-pituitary-adrenal (HPA) axis.

If you believe you have symptoms of PCOS, or you already have a diagnosis and are looking for a more holistic approach to treatment, we encourage you to give us a call today.

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