Why Choose Breastfeeding?

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Breastfeeding, or giving your infant expressed breast milk, is the most natural source of nourishment for your infant. When you choose to breastfeed your baby, you are providing him/her with the best possible infant food, and no product has ever been as time-tested as human milk.

Mother’s milk contains all the nutrients your baby needs and is more easily digested than any other baby food. Breastfeeding provides extra protection to infants against many common childhood infections such as: gastrointestinal, respiratory, ear, urinary tract, and dental caries. Breast milk has also proven to protect against more serious illness such as meningitis, juvenile diabetes, celiac disease, childhood cancer, acute appendicitis, and liver disease. There has even been research to support that breast milk helps to reduce the risk of SIDS (sudden infant death syndrome).

Not only does breastfeeding provide so many priceless benefits to your infant, but it also turns out to the best for a mother’s body as well. The lactation process causes changes in the mother’s body that benefit her directly. Some of these benefits include: helping the uterus get back in shape faster after delivery, changing metabolic rates thereby enabling most mothers to lose pregnancy weight gradually without dieting, protection against breast and ovarian cancer, urinary tract infections, and osteoporosis.

How Do I Prepare to Breastfeed My Infant?

Reading and taking a prenatal/breastfeeding class can be helpful. Many mothers find it most helpful to talk to experienced professionals such as a lactation consultant, nurse practitioner, pediatrician, nurse midwife, or obstetrician. There is no replacement for advice from your family members or friends who have breastfed; they often have many useful tips.

However, because every mother and baby is different, the real experience will come after the baby is born. It will be a learning process for both of you, and patience is key. A supportive team of family, friends, and professionals will be valuable to you. Also, it would be helpful to check with your insurance policy before your baby is born to see if they will help cover the price of a breast pump. Most nursing moms find it beneficial for many reasons to have their own pump. Optimally, you might want a support pillow such as a Boppy, a nursing bra, breastpads, Soothies gel pads, and PureLan cream.

Who Will Help Me With Breastfeeding/Pumping After Delivery?

Your labor and delivery nurse or midwife will likely be the first person to help with breastfeeding and/or pumping after the delivery of your infant. Next, the nursing staff and lactation consultants at the mother-baby unit will be happy to assist you with breastfeeding. Once discharged home, you will have access to help through your pediatric office. IHA has many experienced pediatricians, nurse practitioners, PAs, and lactation consultants who would love to help with this life changing experience. If you have questions or concerns, or would like to schedule an appointment, please call 734.995.2950.

Back to School Physicals and Immunizations

With the kids going back to school soon, now is a great time to get their annual checkup by their physician or health care provider. This visit is also the best time to make sure their immunizations are up-to-date with the current recommendations and school requirements.

Most school-aged children receive several vaccines at their 4, 5, or 6-year-old checkup, and then the next set of vaccination occurs at 11 or 12 years of age. However, each year the physician will assess the child’s status of vaccines to make sure he or she is up-to-date.

Some important vaccine highlights this year include:

The meningitis vaccine: One of the newest recommendations is a second dose of the meningitis vaccine for high school students, usually at the age of 16; the first dose has been routinely given at 11 or 12 years of age. Meningitis is an infection of the lining of the brain and spinal cord that can be more easily transmitted when students are in close contact with each other. The HPV vaccine: This vaccine—which prevents genital warts in boys and girls and cervical cancer in girls—is now approved for boys ages 9 to 26 and has been approved for girls of the same age since 2006. It is a series of three vaccines, and the first dose is usually given at 11 or 12 years of age. Because the vaccine is to prevent a sexually transmitted infection from occurring, it is important that children get this vaccine before they become sexually active.

The tetanus-diptheria booster: Your child’s tetanus boosters should be up to date, especially because the booster contains the vaccine for pertussis, also known as whooping cough. Pertussis has been on the rise in Michigan recently, but the risk of this respiratory illness can be greatly reduced with the vaccine. Although immunizations are an important part of the annual checkup, the visit to the office is also an opportunity for the physician to review the child’s growth, eating habits, school performance, social interactions, and safety. The health care provider will do a complete physical exam and assess the child’s need for any testing. Additionally, he or she will be able to provide recommendations to the parent and child about topics such as healthy eating, exercise, risk reduction, and any other areas of concern that have come up during the visit.

IHA Domino’s Farms Medical Center Now Open!

We’re excited to announce the opening of the brand new IHA Domino’s Farms Medical Center. The state-of-the-art 42,000 square-foot building, located on Whitehall Rd. near Earhart Rd., is the new home to a variety of IHA practices, including a new Urgent Care location, open 14 hours a day Monday-Friday, and 10 hours Saturday and Sunday. Other patient-centered programs and services being offered are: pediatrics, internal medicine, obstetrics and gynecology, certified nurse midwives, dermatology, pediatric neurology, imaging and ultrasound, travel medicine, physical therapy and lab services. We look forward to welcoming you to this new kind of medical center – one that is centered on you!

 

 

First Floor

IHA Imaging & Ultrasound – Domino’s Farms
734.434.0539

IHA Internal Medicine – Domino’s Farms
734.995-0303

IHA Midwest Travel Care
734.995.0308

St. Joseph Mercy Clinical Laboratory
734.712.7136

IHA Urgent Care –Domino’s Farms
Open 7 days a week, including holidays
Monday-Friday 8:00am-10:00pm
Saturday-Sunday 9:00am-7:00pm
734.995.0308

Second Floor

IHA Primary Pediatrics – Domino’s Farms
734.677 DERM (3376)

IHA Pediatric Neurology Consultants
734.622.5000

IHA Dermatology– Domino’s Farms
734.769.3896

St. Joseph Mercy Physical Therapy
734.712.7171

Third Floor

IHA Ann Arbor OB/GYN– Domino’s Farms
734.434.0477

IHA Nurse Midwives
734.572.9600

 

Spring has Sprung! Seasonal Allergies and Children

This time of year seems to be appreciated by most who live in Michigan. The children can finally begin to go out to play and families can spend some quality time outdoors. Unfortunately, along with onset of spring comes the sneezing, the coughing and the itchy, watery eyes. For most parents, the hardest part is trying to distinguish these typical symptoms from a cold. Generally speaking, if your child does not have a fever and the sneezing and watery eyes occur every year around the same time, it is usually seasonal allergies. Children with seasonal allergies can also manifest signs of dark circles under their eyes called “allergic shiners” or little wrinkles in the middle of their nose because they are constantly taking the palm of their hand and wiping their nose upward, commonly referred to as the “allergic salute.”

 

 

In Michigan, different seasons sprout different allergens (substances causing allergy symptoms). In the first few weeks of spring, the pollen coming from trees (elm, maple and birch) are likely to blame. In late spring and summer, grass pollens and some weeds begin to spread throughout the air. By late summer and fall more weeds, especially ragweed, produce their strongest pollen, usually until the first frost. In the fall, some molds will also develop due to decaying leaves. Molds can be found year-round whenever conditions are damp and humid.

Allergens can irritate the body and activate what is called the histamine response. This gives children the symptoms of sneezing, itchy watery eyes and scratchy throat. If these symptoms persist they can start to cause swelling or inflammation symptoms in the nasal passages. Thick mucus can block the nasal passages, and infection can potentially develop. Other complications from seasonal allergies are that they may trigger asthma or wheezing, or they may complicate eczema. For children and adults alike, nasal saline flush is best to open blocked passages. Medication for seasonal allergies usually begins with a trial of anti-histamine oral medicines. Studies have shown, however, that nasal sprays can be more effective at treating seasonal allergic symptoms because they prevent the allergen from triggering the histamine response right at the source. There are also natural ways to combat seasonal allergies, such as air conditioners and indoor air filters. Some research has shown that citrus fruits rich in vitamin C may provide anti-histamine benefits and help reduce allergy symptoms.

If a child has repeated symptoms around the same time every year, it may be helpful to discuss with your pediatrician if your child may have seasonal allergies. If the symptoms persist, allergy testing is also an option to try to figure out exactly which allergens to avoid.

Additional Information about Seasonal Allergies

What are allergy tests?

How do allergies occur?

Patience Pays Off for You and Your Baby

It is becoming more common for mothers who are nearing the end of pregnancy to request an induction of labor early, but waiting until natural labor occurs is good for both the mother and the baby in a healthy, uncomplicated pregnancy. A pregnancy is considered full term between weeks 37-40. Even though 37 weeks is the earliest point of a pregnancy being considered full-term, there is still so much growth and development that is happening in the last couple weeks of pregnancy.

 

 

It is hard to believe that there would be any benefit to the mother to stay pregnant any longer than she would absolutely have to, but there are several reasons to not induce labor unnecessarily (elective induction). Here are a few benefits for the mother:

 

  • Increased likelihood that you will go into labor on your own when your body is ready, which can improve your labor experience
  • Fewer medical interventions to start or continue the labor process
  • Increased success with breastfeeding since the baby is more interested in eating
  • Decreased chance of having a cesarean section

 

The baby seems to get the most benefit of not electively inducing labor. Here are some things mothers can focus on in the last weeks of pregnancy so they know they are doing the most for their baby:

 

  • Important organs, especially the brain, have time to fully develop
  • Less likely to have breathing, hearing or vision concerns immediately after birth and long-term
  • Increased interest in eating and a better latch during breastfeeding
  • Better at maintaining their body temperature and blood sugar levels following birth
  • Able to transition to the outside world easier
  • Less likely the baby will be separated from the mother for testing thus decreasing the initial mother-baby bonding

 

There are many favorable reasons to not pursue an elective induction that both the mother and the baby can benefit from. Ask your provider about helpful techniques that can mentally and physically help you with the last few weeks of pregnancy. Certified nurse-midwives are knowledgeable about ways that can help pregnant women get the most out of their pregnancies even in the last couple of weeks. In addition to caring for pregnant women, certified nurse-midwives also provide routine gynecological care to women of all ages. This includes pre-conceptual care, family planning, annual exams, contraceptive counseling and menopausal care.

Keeping Your Family Safe in the Sun

July is here with blue skies, hot days and summer vacation. It is time for picnics, parks, swimming and playing in the sun. Here are some tips for enjoying the sun safely:

  • Wear long-sleeved shirts, long pants and wide-brimmed hats. If that is not practical for you, wear a cover-up or t-shirt.
  • Stay in the shade as much as possible, especially between 10 a.m. and 4 p.m., when the sun’s ultraviolet (UV) rays are at their strongest.
  • Wear wrap-around sunglasses that provide as close to 100% UV protection as possible.
  • Stay hydrated by drinking plenty of water.
  • Generously apply sunscreen 15 minutes before sun exposure, and reapply every two hours (more frequently when swimming or sweating).

 

FDA labeling of sunscreens has changed to make it easier for you to choose a product that provides adequate protection from the harmful effects of the sun. Look for a sunscreen that is labeled “broad-spectrum” and has an SPF rating of at least 15. “Broad-spectrum” means that it protects against both UVA and UVB rays. UVB protection prevents sunburn, but both UVA and UVB rays can cause skin cancers. UVA rays also cause premature skin aging, such as sun spots, wrinkles and “leathery” skin. If a sunscreen does not have the label “broad-spectrum,” it may not have UVA protection. Sunscreens are no longer able to contain labels saying that they are waterproof. Instead, they may be labeled “water-resistant” and list a time period that they are proven effective in water (40 or 80 minutes).

It is best to keep babies under six months of age out of the sun due to their thinner, more sensitive skin. Keep them in the shade with long sleeves, pants and hats. If it is not possible to avoid sun exposure, apply sunscreen in small amounts to exposed areas, and wash off afterwards.

Though most of us enjoy the sunny days of summer, it is very important to keep in mind that the sun’s radiation is classified as a human carcinogen. According to the American Cancer Society, skin cancer is the most common type of cancer in the United States, with over two million new cases found each year. Broad-spectrum sunscreen with SPF 15 or higher does not completely protect from harmful UV rays, but it does help when combined with other sun protection measures. While enjoying your time outdoors this summer, please remember to protect your skin, even on cloudy days. Help your family to develop good sun protection habits that will benefit them throughout their lives.

Five Reasons to Vaccinate Your Infant

As April winds down, the warm weather ahead isn’t the only thing we should be thinking about. This week is National Infant Immunization Week, which is a great time to consider some of the benefits that come from vaccinating your infant, or to start a dialogue with your child’s health care provider. Based on my experience as a pediatrician, and also from excellent resources such as the Center for Disease Control and Prevention (CDC), outlined below are five reasons to vaccinate your infant.

 

Immunizations can save your child’s life.

Because of advances in medical science, your child can be protected against more diseases than ever before. Some diseases that once injured or killed thousands of children have been eliminated completely and others are close to extinction– primarily due to safe and effective vaccines. One example of the great impact that vaccines can have is the elimination of polio in the United States. Polio was once America’s most-feared disease, causing death and paralysis across the country, but today, thanks to vaccination, there are no reports of polio in the United States.

Vaccination is very safe and effective.

Vaccines are only given to children after a long and careful review by scientists, doctors and health care professionals. Vaccines will involve some discomfort and may cause pain, redness, or tenderness at the site of injection but this is minimal compared to the pain, discomfort, and trauma of the diseases these vaccines prevent. Serious side effects following vaccination, such as severe allergic reaction, are very rare. The disease-prevention benefits of getting vaccines are much greater than the possible side effects for almost all children.

Immunization protects others you care about.

Children in the U.S. still get vaccine-preventable diseases. In fact, we have seen resurgences of measles and whooping cough (pertussis) over the past few years. In 2010 the U.S. had over 21,000 cases of whooping cough reported and 26 deaths, most in children younger than 6 months. To help keep those who cannot be vaccinated safe, it is important that you and your children who are able to get vaccinated are fully immunized. This not only protects your family, but also helps prevent the spread of these diseases to others in the community.

Immunizations can save your family time and money.

A child with a vaccine-preventable disease can be denied attendance at schools or daycare facilities. Some vaccine-preventable diseases can result in prolonged disabilities and can take a financial toll because of lost time at work, medical bills or long-term disability care. In contrast, getting vaccinated against these diseases is a good investment and usually covered by insurance. For those without insurance coverage, the Vaccines for Children program provides vaccines at no cost.

Immunization protects future generations.

Vaccines have reduced and, in some cases, eliminated many diseases that killed or severely disabled people just a few generations ago. For example, smallpox vaccination eradicated that disease worldwide. Your children don’t have to get smallpox shots any more because the disease no longer exists. By vaccinating children against rubella (German measles), the risk that pregnant women will pass this virus on to their fetus or newborn has been dramatically decreased, and birth defects associated with that virus no longer are seen in the United States. If we continue vaccinating now, and vaccinating completely, parents in the future may be able to trust that some diseases of today will no longer be around to harm their children in the future.

Adolescent women’s health: when to see a doctor and what to expect

Adolescence, simply defined, is the state or process of growing up… sounds easy enough. One’s body knows what to do: eat, sleep, drink and one day, as if by magic, it wakes up and is different. But, what about those other changes, the ones we’re not so eager to discuss; changes in mood, acne, menstruation. Is this normal? Though the simple answer in most cases is yes, there are many topics and questions a healthcare provider familiar with adolescent women’s health can help to address.

While there is no set age or reason to begin routine care with a women’s health professional, the American Congress of Obstetricians and Gynecologists recommends adolescents establish care between the ages of 12 and 15. By initiating this relationship early in one’s reproductive life, patients and physicians are more easily able to bridge communication barriers, particularly regarding the sensitive issues which arise in the course of care for adolescent women.

Unfortunately, the fear of one’s first gynecologic visit deters many young women from going to the doctor. A visit to a gynecologist does not necessarily mean a pelvic exam will be performed. In fact, a first visit is sometimes just a good chance to talk about health, healthy behaviors and answer questions a young woman may not feel comfortable asking anyone else. Initial visits can include a pelvic exam in certain situations. This may involve an external exam only or a gentle internal exam depending on a patient’s health history or concern.

In addition, there are many situations in which an adolescent woman may seek care for a specific problem or need. Common reasons to consult with your women’s health professional are: concerns regarding the menstrual cycle, pain in the pelvic region, overall sexual health, or questions about normal growth & development.

In recent years recommendations have changed for immunizations and routine health screening in the adolescent population. It is recommended that all young women be administered a HPV vaccine series. HPV (human papiloma virus) is the main cause of abnormal pap smears. The HPV vaccine is recommended between ages 11-12, though can be given up to age 26. Though the vaccine will not protect against all forms of HPV, it does offer protection against the two most common forms of high-risk HPV which cause cervical cancer.

In the case of heavy or irregular menstruation, there exists a broad spectrum of normal for young women. This is especially true of the first one to two years following menarche (a woman’s first period.) In the adolescent patient, the interval between periods may fall outside of the typically accepted normal range due to ongoing development of hormone producing centers in the brain.

Frequently missed school or participation in sports due to heavy menstrual bleeding or pelvic pain should be discussed with a physician. Any woman experiencing bleeding so heavy as to prompt evaluation in an Urgent Care facility or Emergency department, should be followed up by a thorough evaluation in her doctor’s office.

The Many Faces of Estrogen

A major health concern for women after menopause is the risk of heart attack and stroke. Throughout the last decade, Hormone Replacement Therapy (HRT) has been used to treat menopausal symptoms and help prevent cardiovascular disease. Now, there is a large body of evidence that has shown that women who take HRT are also at a lower risk of heart disease.

In the first 5-10 years after menopause, estrogen is actually effective in preventing cardiovascular disease. It is in this group that HRT can make a difference. This concept was discovered in the first and only prospective, double blinded, placebo controlled study of HRT in older women, called the Women’s Health Initiative Study (WHI). This was a controlled study designed to test the hypothesis that HRT is beneficial in preventing heart disease in women. Primarily studied were older women, well past menopause.

 

 

Because this was such a large study, the data was analyzed by looking at many aspects of women’s health. The issue of breast cancer is paramount in women’s concerns for their immediate and long-term health. Recently, the data from the WHI showed that there was less breast cancer in the group of women who only took estrogen and not both hormones (estrogen and progesterone). However, this is not necessarily the answer. Many observational studies suggest that there is an increased risk of breast cancer when estrogen is used over a long period of time. This risk is reduced after about five years of discontinuing use. The risk of breast cancer is higher in those women who use both estrogen and progesterone daily.

The key is to speak with your health care provider in order to individualize HRT to the individual situation:

 

  • If a woman has symptoms that are affecting the quality of her daily life at work and/or at home, there are many options for her to manage her symptoms. Some of these include better handling of stress, and avoiding hot drinks, coffee, alcohol, spicy foods and carbohydrates.
  • For women who need hormone replacement and who still have their uterus, a patient specific combination of estrogen and progesterone should be considered.
  • Women who do not have a uterus should not take progesterone because of the increased risk for breast cancer with daily use.

 

Advantages of HRT

Lower risk of cardiovascular disease (when started around the time of menopause), improvement in bone strength, symptom improvement, lower risk of colon cancer, and improved bladder and vaginal health.

Disadvantages of HRT

Increased risk of cardiovascular disease (if started well after menopause), and increased risk of breast cancer if used for an extended period of time.

Recommendation

With the help of your health care provider, use the lowest amount of estrogen and progesterone as needed to control symptoms of menopause, and stop its use when symptoms abate. Exercise, breast monitoring, and controlling alcohol intake will lower the risk of breast cancer. A healthy diet, exercise, monitoring cholesterol and not smoking will lower the risk of cardiovascular disease.

Empower Yourself in the Fight against Breast Cancer

October is Breast Cancer Awareness Month, and an opportunity for us to consider ways in which women can empower themselves when facing the possibility of this disease. A woman can make lifestyle decisions for prevention, choose to access early detection methods for diagnosis, and understand her options if diagnosed with breast cancer.

With respect to prevention, it can be as basic as diet and exercise choices. We know that diets focused on richly colored vegetables and fruits, low in saturated fats, and limited to one alcoholic drink per day can lower risk of developing breast cancer. Maintaining an ideal body weight and exercising just 30 minutes five days per week is also beneficial. If you are unsure about the use of hormone replacement therapy, meet with your primary care physician or gynecologist to discuss the pros and cons in your particular situation. For those women with a strong family history of breast cancer, ask your primary care physician about the need to see a breast surgeon or genetics counselor about more aggressive ways to manage potential higher risks.

 

There has been some debate in the press recently regarding the usefulness of mammograms. It is important for women to know that the American Cancer Society, American Society of Breast Surgeons, and the American College of Radiology continue to recommend that women of average risk begin screening mammography at age 40. This recommendation is based on many studies that have shown screening mammography improves survival from breast cancer, and that newer digital mammography is more effective in younger women with dense breasts than the older film mammograms, leading to earlier detection. Patients diagnosed at an earlier stage are less likely to require mastectomies and chemotherapy, and have improved survival rates. You may be advised to start screening at an earlier age if you have other risk factors, including a strong family history. In some patients, there may be additional tests available to help with early detection. If you feel a mass, you should seek an evaluation with your primary care provider regardless of your age. While there is still debate about recommending self-breast exams, I continue to advocate them for women who feel comfortable performing them. Many women in my practice found their own breast cancer with a thorough self- breast exam.

If you are facing a diagnosis of breast cancer, here are some things to remember:

  1. Most women have early stage disease, which is often curable.
  2. There are effective treatment options available for all stages of breast cancer. Discuss options for seeking care with your health care provider.
  3. Each woman’s treatment plan needs to be planned carefully and individualized. When looking for a surgeon, inquire if they focus their practice on treating patients with breast disease. Most surgeons who focus on the most up-to-date treatment of breast cancer also partner with medical oncologists, radiation oncologists, pathologists, radiologists, nurses, reconstructive surgeons, social workers, and research coordinators in a team approach to offer cohesive, compassionate and exemplary care to each and every patient.

 

In the end, you should feel that your team of physicians and other care providers partner with you and your loved ones to obtain the best outcomes possible.