Listening to Your Body – Living with Endometriosis

Listening to Your Body – Living with Endometriosis

Imagine being a senior in high school excited for your senior prom then hearing the words, “You might not be able to have kids.” That was me. Obviously, as an 18-year-old I wasn’t thinking about my future children right then but as previously mentioned, when asked what I wanted to be when I grew up, all I wanted to do was be a mom. So here I was in high school and hit with the thought that my dream may never come true.

Getting Diagnosed

Throughout my senior year, I would have this sporadic pain in my stomach. It was so debilitating I had to stay home from school. It would come and go, and I didn’t think it wasn’t associated with my cycle. I saw multiple doctors, but no one could diagnose my pain. Luckily, my mom believed me and fought for her child. We eventually saw a gynecologist in hopes she could figure it out. After several tests with no results, the gynecologist didn’t think the pain had anything to do with my ovaries or lady parts and the ultrasound didn’t show anything. I was sent home with the response “come back next time you have this pain.” But since the pain would come and go and I had no indication of when it was coming it took several more months for anything to be diagnosed.

People say it all the time — “listen to your body.” Some people feel really in tune with their bodies, others feel like they’re completely disconnected. Sometimes the phrase feels like it’s lost its meaning altogether. Especially when doctors keep telling you nothing is wrong.

The next time I had the pain we went back to the gynecologist, still with no conclusive reason. The doctor scheduled me for a laparoscopy. Through this procedure, she eventually diagnosed me with endometriosis. My first reaction was, “I’m not crazy – there’s really something wrong here!” My next response was to learn as much as I possibly could about the disease and its treatment.

Endometriosis is a chronic and painful disease that occurs when the endometrium (tissue that originates from the lining of your uterus) starts growing outside of your uterus, where it doesn’t belong. The endometrial tissue that grows outside of your uterus is called a lesion or an implant. These lesions are fueled by a sex hormone called estrogen. When estrogen levels rise, these lesions (patches of endometrial tissue) can grow. Later in the menstrual cycle, they may break down and shed. This can cause pain throughout the month.

Through this procedure, the doctor saw that the lesions were so severe they had to open me up through a bigger incision and remove my left ovary and fallopian tube. The lesions were encapsulating both and they couldn’t be saved. Not only that, but the doctor also didn’t want the lesions to come back so they prescribed a hormone treatment that put my body into menopause for a year.

Here I was, spring semester of my senior year going through menopause. On the plus side, I wouldn’t have a period for the next year. However, with menopause came hot flashes, mood swings and other symptoms. Try explaining that to your friends. The doctors also said conceiving a child may be difficult, but we’ll have to wait and see.

After a year of menopause, I was put on birth control to regulate and somewhat control my periods. I didn’t have any problems. I was in college and felt like my normal self again. Fast forward several years, the good news, my periods are back to normal, and I didn’t have any problems conceiving. We are blessed with 2 beautiful children.

Managing My Endometriosis

But here I sit at the age of 35 with this sporadic, debilitating pain in my lower abdomen again. After seeing the gynecologist and doing an ultrasound, once again there was nothing suggesting why there is pain. So, the doctor gave me my options: 1) exploratory surgery 2) hysterectomy 3) deal with the pain every so often.

Right now, I am dealing with the pain. The doctors and I agreed that a hysterectomy was probably in my future but wanted to wait until I was closer to 40. So, I started to keep a pain journal. I’ve found this to be very important both in managing my own illness – I was able to see, for instance, a link between my caffeine and alcohol consumption and pain – and in helping doctors to see patterns that can guide treatment. People, doctors and friends alike also take you more seriously when you’re able to demonstrate exactly what you’re experiencing and when you felt it. I made a chart based on a 28-day cycle and kept track of things I ate or drank that might be potential triggers, when I had discomfort, and what seemed to make me feel better.

I sought out the support of other women with endometriosis. No one can really understand until they’ve been through it themselves. In the meantime, I keep looking after myself! A diagnosis of endometriosis may feel like the end of the world, especially at first, but I continue to find that it’s not!

Mallory Connelly

Mallory Connelly

Babies & Toddlers

In addition to the time I devote to being a mom, I also work full-time outside the home, which means my day is hardly ever as simple as nine to five. With an all-too-established schedule, as soon as I walk through the door, my day doesn’t end, but rather just begins. It’s a balancing act, especially with two children, but being a mom is one full-time job that I never want to quit!

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Should Pregnant Women Get the COVID-19 Vaccine?

Should Pregnant Women Get the COVID-19 Vaccine?

I’m pregnant, should I get the COVID-19 vaccine?

This is a good question that many pregnant women or women thinking about becoming pregnant are asking. As a maternal-fetal medicine specialist, I’ll answer this and a few other questions in this blog.

Everything we do or do not recommend comes down to risks vs. benefits. This is true in all aspects of life. Riding in a car carries a small chance of a car accident, but we take that risk frequently. Riding with a 13-year-old driver on the interstate, this is a risk we’re not so willing to take. (Sorry, Zoe. My 13-year-old daughter is very responsible, just not quite ready for the interstate.)

Vaccines & Pregnancy

As a baseline, there are two vaccines we routinely recommend during pregnancy:

  • Flu vaccine
  • TDAP or Pertussis

Why are these vaccines recommended?

Flu vaccine: Pregnant women tend to get sicker or have more pulmonary complications with the flu. When this happens and you have a high fever or low oxygen level, you are at increased risk for preterm labor and other pregnancy complications. So, we don’t want you to get the flu while you’re pregnant, and the best preventative measure is the vaccine. This was especially important with H1N1, as the pulmonary complications were worse than other strands of flu. Increased pulmonary complications are also being seen with COVID-19. The flu vaccine, however, had been around for years. So, there had been exposed pregnancies and it felt safe, though there had been no actual randomized trials.

TDAP/Pertussis: About 15 years ago, we started to see an increase in Pertussis in the U.S., primarily from immigrants that were not routinely immunized in their countries. Since the vaccine doesn’t work until the baby is older, they looked at cord blood levels and found if you gave the mom the vaccine in the third trimester, you would give the baby high levels of antibodies that would protect the baby. It was considered low risk, since there had been lots of inadvertent exposure and no bad outcomes. Again, there was no formal randomized study.

How does this relate to COVID-19 vaccines?

Although the Pfizer and Moderna vaccines are new mRNA (messenger RNA) vaccines and the first of their kind, the technology behind these vaccines has been in place for years. This led to the advantage of being able to develop these vaccines faster than traditional vaccines.

mRNA DOES NOT change your DNA. It is just a recipe that your cells use to make a protein that is found in the COVID-19 virus. Your body recognizes that protein as “foreign” and builds antibodies to destroy it. Traditional vaccines inject the protein(s) itself.

There is no theoretical reason to believe that an mRNA vaccine would be harmful to pregnancy. The people who are immunized and pregnant or become pregnant are being registered to do follow ups to get data to prove this, but for now we have to go with our best theory.

Yes, there are risks of reactions to the components of the vaccine, and because your body is “fighting” the protein, you may feel a little ill, but that’s OK. This also happens with more traditional vaccines like the flu. Overall, the risk is low, but there are some theoretical unknowns, just to be honest. (But there are a lot of low risks we take in life: Did you know you can get listeria from lettuce? – just to be honest.)

What risk does COVID-19 present for pregnant women? I’m weighing the risk vs. the benefit of the vaccine.

With pregnant women, 1-3 per 1,000 with COVID-19 get severe symptoms compared to those who aren’t pregnant. Pregnant women are:

  • Three times more likely to need ICU care
  • Two to three times more likely to need advanced life support and a breathing tube
  • Have a small chance of dying due to COVID-19

New data is also showing pregnant women are at an increased risk for stillbirth and preterm birth.

To summarize: The benefit of the vaccine is that it prevents or lessens the severity of COVID-19. COVID-19 is very contagious. Women who contract COVID-19 while pregnant have higher risk factors than the general population, including the increased need for ICU care, ventilator support, and a probable increased risk of stillbirth/preterm delivery. You DO NOT WANT COVID-19.

Other Common Questions About the COVID-19 Vaccine

Here are a few additional questions people often have about the COVID-19 vaccine.

What about breastfeeding and getting the vaccine?

Vaccination while breastfeeding is currently recommended. The risks are not yet known since like pregnant women, no studies were done on lactating women. However, one great benefit is if mom is vaccinated she will not be exposing her baby inadvertently to COVID-19.

Is there someone who doesn’t need the vaccine?

If someone has allergies to any ingredients in the vaccine or has been otherwise recommended by a physician to not receive the vaccine, then you would not be a candidate.

Is there someone who should get the vaccine?

Although it is still up to each person, health care workers, essential workers, people at high risk for exposure or with other preexisting conditions, including those of Latin and African descent, should strongly consider getting the vaccine.

What if I had COVID-19 already?

Current recommendations are to wait about 90 days after you had COVID-19 to get the vaccine.

Does the COVID-19 vaccine cause infertility?

There’s no reason to believe the vaccine would cause infertility. There has been no evidence of this in prior animal studies.

Medical Resources for Your Review

The Society for Maternal Fetal Medicine has a talking points guide for you to discuss with your health care provider.

I encourage you to View this Guide and talk to your health care provider.

Sean Kenney, MD

Sean Kenney, MD

Maternal-Fetal Medicine Specialist

Dr. Kenney is a Maternal-Fetal Medicine specialist with the Center for Maternal & Fetal Care, part of the Bryan Physician Network.

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The Surprising Risk of Sepsis for Pregnant Women, New Moms and Newborns – What You Need to Know

The Surprising Risk of Sepsis for Pregnant Women, New Moms and Newborns – What You Need to Know

As an infectious disease pharmacist and member of Bryan’s Sepsis Committee, I have seen many cases of infections and sepsis in many different patients. I specialize in getting the right antibiotics to patients with severe infections like sepsis, and work mostly with adult patients.

Now that I’m a father and we are expecting again very soon, I started looking deeper into the risk of sepsis for pregnant women and newborns. And, I was surprised at what I found.

Infections are a Serious Risk for Pregnant Women and Newborns

Thanks to improved prenatal care, most pregnancies and deliveries happen without complications. However, infections are still a serious risk for pregnant women, new moms and newborns. In fact, recent data shows an increase in sepsis-related deaths for pregnant women in the United States.

Newborn sepsis remains a leading cause of death among infants. There are two times sepsis can occur in infants:

  • Before a baby is 72 hours old, called early-onset sepsis. This is usually the result of viruses or microorganisms passed from the mom to the baby in-utero or during delivery. The incidence of this type of sepsis has decreased considerably since the 1990s due to new health screenings for pregnant women
  • After a baby is 72 hours old, called late-onset sepsis. This is usually the result of viruses or microorganisms acquired in the environment or through invasive procedures

What Exactly is Sepsis?

Sepsis is a potentially life-threatening condition caused by the body’s response to an infection. Basically, it’s when your body “over-reacts” to an infection. This can cause your organs (i.e. heart, kidney, liver, lungs, etc.) to fail, and can lead to death. Sepsis can be thought of as the sickest a person can get from an infection. Lots of people get infections, but not everyone develops sepsis. Some people are at a higher risk of developing sepsis than others.

What Can Increase Your Risk of Pregnancy-Related Sepsis?

Many of the risks are associated with the individual person and the type of pregnancy, such as:

  • Have never delivered a baby before (called nulliparity)
  • Currently pregnant with or recently delivered twins, triplets, etc. (called multiple gestations)
  • African American race

Others are associated with the type of delivery or medical therapies, such as:

  • Cesarean-section delivery (i.e., C-section)
  • Assisted reproductive technologies (i.e., artificial insemination, in-vitro fertilization, etc.)

What Can Increase the Risk of Sepsis in Newborns?

Some are associated with mom:

  • A common bacteria called Group B Streptococcus (GBS), most of the time this is not harmful but it can cause a severe infection in some newborns
  • Inflammation of membranes surrounding the baby due to bacterial infection (this is called chorioamnionitis)
  • Currently pregnant with or recently delivered twins, triplets, etc. (called multiple gestations)

Some are associated with the birth:

  • Prelabor rupture of membranes (occurs when the amniotic sac breaks before labor begins)
  • Prolonged rupture of membranes (over 18 hours)
  • Preterm birth (defined as a birth before 37 weeks)
  • Low birth weight

Some are associated with procedures after birth:

  • Invasive procedures such as a cervical stitch
  • Prolonged use of antibiotics
  • Prolonged use of a catheter inside the baby’s body
  • Ventilator associated pneumonia

What are the Warning Signs of Sepsis?

The signs and symptoms are different for moms and babies. It’s important to know the warning signs and seek care immediately. The sooner you or your loved one receives care, the better the chance for a full recovery.

Sepsis symptoms in pregnant women or new moms:

  • Shivering, fevers, shakes or very cold
  • Extreme pain or discomfort (feel the “worst you have ever felt”)
  • Pale or discolored, or clammy/sweaty skin
  • Sleepy, difficulty waking up, confused
  • “I feel like I might die”
  • Shortness of breath
  • Decreased urination

Sepsis symptoms in newborns:

  • “Just not looking right”
  • Unusually sleepy, lethargic or difficult to wake up
  • Unusually irritable, inconsolable
  • Not feeding or eating normally, vomiting
  • Less than three wet diapers or stools in a day
  • Fever or hypothermia (low temperature)
  • Shivering, shaking or poor muscle tone
  • Respiratory distress (not breathing right)
  • Abdominal distention or bloating
  • Bulging fontanel (soft spot on a baby’s head)
  • Unexplained jaundice (yellow skin)
  • Blood in stools

Take Action

If you see a combination of the above symptoms and suspect sepsis, or just feel like something isn’t right, call your doctor or go to the emergency room IMMEDIATELY. It’s important to say “I’m concerned about sepsis”. The sooner treatment is started, the better chance you or your loved one has of surviving and making a full recovery.

When caught early, immediate administration of IV antibiotics and fluids can be all you need to make a full recovery. The longer someone delays getting treatment for sepsis, the greater the likelihood that the person will have severe complications such as kidney failure requiring dialysis or problems taking care of themselves (such as walking by yourself, bathing, brushing your teeth, etc.). It can even lead to death.

Be Informed, Tell Others – Let’s Raise Awareness and Save Lives

As an infectious disease pharmacist, treating sepsis and letting others know how to recognize the signs and symptoms of sepsis is my job. As a new father and husband, it’s my passion.

Sepsis is always a serious condition. The sooner signs and symptoms are recognized and treatment is sought, the better chance to save a life. Every patient is somebody’s loved one, and now that I’ve got two little ones depending on me, I feel even more responsibility to make sure people understand how serious and common sepsis actually is.

Prevention of pregnancy-related and newborn sepsis starts with good prenatal care, good hygiene and frequent handwashing. Bacteria and viruses are naturally found on surfaces and easily spread by unwashed hands.

I urge you to tell everyone you know about the signs and symptoms of sepsis as well as the ways to prevent it. With your help, we can increase awareness of sepsis so people will seek treatment sooner, and lives will be saved.

Learn More About Sepsis

To learn more about sepsis, listen to our Bryan Health podcast. Bill Johnson, MD, Nebraska Pulmonary Specialties, tells you how to spot sepsis, and how early diagnosis and treatment can be lifesaving.

Kevin Sponsel

Kevin Sponsel

Infectious Disease Pharmacist

Kevin Sponsel is an infectious disease pharmacist and a member of Bryan Health’s Sepsis Committee.

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Plastic Surgery after Babies…Yay or Nay?

Plastic Surgery after Babies…Yay or Nay?

Saggy breasts, excess skin and my favorite, the love pouch. Like most women, my body changed after having kids. It wasn’t until I knew I was done having babies that I considered plastic surgery.

Mothers, by nature, are givers. We take care of our children, our husbands, our coworkers, other family members and friends…all before we think of ourselves. It’s rare for a mom to schedule time or activities just for herself, without feeling some degree of guilt that she’s taking time away from her family or work.

My body image is directly related to my self-esteem and how I view myself. When I feel fit, healthy and sexy, everyone benefits. My family sees a happy, confident, energetic mother who serves as a great role model.

Finding Pride in a Mother’s Body

I am proud of this body. It made two beautiful children. This is the body God gave me and I’m grateful. I’ve put in the work, I’ve lost over 40 pounds in the last year and a half, and I continue to workout and eat healthy almost every day. I’m full of energy and overall happier with my transformation. Yet, the excess skin is still there, and I’m self-conscious of my mid-section and my nonexistent boobs. I want to look as good as I feel. My children see me push through every workout. They see me say no to desserts (most of the time). Now, I want them to see my happiness. I want to see my gains in the mirror but all I see is a big stomach.

It is NOT selfish or vain for a woman to want to look good! A mother deserves to look as fit, youthful and toned as she can. Who wouldn’t want to look their very best physical self?

How a mother feels about herself as a wife and a woman is integral to her body image and self-esteem. When we look our best, we feel more secure and reflect that to others, exuding confidence, happiness and overall attractiveness. When a mother feels confident about her body, she is happier overall, her marriage benefits and so does her relationship with her children.

The Pros and Cons of Having Plastic Surgery

I know the pros and cons of having plastic surgery but the struggle I can’t seem to come to terms with is: how can I explain to my daughter that you should love yourself the way you are and that the way you look on the outside doesn’t matter, then turn around and get plastic surgery to fix something about me? However, she sees me struggle and my want for something I can’t seem to obtain on my own. Should that be enough justification? Does it make me a bad mom to say one thing and do another?

For a mom to want to take care of herself and feel youthful, feminine and attractive is NOT self-centered or unreasonable.

Having a surgical procedure is a BIG DEAL. Surgery should not be taken lightly, and planning for recovery time and help with child care, driving and the usual activities of daily living after plastic surgery is extremely important.

As long as you can afford the time needed for surgical recovery, have help in caring for your children and understand fully the risks of surgery, I can completely understand why a mom would consider going under the knife! However, knowing that you should love your body and yourself is the main priority. If you’re happy with yourself but want to enhance or better your body, then there’s no problem with considering plastic surgery.

Schedule Your Free Consultation

Did you know Dr. Cassidy Mitchell, plastic and reconstructive surgeon, offers free consultations to answer your questions and help you decide if plastic surgery is right for you.

Mallory Connelly

Mallory Connelly

Babies & Toddlers

In addition to the time I devote to being a mom, I also work full-time outside the home, which means my day is hardly ever as simple as nine to five. With an all-too-established schedule, as soon as I walk through the door, my day doesn’t end, but rather just begins. It’s a balancing act, especially with two children, but being a mom is one full-time job that I never want to quit!

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Advice about Eating Fish: What Pregnant Women and Parents Should Know

Advice about Eating Fish: What Pregnant Women and Parents Should Know

Can you eat too much Salmon or Tilapia?

A healthy diet during pregnancy is important for the proper growth and development of your baby. As a specialist in Maternal-Fetal Medicine, I am often asked about eating fish during pregnancy. 

  • How much fish can I eat?
  • Can I eat sushi?
  • Are there “good” and “bad” fish to eat during pregnancy?
  • Is fish good for my baby’s brain development?
  • What about mercury? That’s bad, right?

Luckily, there are some clear guidelines about eating fish for pregnant women, infants and children, and people in all stages of life!

How does eating fish affect my baby’s health and brain development during pregnancy?

  • Fish, including finfish and shellfish, is low in saturated fat, high in protein and healthy to eat during pregnancy. It is also the primary dietary source for two n-3 (also called omega-3) long-chain polyunsaturated fatty acids.
  • For your baby’s optimal eye and brain development, moms need to include foods with omega-3 fatty acids in their diet.
  • Omega-3 fatty acids are especially important for moms during the last trimester of pregnancy and while breastfeeding as this is when your baby’s brain is rapidly developing.
  • Omega-3 fatty acids are also available as supplements and in fortified foods such as milk, yogurt, bread and even chocolate. You’ll just need to read the nutrition label to find out if the food includes omega-3 fatty acids. This can be an alternative source of omega-3 fatty acids for women who cannot or choose not to consume fish.

What about mercury?

  • While mercury is present in all fish, the levels vary depending on the type of fish.
  • One to three servings per week of a variety of seafood high in omega-3 fatty acids and low in mercury are recommended by the United States Food & Drug Administration and Environmental Protection Agency.
  • Mercury, also called methylmercury, is toxic to your baby’s developing brain. For this reason, it is important to avoid eating fish high in mercury. It cannot be ‘cooked out’ of the fish, and over 95 percent of it is absorbed. You want to gain the benefits of omega-3 fatty acids that fish provide while limiting the negative side effects of mercury.
  • Avoid eating fish high in mercury such as: king mackerel, marlin, orange roughy, shark, swordfish, tilefish (Gulf of Mexico), tuna and bigeye.

Can I eat fish caught at a lake, river or coastal area?

  • Fishing is a popular pastime for many Nebraskans.
  • Check for advisories about the safety of eating fish caught in areas where you plan to fish. This can usually be found on websites or through a Google search.
  • If no advice is available, the United States Food & Drug Administration recommends limiting the amount of fish you eat caught in these areas to six ounces (one average meal) per week and not eating any other fish during that week.

What about sushi?

If you’re pregnant, you should only eat cooked fish. And if you love sushi, don’t worry! There are many sushi options that use cooked fish. You can usually find these options on the menu or you can ask your server.

Which fish are good for me, my baby and family?

To answer the question in this blog title, Salmon and Tilapia are in the Best Choice category, and two-three servings per week is recommended.

The following table sums it up nicely!

Advice for eating fish.

Follow this link for more advice regarding eating fish from the FDA.

What is a Maternal-Fetal Medicine doctor?

Benjamin Byers, DO

Benjamin Byers, DO

Maternal-Fetal Medicine Specialist

Dr. Byers is a Maternal-Fetal Medicine specialist with the Center for Maternal & Fetal Care, part of the Bryan Physician Network.

He has been in practice in Lincoln since 2014. Before this, he was a doctor in the US Army for 13 years, achieving the rank of lieutenant colonel. Although native to Iowa, he is an avid Cornhusker fan!

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