Q&A

  • Why do you need to see my insurance card at every visit?

We must view your insurance card at each visit to ensure that all information is the same as what we have in our system.

  • Do I need to bring in my old records and how do I get them sent?

Your prior records can be helpful, especially if the doctor’s medical decision-making will be
based upon information contained in your medical history. You can contact your
previous doctor’s office before your visit with us and have the records sent to our
office, or you can complete a form at your visit with us and we will fax it to the other
office for release of the records (you will need to provide their fax number).

  • Why do you recommend that I arrive 15-20 minutes before my schedule
    appointment time?

Arriving early allows you time to complete any necessary paperwork and gives our receptionists time to process your chart and any changes to your information. We strive to keep your wait time to a minimum and this makes it easier to keep our schedules running on time to better accommodate our patients.

  • I am running low on my prescription – how do I obtain more medication?

Depending upon individual circumstances, we reserve the right not to prescribe medications without the benefit of evaluation by history and a physical examination.

  • When should I have my first pap smear?

At age 21.

  • How often do I need a gynecologic exam and / or pap smear?

If you are taking birth control pills, sexually active with more than one partner or having any gyn problems, you need an exam once a year. Pap smears may be recommended more frequently if they are abnormal. However, you still need annual visits including a screening mammogram with a breast and pelvic examination.

  • What is a thin prep pap smear and why is it better?

Thin prep is a liquid based pap test. The collection and processing method used in this test provides a better cell sample for analysis. Thin prep has become the preferred test over the conventional pap because it has been more effective in the detection of abnormal cells. Our office uses the thin prep pap test unless you specifically request the conventional test at the time of your visit.

  • What if my pap smear is abnormal?

Our office automatically screens all paps with atypical squamous cells of undetermined significance (ASCUS) for the high risk human papilloma virus (HPV). This virus is the most common reason why abnormal cells are found with pap smears. You will be scheduled for an office procedure called a colposcopy to take a closer look at your cervix for abnormal cells. Follow-up may require only monitoring or may involve treatment if cell changes are significant. Click here for additional information on pap smears and abnormal results. For more information about HPV click here.

  • Do I need to be screened for Sexually Transmitted Diseases (STDs)?

We recommend screening for all women who have been sexually active with more than one partner. Tests may include Chlamydia, gonorrhea, HIV, Hepatitis B and C, Herpes Type 1 & 2 and syphilis. Consider screening on an annual basis if you have had unprotected intercourse with a new partner. Click here to know more about how to prevent STD. Contact our office any time for STD screening if you are worried you may have been exposed or are showing symptoms of an STD.

  • What is Gardasil?

Please click here for information about this vaccine.

  • What birth control method is best for me?

There are many contraceptive methods available depending on your interests and lifestyle. Most people are familiar with birth control pills that are taken on a daily basis. Click here for more information on the pill. The Nuva Ring is more convenient, it is inserted like a tampon and stays in the vagina for 3 weeks. It is very comfortable and very discrete. Other options include the Depo provera shot, and Mirena IUD. The shot is given every 3 months and eventually makes your periods go away. The Mirena is available for women who have had children and want reversible contraception. This IUD is good for 5 years and helps to reduce heavy periods. Contact our office for an appointment to further discuss the best option for you.

  • Can I skip periods with my birth control pills?

Yes, many women are taking continuous birth control pills and choosing to have a period every 3 months instead of every month. A new pill called “Seasonal” contains 84 active pills and one week of placebo pills in one pack. You can also do this with regular monophasic pills (skip the 4th week of pills), the Ortho Evra Patch and the Nuva Ring. When you are ready to have a period, discontinue your contraception for 5-7 days, then restart it. Initially, you may experience occasional spotting, but this improves with time. It is not harmful to skip periods while taking birth control and many women with menstrual problems benefit from this type of schedule.

  • What is emergency contraception?

Emergency contraception (EC) is a way to prevent pregnancy after a condom accident, unprotected intercourse or if you forget 2 or more days of birth control pills. EC must be taken within 72 hours of sexual activity in order to be effective. Our office prescribes “Plan B” which has fewer side effects. EC does not cause an abortion and will not harm a pregnancy if a woman is already pregnant. Contact our office if you need a prescription called in.

  • Is it normal to miss my period?

It is not uncommon for women to have very light to non-existent periods on birth control pills. This is fine because the pill protects the uterus from abnormal cells. Missing periods when you are not on the pill can be a sign of menopause, perimenopause, pregnancy or a hormonal imbalance. If you miss 3 periods and are not pregnant, you should contact our office.

  • What is abnormal uterine bleeding?

Bleeding that lasts longer than 7 days or comes more often than 21 days needs evaluation. Abnormal bleeding can be due to pregnancy, abnormal cells, mechanical problems (fibroids, polyps) or a hormonal imbalance. Abnormal bleeding after age 35 or any bleeding after menopause needs evaluation by your provider. Intermittent spotting on birth control pills is common in the 1st three months or if a pill is taken late.

  • What can I do for menstrual cramps?

You can try any over the counter product with Ibuprofen (Motrin) or naproxen (Aleve). Start taking this medicine when you first feel the first signs of your period beginning. For most women, 400-600 mg of Motrin or Aleve 1-2 tablets will relieve cramps. A warm heating pad over the abdomens is helpful too. Birth control pills may provide additional relief. If you still have significant cramps after trying the above, please contact our office for an appointment.

  • What can I do about urinary leakage?

This problem is more common than you think and can be helped. “Accidents” can occur with stress (coughing, exercise, etc.), or the urge to use the bathroom. Overuse of certain foods such as caffeine or citrus can add to the problem. Please contact our office for an evaluation. There are several treatment options available to help meet your needs. Click here to learn more about urinary incontinence.

  • When should I begin getting mammograms?

Routine mammograms should begin at age 40 unless specified otherwise by your physician or nurse practitioner. Talk with your provider if you have a family history of breast cancer especially under the age of 45. This would accelerate the start of mammogram screening for you. Many insurance companies will approve a one-time screening mammogram between the ages of 35-40. Check with your carrier to ensure it is a covered expense. To learn more about breast problems, click here.

  • How do I treat hot flashes now that I’ve stopped my hormones or don’t want to start them?

Hot flashes are mild for some women while other women are just plain miserable. We know estrogen works the best in relieving hot flashes during menopause, but hormone therapy may not be an option for everyone. Recent research on herbal remedies have mixed reviews as to whether they work and if they are safe. Some plant-based products have estrogen-like properties and very little is known about their relationship to the risk of breast cancer. Plants in this category include soy, black cohosh, and wild yam. Non hormonal medications that have shown to reduce hot flashes are in the class of anti-depressants. These include low doses of Effexor, Paxil, and Prozac, which can reduce hot flashes by 70%. Lifestyle changes that can reduce hot flashes include regular exercise, reducing your weight, avoiding spicy foods and caffeine, and staying hydrated. Talk to your provider on the best way to manage your symptoms.

  • What is a bone density scan?

Women are especially at risk for osteopenia (bone thinning) and osteoporosis (bone loss). A way to evaluate bone density is with an easy, quick, painless x-ray of your spine and hip joints. The type of bone density test performed frequently is a DEXA test (a way to evaluate degree of osteoporosis).

  • Who needs bone density testing?

Any estrogen-deficient woman felt by her provider to be at risk for osteoporosis is a candidate for bone density testing. This may include women on estrogen replacement. Other indications include x-rays of the vertebra showing osteopenia, osteoporosis, or vertebral fractures. If you have a history of steroid use of daily prednisone for 3 or more months or a history of primary hyperparathyroidism you may need a scan. A history of hyperthyroidism, smoking and regular alcohol use are also risk factors.

  • How do I prevent osteoporosis?

Your skeleton continues to grow until you are almost 30. During this time calcium and exercise are your best bets for increasing the density of your bones. Calcium 1200 mg a day and regular weight bearing exercises 3-5 times a week is recommended. If your diet doesn’t include dairy or other calcium rich foods, taking a calcium supplement with 400 IU of vitamin D daily is needed. Stay away from too many carbonated drinks as it can remove calcium from your bones. The above holds true as a woman ages to prevent bone loss. After menopause, women need to increase their calcium to 1500 mg a day and continue with regular exercise. Click here to learn about osteoporosis.

  • What is Gardasil?

Gardasil is a vaccine that helps protect against certain diseases caused by Human Papillomavirus (HPV). Gardasil helps prevent these diseases BUT will not treat them. You cannot get the disease from the vaccine. Click here to learn more.

  • Who can receive Gardasil?

Females age 9 through 26 years

  • How is Gardasil given?

You will receive 3 injections, the first dose at a date you decide, a second dose 2 months after the first and your 3rd dose 6 months after the 1st dose.

  • Is there other information that I should know?

Gardasil will not protect against diseases due to non-vaccine HPV types. There are more than 100 HPV types. Gardasil helps protect against 4 (6, 11, 16 and 18). These 4 types have been selected for Gardasil because they cause approximately 70% of cervical cancers and 90% of genital warts. This vaccine will not protect you against HPV types to which you may have already been exposed. Gardasil works best when given before you have any
contact with certain types of HPV, but may still be given to those who have tested
positive for HPV in the past.

  • What are the side effects?

Most commonly pain, swelling, itching, fever and redness at the injection site.

Cost: $275.00 per injection (this includes vaccine and administration) for a total of
$825.00. Self Pay patients will pay $220.00 per injection. We will verify your benefits
with your insurance prior to the injections. Non covered vaccines must be paid for at
the time of injection, as we order this just for you.

  • What should I do if I want to receive the vaccine?

If you decide to proceed with the vaccine you should first contact your insurance company to verify your benefits for this medication – the diagnosis code is V04.89 and the Gardasil is 90649. You can call our office to schedule the injection. If your insurance does not cover Gardasil and you will be self-pay, you may obtain the medication at our office by paying out of pocket.

  • I am pregnant – when should I have my first visit?

Your first visit should be as soon as you suspect pregnancy. Gestational weeks are counted beginning with the first day of your last menstrual period. If you are unsure of your last menstrual period or have had any prior history of miscarriage, we would like to see you for a “confirmation of pregnancy” visit. Please call our office to schedule this appointment.

  • How long will the first prenatal visit take?

You can anticipate the OB work-up visit will last about 2 to 2 1/2 hours. It will entail completing several forms, and answering any questions you might have; an examination by the doctor and lab work.

  • What dietary recommendations do you give your patients?

Click here to see information about nutrition during pregnancy. Click here to see what to do for nausea during pregnancy.

  • Where does your practice deliver?

We are affiliated with Mercy Hospital.

  • Can I come if I plan to home-birth?

Our practice does not support home births because of the risks associated with them. We cannot assume the care for you through your prenatal course.

  • When should I start taking folic acid if I’m considering getting pregnant and can I take over-the-counter prenatal vitamins?

You should begin folic acid supplementation as soon as you decide you may attempt pregnancy. For more information about folic acid, click here. You can take over-the-counter prenatal vitamins as long as they contain at least 400 mcg or .4 mg of folic acid. Women at increased risk, that is with a family history of Spina Bifida, should take 4 mg (or 4000 mcg) of folic acid.

  • What do you suggest if my prenatal vitamin makes me nauseous?

Many patients have found that Flintstones Vitamins are tolerable. Taking two Flintstones Vitamins will suffice as a supplement.

  • How often will I come in and what tests will I have done during my pregnancy?

Click here to view the normal pregnancy schedule and a list of tests that should be performed.

  • How does the practice handle disability during and after pregnancy?

The great majority of expectant mothers can continue to work until late in pregnancy without any problem. Sometimes, however, the physical changes entailed in pregnancy or the demands of a woman’s job can create workplace difficulties.

Please let us know if you have any concerns in this regard. We usually are able to
suggest simple steps to deal with the fatigue, morning sickness, or aches and pains
that can be particularly challenging while you’re at work.

If you have more serious symptoms, or concerns about potential workplace hazards
to you or your baby, we will evaluate the situation and respond accordingly.

When medically appropriate, we will recommend that a pregnant patient be placed on
disability leave from her job. Such leave is rarely required, however, and in the
absence of a serious condition that would endanger the health of the mother or baby,
medical ethics prevents us from making such a recommendation. We will, however,
do everything we can to reduce or eliminate pregnancy-related difficulties you may be
having at work. This includes writing letters to your employer, when appropriate, to
recommend helpful adjustments to your duties.

We can often certify disability to begin a few days before your due date if you are
uncomfortable, although many women find that continuing to work takes their mind off
the discomfort of late pregnancy. Following an uncomplicated vaginal delivery, we will
routinely place you on disability for 6 weeks afterwards. Six weeks is routine following
a cesarean section. Any additional time you choose to take off beyond this must be
taken in the form of leave and should be arranged directly through your employer.

Again, please tell us of any work-related concerns you may have.

  • Can I have an epidural if I choose to?

Yes. The anesthesiologist will administer your epidural while the physician or midwife continues to manage your labor and delivery.

  • May I travel long distances while I am pregnant?

Yes, but only until you reach 34 weeks of pregnancy for international travel or 36 weeks for domestic travel. After 36 weeks you should go no farther than one hour away from the hospital without your doctor’s permission. You should stop every one to two hours and walk for about 10 minutes to increase circulation and prevent leg and feet swelling.

  • May I travel by airplane?

Yes, with authorization by your physician. Click here for more information about travel during pregnancy. Some airlines require a written letter from the physician authorizing travel by air. Remember if you go out of town, take a copy of your prenatal records with you.

  • May I go swimming?

Yes, provided you have not experienced a rupture of your membranes (water breaking)

  • May I go to the dentist while I’m pregnant?

Yes, and we encourage you to do so. Your dentist should use only local anesthesia and must cover the abdominal area during all X-rays. No nitrous oxide may be used.

  • May I get a hair permanent?

Yes. Remember, because of the changes in your body related to pregnancy, the permanent may not take.

  • May I have my hair colored/dyed?

Yes.

  • May I use a salt substitute?

No, because it contains potassium salts that could cause problems.

  • Are diet drinks okay?

Yes, after the first trimester (13 weeks), but try not to drink more than one a day.

  • May I drink coffee, tea or drinks with caffeine?

In moderation

  • When will I feel the baby move for the first time?

You may feel the baby move around 18 to 22 weeks. If this is not your first pregnancy, you may feel movement earlier.

  • May I have intercourse throughout pregnancy?

Yes. There are no restrictions as long as there are no complications (i.e. vaginal bleeding or premature labor). If in doubt, consult your physician. Intercourse is not allowed once your water has broken.

  • May I exercise during my pregnancy?

Yes, but only in moderation as directed by your doctor. Low impact or prenatal aerobic exercise classes, as well as walking and swimming are recommended. Remember, do not lie flat on your back during any exercise. Click here to know more about exercise during pregnancy.

  • May I sit in a Jacuzzi or hot tub?

No, because your body temperature could become too high. This could be harmful to both you and your baby.

  • Is alcohol safe?

Since no safe level of alcohol consumption has been documented at any point, our general recommendation is to avoid all alcohol intake throughout the entire pregnancy. If you have any further questions, please consult your physician.

  • I’ve been placed on bed rest – what can and can’t I do?

Guidelines for Obstetrical Bed rest

3 uninterrupted periods of recumbent rest at <90 (bed,
couch, recliner, etc.) lasting at least 3 hours each. This is in addition to night
time sleep.
House confined
Bathroom privileges
No lifting >15lbs.

* Sedentary out-of-house work only without physical exercise beyond
stretches.
* When not working, house confined and recumbent 3 hours every 1 hour
standing.

  • When leaving a message please be sure to include your full name, date of birth, and a contact number where we can reach you to discuss your question or concern. Your phone call will be returned as soon as possible.
  • All prescription refills and non-urgent questions must be handled during regular office hours. We will not phone in any pain medications or narcotics after hours. If you require this medication, please go to the emergency room to see the doctor on call.