Frequently Asked Questions
Dr. Daum's practice is different from many. He is in solo private practice and does not use nurse practitioners or PA's. Emphasis is placed on one to one contact, education, and physician availability. Dr. Daum, M.D. is progressive and innovative.
During pregnancy ultrasound is done in the office by Dr. Daum, M.D. with assistance one day a week by Vicki, our sonography technician. Sonograms are used liberally to answer questions or sometimes just for fun or reassurance. A sonogram will usually be performed at your first pregnancy visit. Sonograms are routinely photographed and videotaped with DVDs for keepsakes.
When pregnancies are complicated by maternal or fetal special needs a team approach may be helpful, including high risk pregnancy physicians and medical consultants. Management of labor is individualized, and a happy, successful experience is paramount. Whether you choose natural childbirth or epidural anesthesia, he will help you to have a great experience.
Generally three persons are allowed in the delivery room with you, making room for grandmothers and Dad. The choice of who attends your delivery is yours, and when difficult decisions arise, Dr. Daum, M.D. and the nursing staff will help with your needs. For gynecology patients Dr. Daum, M.D. is well versed in all phases of a woman's life.
Contraceptive options, adolescent development, menopause, and when surgery is needed, progressive in surgical techniques. Minimally invasive Laparoscopic and hysteroscopic surgery are his specialties. Treatment of urinary incontinence can be accomplished as day surgery, usually without catheterization. Dr. Daum's laparoscopic hysterectomy patients regularly are able to be comfortably discharged home the same day, Return to normal daily life is much more rapid, with most patients comfortably active within two weeks. Dr. Daum, M.D. has been an innovator and leader in laparoscopic surgery within the Methodist Hospital System.
Not usually, Dr. Daum, M.D. tries to see all patients, new and returning, within a few days to a week. Emergency walk-ins can usually be seen the same day.
Yes. The Nuva ring is a low dose oral contraceptive contained and dispensed through vaginal absorption from a soft, flexible ring. The ring is inserted and removed easily and is left in place for three weeks. Your period will come during the week the ring is removed. The Nuva ring usage cycle is easy, three weeks in, one week out.
Endometriosis is common. The most common symptom of endometriosis is pain. Pain arises from the irritation of pelvic tissues (uterus, rectum, ovaries, tubes, bladder) which arises from the secretion of chemicals from the implants of endometriosis. How does it start? There are genetic predispositions, and possibly some increased risk in redheads.
The most common an most easily understood explanation is that most women have retrograde (back through the tubes) menstruation. This menstrual blood contains living endometrial cells from the inside lining of the uterus. These cells implant and grow in the areas around and behind the uterus. Initially they may appear clear, but eventually take on a blue-black powder burn appearance. They make your pelvis sore.
These implants respond to your monthly hormonal changes as the inside of your uterus does. The result is cramp pain, often radiating to the back or to one side. Cysts of endometriosis can occur in the ovary and are called endometriomas. Since the pelvis is sore, intercourse often is painful, especially around your period. Pain often occurs at ovulation as well. Mild endometriosis may be more painful than advanced endometriosis.
Eventually scar tissue forms between the tubes, ovaries, pelvic sidewalls, rectum and uterus. Many times it seems like someone poured glue into the pelvis. At this stage infertility is common. In early stages there seems to be little effect on fertility. Some women are more able to destroy the endometrial cells in the retrograde menstrual blood. These people often do not develop endometriosis.
With others whose immune functioning is different endometriosis may begin to develop in the teen age years.
The answer to that question is totally dependent upon what your goals are. Initially, pain control is most important. Reductions in pain can sometimes be obtained by simply taking noncylic low dose birth control pills. (Skip the inactive last seven pills and have no periods). Endometriosis can be suspected clinically, but can only be diagnosed with laparoscopy.
Endometriosis can also be treated laparoscopically by destroying visible endometriosis with electrical energy (heat), excision, or by laser. Pain is often reduced but microscopic endometriosis is not treated. Endometriosis needs estrogen to grow and remain active. There are hormone treatments which will induce a month by month menopause.
With low estrogen levels you will have hot flashes, but the pain should resolve. Lupron is the most commonly used medication. Unfortunately many women with endometriosis will have recurring pain with the above mentioned conservative treatments. These treatments may be repeated, and may be effective each time.
Eventually, when your family is complete and if pain has returned, many women resort to hysterectomy, probably with removal of the ovaries. That is a dramatic step, but does in most all cases end the pain from endometriosis. Hormone replacement is possible and it is uncommon to have recurrences on reasonable doses of hormone replacement. There is hope. You can be free from pain.
Unfortunately, until the final definitive treatment, it is also likely to be a recurring problem. It is for that reason that I say that endometriosis treatment should be goal oriented, depending upon where you are in your life. It's not OK to have a hysterectomy when you want to have children. It may never be OK with you to have hysterectomy and lose your ovaries.
These are the topics you need to take the time to explore with your gynecologist. Don't accept only one proposal of treatment without considering your other options.
With the exception of cancer of the uterus, cervix, or ovary, most gynecologic surgery is done to improve quality of life. It's your life and your body, and choices as to how and when you proceed should be discussed thoroughly. Your needs and desires should be understood and respected by your gynecologist.
There are usually multiple ways to approach each particular problem. When surgery is needed, a well informed patient makes the best choices and will be most satisfied with the outcome. Surgical procedures carry risk, and even the best of surgeons will have complications.
Don't enter into a surgical situation without understanding the risks, and understanding your genuine need. Explore your options, question your gynecologist's experience and results. Searching the web is often helpful, but can sometimes be frightening.
Your ovarian cyst is very likely benign, but reading about ovarian cancer can scare anyone. The best solution is to talk to your gynecologist, avoid surgery for small problems and when large problems arise, proceed at your own pace. The patients who are most satisfied are those with genuine problems, who chose the best procedure available at the time, and reap the benefits of feeling better.
The quality of your life can be improved. You can and should be able to enjoy all the days of the month.
At least half of all pregnant women seem to have problems with constipation. One reason for this may be changes in hormones that slow the movement of food through the digestive tract. Sometimes iron supplements may also cause constipation.
During the last part of pregnancy, pressure on your rectum from your uterus may add to the problem. Here are some suggestions that may help:
- Drink plenty of liquids – at least 6-8 glasses of water each day, including 1-2 glasses of fruit juice such as prune juice.
- Liquids (such as coffee, tea and cola) which make you go to the bathroom should not be consumed. They will tend to create a negative water balance in your body and thus make your stools harder and more difficult to pass.
- Eat food high in fiber, such as raw fruits and vegetables and bran cereals.
- Exercise daily – walking is a good form of exercise. If those forms of treatment are not successful, you might consider skipping your prenatal vitamin for a few days, and adding a daily dose of Milk of Magnesia until regular again.
- The iron in the prenatal vitamin worsens constipation.
- If there is a boulder at the opening that you can't pass, then probably the best bet is the use of a disposable enema or a glycerin suppository. The enemas come in water and oil retention. The longer you hold them the better they will work. (sounds gross, eh? Not to the desperate.)
Most women can travel safely until close to their due date. For most women, the most comfortable time to travel is in the middle of pregnancy. Problems are least likely to happen during this time. During pregnancy, many women have concerns about seat belts. There is no question that you are much better off wearing your seat belt during pregnancy.
The baby is very well protected in the uterus from trauma, but car accidents are the most common source of trauma during pregnancy. The most common reason for fetal death is maternal death, and maternal death is much less likely in mothers who wear seat belts. Both lap and shoulder belts should be worn at all times. The lap belt should be worn low on the hips, not over the uterus. Also remember that after delivery, an approved car seat must be in you car in order to take your baby home from the hospital. We recommend you not sit with your legs crossed and that you get out to walk every two hours.
People also have concerns about flying during pregnancy. In general, there does not seem to be an increased risk for women who fly during pregnancy. Any woman who sits for long periods of time without getting up for a walk is at risk for developing a blood clot in her legs. For this reason, on flights over two hours, you should get up, stretch your legs, and take a walk up and down the aisle. Because of this, an aisle seat is usually advisable.
Our office recommends that patients do not travel at all in their ninth month, and restrict travel to within two to three hours from home during their eighth month.
The use of saunas, hot tubs, and tanning booths is not recommended in pregnancy. The extreme temperature could potentially damage the developing baby. Extremely hot baths are not recommended during pregnancy. Bath temperatures should be below 100 ° Fahrenheit.
Exercise can help strengthen muscles used in labor and delivery and lessen some of the discomforts of pregnancy. It may give you more energy and make you feel better. The type of exercise you can do during pregnancy depends on your health and how active you were before you became pregnant.
This is not a good time to take up a new, hard sport. If you were active before, you can continue to be within reason. If, for example, you play tennis, you can still play unless you have special problems or feel very tired. A good idea is to limit exertion to about 2/3 of what you could do before pregnancy.
Most of the time, a healthy woman with no complications in her pregnancy can keep working until the end of her pregnancy. Some may need to make some changes. If you are experiencing problems that you feel may be related to your job, please discuss this at one of your office appointments.
Your family should be able to help you at home as fatigue increases at the end of your pregnancy.
A certain amount of swelling (called edema) is normal during pregnancy. It occurs most often in the legs. Elevating the legs usually makes the swelling less by the next morning. Swelling can begin during the last few months of pregnancy, and it may occur more often in the summer.
Let your doctor or nurse know if you have swelling in your hands or face, because this may be a sign of another problem. A clue that your hands are swollen is that your rings are too tight. Never take medications (water pills) for swelling unless they have been prescribed for you.
- Elevate you legs when possible.
- Rest in bed on your side.
- Lie down with your legs raised on a small footstool or several pillows.
- Do not wear stockings or socks that have a tight band of elastic around the legs.
- If you must sit a lot on the job, stand up and move around from time to time.
- Try not to stand still for long periods of time.
The following suggestions may be useful in relieving nausea and vomiting:
- Remember, any calorie is a good calorie so eat what stays down for you.
- Foods may not be well tolerated include greasy or fried foods, as they take longer to leave the stomach or very sweet foods or spicy hot foods or foods with strong odors.
- Eat smaller, more frequent meals, that is six small meals and snacks.
- Drink fluids between meals, not with meals.
- Eat foods that are at room temperature or cooler. Hot foods may trigger nausea.
- Drink beverages chilled or cold. Decaffeinated soda is often well tolerated. Don't opt for diet soda, you need the calories right now.
- Eat slowly and rest after meals. It is best to rest sitting in an upright position for about one hour after eating.
- Dry toast, soda crackers, or dry pre-sweetened cereals may relieve periods of nausea.
- Keep track of when you feel nausea and what causes it.
- If continued vomiting occurs, do not eat or drink anything until the vomiting has stopped. As you feel better, try some small amounts of clear liquids (broth, Jello, apple, grape, or cranberry juice, and/or popsicles.)
- Tart or salty foods such as lemons or pickles may help decrease nausea.
- Avoid mixing hot and cold foods at a meal, as it may stimulate nausea.
- Ask your doctor about medicine to control nausea.
- Avoid eating in a room that is stuffy, too warm, or has cooking smells/odors that may disagree with you.
- Wear loose fitting clothing.
- To avoid the sight/smell of foods, eat meals out or have others bring prepared food to you.
- Call your doctor if you are unable to keep anything down for more than two days or fainting or vomiting blood or rib pain or Jaundice (skin is greenish or yellow) or your weight drops more than five pounds within a week.
When bleeding happens, it is frightening. Am I losing the baby? is bound to be the biggest fear in early pregnancy. Bleeding in early pregnancy does not usually mean miscarriage, but it can be one of the early signs that the pregnancy is not going well.
How can I tell what is going to happen?
There are two different ways to investigate bleeding in early pregnancy.
When bleeding happens very early, hormone levels can be measured and followed to help determine if things are going well. HCG and Progesterone levels can be checked in your blood, and if the level of progesterone and the increase in HCG levels is normal, your pregnancy is probably doing well. HCG levels in early pregnancy should double about every three days.
When can we see the baby on sonogram?
The pregnancy sac can be seen before the baby.
When HCG levels are greater than 1500, Dr. Daum should be able to see the sac with transvaginal sonograms. If the sac is not visible at this hormone level, the possibility of an ectopic (tubal) pregnancy must be considered. If the sac is seen in the uterus, the baby and a heartbeat should be able to be seen by about 6 1/2 weeks from the last period. Seeing the heartbeat usually means that things will be OK.
How will I know the danger is over?
When the baby's heartbeat is seen, everyone can breathe a little easier. Miscarriages usually happen before 10 weeks of pregnancy, and are very unusual after 12 weeks.
When bleeding happens and the heartbeat is there, more frequent sonograms may be done to make sure the baby is growing normally. When bleeding stops and the pregnancy reaches 9 to 10 weeks, usually the danger is past.
Why do miscarriages happen?
Most early miscarriages happen because something went wrong with the combination of the sperm and the egg.
The majority of first trimester miscarriages contained an abnormal number of chromosomes. Normal pregnancies have 46, but miscarried pregnancies may have 45, 47, broken chromosomes, or completely duplicated sets. Health problems and severe illness can be related to miscarriage, but are not common. Most losses are random events and not related to your feelings, stress, or physical activity.
Unless you have had multiple miscarriages in a row, your risk of miscarriage in your next pregnancy should not increase. Have faith, things should go well next time.
For women at term deciding when to go the hospital is not always easy. Sometimes it will seem like labor and next thing you know you have been sent back home. Many times these frustrations are unavoidable. It can be difficult to tell whether labor is true or false labor.
Your goal should be to get to the hospital when labor is advanced enough that your cervix will be dilating. If you are observed for several hours and your cervix doesn't change, you may be sedated and sent back home to wait. If this happens it doesn't mean you're not in early labor, and it certainly doesn't mean you're not in pain. It probably means you are still in prodromal labor, and that more time is needed to enter active phase labor.
In general, 5:1:1 is an easy rule to remember. Your contractions should be 5 minutes apart (or closer), lasting for 1 minute, for 1 hour of timing. If you make all three of these criteria you will probably be in early labor. Don't worry too much about not getting there in time. Most women will have contractions as close as 2 minutes apart as they enter the advanced stages of labor.
If your water breaks, well, the 5:1:1 rule doesn't apply. Within a reasonable period of time you should go to the hospital. What is a reasonable period of time? Within a few hours. Don't stay at home for long periods of time waiting for contractions. If you aren't sure what to do, call Dr. Daum, M.D. He will help you decide how to proceed.
This depends on whether you are breastfeeding or not. If you are not breastfeeding, your first period will occur about two months after childbirth. However, there is no way to know when you begin to ovulate again - 90 percent of women will not ovulate before their first period. So contraception is essential if you have sex soon after childbirth.
If you are breastfeeding, your period may resume at any time from about two months after childbirth. Some women only get their period back once they stop breastfeeding. It is important to know that breastfeeding is not a form of contraception. It is the sensation of the baby sucking that send a message to the brain to suppress the hormone that stimulates ovulation.
There is no way to cease the production of breast milk. If you choose not to breastfeed or want to discontinue breastfeeding, the following will assist in allowing you a break to return to normal as quickly as possible:
- Wear a good, supportive bra.
- Avoid stimulation of the breast, especially the nipples.
- Use Tylenol or Ibuprofen as needed for discomfort.
- Cold cabbage leaves applied to the breast may be helpful, or an ice pack.
It will usually take several days for the engorged breast to return to normal.
The most commonly accepted definition of infertility is failure to conceive over one year of unprotected intercourse. This will happen to 10 to 15% of couples, and presumes that you have intercourse frequently enough to have the sperm and egg meet.
How often is that?
If you have regular periods every twenty eight to thirty days, ovulation should occur around day fourteen to sixteen. (Day one is the first day of your period.) It may be that you only need to pay closer attention to sex every other day beginning around day 12.
Sperm will live in the tubes for three to five days waiting for an egg to pop out. I have had many couples having problems who succeeded just by changing their timing of sex.
It takes longer to conceive when you are older. After 35 it is not uncommon to take 8 to 12 months to conceive. Earlier in life it is common in the first 3 to 6 months.
What should I be doing?
If you think you may have a fertility problem, keep track of your periods and mark when you had intercourse. 40% of fertility problems are male, and it might be worth going ahead and getting a semen analysis done through his family doctor. He needs to abstain from ejaculation for 48 hours prior to providing the sample.
Many men have problems with their virility and egos all tied up in their sperm counts. Be sensitive in how you approach the topic, and tell him that you will be going to the gynecologist after the results are obtained. Feel free to bring him along to the initial consultation.
The basic evaluation is fairly simple to understand. There have to be sperm of good quality. They have to meet with the egg at the right time. The passageway (cervix, uterus, and tubes) must be open. And finally the uterus must be able to accept the fertilized egg. There are tests to address each of these steps.
Call and make an appointment to discuss your situation. It doesn't hurt to take a few of the above mentioned steps to get a head start. Don't keep basal body temps. It creates too much stress. Stress and anxiety are among the hardest of things to deal with is these situations. We can check for ovulation by measuring blood tests for progesterone. Good luck. It will happen.
Bacterial Vaginosis (BV) is the most common of vaginal infections. It will usually present as a gray-white discharge, and is often accompanied with an unpleasant odor. Often it is the odor which bothers women the most, and it is most noticeable after intercourse. The normal vaginal flora consists of predominantly lactobacillus acidophilus.
Acidophilus produces acid as it grows and suppresses the growth of other bacteria. If this balance is disturbed ( antibiotics, douching, etc.) other bacteria will overgrow. BV is not usually considered sexually transmitted, and treating the partner is unnecessary.
Treatment is aimed at killing the abnormal bacteria with antibiotics specifically not affecting acidophilus. Unfortunately, BV is commonly recurrent, and repeated treatments or modifications of behaviors such as douching may be needed.
Generally, if you miss a pill, take it as soon as you remember. If it is the next day, and you haven't taken yesterday's pill take both pills that day to catch up. You generally won't get pregnant from missing one pill. If, however, you miss one of the first four or 5 pills in a new pack, you do have a significant risk of pregnancy.
Catch up on your pill and use protection (condoms, abstinence) for two weeks. If you miss two pills, many times you will have break through bleeding (bleeding when you are not supposed to be on your period). You should probably catch up on one pill, but taking three pills in one day will make many people sick (Nausea).
If you miss two pills in a row, one of the pills in the first week, or if you take antibiotics while on the pill, use a backup method for two weeks.
Mirena® provides over 99% contraceptive efficacy. Mirena® is a relatively new IUD, (Intrauterine Device), with the stem of the IUD impregnated with levonorgestrel, the progestin hormone found in many birth control pills. It is an extremely effective, very low maintenance, long lasting form of birth control. Once inserted, it is immediately effective, and lasts for 5 years. It is ideal for insertion when breast feeding, avoiding most of the initial side effects.
What side effects?
Well, Mirena® has the potential to completely eliminate your periods. This is accomplished by the high hormone concentrations in the uterus itself. The lining of the uterus gradually thins to the point that it no longer bleeds. The thinning of the lining is accomplished by bleeding it down to its thinnest possible thickness. When you are breast feeding the lining is already thin, and the break-in time is very short. If you are not breast feeding, the bleed down period can be two to three months.
What does that mean?
Well, you may bleed irregularly for two to three months. Sounds terrible. However, this is similar to what can happen with other hormonal methods such as birth control pills or deprovera (the shot). Once you get through this time, many women will have either very light periods or no periods at all!
Is that healthy?
Yes. Bleeding represents failure to conceive, and the body preparing for the next cycle, attempting to conceive again. The bleeding with your period is not cleansing the uterus, and the lost blood wastes iron from your body. Imagine.... 5 years with no periods. Your ovaries continue to make your normal hormones, but the strong effect of the IUD directly on the uterus prevents bleeding.
How likely am I to really have no periods?
Most women will have only very light occasional bleeding. This is more likely if you are relatively thin. Heavier women make more estrogen, and are less likely to have complete absence of periods.
Doesn't this sound too good to be true?
It may be too much to expect. Some women will have pain from the presence of the IUD, which is a foreign body in the uterus. If you have exposure to more than one sexual partner, the risk of infection in the uterus and tubes may be increased.
Women with Bacterial Vaginosis (see What is Bacterial Vaginosis?) may have more problems with bleeding and pain. A serious infection could make it harder for you to get pregnant. If you get pregnant with the IUD in place, you are more likely to have a tubal pregnancy.
Some women will absorb enough of the hormone from the IUD to have mild side effects such as oily skin or acne, breast tenderness, or moodiness. Sometimes the irregular bleeding persists and women just give up on the IUD.
Removal of the IUD, like insertion, is short office procedure performed through a speculum, like a pap smear. The insertion can cause painful cramping, so it is good to take ibuprofen prior to coming in for insertion. If you are not breast feeding, the IUD is inserted while you are on your period. Fertility returns immediately after removal of the Mirena®, unlike the shot, which may take up to one year to return to normal.
In summary, the Mirena® IUD is not a perfect product, it takes a commitment to the method to get through the initial break in time. But if you are the right candidate, and you make it through the first 3 months, it can be a life changing method. Freedom from pregnancy, nothing to remember to do each day, and hopefully, few if any periods. You may want to visit Mirena's website for more information.