Health365 eNews
October 2015 • Volume 8, Issue 10

Choosing An OB-GYN For Primary Care

According to the most recent data available from the American College of Obstetricians and Gynecologists (ACOG), over half of women surveyed (54%) consider their ob-gyns to be their primary physician – the first doctor they see for all their health care needs.

When women select their ob-gyns as their PCPs, what should they keep in mind to ensure that this is the best choice for their health? We asked several experts to weigh in on this issue.


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According to the most recent data available from the American College of Obstetricians and Gynecologists (ACOG), over half of women surveyed (54%) consider their ob-gyns to be their primary physician – the first doctor they see for all their health care needs.

When women select their ob-gyns as their PCPs, what should they keep in mind to ensure that this is the best choice for their health? We asked several experts to weigh in on this issue.

Background and Training

“One of the first things women need to be aware of is that the training requirements for ob-gyns have changed,” says Amy Young, M.D., director of the division of medical education at Baylor College of Medicine in Houston. “During 48 months of residency, ob-gyn residents must complete 4 to 6 months of primary care training. And, 20% of the exam for Board certification in ob-gyn is devoted to primary care of women.

These training requirements were developed in 1995 and revised again in 2000 to continue to support the teaching of primary care to ob-gyn residents, says Dr. Young. That means physicians who completed their training in ob-gyn prior to that time will not have formal training in primary care. “An earlier generation of physicians will not be trained in primary care,” she says. “Women need to establish that with their physicians,” she notes.

Even physicians who went through training before the primary care requirement was instituted for ob-gyns often provide primary care by default, Dr. Young points out. “We’ve always been doing primary care, because once patients became pregnant no other physicians wanted to take care of them anyway,” she observes.

Some of her patients are surprised when she addresses primary care issues with them. “There is still a culture change going on,” she says. “When I recommend a colonoscopy or talk about a lipid profile, some patients, especially if they are older and not used to having an ob-gyn who provides primary care, are surprised that I even know about these things.”

Comfort Level

It is important to find out if your ob-gyn is comfortable providing primary care – not all are completely at ease in that role. “Ask your ob-gyn what percentage of his or her patients are primary care patients,” advises Naomi Stotland, M.D., clinical instructor in ob-gyn at the University of California, San Francisco.

“If it is a very small fraction, you might want to see a family physician or internist in addition to your gynecologist.”

She points out, “Many internists and family practice doctors are skilled at gynecologic care, just as many ob-gyns are skilled at primary care. Just ask your doctor.” She adds, “If the doctor is not comfortable with some aspect of your care, he or she will generally tell you this, and refer you to someone else for that care.”

Some ob-gyns prefer that their patients establish a relationship with another physician for primary care. Kathleen Ober, M.D., an ob-gyn at Partners for Women’s Health in Exeter, New Hampshire says, “There is so much to know about primary care. I feel completely confident as a specialist, knowing what I know and knowing when to refer.”

However in her view, the primary care training she completed is inadequate to manage many primary care issues, “Personally, I don’t feel that my 6 months of training makes me competent to manage hypertension, hypercholesterolemia, or type II diabetes,” she says. “And I don’t really want patients with a 103 temperature and a sore throat calling my office.” Women are better off in the hands of a family practice or internal medicine physician, per Dr. Ober.

There are Advantages

In general, ob-gyns are “very good at prevention of diseases that women get fairly regularly” says Michelle P. Warren, M,D., professor of medicine and obstetrics and gynecology at Columbia University. “There are advantages to seeing an ob-gyn from that perspective, because they will screen for osteoporosis and order regular mammograms,” she says.

In addition, an ob-gyn will understand hormonal changes and the diseases that can surface as a result of these changes, per Dr. Warren. A case in point is polycystic ovarian syndrome (PCOS), she says. “PCOS often goes undiagnosed in general medicine, especially in young women. It is a premorbid condition and medical people should be diagnosing it, but they’re not.”

Timing is Important

In deciding who is best suited to provide your primary care, keep in mind that your health needs change over time. “During a woman’s reproductive years, before menopause, most of a woman’s health care needs are easily addressed by her ob-gyn,” says Dr. Naomi Stotland. “After menopause, women are at higher risk for diseases like hypertension and heart disease.”

Dr. Ober who prefers not to treat sore throats or sprains, acknowledges that younger women with no chronic conditions may well seek primary care from their ob-gyn. “When a young patient comes to me for PAP smears and birth control pills, I don’t encourage her to see another physician,” she says. “But when a woman gets into her mid – 40s or 50s and isn’t seeing someone besides myself, I let her know that she needs to establish herself with a primary care physician.”

The focus of a woman’s primary care will change after she reaches 60, says Dr. Warren. The key to determining where to get the best care is to ask plenty of questions, she points out. “If you have a specific condition or concern, ask up front whether the doctor treats it,” she recommends. “Certain medical practices are more women’s health friendly than others.”

Getting What You Need

You will also need to take an active role in ensuring that you are being offered recommended health screenings at the appropriate age. Talk with your prospective doctor about the tests and procedures you may need, given your age, current health status, and family history. Your doctor may refer to the guidelines developed by the U.S. Preventive Services Task Force in 1996. This review and discussion will help to safeguard your health, whether you select a family practice physician or an ob-gyn to provide your primary care.

Before You Choose

  • Ask your ob-gyn what percentage of his or her practice is primary care.
  • If you have a specific condition or concern, (menopause, diabetes, other) talk with the doctor about prevention and treatment for that issue.
  • If your ob-gyn is providing primary care, clarify what to do and whom to call when you have a routine illness or minor injury (e.g., sore throat, sprain).
  • Review the health screenings you need, and talk with your doctor about scheduling these tests.

Presented by, WomensHealth.com editorial teamTo find your OB-GYN, visit Center for Women’s Health Home Page

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Women's Health Care Guidelines

The National Women’s Health Information Center offers the following 10 things you can do to help live longer, live better, and live happier.


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The National Women’s Health Information Center offers the following 10 things you can do to help live longer, live better, and live happier:

  1. Be informed. Learn about health promotion and disease prevention and ask your health care provider for specific information regarding your needs.
  2. Be good to your bones. For healthy bones, be sure to replenish your stock of calcium every day with plenty of foods such as milk and other dairy products, tofu, leafy green vegetables, canned salmon or sardines, and calcium-fortified juices or breads. Speak with your health care provider about calcium supplements.
  3. Avoid illegal drugs and alcohol. For women, the definition of moderate drinking stops at one drink a day. The National Institute on Alcohol Abuse and Alcoholism defines a drink as one 5-ounce glass of wine, one 12-ounce bottle of beer or wine cooler, or 1.5 ounces of 80-proof distilled spirits. Remember that the alcohol content of each type of drink can vary widely. Where illicit drugs are concerned, there is no such thing as “moderate” use.
  4. Take medicine wisely. Read the labels, follow the instructions carefully, and remind your health care provider or pharmacist about any other medicines or supplements you might be taking that could interact with your medication. For your safety – to lower your risk for adverse side effects or medication interactions, for instance – you should also let your health care provider know if you use any illicit or “recreational” drugs. If you have any questions about possible side effects, call your health care provider or pharmacist.
  5. Play it safe. Avoid injuries. Buckle up. Wear a bike helmet. Use smoke and carbon monoxide detectors. Wear sunscreen and UV protected sunglasses. Use street smarts and common sense. Practice safe sex by using condoms to protect against sexually transmitted diseases.
  6. Get checked. Get regular checkups, preventive exam, and immunizations. Do not forget self-exams, too.
  7. Don’t smoke. Smoking is the leading preventable cause of death in our country.
  8. Eat smart. It is the secret to good health. Eat plenty of fruits, vegetables, and whole grains. Enjoy a variety of foods, balance foods from each food group, and exercise in moderation.
  9. Get moving. The other secret to good health: just 30 minutes of physical activity, accumulated over the course of each day, can radically improve the way you look and feel, both physically and mentally.
  10. Be happy. Take time for yourself. Get connected with family, friends, and community. Do things you enjoy!

These charts provide general health care guidelines for women, but are not meant to replace any advice and guidance given by your health care provider. Please use them as a reminder to take care of your personal health care needs, and also as a list of topics you may want to discuss with your health care provider.

Each Day Each Month Each Year Other
Exercise 30 minutes a day. Have a dental checkup once or twice a year. Have vision and hearing checked annually. Starting at age 45: every 5 years have a full lipid profile test for cholesterol and triglycerides.Earlier screening is recommended if there are risk factors present for coronary artery disease.
Protect yourself from the sun – use sunscreen and dress appropriately. Perform an oral cavity self-exam – gums, teeth, lips, tongue. After age 50:have a physical exam by your health care provider.have a yearly clinical breast exam Before age 50:have a physical exam every 3 years after age 30.have a physical exam every 2 years after age 40.
Watch your fat intake – no more than 25 % to 35% of your calorie intake. Most fats should come from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts, and vegetable oils. Perform a full-body self exam for unusual moles or other skin conditions. Have your health care provider examine moles annually, or immediately for suspicious growths.
Eat sources of protein such as lean or low-fat meat, poultry, fish, dry beans, eggs, and nuts. Be aware of your weight – check your BMI (body mass index). Have your blood pressure and cholesterol levels checked. After age 50:have a fecal occult blood test every year, OR
have a flexible sigmoidoscopy every 5 years, ORhave a double contrast barium enema every 5 years, ORhave a colonoscopy every 10 yearsBegin screening with a colonoscopy at age 45 in African Americans.
Eat 5 to 9 servings of fruits and vegetables daily.At least half of all of the grains eaten should be whole grains.Consume 3 cups of fat-free or low-fat milk or equivalent milk products per day. Get a flu shot.
Be aware of your alcohol intake. Talk with your doctor about when you should have a mammogram and/or a clinical breast exam
Be aware of your stress level. Get a tetanus/diphtheria (td) booster every 10 years
Have a pelvic exam and Pap test beginning at age 21. Talk with your health care provider about his or her recommendations for further testing and screening for the human papillomavirus, or HPV.* Get pneumococcal vaccines. After age 65: get the pneumococcal vaccines; also recommended for those younger than 65 who have medical problems that increase the risk for serious complications and death.

* The American Congress of Obstetricians and Gynecologists recommends that women have their first Pap test at age 21. Women ages 21 to 29 should have a Pap test every 3 years. Women 30 and older are recommended to have co-testing every 5 years, and cytology and HPV every 3 years. It’s reasonable to discontinue screening for cervical cancer in women age 65 and over after receiving negative prior screening tests if there is no history of cervical intraepithelial neoplasia (CIN) 2+ within the last 20 years. After screening has been discontinued, it should not be resumed, even if a woman has multiple sexual partners.

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The HPV Vaccine: Fact vs. Fiction

The latest statistics show that those who would benefit most from the HPV vaccine—adolescent girls and boys—aren’t necessarily taking advantage of its cancer-preventing potential. Understanding more about the vaccine may convince you that it’s right for you or a loved one. Consider these 5 misconceptions.


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  1. The HPV vaccine prevents only cervical cancer.
    The vaccine actually protects against several types of cancer. It does so by targeting certain strains of the human papillomavirus, or HPV. These infections are spread through sexual contact. They can cause genital warts. But most cause no symptoms and go away without treatment.Some HPV infections may linger for years in your body. These viruses may damage cells, eventually causing cancer. The HPV vaccine prevents those strains responsible for the majority of cervical cancers. It may also prevent HPV infections that lead to cancers of the throat, anus, penis, and vagina.
  2. The HPV vaccine is only for girls and young women.
    In 2006, health experts recommended the HPV vaccine for females ages 9 to 26. But its potential to prevent other cancers besides that of the cervix made it appropriate for boys and young men, too. Doctors now encourage males ages 9 to 26 to also receive the vaccine.Two types of HPV vaccine are available. They are Gardasil and Cervarix. Gardasil is approved for use in both sexes. Cervarix is only for girls and young women. Ideally, three doses of either vaccine are given over a 6-month period at ages 11 or 12 before any sexual activity.
  3. The HPV vaccine isn’t very effective.
    The HPV vaccine may not protect against all HPV infections that may promote cancer. But it can substantially lower your child’s risk. In a recent study, researchers compared the HPV history of more than 4,000 women ages 14 to 59 over two 4-year periods. Those timeframes included 2003 to 2006—before the HPV vaccine became available—and 2007 to 2010—after it was in use. They found that the vaccine cut in half the number of HPV infections in girls ages 14 to 19.
  4. The HPV vaccine isn’t safe.
    Past research including nearly 60,000 participants has confirmed the vaccine’s safety. But like all vaccines, side effects are possible. Most are minor. They may include pain and redness at the injection site, fever, dizziness, or nausea. Some people have fainted after receiving the shot. In rare cases, blood clots and Guillain-Barré syndrome—a disorder that weakens muscles—have been reported.
  5. Women who receive the HPV vaccine don’t need Pap tests anymore.
    Pap tests detect abnormal cells in the cervix. They alert your doctor to potential cervical cancer. The HPV vaccine may prevent future HPV infections, but it doesn’t treat pre-existing ones. It also doesn’t prevent all types of cervical cancer. For these reasons, women should still schedule regular Pap tests.
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As Prescribed
Looking for timely and accurate health and wellness information from the Fort HealthCare clinicians you know and love? Visit FortHealthCare.com/Blog for updates on women's health, nutrition, skin care, foot pain and many other health topics.

Hyperbaric Oxygen Therapy- Not Just for Scuba Divers

You may be wondering why a wound specialist in WI cares about hyperbaric medicine. After all, we aren’t near any oceans treating divers who get “the bends” and carbon monoxide poisoning isn’t all the common – thankfully! The truth is though, wound care and hyperbaric oxygen therapy (HBOT) are nearly inseparable.


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News

Joint Pain? …Know Your Choices

Many people suffering with arthritis, hip pain, joint stiffness and limited joint movement can learn about both surgical and non-surgical options that are available today. From minimally invasive surgery for hip replacement to newer and more effective therapy options, our joint pain experts can help you find the best treatment options for you.


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Many people suffering with arthritis, hip pain, joint stiffness and limited joint movement can learn about both surgical and non-surgical options that are available today. From minimally invasive surgery for hip replacement to newer and more effective therapy options, our joint pain experts can help you find the best treatment options for you.

bruno-schuppner

On Tuesday, October 6th, starting at 4:30 p.m., James Bruno, MD and Paul Schuppner, DO, with Fort HealthCare Orthopaedic Associates will be hosting a FREE informational seminar about joint pain, treatments, and the today’s options for the patient with painful joints. The presentation will take place at the Fort Atkinson Club at 211 S. Water Street East in Fort Atkinson. Individuals are invited to register for the seminar online at FortHealthCare.com/Classes (click on “A Healthier You”), or by calling 920-568-5475.

Dr. Bruno and Dr. Schuppner specialize in treating patients of all ages. They and their partners Dr. Nordland and Dr. Zambrano provide treatments for arthritis care, arthroscopy of the ankle, elbow, knee, wrist and shoulder, fracture treatment, pediatric orthopedic surgery, sports medicine, total knee and hip joint replacements, and partial knee replacements.

Register for the FREE Joint Pain Seminar Today!

Attending the presentation will give guests an opportunity to meet Dr. Bruno and Dr. Schuppner, have their joint pain questions answered. To learn more, visit FortHealthCare.com/JointPain.

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Upcoming Events
Fort HealthCare is proud to sponsor a number of community events. All year long, you can find a number of health and fitness related events and classes for the whole family. Check out Health365Events.com to find more activities throughout the community.

FREE Joint Pain Seminar – Know Your Choices

Health, Training & Fitness Classes
Body Blast
Childbirth Preparation Classes
Glutes & Abs
Having Healthy Babies
On My Own at Home
Red Cross Babysitting
Skinny Arms Express
Zumba®

American Heart Association
ACLS Renewal
Heartsaver CPR/AED
Heartsaver First Aid/CPR/AED
Basic Life Support – HealthCare Provider Certification

Healthcare Provider Course
Pediatric Advanced Life Support
Basic EKG Class
Critical Care Classes
Differential Diagnosis: Direct Access – Bill Boissonnault

Three Ways to Register:
Online @
FortHealthCare.com/Classes
Call (920) 568-5475
Visit the Registration Desk at Fort Memorial Hospital in Fort Atkinson

Fort HealthCare has developed a community website for posting, sharing and browsing local health and wellness events. The Health365Events.com website goes hand-in-hand with our mission to improve the health and well-being of our community.
The purpose of Health365Events.com is to make it easier for non-profit organizations to share details of their community fitness and wellness events. We believe this website offers a greater sense of community well-being. We also believe that being healthy and active should be fun. By helping our partners in wellness offer a variety of organized activities for everyone to participate in, we are achieving our vision to be the healthiest community in Wisconsin.

Find fun activities and events in southern Wisconsin at Health365Events.com. You can create an account to track event types or add your own healthy event. It’s FREE to use.

Recipes

Recipe: Simple Salmon with Dill Sauce

Serves 6 — Each serving contains approximately 288 calories, 5 g carbohydrates, 31 g protein, 17 g fat, 292 mg sodium, and 0 g fiber.



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Ingredients:

  • 1 salmon fillet (approximately 2 pounds)
  • 2 tablespoons low-sodium soy sauce
  • Coarse black pepper

Directions

Preheat oven to 450 degrees. Rinse salmon fillet and place skin-side down on a flat baking pan. Pour soy sauce over salmon and sprinkle with pepper. Roast salmon using the 10-minute rule–approximately 10 minutes per inch of thickness at the thickest point. If you want to brown the top, brush lightly with olive oil and sear the salmon before roasting, or run briefly under broiler.

Serve salmon hot or cold with dill sauce made by combining 1/2 cup low-fat sour cream, 1/2 cup finely chopped cucumber that has been lightly salted and drained, and 1 teaspoon chopped fresh dill (or more to taste).

Serves 6

Each serving contains approximately 288 calories, 5 g carbohydrates, 31 g protein, 17 g fat, 292 mg sodium, and 0 g fiber.

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