Rock Your Cortisol and Dance with Your Stress

“7 Ways to Rock Cortisol and Manage Your Stress”, is a remarkable, uplifting and conversational talk given by prominent functional medicine gynecologist, Dr. Sara Gottfried, in 2013 to Naropa University in Colorado. Find it on YouTube, if you are interested, see the link beneath this post. You really need to hear this. Dr. Gottfried is the author of 3 best-selling books including Younger, Hormone Reset Diet, and The Hormone Cure. In this 70-minute talk, “Dr. Sara” describes how to “entrain the parasympathetic and sympathetic nervous systems” with active management of stress and cortisol. In her words, the goal is not to reduce your stress, it’s in “how you dance with it.”  

Her approach has a personal side, as she relates her own experiences with stress, and the effects that cortisol had on her in her thirties, when she reached a defining moment where “the pain of staying the same was worse than (the pain of) change.”  

If you “have a hunch” (or have been told) that some of your problems may have to do with stress and cortisol, then you may be interested in the following points in this talk, which is woven with humor, her personal style, and the testimony of personal experience.  

Topics covered: 

Cortisol vs oxytocin and growth hormone 

Effects of cortisol: frazzled, fat and frumpy, PMS, low sex drive 

Experiences within conventional medicine versus the medicine of “root cause” and bio-hacking 

Balancing hormones like progesterone, testosterone, and why birth control pills and antidepressants may not be the answer for some 

Bio-hacking, testing, genetics, tracking and re-testing 

Telomere length and anti-aging as it relates to cortisol excess and the brain 

Adrenal fatigue and “the repair conversation” (it has “a beginning, a middle and an end”) and it has to do with the quality of sleep, sleep and cortisol, sleep and growth hormone 

Your relationship to stress, how your “perception of stress” influences cortisol, aging, and the management of stress 

The brain, the size of the hippocampus and the aging effects of cortisol, also interplay with serotonin and dopamine 

The differences between men and women and the reaction to stress 

Stress and the heart 

Stress and the gut 

Organ reserve and the effects of aging, telomere length 

Measuring cortisol 

Blood sugar and cortisol 

The long term benefits of well managed cortisol 

Cortisol as the “bad boyfriend” you may have had in the past 

Practices (alternating nasal breathing, Heartmath) as well as Tibetan/Buddhist practices which are designed to decrease or manage stress and cortisol 

The seven prescriptions (which she carries in her purse) 

1) Self-care – Tiara time 

2) Cocktail hour – holy basil, phosphatidyl serine, omega 3 

3) One pound of vegetables per day 

4) Hugging – increasing oxytocin – orgasm and orgasmic meditation, “OM’ing” 

5) Mastering your sleep 

6) Dark chocolate – 80% or greater cacao 

7) Coherence – Heartmath, heart rate variability as a biofeedback tool and apps for that like “GPS for the Soul”, and “Inner Balance” which you may use on your iPhone 

If you are feeling not particularly motivated, or wired and tired, and have an hour to spare, instead of watching TV, I highly recommend listening/watching this talk, and learning a new approach or fresh perspective on stress and cortisol. This is important. Then you may want to learn more about the signs and symptoms of high or low cortisol, and do a symptom inventory of how you are feeling. Chronic expenditure of your adrenal reserve, and high stress and cortisol eventually “burn out” your adrenal glands, leaving you with poor immune tolerance, and chronic fatigue. If you have ever experienced “hitting the wall”, and waking up as tired as you were going to bed, then you may already be in Stage III adrenal fatigue. However, being a “cortisol junkie” feels good, as you burn the candle at both ends, and get a fake energy lift or high from things like sugar and caffeine. Chronic excess cortisol (sustained over a long period of time) may contribute to poor metabolism, insulin resistance and other chronic long term health effects, like hypertension, obesity, and even dementia, and a higher risk of cancer, as well as potential decreased longevity and a poorer quality of life.  

If you found this talk by Dr. Sara interesting, and you would like to find a like-minded physician who is interested in root cause medicine, solving problems with the power of lifestyle change, food as medicine, the judicious use of supplements and botanicals, and using gentle means which allow the body to re-balance itself, then please like and follow our page, sign up for my email list, and consider making an appointment for a personal health consultation at my office in Hartsville, SC, where I practice gynecology with an emphasis on functional medicine. I would like to think we are offering something unique to our community. Many think they have to go elsewhere to find what we have right here. We have services like bio-identical hormone replacement, health coaching, cutting edge testing of urine hormone metabolites, adrenal stress testing, as well as comprehensive digestive stool analysis, food antibody testing, as well as assessment of toxicity and nutritional sufficiency. We have the latest and top of the line dietary supplements and testing for you.

I know that the women who master this are the ones who not only take the first step, but also follow through and walk the walk. At The Wellness Boutique, we are here to help you along the journey, but the beginning step begins with you.

How to build a better baby

Pregnancy is an important time to re-evaluate your diet and nutrient intake. When morning sickness strikes, we often fall back on comfort foods, which may not be so healthy. This presents some challenges to actually getting a balanced diet. Just think of the fact that all the elements in the molecules that make up of our bodies come from our food, orchestrated by the code that we call our DNA. So, it’s an amazing dance between nature and nurture. At the cellular level, we are constantly rebuilding and regenerating. With that view of the body in mind, it makes sense that eating well is a good thing and gives new meaning to the old adage, “you are what you eat”!

At our prenatal visits for new moms, I include handouts to encourage and support a healthy diet in pregnancy. Among these are my Nutrient Smoothie Recipe, and the Modified Paleo-Mediterranean Diet (which is a table, listing the good stuff on the left, and the not so good stuff on the right, as a shopping and meal planning guide). It goes without saying that a healthy diet is important at all times, but in the early stages of pregnancy, it is an especially important time to pause and re-evaluate. I remember my first pregnancy, and how tired I felt, and how little I knew then about a really good diet 28 years ago. I remember that I tried to get enough protein to keep my energy level up during the grueling hours of studying before entering medical school. I tried eating good, and tried to get a balanced diet.

A few months ago, one of our young moms shared a book with me about nutrition in pregnancy called “What to eat when you’re pregnant“. The author, a PhD in neuroscience, covers information about nutrition, weight gain, and brings out some important ideas about eating. I never got a chance to read it from cover to cover, but I flipped through some of the pages and read the Amazon reviews. What I appreciate, is knowing that some of the seeds that we plant here and the ideas that we talk about are bearing fruit, and that we are really reading more and paying attention to the content of our diets.

Anybody who knows me, knows that I always listen to The People’s Pharmacy on NPR in the morning on Saturday at 7 am. This morning, a female cardiologist covered heart disease in women. One of the things that she mentioned was modifiable risk factors like smoking, diet and lifestyle. It made me think of the modifiable risk factors in pregnancy. While we can’t change our DNA code, the genetic code of information we are born with, we CAN influence that DNA in either a positive or negative way. One of the most important ways is through a healthy diet and lifestyle. That’s empowering!

Disclaimer: The above information is given for educational purposes only, and cannot substitute for the advice of your own health professional, that is familiar with your unique medical condition. The advice represented here is not intended to cure, treat or prevent a disease, and these comments are not evaluated by the FDA. Please seek the care of a qualified health professional as soon as you suspect you may be pregnant, and in the event of a suspected medical emergency, go to your nearest hospital emergency department for further evaluation when it is urgently needed. Remember to consult with your health professional or pharmacist before you take medicines, either prescription or over the counter, to make certain these are safe in pregnancy. 

For more information on my practice at the Wellness Boutique, or to subscribe to my email list, please use the email contact box.

Wellness Boutique is my OB/GYN practice and has been in downtown Hartsville since 2012. We are located around the corner from the Center Theater on North Fifth Street and West College Avenue. If you know where the Black Creek Arts Council and SPC Credit Union are, we are across the street in a small brick building with the black window awnings, and yellow trim. I have been a practicing OB/GYN in Hartsville, on staff at Carolina Pines Regional Medical Center since 2001.

I was featured on The Discovery Channel, A Birthday Story, in 2001, and the episode called “Sickle Cell”, which was filmed at Crawford Long Hospital of Emory University, in Atlanta, Georgia where my four children were born.

If you enjoyed this post, and want to see more, please remember to do these things for me. 

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They were going to induce my labor, even though I thought things were going fine!

In my second pregnancy, I was again diagnosed with gestational diabetes. I thought I had done a great job of controlling my blood sugar and my diet. So, at 38 weeks, after keeping all my visits, and trying hard to be a good patient, it was explained to me, that my labor had to be induced the following day. I was to going to be scheduled for an ultrasound, an amniocentesis to check lung maturity, and if all of that was fine, labor induction would begin. You can imagine my reaction. What made matters worse, is that my own doctor was not even there that day, and my husband and I got this news in the hallway! After that experience, I went home mostly tearful and upset, but also pretty angry. I would do whatever was needed for my baby. But my doctor had been called out for an emergency, and this other doctor saw me that day in a busy, crowded, Atlanta clinic.

This story has a happy ending. I went home that night just praying for God to help me, and he did. That night, I woke up at around 1 am, and discovered that my water had broken. We got in the car, and hurriedly drove downtown to the hospital. I got there in time, and this was real labor. Soon after they put me in the labor and delivery room, I was getting the urge to push! The doctor on call who I had never met before was very nice, and my daughter was born at around 4 am that morning with no problems. I was so thankful that everything was ok, and most of all that I did not have to go through any of those other procedures.

The same doctors that took care of me that day in my pregnancy, were eventually the ones who trained me in high risk OB clinic as a resident. So, looking back, I still wonder what in my chart, alerted them to make the decision to induce labor as they had done. Could it be they had the impression that my glucose control was not that good, or that the baby was too big, or that my blood pressure was up?

That brings me to my second article in a series. One thing you will learn as an OB patient, is that in a medical setting involving you, and your pregnancy, is that you have to speak up for yourself, and be your own patient advocate. I learned that, on that day. No one was going to stand up for me, except me.

That brings up so many topics that we could talk about. Induction, that feeling of losing control in the doctor-patient relationship or in the hospital, how to address problems with your healthcare provider, among many more. We could start by talking about labor induction, which is a common practice in modern obstetrics. There are probably many reasons for this.

For some, the end of pregnancy is just so uncomfortable, and so some women just push for it to be over. Wanting the discomforts of pregnancy to end makes induction attractive for a patient. For the OB doctors, they are pushing to bring the pregnancy to a safe close, and deliver a healthy baby, so they are all over the details of looking for any potential medical indications that need to be addressed. And the ability to schedule a delivery is attractive, which means more babies are not being delivered at 2, 3, or 4 o’clock in the morning, which is also nice for the doctor and the medical staff. Some patients are very interested in the logistics of the birth. They may have family members who are trying to make travel and work arrangements to be present for the big event. So, being able to plan the birth day is attractive.

An important thing to remember is that doing an induction for convenience has to wait for 39 completed weeks. And, it has to be scheduled. Usually this is not going to happen on a holiday or a weekend, just FYI. Of course there are plenty of reasons why labor sometimes has to be induced, regardless of whether a cesarean might be the result, when immediate delivery is medically needed.

Just as there may be some advantages, let’s consider some of the disadvantages.

In a labor induction, your body is being pushed to do something it may not be quite ready to do. When the cervix is unfavorable (determined by the Bishop’s score –measuring five parameters of favorability) even at full term, the ripening that needs to occur to make the cervix responsive to labor contractions may not be fully developed. This means, there is a possibility of increasing the need to progress to a cesarean section. This is important to know, if you are hoping to avoid a cesarean section. If you really don’t care whether you have a C-section of not, and just want to be delivered at any cost, the price you may have to pay is to have a cesarean section with each delivery after that (the risk of C-section starts to go up after the first two). There are situations where vaginal birth can be attempted in the next delivery (VBAC, or vaginal birth after cesarean, or TOLAC for trial of labor after cesarean), but for the most part, it can also be regarded as being slightly higher in risk, and depending on the reasons for the first cesarean, you may end up being offered a repeat cesarean again and again.

The process of induction may prolong the hospital stay, and the labor itself may take longer. Of course, everyone can think of an example when labor progress may go much quicker with a little Pitocin, but in the case that your body is not really ready, it could take longer. Some patients remark that the contractions experienced with the IV medicine Pitocin feel harder and more painful than the contractions of natural labor. This may not make much difference if you are planning an epidural anyway, but it is worth mentioning.

Every pregnancy is different. What worked out for someone you know, may not work out for you. It’s important when timing an induction to make sure that the cervix is favorable. I like to use an analogy of picking fruit. It’s a good idea to wait until the fruit is perfectly ripe and just about ready to fall off the tree, to pick the fruit. So, if you can follow this analogy, we are waiting for the cervix to be just about ready to do its thing on its own. Actually waiting for spontaneous labor has its own good points. Labor seems to go more quickly, often an epidural is not needed. But then again, sometimes it goes so quickly, that there is not even time for an epidural, and that can be a little scary, but it is usually over before you know it.

When, as a patient, you feel like you are going to have a meltdown about some issue, it’s a good idea to make an appointment and also let your healthcare provider know ahead of time about the issues that are on your mind. If you spring this on them when they are in the middle of a busy schedule, you are apt to be met with a less than favorable response, simply because there is just no time allowed for it in the schedule, and everybody hates not being on time. Think about that. Patients hate waiting, and doctors hate that feeling of always feeling an hour behind schedule. If you have ever worked in a restaurant, one thing you learn is that people are the most cranky when they are hungry. Add to that the stress of waiting for an office appointment, and thinking about all the things you could be somewhere else doing, you begin to realize the problems we as healthcare providers are faced with on a daily basis. So, if you have been keeping a notebook full of questions, or have decided that this will be the day that you are going to bring up the discussion about the birth plan, bear in mind that many larger clinics are expecting the doctor to see upwards of 20 patients per half day. That means that return OB patients are about five or ten minute appointments, and that’s barely enough time to scratch the surface, review the pertinent labs, etc. Most clinics keep schedules that make it very demanding for the doctor, so realize that special scheduling may have to be made consultations about “other than” routine issues.

However, as a patient, you should feel like you are getting explanations that you need to make you feel comfortable with the process. When there are alternatives, you can ask about these, and educating yourself about pregnancy issues is always an advantage, because the more you know, the more you will understand about what your healthcare provider is thinking, and some of the decisions that are being made regarding your pregnancy. Keep in mind that your healthcare provider’s goal is essentially the same as what you want. They want you to have a happy, healthy pregnancy, without a lot of hassles. They also want what you want. Usually, a birth plan is not really needed.

Depending on the situation, usually things are allowed to proceed as naturally as possible, with minimal interventions. Where interventions are needed there are usually good reasons, and there are usually options. You should feel like you are being informed and being brought into the decision making process. On the subject of the birth plan, you can always find a basic birth plan by Googling it, and this can be the basis of research that you do for yourself on all the options you will need to know about for your delivery. Or, you can just leave that to the professionals. This is not our first rodeo.

Another point to make is that you really want to be on the same wavelength with your healthcare provider long before it is time to make major decisions about your pregnancy. If you have the feeling that they are listening and receptive to your needs, and responsive, it is much more likely that they will take your personal needs into consideration when it comes to making decisions concerning you and your pregnancy outcome. Write down your concerns so that you can ask questions like bullet points. Just get straight to the point and keep it simple, so that you will get a straight answer.

Disclaimer: The above information is given for educational purposes only, and cannot substitute for the advice of your own health professional who is familiar with your unique medical condition. Please seek the care of a qualified health professional as soon as you suspect you may be pregnant, and in the event of a suspected medical emergency, go to your nearest hospital emergency department for further evaluation when it is urgently needed. Consult with your health professional regarding your pregnancy.

For more information on my practice at the Wellness Boutique, or to subscribe to my email list, please use the email contact box.

Wellness Boutique is my OB/GYN practice and has been in downtown Hartsville since 2012. We are located around the corner from the Center Theater on North Fifth Street and West College Avenue. If you know where the Black Creek Arts Council is, and SPC Credit Union, we are across the street. I have been a practicing OB/GYN in Hartsville, on staff at Carolina Pines Regional Medical Center since 2001. I have been in private practice since 1999. In 2000, I was featured on The Discovery Channel, A Birthday Story, in the episode called “Sickle Cell”, which was filmed at Crawford Long Hospital of Emory University, in Atlanta, Georgia where my four children were born.

If you enjoyed this post, and want to see more, please remember to do these 3 things for me. 

1) Like our Facebook page using the Facebook, or LinkedIn icons provided below.

2) Share this post with your friends who may be interested in our unique approach to healthcare at The Wellness Boutique.

3) Hop on over to The Wellness Boutique Facebook page. Join me in the discussion, and let me know about your questions and concerns, so that I may answer them in my next blog post. 

4) Sign up for my e-mail list using the contact box provided on the upper right hand side of this page, (up there ^^). That way, I can share my with you my specials, healthy eating and hormone healing advice, and value added free stuff (and who doesn’t love FREE stuff!).  That way you can have my next exciting labor and delivery story blog post delivered straight to your email.

What scares you the most about pregnancy and becoming a new mom?

Michelle

I was 29 years old, a senior in college, and a chemistry major, when I found out I was pregnant with my oldest son. I was also applying to medical school, hoping to move to Atlanta, Georgia, where my husband was already in medical school. So, I can tell you from my experience about all the things I worried about.

As young newlywed and in college and medical school, I worried a lot. Upon arriving to Atlanta mid-pregnancy, I had to find a doctor, and when I did, I was diagnosed with gestational diabetes. I went to the library (long before Google) and looked it up. I was terrified that the baby would not be ok. Those were the bad old days when you were admitted into the hospital for glucose monitoring every 2 hours. They admitted me straight from the office. My first meal (lunch) in the hospital consisted of a salad topped with something I will describe as a type of processed “cheese food”. It took several bites of it for me to try and decide if it was actually tofu or something else like Velveeta cheese, and to this day I’m still not 100% sure…

So, as you can imagine by now, I can tell you all about stress, and what it will do to you when you are young, broke, pregnant, worried, and all you really want is what is best for your pregnancy, when it comes down to it.

I was too scared in the delivery room to open my eyes, until they told me the baby was ok. Thank God it was out. At least that part was over. I kept my eyes clenched tightly shut. “Is it ok? Tell me if it is ok!” I managed to gasp. The nurses turned to me and told me, “open your eyes!” and, “look at your baby boy!”

So, what is your worst fear about pregnancy?

For over fifteen years I have been caring for pregnant women in private practice (longer than that since being in medical school). Sometimes, I just think that I have heard everything, and then something else comes along to amaze me. Deep down, we all have something to be scared of, something unknown, that’s hard to put into words. Maybe we just bury those thoughts deeper and deeper to avoid thinking about them. But they are still there.

Ironically, I had read about water birth as a high school student, doing a term paper on Le Boyer and natural childbirth. Who would’ve thought back then, that I would be an OB doctor one day. I learned a little about how the medical establishment did things for the convenience of medical staff, and that some of these practices seemed to be counter-productive to having a natural birth. For example, putting the legs up in stirrups, when really the mom might need gravity on her side to push the baby down!

So, yeah, one of the things I wanted to avoid back then was anything that would lead to having a cesarean section. And epidural? No, no, no! Please don’t come near me with anything sharp in my back (remember, I was just a scared college graduate). I think I was just really afraid of pain and more than that, needles going where I could not see what was going on. I see things differently now, but that was my own experience 27 years ago.

Back then, at age 29, essentially broke, vulnerable, a college graduate, and wondering how I was going to pay for everything, and I had a lot of fears. I worked part time as a paste up artist in a local advertising print shop between college and medical school, sitting out a year for my first child to be born. I also did some babysitting for a working mom to have money to buy groceries for us. Little did I know at the time, that I would spend the next 27 years of my career, working toward helping other pregnant women. After I moved to Atlanta, I was accepted to the Morehouse School of Medicine. I later trained at Emory University, Grady, Crawford Long (now called Midtown) and Piedmont Hospitals in Gynecology & Obstetrics. (We said “gin”-a-cology at Emory Hospital where I trained).  I spent a year writing and doing a research fellowship in Pelvic Imaging. My four kids were little, and our lives were busy and full. At the time, we didn’t know how we would get through it all, but we did.

Now, looking back, I realize that a lot of the care that we professionals provide is surveillance and reassurance. While we are making sure that we look carefully for the warning signs of a problem, a lot of what we are doing is giving reassurance that everything is going to be ok. And, thankfully, most of the time we have happy endings, because young moms are generally healthy and the body takes care of everything. So, that makes life easier.

The other part of my job is taking care of things that are not going ok, when things start looking like a train wreck is about to happen in slow motion, and time stands still as the seconds tick off, and an immediate emergency response is needed. Thankfully, that is not every day. My adrenaline and cortisol levels have peaked over the years and this has taken its personal toll on my health.

And, I would say there’s another part of my job that I take very seriously, and that is trying to prevent problems from occurring. So, the longer I take care of women, I now see things through a new lens. It might have started with my mom (who was one of the mothers who visited the seedy little health food stores of the 1970’s and kept weird stuff like brewer’s yeast and raw nuts in the refrigerator, and read the health nut literature of the day). It comes from realizing that in my own health, that healthy lifestyle is not just an option, it is a must. And a part of it comes from my additional years of training in functional medicine, since reading what that was about in around 2005.

So, I try to emphasize the things which I feel are important with respect to diet and lifestyle. When you think about it, all the building blocks we are made of chemically are a product of food. Every nitrogen and protein molecule and every vitamin and mineral that fuels a chemical reaction, or becomes incorporated into the body as a developing body part, comes from our food. So, it makes sense, that if you eat a diet rich in clean healthy nutrients, and you get plenty of fresh air, water and sunshine, and are able to stay away from toxic chemicals, that things should go better, and they do. When you have a heavy burden of ingested sugar, salt, fat, and toxic chemicals, things just do not seem to work out as well. In fact, a high carbohydrate diet, high in sugar due to a high glycemic index, and a high glycemic load, actually increases your body’s demand for vitamins and minerals. The same vitamins in our food are co-factors in the chemical reactions which help us metabolize glucose to make energy in the Krebs cycle (that awful diagram thing that you hoped to forget after high school chemistry) to make ATP which is known as the energy molecule. So, it’s like putting gas in your car (sugar) without ever changing or checking the oil, the transmission, the brake fluid or the air filter. Your body needs nutrients for maintenance, just like your car needs an oil change checkup.

So, if you want to have a successful pregnancy, begin by taking care of your body with good nutrition and paying attention to your lifestyle habits. These simple tips may help you get started on the right foot.

  1. Get enough protein with your meals. How much is enough, is the subject of a lot of heated debate. But get a good breakfast with some protein, and some protein with each meal. There are experts on each end of the argument, but only you can decide how much makes you feel at your best. (Too many carbs can give you sugar cravings and spikes in your glucose and insulin). So make sure you are getting enough protein and healthy oils like avocado, olive oil, and extra virgin coconut oils, and oils from small clean fish like sardines, and also nuts and seeds.
  2. Watch your carbohydrate load. Too many dietary starches and sugars will pile on the weight. Glucose is a small molecule which easily crosses the placenta. If you have a constant overload of glucose, you are more likely to be insulin resistant (more like a diabetic), and therefore you could have a tendency to grow a larger fetus, which could translate into a higher chance of that infant not fitting as well through the pelvis, or even needing a cesarean section. Avoid sugary drinks, KoolAid, sodas and sweet tea, and “white foods” (which add a lot of calories, and influence your metabolism). Make sure your choices are healthy.
  3. Get some moderate exercise, but take it easy, don’t overdo it. Ok. This is where it gets real. You are going to gain weight. Your baby is depending on you for a source of nutrition, oxygen, water, and constant temperature. If you exercise, use common sense. This means not getting breathless. You have to share your oxygen with the baby. Raising your core body temperature is like a fever for the growing fetus, and we don’t want a healthy behavior like exercising to cause a problem with the development of healthy fetal brain tissue. Choose moderate exercises like walking and swimming, in moderation. Talk over your exercise program with your health professional.
  4. Get out in the sun. Vitamin D is important for not only the development of bones, but also known to be important for a healthy immune system. There is research to suggest that kids born with the lowest cord blood vitamin D levels have the most respiratory infections. There is other good stuff to learn about Vitamin D, and it is something that you probably don’t have enough of, but can get too much of.
  5. Get enough sleep. This helps all your little receptors reset, and recharge. Rest is important for us all, and you will find that at certain times of pregnancy you will need more of it. Your body is sending you a message. You are going through a “growth spurt”, so get your rest when you need it. Power naps, and getting to bed at a decent hour will help you. Consider turning off your wireless router in your house at night when you will not need it, to avoid exposure to excess electromagnetic energy. Keep your cell phone at a safe distance as well, and not near your body. Some experts think that all of the potential health effects of the many sources of radiation we are exposed to, will be the next big area of health research. Until all the experts have concluded their research, why do an experiment on yourself, where you will be the pregnant guinea pig?
  6. Find a qualified health professional who is interested in your concerns. You are educated, can think for yourself, and have questions. Do you deserve to be cared for by someone who is condescending, and cannot give you the time of day? True, as healthcare providers with declining reimbursements, there is a certain pressure to see more, do more, to stay alive financially. But sometimes it is just a mindset, or a matter of degree. Good questions to ask: what is their view of natural childbirth, and a birth plan?
  7. Get some prenatal education. There is so much awesome education on the internet. You can pretty much learn about anything on YouTube! But, really, with the increased reach of information out there on the internet pages, in the form of handouts, eBooks and videos, you can really learn about any pregnancy related topic at your fingertips. One old standby I have used is the book “What to expect when you are expecting”. But now these days, there are lots of health bloggers (Chris Kresser in Berkeley, California, for example) who has blogged extensively about getting as healthy as you can, so you can not only get pregnant, but have a successful pregnancy as well.
  8. If you smoke, or use alcohol or drugs, get some help with that if you need to, but cut down as much as possible, or cut it out completely if you can on your own. These are not beneficial to good fetal development. Your baby gets this one chance at coming into the world, so let it be as good of a chance as you can make it. Everyone wants their kids to do well in school.

Disclaimer: The above information is given for educational purposes only, and cannot substitute for the advice of your own health professional that is familiar with your unique medical condition. Please seek the care of a qualified health professional as soon as you suspect you may be pregnant, and in the event of a suspected medical emergency, go to your nearest hospital  emergency department for further evaluation when it is urgently needed. Remember to consult with your health professional or pharmacist before you take medicines, either prescription or over the counter, to make certain these are safe in pregnancy. 

For more information on my practice at the Wellness Boutique, or to subscribe to my email list, please use the email contact box.

Wellness Boutique is my OB/GYN practice and has been in downtown Hartsville since 2012. We are located around the corner from the Center Theater on North Fifth Street and West College Avenue. If you know where the Black Creek Arts Council is, and SPC Credit Union, we are across the street. I have been a practicing OB/GYN in Hartsville, on staff at Carolina Pines Regional Medical Center since 2001.

If you enjoyed this post, please remember to like our Facebook page, and tell us what health topics you would like to hear more about! I look forward to hearing from you as I prepare my next upcoming blog post.

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What is functional medicine?

Functional medicine is a fundamentally different approach to diagnosis and treatment which concerns itself with two basic questions, 1) what does that patient have too much of, that needs to be reduced, and 2) what does the patient have not enough of, which needs to be replenished, or rebalanced. Rather than diagnosing a disease by a collection of end organ problems and symptoms as is done in the conventional medicine model, functional medicine concerns itself with identifying the underlying microscopic and biochemical mechanisms of disease which are at the root cause of the disease process and which may then be correctible. Other terms which are fairly synonymous for the functional medicine model are systems biology medicine and orthomolecular medicine. Some may consider it a “holistic” approach, and yet others would consider it “integrative” medicine because it integrates various approaches to healing.

Functional medicine may also rightly be called personalized medicine, because each patient presents a unique genetic or genomic predisposition, a unique set of environmental exposures, stressors and beliefs, which the practitioner considers in each unique case. The Institute for Functional Medicine (also referred to as IFM) is an international educational institution based in the Western United States, which provides advanced practice continuing education for like-minded practitioners who may also seek certification in this discipline.

Unlike the many specialties recognized by the American Board of Medical Specialties, functional medicine is not a specialty unto itself, but is rather an approach toward the patient which spans across many specialties. Some practitioners do limit their practice to this approach, rather than the acute care model of medicine. Some may consider this brand of practice alternative, or integrative, because it brings many modalities of diagnosis and treatment into the clinical toolkit, beyond those things which are trained in typical conventional medical residency training.

The Institute for Functional Medicine (IFM) has developed an extensive advanced educational training program which incorporates a rigorous review of the latest scientific research, and prepares practitioners to use all of the basic science that they learned in medical school. Completing this training may take up to a few years, as the required courses are offered two or three times per year, and this culminate in a written and oral certification examination process. The first such class of graduates were certified by IFM in 2013.

The various areas addressed during the functional medicine evaluation include identifying problems affecting function within the underlying mechanisms of disease such as oxidative stress, alterations in the production of energy, inflammation and altered function of the immune system, digestion, elimination and biotransformation, hormonal health, and functional nutrition. The functional medicine practitioner reviews an extensive history intake and plots the patient’s risk factors, life events, and symptom development along a time line. In addressing the core areas of function, a grid called the “matrix” is used. Along the matrix are eight main core areas including assimilation, defense and repair, energy, biotransformation and elimination, transport, communication, structural integrity, and the mental, emotional, and spiritual core areas.

Is functional medicine for you?

Functional medicine may not be for everyone. There are now the beginnings of residency programs which offer this type of training experience. In fact, more functional medicine ideas are becoming mainstream as people everywhere are beginning to realize that we must personalize medicine, and that disease comes about in large part due to modifiable lifestyle risk factors.  Among these, in this country, is a nutrient poor diet, which is heavy in flour, gluten, sugar, salt, hydrogenated fats and chemical additives. So many modern illnesses which hardly existed over 100 years ago, can be directly linked to diet, such as autoimmune disease, cardiovascular disease, hypertension and heart disease, hypothyroidism, and diabetes.

If you are a person who has tried other approaches to your health issues, and no one seems to have the answer, then functional medicine might be for you. If you are wanting to reverse the disease process at its root cause, and entertain the possibility that you might not need a prescription drug for every problem, then maybe you would be interested. If you are willing to enter a therapeutic relationship with a practitioner who is concerned with your unique challenges, in order to investigate the underlying causes of your symptoms, this approach might be for right. If you are trying to find a practitioner who is willing to think outside of the box about your unique situation, but you just haven’t found him or her, then functional medicine might be the answer you are looking for.

Functional medicine might not be for you if you are not willing to hear a different perspective. That’s ok, and we recognize that. If you are either unwilling, or for whatever reason, unable or incapable of changing your diet, it might not work out for you. If you are content to continue to take your prescription medicines and want a pain pill or a magic pill for everything, then this probably is not what you are looking for. And, if you would feel uncomfortable working with your own primary doctor to try to discuss options for treatment to see what they say, then it might not work out. If you wish to get all of your medicines from the pharmacy, and are simply not able or are just unwilling to pay for anything out of pocket, like certain labs or dietary supplements, then it might not work out. However, you may still benefit from learning how you can take control of your diet.

Ideally, functional medicine patients are motivated and eager to learn, look forward to trying a nutritional support approach in the form of quality foods and/or pharmaceutical grade nutrients, might also be willing to try some very safe medicinal grade botanicals, and are in favor of trying new techniques in order to manage coping with daily stress, etc. Together with your functional medicine practitioner, you may decide what approach is right for you. In fact, many find that they simply feel better than they have in years, and are able to be weaned off old meds since they simply don’t need them anymore.

How our unique approach may be an advantage for you.

While some may be a little bit put off by the possibility of this approach being an expensive proposition, we have made it as economical as is feasible for everyone. For your initial evaluation with our practice, you may be seen as a conventional gynecology patient. If we then together determine that your care would be better served by a functional medicine approach, the initial step would be to obtain an adult medical history form. We have these pre-printed booklets including information for you about functional medicine and our practice. They may be picked up at our office, or we can email them to you, so that they may be printed out and filled out by you. Once you have read over our practice privacy and financial policies, signed your consents, and are familiar with our practice policies, you can submit your paperwork to us.

Fees for our services

For the initial review of your medical history and records, a service that can easily take 2 hours, we charge a pre-paid fee of $300.00. This fee is non refundable. This part of the service must be done before you can be scheduled for a functional medicine consultation with us. Once the doctor has reviewed your case, an initial evaluation consultation can be scheduled at the doctor’s discretion. This consultation meeting fee is set at $300.00, so your total cost of the initial consultation including the history review will be $600.00. This will be paid to us prior to the services being rendered. However, if you have an insurance billable diagnosis, we are willing to bill your insurance as a courtesy to you for our consultation services. If your insurance pays us for our services, then we can credit the amount of their payment to your account, which would reduce your total cost of being seen. However, if your insurance denies the claim for whatever reason, such as an unmet deductible, you would pay for that portion of the services.

Functional laboratory evaluation

We are a lab provider for Genova Diagnostics. We encourage patients to take advantage of these specialty labs, which help us to better serve you as a patient. We do not mark up and sell the labs at their suggested retail price as some functional medicine practitioners do, and the lab participates in third party billing, so many labs have a small and reasonable insurance co-pay. We receive no monetary compensation from the lab, we just receive your results. Before any lab is ordered we can show you a sample report, let you search the website beforehand if you wish, and quote you your expected out of pocket cost, so that there are no surprises, no unknowns. Government insurance providers such as Tricare, and Medicare can take advantage of many of these lab evaluations without out of pocket cost. Unfortunately, South Carolina Medicaid is not an eligible provider, although North Carolina Medicaid is. We also are able to provide several unique brands of pharmaceutical grade, good manufacturing practice dietary supplements on site, which we prescribe to our functional medicine patients. Buying our recommended brands will save you time, and money on shipping and handling charges versus buying online. Although you may shop and compare with other similar products from other supplement manufacturers on the market, we can provide no claim as to the efficacy of these other commercial brands which may contain impure, substandard or inferior, synthetic, or poorly bioavailable ingredients. In our experience, we promote the brands which we are familiar with, and which have a good manufacturers reputation for giving reproducible patient safety, results and satisfaction.

 

 

 

 

 

 

 

 

 

 

 

Our Specialty & Services

Years ago, when I envisioned The Wellness Boutique, it was my goal to create something different. Our focus here is on creating a healthy lifestyle, promoting wellness, and individualized care, by offering a unique approach to women's health issues. Does this sound like you?

Obstetrics

Since my residency program at Emory in Atlanta, I developed a special interest in obstetrics. As a student and resident, I always thought that our training program was head and shoulders above the oth...

Women’s Issues

Women in the childbearing years often suffer from adrenal stress, and undernutrition. We often know, even before any detailed testing is done, that at least 75% of women eating a standard American die...

Bio-identical hormones

When hormonal imbalance and chronic stress lead to a dysfunctional transition to menopause, the expert application of bioidentical hormones can give relief of these very distressing symptoms. There is...

Functional Medicine

Our functional medicine appointments are now being offered through NextPhaseMD, which is the private consultation practice of Dr. Michelle Quaye, MD. This is a new practice which will operate as a sep...

Latest Blog Posts

Wellness is a process. It doesn't happen overnight, but rather results from deliberate efforts to create the conditions needed for attaining an optimal state of health.
03
Oct

Rock Your Cortisol and Dance with Your Stress

"7 Ways to Rock Cortisol and Manage Your Stress", is a remarkable, uplifting and conversational talk given by prominent functional medicine gynecologist, Dr. Sara Gottfried, in 2013 to Naropa Univ...
27
Feb

How to build a better baby

Pregnancy is an important time to re-evaluate your diet and nutrient intake. When morning sickness strikes, we often fall back on comfort foods, which may not be so healthy. This presents some challen...

About our doctor:

Dr. Quaye has served the women of the greater Hartsville area since relocating from Atlanta in 2001. After graduating from medical school in 1994, and starting private practice in 1999. She was formerly a research fellow in the division of pelvic imaging in 1995, where she co-authored a book chapter in Te Linde's Gynecology 50th anniversary edition with Dr. David Graham in the perinatal center at Crawford Long Hospital of Emory University, now Emory Midtown.
"7 Ways to Rock Cortisol and Manage Your Stress", is a remarkable, uplifting and conversational talk given by prominent functional medicine gynecologist, Dr. Sara Gottfried, in 2013 to Naropa University in Colorado. Find it on YouTube, if you are interested, see the link beneath this post. You really need to hear this. Dr. Gottfried is the author of 3 best-selling books including Younger, Hormone Reset Diet, and The Hormone Cure. In this 70-minute talk, "Dr. Sara" describes how to "entrain the parasympathetic and sympathetic nervous systems" with active management of stress and cortisol. In her words, the goal is not to reduce your stress, it's in "how you dance with it."   Her approach has a personal side, as she relates her own experiences with stress, and the effects that cortisol had on her in her thirties, when she reached a defining moment where "the pain of staying the same was worse than (the pain of) change."   If you "have a hunch" (or have been told) that some of your problems may have to do with stress and cortisol, then you may be interested in the following points in this talk, which is woven with humor, her personal style, and the testimony of personal experience.   Topics covered:  Cortisol vs oxytocin and growth hormone  Effects of cortisol: frazzled, fat and frumpy, PMS, low sex drive  Experiences within conventional medicine versus the medicine of "root cause" and bio-hacking  Balancing hormones like progesterone, testosterone, and why birth control pills and antidepressants may not be the answer for some  Bio-hacking, testing, genetics, tracking and re-testing  Telomere length and anti-aging as it relates to cortisol excess and the brain  Adrenal fatigue and "the repair conversation" (it has "a beginning, a middle and an end") and it has to do with the quality of sleep, sleep and cortisol, sleep and growth hormone  Your relationship to stress, how your "perception of stress" influences cortisol, aging, and the management of stress  The brain, the size of the hippocampus and the aging effects of cortisol, also interplay with serotonin and dopamine  The differences between men and women and the reaction to stress  Stress and the heart  Stress and the gut  Organ reserve and the effects of aging, telomere length  Measuring cortisol  Blood sugar and cortisol  The long term benefits of well managed cortisol  Cortisol as the "bad boyfriend" you may have had in the past  Practices (alternating nasal breathing, Heartmath) as well as Tibetan/Buddhist practices which are designed to decrease or manage stress and cortisol  The seven prescriptions (which she carries in her purse)  1) Self-care – Tiara time  2) Cocktail hour – holy basil, phosphatidyl serine, omega 3  3) One pound of vegetables per day  4) Hugging – increasing oxytocin - orgasm and orgasmic meditation, "OM'ing"  5) Mastering your sleep  6) Dark chocolate – 80% or greater cacao  7) Coherence – Heartmath, heart rate variability as a biofeedback tool and apps for that like "GPS for the Soul", and "Inner Balance" which you may use on your iPhone  If you are feeling not particularly motivated, or wired and tired, and have an hour to spare, instead of watching TV, I highly recommend listening/watching this talk, and learning a new approach or fresh perspective on stress and cortisol. This is important. Then you may want to learn more about the signs and symptoms of high or low cortisol, and do a symptom inventory of how you are feeling. Chronic expenditure of your adrenal reserve, and high stress and cortisol eventually "burn out" your adrenal glands, leaving you with poor immune tolerance, and chronic fatigue. If you have ever experienced "hitting the wall", and waking up as tired as you were going to bed, then you may already be in Stage III adrenal fatigue. However, being a "cortisol junkie" feels good, as you burn the candle at both ends, and get a fake energy lift or high from things like sugar and caffeine. Chronic excess cortisol (sustained over a long period of time) may contribute to poor metabolism, insulin resistance and other chronic long term health effects, like hypertension, obesity, and even dementia, and a higher risk of cancer, as well as potential decreased longevity and a poorer quality of life.   If you found this talk by Dr. Sara interesting, and you would like to find a like-minded physician who is interested in root cause medicine, solving problems with the power of lifestyle change, food as medicine, the judicious use of supplements and botanicals, and using gentle means which allow the body to re-balance itself, then please like and follow our page, sign up for my email list, and consider making an appointment for a personal health consultation at my office in Hartsville, SC, where I practice gynecology with an emphasis on functional medicine. I would like to think we are offering something unique to our community. Many think they have to go elsewhere to find what we have right here. We have services like bio-identical hormone replacement, health coaching, cutting edge testing of urine hormone metabolites, adrenal stress testing, as well as comprehensive digestive stool analysis, food antibody testing, as well as assessment of toxicity and nutritional sufficiency. We have the latest and top of the line dietary supplements and testing for you. I know that the women who master this are the ones who not only take the first step, but also follow through and walk the walk. At The Wellness Boutique, we are here to help you along the journey, but the beginning step begins with you. https://youtu.be/-ZnS5_WWt-A
-Rock Your Cortisol and Dance with Your Stress
Pregnancy is an important time to re-evaluate your diet and nutrient intake. When morning sickness strikes, we often fall back on comfort foods, which may not be so healthy. This presents some challenges to actually getting a balanced diet. Just think of the fact that all the elements in the molecules that make up of our bodies come from our food, orchestrated by the code that we call our DNA. So, it's an amazing dance between nature and nurture. At the cellular level, we are constantly rebuilding and regenerating. With that view of the body in mind, it makes sense that eating well is a good thing and gives new meaning to the old adage, "you are what you eat"! At our prenatal visits for new moms, I include handouts to encourage and support a healthy diet in pregnancy. Among these are my Nutrient Smoothie Recipe, and the Modified Paleo-Mediterranean Diet (which is a table, listing the good stuff on the left, and the not so good stuff on the right, as a shopping and meal planning guide). It goes without saying that a healthy diet is important at all times, but in the early stages of pregnancy, it is an especially important time to pause and re-evaluate. I remember my first pregnancy, and how tired I felt, and how little I knew then about a really good diet 28 years ago. I remember that I tried to get enough protein to keep my energy level up during the grueling hours of studying before entering medical school. I tried eating good, and tried to get a balanced diet. A few months ago, one of our young moms shared a book with me about nutrition in pregnancy called "What to eat when you're pregnant". The author, a PhD in neuroscience, covers information about nutrition, weight gain, and brings out some important ideas about eating. I never got a chance to read it from cover to cover, but I flipped through some of the pages and read the Amazon reviews. What I appreciate, is knowing that some of the seeds that we plant here and the ideas that we talk about are bearing fruit, and that we are really reading more and paying attention to the content of our diets. Anybody who knows me, knows that I always listen to The People's Pharmacy on NPR in the morning on Saturday at 7 am. This morning, a female cardiologist covered heart disease in women. One of the things that she mentioned was modifiable risk factors like smoking, diet and lifestyle. It made me think of the modifiable risk factors in pregnancy. While we can't change our DNA code, the genetic code of information we are born with, we CAN influence that DNA in either a positive or negative way. One of the most important ways is through a healthy diet and lifestyle. That's empowering! Disclaimer: The above information is given for educational purposes only, and cannot substitute for the advice of your own health professional, that is familiar with your unique medical condition. The advice represented here is not intended to cure, treat or prevent a disease, and these comments are not evaluated by the FDA. Please seek the care of a qualified health professional as soon as you suspect you may be pregnant, and in the event of a suspected medical emergency, go to your nearest hospital emergency department for further evaluation when it is urgently needed. Remember to consult with your health professional or pharmacist before you take medicines, either prescription or over the counter, to make certain these are safe in pregnancy.  For more information on my practice at the Wellness Boutique, or to subscribe to my email list, please use the email contact box. Wellness Boutique is my OB/GYN practice and has been in downtown Hartsville since 2012. We are located around the corner from the Center Theater on North Fifth Street and West College Avenue. If you know where the Black Creek Arts Council and SPC Credit Union are, we are across the street in a small brick building with the black window awnings, and yellow trim. I have been a practicing OB/GYN in Hartsville, on staff at Carolina Pines Regional Medical Center since 2001. I was featured on The Discovery Channel, A Birthday Story, in 2001, and the episode called "Sickle Cell", which was filmed at Crawford Long Hospital of Emory University, in Atlanta, Georgia where my four children were born. If you enjoyed this post, and want to see more, please remember to do these things for me.  1) Don't forget to like our page on Facebook, or LinkedIn. 2) Share this post with all your friends who may be interested in our unique approach to healthcare at The Wellness Boutique. 3) Hop on over to The Wellness Boutique Facebook page. Join me in the discussion, and let me know about your questions and concerns, so that I may answer them in my next blog post.  4) Sign up for my e-mail list using the contact box provided. That way, I can share my with you my specials, healthy eating and hormone healing advice, and value added free stuff (and who doesn't love FREE stuff!). Thanks for signing up!
-How to build a better baby
In my second pregnancy, I was again diagnosed with gestational diabetes. I thought I had done a great job of controlling my blood sugar and my diet. So, at 38 weeks, after keeping all my visits, and trying hard to be a good patient, it was explained to me, that my labor had to be induced the following day. I was to going to be scheduled for an ultrasound, an amniocentesis to check lung maturity, and if all of that was fine, labor induction would begin. You can imagine my reaction. What made matters worse, is that my own doctor was not even there that day, and my husband and I got this news in the hallway! After that experience, I went home mostly tearful and upset, but also pretty angry. I would do whatever was needed for my baby. But my doctor had been called out for an emergency, and this other doctor saw me that day in a busy, crowded, Atlanta clinic. This story has a happy ending. I went home that night just praying for God to help me, and he did. That night, I woke up at around 1 am, and discovered that my water had broken. We got in the car, and hurriedly drove downtown to the hospital. I got there in time, and this was real labor. Soon after they put me in the labor and delivery room, I was getting the urge to push! The doctor on call who I had never met before was very nice, and my daughter was born at around 4 am that morning with no problems. I was so thankful that everything was ok, and most of all that I did not have to go through any of those other procedures. The same doctors that took care of me that day in my pregnancy, were eventually the ones who trained me in high risk OB clinic as a resident. So, looking back, I still wonder what in my chart, alerted them to make the decision to induce labor as they had done. Could it be they had the impression that my glucose control was not that good, or that the baby was too big, or that my blood pressure was up? That brings me to my second article in a series. One thing you will learn as an OB patient, is that in a medical setting involving you, and your pregnancy, is that you have to speak up for yourself, and be your own patient advocate. I learned that, on that day. No one was going to stand up for me, except me. That brings up so many topics that we could talk about. Induction, that feeling of losing control in the doctor-patient relationship or in the hospital, how to address problems with your healthcare provider, among many more. We could start by talking about labor induction, which is a common practice in modern obstetrics. There are probably many reasons for this. For some, the end of pregnancy is just so uncomfortable, and so some women just push for it to be over. Wanting the discomforts of pregnancy to end makes induction attractive for a patient. For the OB doctors, they are pushing to bring the pregnancy to a safe close, and deliver a healthy baby, so they are all over the details of looking for any potential medical indications that need to be addressed. And the ability to schedule a delivery is attractive, which means more babies are not being delivered at 2, 3, or 4 o’clock in the morning, which is also nice for the doctor and the medical staff. Some patients are very interested in the logistics of the birth. They may have family members who are trying to make travel and work arrangements to be present for the big event. So, being able to plan the birth day is attractive. An important thing to remember is that doing an induction for convenience has to wait for 39 completed weeks. And, it has to be scheduled. Usually this is not going to happen on a holiday or a weekend, just FYI. Of course there are plenty of reasons why labor sometimes has to be induced, regardless of whether a cesarean might be the result, when immediate delivery is medically needed. Just as there may be some advantages, let’s consider some of the disadvantages. In a labor induction, your body is being pushed to do something it may not be quite ready to do. When the cervix is unfavorable (determined by the Bishop's score --measuring five parameters of favorability) even at full term, the ripening that needs to occur to make the cervix responsive to labor contractions may not be fully developed. This means, there is a possibility of increasing the need to progress to a cesarean section. This is important to know, if you are hoping to avoid a cesarean section. If you really don’t care whether you have a C-section of not, and just want to be delivered at any cost, the price you may have to pay is to have a cesarean section with each delivery after that (the risk of C-section starts to go up after the first two). There are situations where vaginal birth can be attempted in the next delivery (VBAC, or vaginal birth after cesarean, or TOLAC for trial of labor after cesarean), but for the most part, it can also be regarded as being slightly higher in risk, and depending on the reasons for the first cesarean, you may end up being offered a repeat cesarean again and again. The process of induction may prolong the hospital stay, and the labor itself may take longer. Of course, everyone can think of an example when labor progress may go much quicker with a little Pitocin, but in the case that your body is not really ready, it could take longer. Some patients remark that the contractions experienced with the IV medicine Pitocin feel harder and more painful than the contractions of natural labor. This may not make much difference if you are planning an epidural anyway, but it is worth mentioning. Every pregnancy is different. What worked out for someone you know, may not work out for you. It’s important when timing an induction to make sure that the cervix is favorable. I like to use an analogy of picking fruit. It’s a good idea to wait until the fruit is perfectly ripe and just about ready to fall off the tree, to pick the fruit. So, if you can follow this analogy, we are waiting for the cervix to be just about ready to do its thing on its own. Actually waiting for spontaneous labor has its own good points. Labor seems to go more quickly, often an epidural is not needed. But then again, sometimes it goes so quickly, that there is not even time for an epidural, and that can be a little scary, but it is usually over before you know it. When, as a patient, you feel like you are going to have a meltdown about some issue, it’s a good idea to make an appointment and also let your healthcare provider know ahead of time about the issues that are on your mind. If you spring this on them when they are in the middle of a busy schedule, you are apt to be met with a less than favorable response, simply because there is just no time allowed for it in the schedule, and everybody hates not being on time. Think about that. Patients hate waiting, and doctors hate that feeling of always feeling an hour behind schedule. If you have ever worked in a restaurant, one thing you learn is that people are the most cranky when they are hungry. Add to that the stress of waiting for an office appointment, and thinking about all the things you could be somewhere else doing, you begin to realize the problems we as healthcare providers are faced with on a daily basis. So, if you have been keeping a notebook full of questions, or have decided that this will be the day that you are going to bring up the discussion about the birth plan, bear in mind that many larger clinics are expecting the doctor to see upwards of 20 patients per half day. That means that return OB patients are about five or ten minute appointments, and that's barely enough time to scratch the surface, review the pertinent labs, etc. Most clinics keep schedules that make it very demanding for the doctor, so realize that special scheduling may have to be made consultations about “other than” routine issues. However, as a patient, you should feel like you are getting explanations that you need to make you feel comfortable with the process. When there are alternatives, you can ask about these, and educating yourself about pregnancy issues is always an advantage, because the more you know, the more you will understand about what your healthcare provider is thinking, and some of the decisions that are being made regarding your pregnancy. Keep in mind that your healthcare provider’s goal is essentially the same as what you want. They want you to have a happy, healthy pregnancy, without a lot of hassles. They also want what you want. Usually, a birth plan is not really needed. Depending on the situation, usually things are allowed to proceed as naturally as possible, with minimal interventions. Where interventions are needed there are usually good reasons, and there are usually options. You should feel like you are being informed and being brought into the decision making process. On the subject of the birth plan, you can always find a basic birth plan by Googling it, and this can be the basis of research that you do for yourself on all the options you will need to know about for your delivery. Or, you can just leave that to the professionals. This is not our first rodeo. Another point to make is that you really want to be on the same wavelength with your healthcare provider long before it is time to make major decisions about your pregnancy. If you have the feeling that they are listening and receptive to your needs, and responsive, it is much more likely that they will take your personal needs into consideration when it comes to making decisions concerning you and your pregnancy outcome. Write down your concerns so that you can ask questions like bullet points. Just get straight to the point and keep it simple, so that you will get a straight answer. Disclaimer: The above information is given for educational purposes only, and cannot substitute for the advice of your own health professional who is familiar with your unique medical condition. Please seek the care of a qualified health professional as soon as you suspect you may be pregnant, and in the event of a suspected medical emergency, go to your nearest hospital emergency department for further evaluation when it is urgently needed. Consult with your health professional regarding your pregnancy. For more information on my practice at the Wellness Boutique, or to subscribe to my email list, please use the email contact box. Wellness Boutique is my OB/GYN practice and has been in downtown Hartsville since 2012. We are located around the corner from the Center Theater on North Fifth Street and West College Avenue. If you know where the Black Creek Arts Council is, and SPC Credit Union, we are across the street. I have been a practicing OB/GYN in Hartsville, on staff at Carolina Pines Regional Medical Center since 2001. I have been in private practice since 1999. In 2000, I was featured on The Discovery Channel, A Birthday Story, in the episode called "Sickle Cell", which was filmed at Crawford Long Hospital of Emory University, in Atlanta, Georgia where my four children were born. If you enjoyed this post, and want to see more, please remember to do these 3 things for me.  1) Like our Facebook page using the Facebook, or LinkedIn icons provided below. 2) Share this post with your friends who may be interested in our unique approach to healthcare at The Wellness Boutique. 3) Hop on over to The Wellness Boutique Facebook page. Join me in the discussion, and let me know about your questions and concerns, so that I may answer them in my next blog post.  4) Sign up for my e-mail list using the contact box provided on the upper right hand side of this page, (up there ^^). That way, I can share my with you my specials, healthy eating and hormone healing advice, and value added free stuff (and who doesn't love FREE stuff!).  That way you can have my next exciting labor and delivery story blog post delivered straight to your email.
-They were going to induce my labor, even though I thought things were going fine!
Michelle I was 29 years old, a senior in college, and a chemistry major, when I found out I was pregnant with my oldest son. I was also applying to medical school, hoping to move to Atlanta, Georgia, where my husband was already in medical school. So, I can tell you from my experience about all the things I worried about. As young newlywed and in college and medical school, I worried a lot. Upon arriving to Atlanta mid-pregnancy, I had to find a doctor, and when I did, I was diagnosed with gestational diabetes. I went to the library (long before Google) and looked it up. I was terrified that the baby would not be ok. Those were the bad old days when you were admitted into the hospital for glucose monitoring every 2 hours. They admitted me straight from the office. My first meal (lunch) in the hospital consisted of a salad topped with something I will describe as a type of processed “cheese food”. It took several bites of it for me to try and decide if it was actually tofu or something else like Velveeta cheese, and to this day I’m still not 100% sure… So, as you can imagine by now, I can tell you all about stress, and what it will do to you when you are young, broke, pregnant, worried, and all you really want is what is best for your pregnancy, when it comes down to it. I was too scared in the delivery room to open my eyes, until they told me the baby was ok. Thank God it was out. At least that part was over. I kept my eyes clenched tightly shut. “Is it ok? Tell me if it is ok!” I managed to gasp. The nurses turned to me and told me, “open your eyes!” and, “look at your baby boy!” So, what is your worst fear about pregnancy? For over fifteen years I have been caring for pregnant women in private practice (longer than that since being in medical school). Sometimes, I just think that I have heard everything, and then something else comes along to amaze me. Deep down, we all have something to be scared of, something unknown, that’s hard to put into words. Maybe we just bury those thoughts deeper and deeper to avoid thinking about them. But they are still there. Ironically, I had read about water birth as a high school student, doing a term paper on Le Boyer and natural childbirth. Who would’ve thought back then, that I would be an OB doctor one day. I learned a little about how the medical establishment did things for the convenience of medical staff, and that some of these practices seemed to be counter-productive to having a natural birth. For example, putting the legs up in stirrups, when really the mom might need gravity on her side to push the baby down! So, yeah, one of the things I wanted to avoid back then was anything that would lead to having a cesarean section. And epidural? No, no, no! Please don’t come near me with anything sharp in my back (remember, I was just a scared college graduate). I think I was just really afraid of pain and more than that, needles going where I could not see what was going on. I see things differently now, but that was my own experience 27 years ago. Back then, at age 29, essentially broke, vulnerable, a college graduate, and wondering how I was going to pay for everything, and I had a lot of fears. I worked part time as a paste up artist in a local advertising print shop between college and medical school, sitting out a year for my first child to be born. I also did some babysitting for a working mom to have money to buy groceries for us. Little did I know at the time, that I would spend the next 27 years of my career, working toward helping other pregnant women. After I moved to Atlanta, I was accepted to the Morehouse School of Medicine. I later trained at Emory University, Grady, Crawford Long (now called Midtown) and Piedmont Hospitals in Gynecology & Obstetrics. (We said “gin”-a-cology at Emory Hospital where I trained).  I spent a year writing and doing a research fellowship in Pelvic Imaging. My four kids were little, and our lives were busy and full. At the time, we didn't know how we would get through it all, but we did. Now, looking back, I realize that a lot of the care that we professionals provide is surveillance and reassurance. While we are making sure that we look carefully for the warning signs of a problem, a lot of what we are doing is giving reassurance that everything is going to be ok. And, thankfully, most of the time we have happy endings, because young moms are generally healthy and the body takes care of everything. So, that makes life easier. The other part of my job is taking care of things that are not going ok, when things start looking like a train wreck is about to happen in slow motion, and time stands still as the seconds tick off, and an immediate emergency response is needed. Thankfully, that is not every day. My adrenaline and cortisol levels have peaked over the years and this has taken its personal toll on my health. And, I would say there’s another part of my job that I take very seriously, and that is trying to prevent problems from occurring. So, the longer I take care of women, I now see things through a new lens. It might have started with my mom (who was one of the mothers who visited the seedy little health food stores of the 1970’s and kept weird stuff like brewer’s yeast and raw nuts in the refrigerator, and read the health nut literature of the day). It comes from realizing that in my own health, that healthy lifestyle is not just an option, it is a must. And a part of it comes from my additional years of training in functional medicine, since reading what that was about in around 2005. So, I try to emphasize the things which I feel are important with respect to diet and lifestyle. When you think about it, all the building blocks we are made of chemically are a product of food. Every nitrogen and protein molecule and every vitamin and mineral that fuels a chemical reaction, or becomes incorporated into the body as a developing body part, comes from our food. So, it makes sense, that if you eat a diet rich in clean healthy nutrients, and you get plenty of fresh air, water and sunshine, and are able to stay away from toxic chemicals, that things should go better, and they do. When you have a heavy burden of ingested sugar, salt, fat, and toxic chemicals, things just do not seem to work out as well. In fact, a high carbohydrate diet, high in sugar due to a high glycemic index, and a high glycemic load, actually increases your body’s demand for vitamins and minerals. The same vitamins in our food are co-factors in the chemical reactions which help us metabolize glucose to make energy in the Krebs cycle (that awful diagram thing that you hoped to forget after high school chemistry) to make ATP which is known as the energy molecule. So, it’s like putting gas in your car (sugar) without ever changing or checking the oil, the transmission, the brake fluid or the air filter. Your body needs nutrients for maintenance, just like your car needs an oil change checkup. So, if you want to have a successful pregnancy, begin by taking care of your body with good nutrition and paying attention to your lifestyle habits. These simple tips may help you get started on the right foot.
  1. Get enough protein with your meals. How much is enough, is the subject of a lot of heated debate. But get a good breakfast with some protein, and some protein with each meal. There are experts on each end of the argument, but only you can decide how much makes you feel at your best. (Too many carbs can give you sugar cravings and spikes in your glucose and insulin). So make sure you are getting enough protein and healthy oils like avocado, olive oil, and extra virgin coconut oils, and oils from small clean fish like sardines, and also nuts and seeds.
  2. Watch your carbohydrate load. Too many dietary starches and sugars will pile on the weight. Glucose is a small molecule which easily crosses the placenta. If you have a constant overload of glucose, you are more likely to be insulin resistant (more like a diabetic), and therefore you could have a tendency to grow a larger fetus, which could translate into a higher chance of that infant not fitting as well through the pelvis, or even needing a cesarean section. Avoid sugary drinks, KoolAid, sodas and sweet tea, and “white foods” (which add a lot of calories, and influence your metabolism). Make sure your choices are healthy.
  3. Get some moderate exercise, but take it easy, don’t overdo it. Ok. This is where it gets real. You are going to gain weight. Your baby is depending on you for a source of nutrition, oxygen, water, and constant temperature. If you exercise, use common sense. This means not getting breathless. You have to share your oxygen with the baby. Raising your core body temperature is like a fever for the growing fetus, and we don’t want a healthy behavior like exercising to cause a problem with the development of healthy fetal brain tissue. Choose moderate exercises like walking and swimming, in moderation. Talk over your exercise program with your health professional.
  4. Get out in the sun. Vitamin D is important for not only the development of bones, but also known to be important for a healthy immune system. There is research to suggest that kids born with the lowest cord blood vitamin D levels have the most respiratory infections. There is other good stuff to learn about Vitamin D, and it is something that you probably don’t have enough of, but can get too much of.
  5. Get enough sleep. This helps all your little receptors reset, and recharge. Rest is important for us all, and you will find that at certain times of pregnancy you will need more of it. Your body is sending you a message. You are going through a “growth spurt”, so get your rest when you need it. Power naps, and getting to bed at a decent hour will help you. Consider turning off your wireless router in your house at night when you will not need it, to avoid exposure to excess electromagnetic energy. Keep your cell phone at a safe distance as well, and not near your body. Some experts think that all of the potential health effects of the many sources of radiation we are exposed to, will be the next big area of health research. Until all the experts have concluded their research, why do an experiment on yourself, where you will be the pregnant guinea pig?
  6. Find a qualified health professional who is interested in your concerns. You are educated, can think for yourself, and have questions. Do you deserve to be cared for by someone who is condescending, and cannot give you the time of day? True, as healthcare providers with declining reimbursements, there is a certain pressure to see more, do more, to stay alive financially. But sometimes it is just a mindset, or a matter of degree. Good questions to ask: what is their view of natural childbirth, and a birth plan?
  7. Get some prenatal education. There is so much awesome education on the internet. You can pretty much learn about anything on YouTube! But, really, with the increased reach of information out there on the internet pages, in the form of handouts, eBooks and videos, you can really learn about any pregnancy related topic at your fingertips. One old standby I have used is the book “What to expect when you are expecting”. But now these days, there are lots of health bloggers (Chris Kresser in Berkeley, California, for example) who has blogged extensively about getting as healthy as you can, so you can not only get pregnant, but have a successful pregnancy as well.
  8. If you smoke, or use alcohol or drugs, get some help with that if you need to, but cut down as much as possible, or cut it out completely if you can on your own. These are not beneficial to good fetal development. Your baby gets this one chance at coming into the world, so let it be as good of a chance as you can make it. Everyone wants their kids to do well in school.
Disclaimer: The above information is given for educational purposes only, and cannot substitute for the advice of your own health professional that is familiar with your unique medical condition. Please seek the care of a qualified health professional as soon as you suspect you may be pregnant, and in the event of a suspected medical emergency, go to your nearest hospital  emergency department for further evaluation when it is urgently needed. Remember to consult with your health professional or pharmacist before you take medicines, either prescription or over the counter, to make certain these are safe in pregnancy.  For more information on my practice at the Wellness Boutique, or to subscribe to my email list, please use the email contact box. Wellness Boutique is my OB/GYN practice and has been in downtown Hartsville since 2012. We are located around the corner from the Center Theater on North Fifth Street and West College Avenue. If you know where the Black Creek Arts Council is, and SPC Credit Union, we are across the street. I have been a practicing OB/GYN in Hartsville, on staff at Carolina Pines Regional Medical Center since 2001. If you enjoyed this post, please remember to like our Facebook page, and tell us what health topics you would like to hear more about! I look forward to hearing from you as I prepare my next upcoming blog post. Please comment to this post on Facebook, at The Wellness Boutique page.
-What scares you the most about pregnancy and becoming a new mom?
Functional medicine is a fundamentally different approach to diagnosis and treatment which concerns itself with two basic questions, 1) what does that patient have too much of, that needs to be reduced, and 2) what does the patient have not enough of, which needs to be replenished, or rebalanced. Rather than diagnosing a disease by a collection of end organ problems and symptoms as is done in the conventional medicine model, functional medicine concerns itself with identifying the underlying microscopic and biochemical mechanisms of disease which are at the root cause of the disease process and which may then be correctible. Other terms which are fairly synonymous for the functional medicine model are systems biology medicine and orthomolecular medicine. Some may consider it a "holistic" approach, and yet others would consider it "integrative" medicine because it integrates various approaches to healing. Functional medicine may also rightly be called personalized medicine, because each patient presents a unique genetic or genomic predisposition, a unique set of environmental exposures, stressors and beliefs, which the practitioner considers in each unique case. The Institute for Functional Medicine (also referred to as IFM) is an international educational institution based in the Western United States, which provides advanced practice continuing education for like-minded practitioners who may also seek certification in this discipline. Unlike the many specialties recognized by the American Board of Medical Specialties, functional medicine is not a specialty unto itself, but is rather an approach toward the patient which spans across many specialties. Some practitioners do limit their practice to this approach, rather than the acute care model of medicine. Some may consider this brand of practice alternative, or integrative, because it brings many modalities of diagnosis and treatment into the clinical toolkit, beyond those things which are trained in typical conventional medical residency training. The Institute for Functional Medicine (IFM) has developed an extensive advanced educational training program which incorporates a rigorous review of the latest scientific research, and prepares practitioners to use all of the basic science that they learned in medical school. Completing this training may take up to a few years, as the required courses are offered two or three times per year, and this culminate in a written and oral certification examination process. The first such class of graduates were certified by IFM in 2013. The various areas addressed during the functional medicine evaluation include identifying problems affecting function within the underlying mechanisms of disease such as oxidative stress, alterations in the production of energy, inflammation and altered function of the immune system, digestion, elimination and biotransformation, hormonal health, and functional nutrition. The functional medicine practitioner reviews an extensive history intake and plots the patient’s risk factors, life events, and symptom development along a time line. In addressing the core areas of function, a grid called the “matrix” is used. Along the matrix are eight main core areas including assimilation, defense and repair, energy, biotransformation and elimination, transport, communication, structural integrity, and the mental, emotional, and spiritual core areas. Is functional medicine for you? Functional medicine may not be for everyone. There are now the beginnings of residency programs which offer this type of training experience. In fact, more functional medicine ideas are becoming mainstream as people everywhere are beginning to realize that we must personalize medicine, and that disease comes about in large part due to modifiable lifestyle risk factors.  Among these, in this country, is a nutrient poor diet, which is heavy in flour, gluten, sugar, salt, hydrogenated fats and chemical additives. So many modern illnesses which hardly existed over 100 years ago, can be directly linked to diet, such as autoimmune disease, cardiovascular disease, hypertension and heart disease, hypothyroidism, and diabetes. If you are a person who has tried other approaches to your health issues, and no one seems to have the answer, then functional medicine might be for you. If you are wanting to reverse the disease process at its root cause, and entertain the possibility that you might not need a prescription drug for every problem, then maybe you would be interested. If you are willing to enter a therapeutic relationship with a practitioner who is concerned with your unique challenges, in order to investigate the underlying causes of your symptoms, this approach might be for right. If you are trying to find a practitioner who is willing to think outside of the box about your unique situation, but you just haven’t found him or her, then functional medicine might be the answer you are looking for. Functional medicine might not be for you if you are not willing to hear a different perspective. That's ok, and we recognize that. If you are either unwilling, or for whatever reason, unable or incapable of changing your diet, it might not work out for you. If you are content to continue to take your prescription medicines and want a pain pill or a magic pill for everything, then this probably is not what you are looking for. And, if you would feel uncomfortable working with your own primary doctor to try to discuss options for treatment to see what they say, then it might not work out. If you wish to get all of your medicines from the pharmacy, and are simply not able or are just unwilling to pay for anything out of pocket, like certain labs or dietary supplements, then it might not work out. However, you may still benefit from learning how you can take control of your diet. Ideally, functional medicine patients are motivated and eager to learn, look forward to trying a nutritional support approach in the form of quality foods and/or pharmaceutical grade nutrients, might also be willing to try some very safe medicinal grade botanicals, and are in favor of trying new techniques in order to manage coping with daily stress, etc. Together with your functional medicine practitioner, you may decide what approach is right for you. In fact, many find that they simply feel better than they have in years, and are able to be weaned off old meds since they simply don’t need them anymore. How our unique approach may be an advantage for you. While some may be a little bit put off by the possibility of this approach being an expensive proposition, we have made it as economical as is feasible for everyone. For your initial evaluation with our practice, you may be seen as a conventional gynecology patient. If we then together determine that your care would be better served by a functional medicine approach, the initial step would be to obtain an adult medical history form. We have these pre-printed booklets including information for you about functional medicine and our practice. They may be picked up at our office, or we can email them to you, so that they may be printed out and filled out by you. Once you have read over our practice privacy and financial policies, signed your consents, and are familiar with our practice policies, you can submit your paperwork to us. Fees for our services For the initial review of your medical history and records, a service that can easily take 2 hours, we charge a pre-paid fee of $300.00. This fee is non refundable. This part of the service must be done before you can be scheduled for a functional medicine consultation with us. Once the doctor has reviewed your case, an initial evaluation consultation can be scheduled at the doctor's discretion. This consultation meeting fee is set at $300.00, so your total cost of the initial consultation including the history review will be $600.00. This will be paid to us prior to the services being rendered. However, if you have an insurance billable diagnosis, we are willing to bill your insurance as a courtesy to you for our consultation services. If your insurance pays us for our services, then we can credit the amount of their payment to your account, which would reduce your total cost of being seen. However, if your insurance denies the claim for whatever reason, such as an unmet deductible, you would pay for that portion of the services. Functional laboratory evaluation We are a lab provider for Genova Diagnostics. We encourage patients to take advantage of these specialty labs, which help us to better serve you as a patient. We do not mark up and sell the labs at their suggested retail price as some functional medicine practitioners do, and the lab participates in third party billing, so many labs have a small and reasonable insurance co-pay. We receive no monetary compensation from the lab, we just receive your results. Before any lab is ordered we can show you a sample report, let you search the website beforehand if you wish, and quote you your expected out of pocket cost, so that there are no surprises, no unknowns. Government insurance providers such as Tricare, and Medicare can take advantage of many of these lab evaluations without out of pocket cost. Unfortunately, South Carolina Medicaid is not an eligible provider, although North Carolina Medicaid is. We also are able to provide several unique brands of pharmaceutical grade, good manufacturing practice dietary supplements on site, which we prescribe to our functional medicine patients. Buying our recommended brands will save you time, and money on shipping and handling charges versus buying online. Although you may shop and compare with other similar products from other supplement manufacturers on the market, we can provide no claim as to the efficacy of these other commercial brands which may contain impure, substandard or inferior, synthetic, or poorly bioavailable ingredients. In our experience, we promote the brands which we are familiar with, and which have a good manufacturers reputation for giving reproducible patient safety, results and satisfaction.                      
-What is functional medicine?
  • 843-639-6012
  • mquaye@wellnessboutique.org
  • http://wellnessboutique.org
  • 107 West College Avenue, Hartsville SC 29551