HOW CAN I INCREASE MY BREAST MILK?
Is there anything we can do to make sure breast milk comes in adequately? Although often times in the past physicians have been asked to treat breast engorgement after a woman has had a baby and elects not to breast feed, studies have indicated that a drug called Metoclopramide can be used to increase the production of milk in women who are breastfeeding.
Clinical studies have been showing increases of milk production from 6% to 100%. This has been studied on and off for the last 20 years. Metoclopramide is transferred into the human breast milk. However, the amount of breast milk transference is only 1%-5% which is a level that is commonly prescribed for infants when required to take this medication for various gastrointestinal conditions.
Two drug regimes have been used. The usual dose of Reglan 10 mg before meals and at bedtime is one of the two standard doses. Another drug regime is to take Reglan three times a day for 7 days and then decrease it to 10 mg twice a day for 4 days and then 10 mg once daily. This is a total of 40 pills. At the end of 40 pills, this medication is discontinued. By that time, the breast milk with both regimes should be adequate.
If you have further questions about this or whether or not it would be useful in your individual case, please feel free to contact Dr. Brian Van Hoozen at Valley Family Medicine.
DO I REALLY NEED A PAP SMEAR EVERY YEAR?
Women have been asking this question since the pap smear was invented. New guidelines from the American College of Obstetricians and Gynecologists have come forward and allow, under certain conditions, for a decreased frequency of pap smears, including not having to do them every year. Pap smears or thin prep paps are alternative screening exams and both are still acceptable.
1) Women, regardless of whether they are sexually active, if under the age of 21, do not need to have a routine annual pap smear. Counseling about sexually transmitted disease and birth control counseling should be considered but the actual collection of a pap smear or thin prep is not necessary.
2) Women between the ages of 21 and 29 should have an initial cervical screening that is repeated every 2 years as long as there is not a history of a previous abnormal thin prep or abnormal pap smear.
3) Women between the ages of 30 and 65 with 3 consecutive negative pap smears or thin preps, not history of severely abnormal pap smears or thin preps, CIN I or CIN II pap smears, no exposure to diethylstilvestial in utero and no history of HIV infection can reduce their pap smears to every 3 years.
4) After the age of 65, pap smears may be discontinued if the last three consecutive pap smears or thin preps were normal and they had no abnormal pap smears in the last 10 years.
5) Women who have had CIN II or CIN III pap smears or cancer or the cervix should for the next 20 years after this diagnosis get annual pap smears or thin preps.
6) Women who have had a hysterectomy not due to cancer or severe dysplasia (CIN II or CIN III) can skip a pap smear completely.
7) women who have had a hysterectomy as part of a treatment to remove severe dysplasia of the cervix (CIN II or CIN III), or had cervical cancer, or the reasons for the hysterectomy cannot be thoroughly documented should continue to have an annual screenings even after the post treatment surveillance.
If you have further questions as to whether or not you need to get an annual pap smear and/or thin preps, please feel free to contact us at Valley Family Medicine. Records will need to be reviewed in each individual case.
Definitions:
Cervical intraepithelial neoplasia (CIN), also known as cervical dysplasia and cervical interstitial neoplasia, is the potentially premalignant transformation and abnormal growth (dysplasia) of squamous cells on the surface of the cervix. CIN is not cancer, and is usually curable. A small percentage of cases progress to become cervical cancer, usually cervical squamous cell carcinoma (SCC), if left untreated.
Diethylstilbestrol (DES, former BAN stilboestrol) is a synthetic non-steroidal estrogen. From about 1940 to 1970, DES was given to pregnant women in the mistaken belief it would reduce the risk of pregnancy complications and losses. In 1971, DES was shown to cause a rare vaginal tumor in girls and women who had been exposed to this drug in utero.
Thin Prep by CytoTech is a fluid based method of preparing a pap smear. A thin prep,under certain circumstances, offers diagnostic advantages over a pap smear.
