It is never too early to start thinking about optimizing your health for a future pregnancy.  Whether you are currently trying to conceive or still years away from babies, knowing this important information will help guide your path to pregnancy.

1. Talk With Your Doctor About Preconception Care
   During an office visit, we can discuss the topics presented here, but also tailor a preconception-plan especially for you.  It is important that existing medical conditions (such as depression, anxiety, high blood pressure, diabetes and asthma) be well controlled before pregnancy.  All prescription and over the counter medications should be discussed with your doctor as some could be unsafe during pregnancy. At this visit, we could also screen for sexually transmitted diseases and be sure you are up to date with vaccinations, especially rubella and varicella.  Finally, a review of any genetic illnesses or abnormalities present in a family should be done and referral to a genetic counselor made, if necessary.
2. Healthy Diet
   When planning for pregnancy you are “eating for two”, but in quality, not quantity.  It is important that you maintain a diet high in fruits, vegetables, lean proteins and whole grain carbohydrates.  Avoid simple sugars and high fat foods.  Though fish can be an important source of healthy Omega 3s, when planning for pregnancy we must be careful of the type and quantity of fish consumed.  Steer clear of tilefish, king mackerel, shark, and swordfish as they are known to contain high levels of mercury.  Limit tuna to 6 oz per week and salmon to 12 ounces per week.  Do not consume raw seafood or meats and be sure all hot dogs and lunch meats are heated to steaming before eating.  Having calcium and Vitamin D in your diet is important, but be sure all dairy products are pasteurized.  Finally, keep caffeine to 300mg per day or less, which comes to about 2 cups per day.
3. Avoid Toxins
   When planning pregnancy it is important to avoid tobacco, nicotine, recreational/illegal drugs and alcohol.  It is also best to avoid certain chemicals including those in paint thinners, paints, and insect and weed killers.  Individuals with pets in the home should refrain from changing cat litter or cleaning cages from rodents.
4. Prenatal Vitamin
   All women contemplating pregnancy should start a prenatal vitamin containing 400-800mcg of folic acid once daily at least 3 months prior to trying to conceive.
5. Achieve a Healthy Weight
   Make exercise a priority BEFORE getting pregnant. Plan to work up to 30min of exercise 5 times a week for optimal results.  Exercise is encouraged once you are pregnant as well. It helps to keep weight gains during pregnancy in an acceptable range.  Talk with your doctor to see if the types of exercise you are doing are appropriate for pregnancy.
6. Learn to Relax
   Knowing how to handle the everyday stresses of life is important at all times of life, but never more so than when pregnant.  Trying to conceive, pregnancy and early motherhood are all very stressful times in a woman’s life and we need the tools to keep that stress under control.  Having family support, a trusted friend or a therapist can be helpful.  In addition, yoga, mindfulness meditation and progressive relaxation can help those stressful times feel more manageable.
7. Detoxify Your Enviornment
   This is the perfect time to think about changing out highly chemical and toxic products in your home for more natural ones.
8. Get Your Partner Involved As Well
   Male partners contribute half of the baby’s genetic material.  A man’s sperm can be damaged by alcohol, drugs, tobacco, caffeine and toxins.  Making sure his health is optimized is extremely important.  Female partners need to be a strong support for a pregnant mom and set the tone for a healthy family, so making sure everyone is in the best health possible is a priority.  Partners should visit their own doctors for a check-up as well.

July 28th is World Hepatitis Day, created to raise understanding and awareness of what viral hepatitis is and what can be done about it.

Viral hepatitis is a term referring to any of several infections that attack your liver and cause damage to its’ cellular structure. The viruses we usually refer to when discussing viral hepatitis are: Hepatitis A, B, C, Delta and E. There are, however, other viruses that cause liver inflammation and, reversely, these five viruses can also cause damage and symptoms outside of the liver.

Viral hepatitis typically presents as an acute infection – there are some cases that are ‘subclinical’ meaning patients do not even have obvious symptoms and may go through an infection without ever knowing they had it! More commonly, however, patients present with symptoms including: fatigue, loss of appetite, nausea, vomiting, and jaundice (yellowing of the skin due to buildup of bilirubin – a pigment that your liver removes from the bloodstream when it is functioning properly). Very rarely, severe cases can even progress to liver failure, brain disease and may be fatal.

Many cases of acute hepatitis resolve within days, weeks or months. However, sometimes acute hepatitis can progress into chronic infection (this only happens with types B, C and Delta). Most often (85% of adult cases) this happens with Hepatitis C. In fact, infection with Hepatitis C can very often present only subclinically with patients experiencing only some fatigue and indigestion. Of course, the concern with these asymptomatic patients is that they may be spreading the infection without being aware of it.

The Delta virus is actually a co-infection that is only present along with Hepatitis B virus. Its presence is usually an indicator of more severe or chronic hepatitis B infection. It spreads through contact with infected blood (through injection or sexual contact)

Hepatitis A is spread primarily through infected food, water or close physical contact with another infected person. It is most common in areas with poor sanitation, such as developing countries or amongst injection drug users. This infection only presents as an acute illness and does not progress to chronic infection.

Hepatitis E is similar to A in that it does not progress to chronic infection and is typically spread through contaminated water, although you can also get this infection by eating contaminated animal products or transfusion of infected blood. This infection is most common in Asia. This infection is most dangerous for pregnant women – the virus can cross the placenta and infect the fetus. Due to immune system changes during pregnancy, pregnant women are more at risk to have severe consequences such as liver failure. Infection in the 3rd trimester can be fatal.

Hepatitis B is transmitted through infected blood or bodily fluid contact – this means both sexual and percutaneous transmission is possible. In some developing countries, dentists with inadequate sterilization equipment can be a source of infection. In general, since hepatitis B can live outside of the body for up to 7 days, any kind of intervention can potentially introduce the virus. This form of viral hepatitis can also develop into a chronic infection; an estimated 240 million people worldwide have chronic hepatitis B. Children under 6 years of age are most likely to develop chronic hepatitis B if they are infected.

Hepatitis C is a blood borne infection – you can only get it through unscreened blood transfusion, unsafe injection practices or unsterilized medical equipment. It can also travel through the placenta of an infected mother and cause infection in her baby. This form of hepatitis can be considered the most dangerous since it can often go undetected for decades as a chronic, asymptomatic infection.

Can hepatitis be cured?

We now have the medications available to clear most patients of their viral hepatitis. Most of the viral infections require only supportive therapy – making sure patients are hydrated and other symptoms – such as nausea and vomiting are reduced. Anti-viral therapies have been shown to be helpful for severe or chronic cases of Hepatitis B. We also now have treatment targeted at Hepatitis C that has made this infection curable as well.

Of course, with severe forms of hepatitis, patients have to be well enough to respond to available medications and fully recover. Some patients will also have irreversible damage from the infection, such as liver failure. Therefore, the best thing is to never become infected in the first place!

What can I do?

First and foremost you should know your status. Get tested for hepatitis B and C to ensure that you are not an asymptomatic carrier of this infection – knowing your status is the best way to protect your partners and future children.

If you are travelling out of the country, schedule a travel visit to find out if your travels will be through an area where Hepatitis A and E are common – this will alert you to be mindful of sanitation shortcomings, make sure you do not eat undercooked food or water that has not been sterilized.

If you are an injection drug user, please use safe practices by not sharing needles. You should also be mindful in any place that uses needles – if you are getting tattoos or piercing, make sure your provider uses proper sanitation techniques.

Healthcare workers are a special risk category for hepatitis infection since they are in contact with patients all the time. For this reason, make sure you are always using proper protection equipment (masks, gloves, eye shields) when working with patients.

Lastly, and most importantly – get vaccinated. Hepatitis A vaccines are available for patients travelling to endemic areas to make your trip worry-free. Hepatitis B vaccinations are available starting from birth! You can get your newborn vaccinated before they ever leave the hospital. Remember – Hepatitis B can live for up to 7 days outside of the body, so your baby can be at risk anytime they are in need of medical intervention – by vaccinating your baby, you can remove this risk-factor entirely. Healthcare workers who have not been vaccinated, should also get the vaccine series so that you can be safe and secure in your work. There is also a vaccine for Hepatitis E in China that will hopefully soon be available worldwide.

Viral hepatitis can be a mild inconvenience for some patients and a life-changing consequence for others, however, now that we have new treatments available, it is no longer a death sentence. Protect yourself by knowing your status and your options – schedule an appointment with one of our providers today!

Hives are raised, red, itchy patches of skin (also called Urticaria, welts, or wheals) that can be frustrating to experience. Hives are commonly caused by a number of triggers, and figuring out the cause is sometimes challenging. Hives can be the result of allergies to medicines like penicillin, or to foods like nut, soy, or shellfish. They can be caused by viral, bacterial, or parasitic infections (especially in children), by physical contact with substances like plants (such as poison ivy or poison oak) or latex, and by insect bites or stings. Some people can even develop hives in response to less obvious triggers, such as exposure to temperature changes, or pressure on the skin. Regardless of the cause, treatment ofhives is usually initiated with medications called antihistamines (Loratadine, Cetirizine, Benadryl); in more resistant or diffuse cases, a short course of oral steroids may be used to reduce the swelling, itching and inflammation.

Occasionally, hives are accompanied by a more serious type of allergic reaction called Angioedema. Angioedema causes swelling of the face, eye area, hands feet or genitals. This can be treated with the same medications as hives, but angioedema should always be evaluated by a health care professional to make sure it does not progress to a more serious type of allergic reaction. Other complications of hives that require emergent attention include hives that are accompanied by throat closing or breathing difficulty; nausea, vomiting or abdominal pain; or passing out–these symptoms will not respond to regular antihistamines alone.

Although typically hives will be a self-limited affliction, with lesions coming and going in minutes to hours, and episodes lasting for a few days, in some cases, they can last for weeks. If hives last for six weeks or more, they are called chronic hives. This type of hives is more difficult to manage, and often, a cause if not found. Symptoms will usually resolve over several months, however. Generally, hives can be successfully managed by avoidance of triggers and prompt treatment of outbreaks. For more information about this and other skin issues, ask you health care provider.