Nurse Advice Line

Patients with health questions can contact us through any of the following methods:

• If you believe you have a medical emergency, please call 911.
• If you would like a short-term response, please call the Marietta office at (770) 422-8505 during office hours or send a secure message through our Patient Portal. Please note that the Patient Portal is not monitored after office hours. Please call the office for urgent problems.

Influenza (flu) Season Information (Seasonal and H1N1) For 2011 – 2012

 

Appointments

For the safety of other patients, we ask that if you have the flu or flu symptoms, please call to reschedule your appointment.

Treatment

Non pregnant patients that have the flu or exposure to the flu, please call your Primary Care Physician or seek medical care at one of the WellStar Urgent Care Centers.

Frequently Asked Nurse Advice Line Questions

OBSTETRICS

Pregnancy
The answer to many questions in pregnancy can be found in What to Expect While You’re Expecting,or most other pregnancy books. The ACOG.org web site is also an excellent resource.

Medications
Many medications are safe to take in pregnancy, although limiting exposure to any medications is recommended, especially in the first trimester. Many medications must be taken by patients who have chronic medical problems such as thyroid disease, seizure disorders, high blood pressure, and many others. In fact, not taking the medications as directed can be very harmful. Some medications require levels to be checked as doses may change throughout pregnancy; this will be done under the direction of your physician.

Please see the following lists for specific symptoms and medications safe for use.

Nausea
This is a very common and actually reassuring sign of a healthy pregnancy (although is does not have to be present to have a healthy pregnancy.) Small frequent meals or snacks, peppermint candies or tea, or even “Sea Bands” (purchased at drug stores to prevent sea sickness) can help. If you experience vomiting more than 2 to 3 times a day or feel you are unable to keep down enough food or liquids you need to contact the office. DO NOT wait until you have not kept anything down for more than 24 hours as you could become dehydrated.

Pain and Headaches
Tylenol (acetominophen) should be the only medication used. Other medications such as motrin, aspirin, and alleve should be avoided, unless directed by a physician, because of potential fetal side effects.

Cold Symptoms
We advise that you increase fluids and get plenty of rest. Use humidifier and saline nasal spray for congestion. For a sore throat, use saltwater gargles. You may use the following over-the-counter medicines for cold symptoms: Sucrets or hard candies for sore throat, Sudafed 30 mg, 1 tablet 3 x a day, Drixoral 1 tablet twice a day, Robitussin plain or DM, 1 teaspoon 3 x a day, Tylenol 2 regular strength every 4 hours as needed for headache or fever. If you have temperature over 101ºF, nasal or chest drainage with color, shortness of breath or wheezing, you must schedule an appointment with your primary care doctor. If you have no doctor other than our practice, you may schedule a non-OB related appointment.

Yeast Infections
Symptoms are a thick white discharge like cottage cheese with vaginal itching without and odor. If you have been previously diagnosed with a yeast infection and are having similar symptoms, it is OK for you to treat yourself with over the counter treatments such as Monistat. You can use the applicator but insert it only gently into the opening of the vagina. If your symptoms persist, your discharge has an odor or unusual color, you have fever or abdominal pain, or you have not been previously diagnosed with a yeast infection, please schedule an appointment for evaluation.

Constipation
This is very common in pregnancy, especially if you have to take extra iron. The best way to treat it is to drink a lot of water (8 to 10 glasses per day) and increase the fiber in your diet. If this does not help, you can use metamucil or fibercon as dietary supplements. Stool softeners such as colace can be used if dietary changes do not work.

Hemorrhoids
These are basically varicose veins at the anus, or lower part of the rectum. They are very common in pregnancy due to the pressure on the pelvic veins of the pregnant uterus. The best prevention is elimination of constipation. Tucks or anusol creams or suppositories can be used if they are painful or tend to bleed. If you have severe pain, you need an appointment for evaluation.

Bleeding
Bleeding is never normal but does not necessarily mean that something is wrong. It is common to have a small amount of spotting or bleeding after a pelvic exam or after intercourse. Some women also have a small amount of pink or brown discharge associated with the passage of the “mucus plug” at term (near their due date.) If you have bleeding at any other time you should contact the office for evaluation.

Sexual Intercourse
Intercourse is safe throughout pregnancy unless you are having complications and have been instructed by a provider to avoid intercourse or be on “pelvic rest”. However, sex may become more uncomfortable, especially late in pregnancy. Some couples find improvement with position changes while others tend to limit this type of intimacy.

Back Pain
Lower back pain, especially at the end of the day and further along in pregnancy is very common. This is due to the fact that your center of gravity is way out in front of where it usually is and pregnancy relaxes your tendons and joints. Wearing a maternity belt during the day can be a big help. Heating pads set on low, a warm (not hot) bath, or a swimming pool can also be soothing.

Swollen Feet
This can be very common, especially late in pregnancy, and for some women it can be very severe. It also tends to be much worse in the hot summer months and for women who stand a great deal at their jobs. It can also be a sign of toxemia so if you also experience headaches, visual changes (seeing spots), or are being followed closely for your blood pressure you should contact the office for evaluation.

The best treatment in this case is definitely prevention. Wearing support panty hose, even though they may be hot, is the biggest help. Limiting salt intake (watch those sodas) and drinking plain water (8 – 10 glasses) per day will also help. Elevate your feet when you can, especially if you sit at a desk most of the day.

Heartburn
This is another symptom that tends to plague women late in pregnancy. Small frequent meals and not lying down for at least an hour after eating relieves some symptoms. Medications such as Tums, Maalox, Pepcid and Zantac can be taken safely as directed on their packages.

Travel
If you are experiencing a normal pregnancy and have no complications, you may travel by car or air up to 36 weeks of pregnancy. Be sure to increase your fluids to avoid dehydration. Make sure you empty your bladder every two hours to avoid a urinary tract infection. We advise exercising your ankles in the car or airplane every hour. If traveling by car, we recommend getting out of the car and ambulating every 2 hours to prevent swelling in your feet. We ask you not to leave the Metro Atlanta area after 36 weeks of gestation.

Please be aware that although most patients deliver after 36 weeks, there is no accurate way to predict the timing of delivery. This means that there is a chance that you could deliver while out of town. If you are experiencing frequent contractions, even Braxton Hicks contractions, have had a previous preterm delivery, or are carrying multiples, you may want to discuss this with your provider at your next appointment.

Painting Precautions
You may paint while you are pregnant if you use a water-based paint. You may not use any lead-based paint. You must paint only in an adequately ventilated area. We suggest painting for only 2 hours at a time. Do not sleep in a room in which you have just painted until paint fumes have fully dissipated.

Dental Appointments
We recommended that you have your teeth cleaned on schedule, even though you are pregnant. If you have cavities that need to be filled, you may have that done. You may receive Novocaine, preferably without epinephrine, during a procedure at the dentist. X-rays may be taken if they are needed and your abdomen is shielded with a lead apron. If you have MVP and normally take antibiotics prior to dental procedures, you will need to take them even though you are pregnant. Normally Amoxicillin or Erythromycin is used. If any different medication is requested, you will need to speak with a nurse. If your dentist has questions, he may contact our office.

Medications are usually prescribed by either your primary care physician/family physician or your dentist.

Exercise
If you have been participating in an active exercise program, we encourage you to continue throughout your pregnancy, unless instructed not to. You may need to lower your intensity and avoid routines at which you are at risk of falling or hitting your abdomen. We also do not recommend any exercises that require you to be flat on your back after about 14 weeks.

If you have not been exercising, it is OK to start an exercise routine. This however should be something such as walking or swimming (treadmills are fine) and you should start at a slow pace.

THE MOST IMPORTANT THING is to not get exhausted or dehydrated. Remember, your body is going through some significant changes and will not function at the same capacity that you are used to.

Medication to Dry up Milk
Medication is no longer used to dry up your milk due to possible serious side effects it can cause. We advise that you wear a tight fitting bra, like a sports bra, day and night, removing only to bathe. Avoid any stimulation to the breast or pumping off milk. This will only continue your milk production and prolong the process. You may use Tylenol or Advil and ice packs for discomfort. If signs of an infection develop, like elevated temperature or redness, call and speak to a nurse.

GYNECOLOGY
An excellent resource for detailed explanations about many gynecologic issues is the ACOG web site.

What is a Pap Smear?
A pap smear is a test where cells from the outside of the cervix (the opening of the womb) are removed to check for precancer or cancerous conditions. It does not check for any other diseases of the female reproductive system, such as endometriosis or ovarian cancer. It is recommended that most women after the age of 18, or before if they are sexually active, have a pap smear every year.

Colposcopy
This is a procedure used usually to evaluate the cause of an abnormal pap smear and the severity of the abnormality if any is present. It is a prolonged vaginal exam…before the procedure. Some light bleeding or dark colored discharge (it may even be thick and clumpy) is very common for 1 to 2 days after the procedure. If you experience heavy bleeding or fever you should contact the office.

Endometrial Biopsy
This is a procedure done usually to evaluate the cause of abnormal bleeding or infertility. It involves removing a small piece of tissue from the inside of the uterus, the endometrium. A small plastic straw-like instrument is use to remove the tissue which is then sent to the laboratory for analysis. Taking 2 Advil one hour before the appointment will minimize any abdominal cramping which could occur during the removal of the tissue. Cramping is usually gone before you leave the office. No anesthesia is used so you should be able to drive yourself. You will be called with the results 1 to 2 weeks from test date.

Yeast Infection
Symptoms are: thick white vaginal discharge like cottage cheese and vaginal itching. You may treat yourself with an over-the-counter yeast medication like Monistat or Gyne-Lotrimin. If symptoms persist without any improvement, schedule an appointment. If you have abdominal pain or fever, or your discharge has an odor, you need an appointment to obtain treatment. Diflucan, the oral yeast medication advertised in magazines, is not routinely prescribed because of the possible serious side effects associated with its use.

Birth Control: When to start?
Start your first package of pills on the Sunday after your period starts. If your period starts on Sunday, you start that day. Take your pills at the same time of day every day without fail. Use a barrier method of birth control during the entire first package and any subsequent package in which you miss a pill or use any new medications or antibiotics. Check with pharmacist to see if your new medication lowers the effectiveness of your birth control pill. Take daily at same time of day. Take with food to minimize any nausea you might have.

Birth Control: Breakthrough Bleeding
Breakthrough bleeding, or bleeding between periods, is normal in the first 3 packages of new birth control pills even if all pills are taken correctly and on time. If you miss a pill and make it up, you may have breakthrough bleeding for the remainder of the package. You need to use back-up contraception, like condoms, the remainder of any package in which a pill is missed or when taking antibiotics and medications that interfere with birth control pills. Breakthrough bleeding should lessen with each subsequent package. If breakthrough bleeding continues after 3 months or is as heavy as a period, you need to speak with a nurse.

Birth Control: Missed Pills
If you miss a birth control pill, take the missed pill as soon as you remember, and take your next pill at the normally scheduled time. Use barrier contraception, like condoms or foam, the remainder of the package. Even one missed pill can cause breakthrough bleeding and pregnancy could occur. If 2 pills are missed, you will need to take two pills daily until missed pills are made up. If 3 pills are missed, your period may start. You will need to stop taking the pills. Start a new package on the following Sunday. Use barrier contraception the entire new package.

Birth Control: Missed Period on the Pill
If you have taken all your pills on time, haven’t been on any other medications and have used barrier contraception, and you don’t get any flow or spotting at the correct time, you need to do a home pregnancy test prior to starting next pack of pills to ensure that you’re not pregnant. A small number of patients on birth control pills will conceive even if taken correctly. Nothing is 100 % effective. If the test comes out negative, you may take your new package on time. If a second period is missed, repeat the pregnancy test and call the nurse, as you might need a prescription change. If pregnancy symptoms develop, speak to a nurse.

Birth Control: Nausea
It is not uncommon to experience some mild nausea when starting the pills. If you experience nausea, taking the pills with food or at night usually relieves this symptom.
Hysterosonogram (Saline infusion sonogram)

This combines a regular vaginal probe ultrasound with a technique used to evaluate the lining of the uterus for any abnormal tissues such as polyps or fibroids. It involves inserting a small tube or catheter in the cervix and injecting a small amount of fluid to better see the shape of the lining of the uterus. There is usually just minimal cramping, if any.

Hysterosalpingogram (HSG)
This is a test usually done on women experiencing infertility. It is an X-ray test done by the radiologist in which dye is injected through the cervix to evaluate the lining of the uterus and whether or not the tubes are open.

When do I need a Mammogram?
For most women it is suggested they have a baseline mammogram at age 35 (this is one used to compare later mammograms to), every 1 to 2 years between 40 and 50, then yearly after 50. The frequency and timing may vary with personal and family history, this can be discussed with your provider.