There are over 100 different types of HPV. Approximately 40 of the types infect the genital areas of men and women. Approximately 12 types of HPV are known to cause genital warts and approximately 15 types are linked to cancer of the anus, cervix, vulva, vagina and penis.

Since HPV is so common, it is important for both women and men to take preventative measures to minimize their risk of infection. Individuals can help reduce the risk of infection by limiting his or her number of sexual partners, using condoms during sexual intercourse and getting vaccinated.

Gardasil, a vaccine that is approved for females and males ages nine to 26, protects against four strains of the human papillomavirus (HPV). Virginia Women’s Center was the only research site in the Richmond area involved in the clinical trial leading to the approval of the Gardasil vaccine in 2006. In females, Gardasil helps protect against the two types of HPV that cause about 70 percent of cervical cancer cases and two additional types that cause 90 percent of genital warts cases. In males, Gardasil helps protect against 90 percent of genital warts cases.

Gardasil is ideally given to patients before they become sexually active. The vaccine is given in three shots over a period of six months. Routine vaccination is recommended for boys and girls at age 11-12. However, it is also recommended for older teens and young adults who were not vaccinated when younger.

The Centers for Disease Control and Prevention (CDC) announced in June 2013 that a new study shows that HPV in young women (ages 14 to 19) has declined by more than half since the vaccine was introduced in 2006. This is encouraging news despite the fact that only one-third of eligible patients have received all three doses of the vaccine.  Dr. Thomas R. Frieden, director of the CDC said of the results, “They should be a wake-up call that we need to increase vaccination rates. The bottom line is this: It is possible to protect the next generation from cancer, and we need to do it.”

To learn more about Gardasil, visit our Web site or speak with your health care provider.

• Make sure the majority of grains you are eating are whole grains
• Choose vegetables that are rich in color
• Select whole or cut-up fruits instead of fruit juice
• Drink skim or low-fat milk
• Choose lean or low-fat cuts of meat and prepare them in a healthy way
• Decrease or eliminate your salt intake
• Drink plenty of water
• Divide your plate into sections
• Eat dinner as a family or with friends

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When diabetes starts during pregnancy, it is called gestational diabetes. Women with diabetes (whether or not it is classified as gestational diabetes) need special care during pregnancy.

Diabetes is a condition that prevents the body from using food properly. The body receives its major source of energy from a sugar known as glucose. Insulin, a hormone manufactured in the pancreas, must be available for glucose to be used in the tissues. During pregnancy, some of the hormones produced by the placenta have a blocking effect on insulin. Gestational diabetes occurs when the pancreas produces its maximum amount of insulin, yet that is not enough to overcome the effect of the placenta’s hormones.

What are the risk factors for gestational diabetes?

Gestational diabetes is more common in women who

• are overweight or obese
• are older than 25
• have had gestational diabetes in a prior pregnancy
• are African American, American Indian, Asian American, Hispanic, Latina or Pacific Islander
• have a family history of diabetes
• have previously given birth to an infant that weighed more than 10 pounds
• had excess amniotic fluid in a prior pregnancy
• had an unexplained stillbirth or miscarriage in a prior pregnancy

How is gestational diabetes diagnosed?

At Virginia Women’s Center, we screen for gestational diabetes at 28 weeks of pregnancy. You will have to drink a syrupy glucose solution and then have your blood sugar level measured one hour later. If your blood sugar level is higher than normal, you will have to do a follow-up glucose test. The follow-up test involves drinking another glucose solution and having your blood sugar level checked every hour for a three hour period. If at least two of the blood sugar readings are higher than normal, you will be diagnosed with gestational diabetes.

What if I am diagnosed with gestational diabetes?

If you are diagnosed with gestational diabetes, you will work closely with our nurse practitioners to create an individualized food plan. You will not have to give up foods you love, but you may have to limit them or eat them with other foods so that your blood sugar isn’t negatively affected. During pregnancy, you will have to manage your blood sugar so that it stays in the optimal range and reduces your risk for complications. Usually, this can be done through diet and exercise. You will also work closely with our physicians and may need additional testing to monitor the baby’s health and reduce the risk of complications throughout your pregnancy.

For most women, once the baby is delivered, gestational diabetes will go away. You will be tested again at your postpartum visit. If it does not go away, it is reclassified almost always as type II diabetes. Women who had gestational diabetes are at high risk of having diabetes later in life. Choosing to pursue a healthy lifestyle by eating nutritiously and exercising regularly may help prevent or postpone diabetes.

Additional Resources:

• Frequently Asked Questions on Gestational Diabetes
• Healthy Weight Management

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By Guest Author: Susan Uhle, NP - Richmond Surgical

Early detection is currently the cornerstone of our arsenal in the war against Breast Cancer.  This is accomplished through Mammographic Screening, and, at times, other imaging methods such as Ultrasound and Breast MRI.   Findings from Mammography can lead to Needle Biopsy, where results can range from benign, to benign but abnormal, to cancer.  These results dictate the next action, which may include surgery or closer surveillance.  The results also allow us to better stratify individual risk.

As an example, Christina undergoes Screening Mammogram, leading to a Needle Biopsy; results show Atypical Ductal Hyperplasia (ADH).  Her risk of developing cancer is now known to be four times that of a woman her age without those findings.  There are certain measures she can take to decrease that risk, including lifestyle modification, surveillance, and chemo prevention.

On the other hand, there are individuals with a personal or family history, who should be further evaluated at the time of Mammography or during the office visit.  We know that a family history in a first degree relative (mother, sister, or daughter) confers an increased risk.

If we look further and the Breast Cancer was one of several types (early onset, two separate Breast Cancers, Male Breast Cancer, Ovarian Cancer, Multi-Generational), we would consider whether there is an inherited mutation in the family. Although this is present in only 5 to 10% of individuals, the Breast and Ovarian Cancer risk is as high as 87% and 44% lifetime.  Preventive Mastectomy and removal of ovaries is the choice of many, but not all, women.  This reduces the risk of Breast and Ovarian Cancer, but not to zero.

This is prevention; one form of risk management, as was chosen by Angelina Jolie. This is a personal decision, to be made with all facts in place and with information from a health care provider with extensive knowledge in this area. For those at a lesser risk, at the opposite end of the continuum, one would start with lifestyle changes and medication.

For further questions, or to schedule a consultation, please contact Richmond Surgical at 804.285.9416.

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