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Saturday, February 27, 2010

What do I need to know about my cervix and why?

Strange title.  I know.  But maybe you'll just read on.

Your friendly cervix is the end of your vagina and the beginning of your uterus.  You probably remember the doctor talking about your cervix dilating if you've had a baby.  This is where most women's knowledge ends.

But, I believe that you should know much more about your cervix.  You should know about it because it is yours.  You should know about because you need to care for it.  You should know about because a small but evil virus can attack it (HPV).  And change it into cancer.  But not if you don't let it.  And now, you can protect your daughters from these evil invaders.

So, a random zoologist, Dr. Papanicolaou (no, I am not making this up) invented the pap smear in 1941.  And now you have to have one.  Maybe every year. Thats all for the history, here's the rest...

The pap smear is only part of your annual gynecological exam (another post).  The pap smear is the part of the exam after the speculum is inserted when the doctor takes 2 brushes to collect cells from the outside of your cervix.  These brushes are then dipped into a liquid based solution and sent to a [strange] doctor that stares into a microscope all day (aka pathologist).  This doctor then interprets the results.  He is looking for changes in the cells caused by the evil invaders (HPV) that can be minor (pre-cancerous), kind of a big deal, or an uber big deal (cancer, rare, not funny but trying to keep this light-hearted).

So, lets delve a bit deeper into HPV.  HPV stands for Human Papilloma Virus.  Not many can pronounce that and no one can remember it so we'll refer to them as the EVIL INVADERS.   The evil invaders are everywhere and there are many different types.  You get them from sex.  (that's right  CERVICAL CANCER is A SEXUALLY TRANSMITTED DISEASE).  Some are very evil (high risk) and some are sort of evil (low risk).  They cause genital warts and cervical cancer.  And as with many other things, men get off scott free.  No symptoms.  They don't usually even know its there (unless they get genital warts and freak out).  But they pass it to us.  And we have to deal with it.  Thanks a lot.

The evil invaders are so common that almost 75-80% of all sexually active women will have an infection by the age of 50.  Thats right, more than 3/4 of you.  So thats you, you, and you but not you.  You get the point.  Its common.

Your body will do 1 of 3 things with this infection.

1.  You will be exposed but your cells will not allow the invaders to penetrate.  Good job cells.

2.  You will be exposed, and your cells will lose in the first line of defense and the evil invaders will get in.  Then your reserve troops (aka immune system) will launch an all out war and win.  Kicking the evil invaders to the curb.  Adios muchachos.

3.  You will be exposed, lose all battles and have what is called a persistent HPV infection.  This is the bad one.

So, the war takes a long time and the evil invaders are pretty stealth and can evade the immune system by being sneaky.  You may have had some sexual indiscretions in college (don't remind me) and everything was fine, then all the sudden, boom, abnormal pap.  That is common.  It can take up to 7 years to see changes from HPV.  That is why you need a yearly exam.  Even after you're with the love of your life.

So, how is the pap interpreted by this men with the microscope (the pathologist)?

Here are the options.

1.  NORMAL.  Awesome.  Thanks for everything, see you next year (frequency of paps to be discussed later)

2.  ASCUS.  Stands for ATYPICAL SQUAMOUS CELLS OF UNDETERMINED SIGNIFICANCE.  I know.  This is absolutely the MOST ridiculous name ever.  But I didn't make it up.  It means cells don't look exactly normal, but they don't look exactly abnormal either.

If you have this, most doctors will do another test called the HPV test.  This will then tell you if you have the high risk or low risk types of HPV.  If you have the high risk type of HPV, most likely you will need a more specialized test called COLPOSCOPY (later).  If you have the low risk types, you may just need a repeat pap smear in 6-12 months.

(NOTE:  these guidelines may not apply to adolescents <20 because they have an easier time clearing HPV infections)

3.  LSIL.  Stands for LOW GRADE SQUAMOUS INTRAEPITHELIAL LESION. Also ridiculous.  Means the cells may be abnormal and you likely have the 2nd form of HPV where your cells were invaded but your immune system is working on kicking the evil invaders to the curb.  Because 15% of women with this result can develop precancerous changes, a colposcopy is needed.

4.  HSIL.  HIGH GRADE SQUAMOUS INTRAEPITHELIAL LESION.  Advanced changes in the cells consistent with persistent infection.  Needs to be followed closely.  Needs colposcopy.  Changes could be cancerous.  Yuck.

So...just a tad about COLPOSCOPY and this torture lesson will be over.  This is a specialized type of pelvic exam where the doctor looks at your cervix up close with a microscope.  A special solution is placed on the cervix to highlight the abnormal areas and biopies (pieces of tissue) are taken.  These are sent to the pathologist to be looked at under the microscope to see if there are pre-cancerous or cancerous cells.

You may have found this to be more information than you wanted to know, but knowledge is power.  An informed patient is well armed.

Stay that you are EVIL INVADER (HPV) experts, we need to discuss GARDISIL, the EVIL INVADER VACCINE.  YAY!

Friday, February 26, 2010

What do you know about the immunizations your child gets?

This is the start of a series of posts about immunizations. The picture above is helpful to many parents to make sense of the "alphabet soup" of immunizations that are given to our children.  After talking to many parents about immunizations, it is obvious to me that the topic brings up strong feelings.  You may be "pro vaccine".  You may be "anti-vaccine".  You may want to take it slow.  You may follow the recommended schedule.  Hopefully you don't not do it at all.  (kind of sounds like I'm talking about sex....but, I'm not!)  So, instead of  getting into the discussion of whether or not to immunize, what do you know about the vaccinations that your child gets and what DISEASES they protect against?

It would not surprise me to hear that more people will know what vaccine has had UNSUBSTANTIATED claims of causing autism (just to stress, NOT TRUE) than about the diseases that we are protecting our children against.  Please see attached materials to evaluate the mountain of evidence that goes against these claims.  Nevertheless, in our society, those who yell the loudest get the most attention, and a certain playboy playmate has done significant damage to the pro vaccine movement.

So lets start with....DTaP, the diptheria, tetanus and pertussis vaccine.

This vaccine is given 5 times at ages 2, 4, 6, 15-18 months and then again as a pre kindergarden booster.


Comes from the Latin word "leather" which refers to the tough membrane that is formed in the back of throat with this infection.  Diptheria causes a significant and severe upper respiratory infection characterized by fever, sore throat and enlarged lymph nodes in the neck.  The more serious infections with diptheria can cause stridor, which is a scary noise coming from the upper airway caused by a blockage which can lead to inability to breathe.  Thankfully the disease is rare in the US due to immunization practices, but in other countries, mortality (death) in children can be as high as 7%.


This one many of you have heard of.  This is a nervous system disorder caused by a bacteria that can cause severe muscle spasm (classically spasm of the muscle that helps us chew, called lockjaw).  You can contract tetanus through any type of cut or puncture wound, and it is more common to contract the disease if the object which penetrated the skin was dirty (with soil or manuer) or rusted.  Once the bacteria is in the body, it can release a toxin that can cause spasm of all your muscles which can be fatal.   Here is a video of a child with tetanus, only inserted for those that need a visual so viewer beware. Yuck.


AKA whooping cough.  This one matters.  It is on the rise due to the largely unvaccinated population and high rates of infectivity.  Though most people are immunized as children, the immunization wears off over time and adolescents  and adults are susceptible to this highly infectious bacteria.  Because these people care for only partially immunized babies, the disease can be spread to young children as well.

Pertussis usually starts similarly to the common cold with a runny nose and mild cough (catarrhal stage).  It then progresses to a severe cough stage (paroxysmal stage).  This is characterized by a long series of coughs with gagging and then occasional vomiting.  The classic "whoop" is caused by breathing in during one of the coughing "attacks".  This video is a classic presentation of pertussis.  The most severe or fatal forms of disease happens in the youngest children (newborn-6 months) if they are partially immunized or not immunized at all.  So actually, the best way to protect your children is to protect YOURSELF.  Most children acquire this from their household contacts (siblings and parents).  The bad news is by the time you know you have it, antibiotics don't work, they only decrease the rate of infection in others.

So how do you get immunized?...EASY.  See your doctor.  Ask for a shot call TdaP or Adacel (adult tetanus and pertussis vaccine).  Its a one time deal.  You may just save yourself or your child from a scary cold and cough, visits to the doctor, missed days of work or worse.

I will write more on this topic, but the best website for information on immunizations is  Another comprehensive source from the American Academy of Pediatrics is linked here.


Wednesday, February 24, 2010

What is your job as a parent?


We have many jobs as parents.    We are teachers.  We are cooks.  We are chauffeurs.  We are playmates.  We are housekeepers.  We are (sometimes) friends.  But we are parents.  And I believe that we have one job.

Simply put, our one job is to foster our child's self esteem.

How can we do this?

I can answer this one.  I hope for my child what every parent hopes.  I hope they are fulfilled.  I hope they are loved and give love.  I hope they are happy.  I hope they are productive members of society and feel the value of achievement.  I hope they make a mark in their little world.

I spend most of my days hoping for different things.  Smaller things.  I hope my Reagan gets dressed without demanding tights and a dress.  I hope the struggle to get Whitney's boots on only takes 2 minutes and does not end in injury.  I hope both of my children eat the first meal I put in front of them.  I hope we don't run out of chocolate milk AGAIN.

But this blog allows me to think about what I really want for my children.  So instead, I will hope for things that will contribute to their self esteem.

  • I hope that I won't yell.  Even if they deserve it.  And I will never hit.
  • I hope I am patient.  My job is to teach them calmly, deliberately and redirect bad behaviors.
  • I hope that I tell them every day how much they mean to me.  Because they are my world.
  • I hope to teach them that they don't have to be perfect to feel good about themselves.
  • I hope to show them how awesome it feels to be a smart and educated girl/woman with a strong head on her shoulders.
  • I hope to help them feel good about their bodies by being a good role model for them.  (I have to do a lot of work for this one!)
  • I hope that they know that family means unconditional love.  Period.
  • I hope to show them that a happy marriage makes 2 people greater than the sum of their parts.
  • I hope that on my journey to find happiness they can see what it is like to enjoy being in the moment.

I hope I can do this.

Friday, February 19, 2010

Do you wish your child was an Olympian?

I love the Olympics.  I watch the personal stories and I am riveted.  The  excitement of competition never gets old.  I feel proud of our athletes and country.  I even cried today at this commercial.

I've been thinking about the reasons that we as mothers do what we feel compelled to do for our children.  We start them in school at 18 months.  Make sure they have swimming lessons.  And gymnastics.  And soccer.  And tennis.  Even if they don't feel like going. We agonize about our decisions and then wonder and worry about the effects of our choices.   Is it just a form of torture?

Why do we (or maybe just me) feel the need to push them?  Is it so they can start early in the competition of life?  Is it to build confidence and social skills?  Is it so we can live vicariously through them and give them every privledge which we didn't have?  Is it to make sure that they don't feel "left behind"?

Do you ever dream (okay, secretely) that your child excels in a sport and will be an olympian?  [PS my daughter was placed in ADVANCED 3 year old gymnastics and I imagined this.] Is that the goal?  Is anything short of that failure?

I don't necessarily have many (or any) answers to the above questions.  I just ask them.  To myself.  Constantly.  

I did recently enroll my 3 year old in tennis.  I thought for a minute that it was quite a bit early to start, but I was taking a league at the same time, and I thought she would enjoy playing near Mommy.  Needless to say I was beaming with pride as she followed the teachers directions, ran around the court and even picked up balls without me.  What a big girl.  And then my mind went wild.  What if she was good, no, great at tennis like I always wanted to be.  What if she serves like my husband, but has a great baseline game like I do.  She could go far.  She could win tournaments.  Travel around with a coach.  Win medals and feel proud.  

Or, she could just be good and have fun doing it.    Wouldn't that be enough?

Then I turn back to myself and focused on my game.  I had recently joined the gym.  I am playing in a league with other men and women of my skill level.  The game is competative and fun.  I think of my parents and am thankful that they pushed me to play.  I am glad that I had the experience of competative play without the pressure.  I am glad that I can pick up a racquet and rally with someone I don't know and make small talk.

And I realize that this is what I want for my children.

Wednesday, February 17, 2010

Who am I?

I am doccarrie.  But that's just my blogging name.

I am...

1.  A mother.  To my favorite 2 girls that make me proud.

2.  A wife.  To a husband that thinks I'm a slob.

3.  A daughter.  To 2 parents that still treat me like a child.  Sometimes.

4.  A sister.  To my best friend and a little boy that I can still tease.

5.  A doctor.  To a small but growing number of patients that I can learn from.

6.  A friend.  To all the other mommies and women out there who I share this road with.

Where am I?  In my bed.  Blogging.

But I am really EXACTLY where I want to be.  And scared if I admit it, that it may all go away.

Thursday, February 11, 2010

Do you ever push pause?

This blog topic was inspired by my 3 year old daughter.  She insists we "push pause" on the TV so that she does not ever miss a minute of one of the many shows which she has seen a mere 100 times (insert comment here about my inadequacies as a mother). However, the other day we were actually watching live TV (a foreign concept to my children) and when pause was demanded, I could not deliver.  I tried to explain this but I simply couldn't.  I had to break the news that this program would continue despite our need to use the potty.  Wow.

Sometimes I find myself trying to "push pause".  On my life.  Sometimes its for selfish reasons: so I can get more sleep, so I can have more time to get ready for work, so I can have a couple more minutes of "mommy time".  But that is not what I'm talking about here.  I'm talking about those times in your life where you are just so in the moment that you wish it could last forever.  That you could push pause or save and return to the moment later.  Store it on your hard drive.  File under extreme happiness.  Have you ever had one of these moments?

I made a commitment to myself after I had my first daughter that I would try to savor all of her 'firsts", not taking them for granted and not forgetting them.  Meticulously recording them in the baby book.  Trying even to make the mundane interesting so I would have fabulous stories to tell her husband and my future grandchildren (oye).  But even these memories I record are just generalities.  Funny things that the kids do or say that we would want to remember that makes each of them unique.  The events I am trying to remember are those priceless moments that happen everyday that make you remember why you wanted to become a mom.  What makes it all worthwhile.

One "push pause" moment that I can readily access is from my oldest's 2nd birthday.  It was a swimming party.  Sunny day, lots of friends, perfect pool.  We had a swim teacher do some activities and sing songs.  I was holding my then 2 year old.  We were spinning around and I felt like you do in the movies.  Where you are focusing on a face and the background goes blurry.  And everything else is silent but your own voice and her laughter. If you were watching us, you wouldn't even had taken notice.  But the visceral sense of happiness that I felt in that moment was something I wanted to remember.  Find the remote.  Push pause.  I can still close my eyes and go there in my mind.  Staring into her eyes, singing and laughing, I told myself, remember this moment.  For you.  For her.  It won't last forever.

I am thinking about recording the "push pause" moments.  Kind of like a DVR of my life.  Naming each of them with a title.  That way I won't forget.  But, I am sure, like everything else in the hustle and bustle of life, I will push it to the side.  But maybe its not about that.  The reason that we remember these otherwise mundane moments as important is because of the feelings we attach to it.  And whatever it is that gives us that feeling of utter happiness is worth remembering, however you choose to do it.


Monday, February 8, 2010

How well do you know...YOURSELF?

So this is not an exsitential post about knowing how you handle certain situations, what type of mother you are, etc...but rather this is something much more concrete.  I spend much of my working days talking to women of all ages and have come to realize that we do NOT know ourselves well.  At least our female anatomy.

You may say...I'm enjoying my coffee, why do I care?

Because we are the windows through which our daughters see the world.  We are responsible for educating them about their bodies.  We are their best role models.  We will determine how they view themselves, their sexuality and our actions contribute to their self confidence.  By teaching our daughters about their bodies, they will know that they are in control of it.  And then, hopefully, they will make more responsible desicions.

So enough of the heavy stuff...Lets see how much you know.  Below you will see a labeled diagram.  Take the quiz. Get an 'A'.  The grading system is as follows:

90-100%: Great job, you are ready to teach your kids one day (uggghhh...)

75-90%:  Study the diagram, look in the mirror.  Keep reading my blog. Repeat quiz if necessary.

<75%: Consider getting a book and commit to familiarizing yourself with ... won't regret it.  Posts to follow about good resources for all women and information about why this is important, so keep reading.  Repeat the quiz until you get it right.

I would love to know if anyone finds this PLEASE comment.  I'd be happy to know that all this work was helpful to someone out there.

PS...if you can't read the letters...they start at A on the left and go down thru G (the last one on the left you can skip).  H through O is on the right.




  • Ovaries
  • Fallopian tubes
  • Testicles
  • Uterus

So this is pointing toward the fingerlike projections that wrap around the ovary...The fallopian tubes.  The fallopian tubes carry the egg from the ovary to the uterus. The egg can be fertilized either in the tubes or in the uterus (womb). ectopic pregnancy occurs when the egg is fertilized in the tubes and stays there and tries to grow.


  • Uterus
  • Vagina
  • Bladder
  • Ovaries
  • Pubic bone

The Bladder.  Nothing to interesting to say about this one.  When its full, you have to pee.


  • Pubic Bone
  • Tibia Bone
  • Clitoris
  • Vaginal Opening
  • I don't know....

Pubic Bone.  This sometimes is painful when it separates when you are prego.

D & E

  • Vaginal Opening
  • Clitoris & Clitoral Crura
  • Urethra
  • Penis
  • Are you crazy?

This is the clitoris (E) and the clitoral crura (D).  I know it seems silly to put the penis here as an option but actually the clitoris is the female equivalent of the penis.  In fact, some women that have too much male hormone can have a large clitoris resembling a small penis (fun fact).

This area has many sensory receptors and stimulation causes orgasm.


  • Vagina
  • Pee Hole
  • Urethra
  • Clitoris
  • This is too hard....

The answer is Urethra (technically) and pee hole (for those of you who didn't remember the word but got the idea).  This is the bladders connection to the outside world.


  • Uterus
  • Urethra
  • Bladder
  • Clitoris
  • Vaginal Opening

Yes, Vaginal Opening.  'Nuf said.


  • Testicles
  • Ovaries
  • Fallopian Tubes
  • Uterus
  • Golf balls....

Ovaries.   The ovaries release the egg waiting for fertilization to make a baby!  Amazing.  FYI...the testicle is the male equivalent of the ovary, aka the gonads.


  • Uterus (Womb)
  • Rectum
  • Cervix
  • Vagina
  • this one you SHOULD know!

Uterus.  Our baby's home for 9 months.  This you should know.  Don't let me down!


  • Uterus
  • Vagina
  • Cervix
  • G spot
  • You SHOULD care about this one...

Cervix.  I hope you know this one.  Later I plan to talk about why the cervix is important.  A pap smear screens for CANCER of the cervix which is a SEXUALLY TRANSMITTED DISEASE.


  • Ovary
  • Urethra
  • Fallopian tube
  • Vaginal Canal
  • Rectum

Vaginal Canal.  Not so interesting, but important.  End of the vaginal canal is the cervix (or the beginning of the uterus).


  • G SPOT
  • G SPOT
  • G SPOT
  • G SPOT
  • G SPOT

Ummm..yeah....the G SPOT.  I really hope you got this one.  This is a bean shaped area of the vagina that is also known as the "erogenous zone".


  • Vagina
  • Urethra
  • Anus
  • Poop Hole

Answer is...anus.  Again, poop hole is not anatomically correct, but you should get 1/2 credit for this.


  • Pelvic Floor Muscles

I didn't think anyone would know this, so its a freebie.  The pelvic floor is important, however, and kegel exercises strengthen the pelvic floor muscles.

Friday, February 5, 2010

Wine, whine and the DSO.


2 years ago at this time I was praying to be induced. Hoping she was healthy and ready to come out and greet the world.  I was ready to hear her squeals, rock her, feed her and learn everything about her.  Now I know her. She is a 2 year old that looks just like me. She has opinions, strong ones.  She has likes, dislikes, she talks and walks and runs and falls (a lot).  And its only been 2 years. Amazing.

Because of my amazing babysitter (really, she's more than that, but that is the subject of another post) Randy and I spent an evening alone with our (almost) 2 year old. I can't remember the last time we got to do this.  We took her to the mall for a birthday "dinner" and ice cream.  Mommy had wine because she needed it. Whitney whined and ate macaroni.  Randy stressed about Whitneys behavior (typical). We held hands and did superjumps. 

After dinner to our surprise the DSO was playing in the middle of the mall.  Whitney was screaming "wanna hear music" which is perfectly appropriate for a two year old. Right on track.  Overall a perfectly normal but special evening for our 'baby'.

Happy birthday to my Mitters.  Mommy truly loves you.

Thursday, February 4, 2010

Its been almost a year...and I have not been blogging!



I confess.  I haven't blogged.  Not for almost 1 year.  But I THINK about blogging constantly.  Does that count?  I'm not sure but I would like to set forth that my intentions are good.  My brother called me today and brought this fault to light and I think I will now again attempt to return to the blogosphere.

Some rules I will TRY to adhere to:

1.  I will attempt to blog AT LEAST 1 time per week.

2.  I will add medically relevant content (as was intended) for all of my mommy friends about common questions I am asked.

3.  I will post about my family and my girls to have a memory of all the adventures we have together.  My babies will only be young once. (tears)

I am unsure if this blog counts as my weekly post.  I don't think so.  After all, much is happening in my world now. A new job, a new home, and most importantly, my baby is turning 2 on Saturday.  Where has the time gone? (this may be rhetorical but I'll attempt to answer it...)

It has been spent cooking and cleaning and dancing (mostly to hoe down throwdown) and watching wubbzy and working and cuddling and (sometimes) exercising and just living.  It has been a good year even though it has not been meticulously recorded.  I will let it go and do better this year.  I promise.