Beloved Holistics Radio

"To help you further understand why we did not get the vaccine, what follows is my assessment of the C19 situation so far. Like I said, there is no doubt that many people were getting very sick over the first half of 2020. What is most challenging for me is the narrative that ensued thereafter, which seems at best misleading and at worst nefarious." www.ObgynoWino.com

"If I could live for another twenty years loving, laughing and touching in the ways that I could before this pandemic, would I choose this over fifty years of living in a place of fear, where I'm forced to question the safety even of hugging my own mother?" www.ObgynoWino.com

I have left the conventional medical model for good in search of brighter pastures! With the amount of painting, dancing, and kissing my baby and wife that I've been doing over the past several days, I encourage you all to try living a life free of the medical industrial complex! I have been liberated, and now I've got the bandwith the shake things up and create the life of my dreams.  The new iteration of my podcast will be titled The Holistic OBGYN Find me at: www.BelovedHolistics.com

Important PSA for healthcare professionals... Theme music by Evan Handyside

Practice Bulletin #136 - Published July 2013 (Reaffirmed 2017) 1. Know your reproductive endocrinology like the back of your hand! 2. AUB-O is classically associated with cycles that differ in length by `10 days or more. Patient with AUB-O also generally don't experience the classical cyclical breast tenderness, mucoid cervical discharge, premenstrual cramping, or bloating seen in ovulatory bleeding. 3. Anovulation is the most common etiology of AUB in 13-18-year olds. Transfusion or hospitalization is rare in this age group, but, when it happens, you should investigate coagulopathy. 4. AUB-O in patients >18 years of age should prompt investigation for hyperplasia/malignancy. 5. Hysterectomy or hormonal contraceptives are the mainstays for treating AUB-O, but neither address the underlying endocrine abnormality. 6 .SIS + EMB is a sweet combo: if both are negative, the likelihood of pathology is extremely low and conservative measures are be offered without you losing sleep Show Notes Theme music by Evan Handyside

Practice Bulletin #135, Published June 2013 (Reaffirmed 2017) 1. It's none of your damn business why a woman desires a 2nd trimester abortion. There are also a lot of scenarios in which 2nd trimester abortion skills are necessary but that have nothing to what many perceive to be a seemingly easy decision to terminate a pregnancy. 2. If you don't feel confident in your skills as a provider to perform 2nd trimester abortions, do your patients the service of developing a referral relationship with another provider who does. 3. Inducing fetal demise prior to 2nd-trimester abortion does not improve safety or decrease procedure time in case of D&E, but he it does shorten induction time for medical abortion. 4. Misoprostol + mifepristone = the most effective protocol of medical options 5. All methods of contraception are effective on the day of 2nd-trimester abortion apart from cervical cap, diaphragm, or hysteroscopic sterilization (including IUD) Show Notes Theme music by Evan Handyside

Practice Bulletin #1114, Published July 2010 (Reaffirmed 2018) 1. Pelvic pain and infertility are characteristic. Severe dyspareunia and dyschezia are indicative of deeply infiltrative disease. 2. The etiology is unknown, but currently thought to be due to the implantation of endometrial glands and stromal cells outside the uterus within the peritoneal cavity due to retrograde menstruation 3. Histologic evaluation of a surgical specimen is the gold standard for diagnosis. Visualization of endometriotic lesions has a high false positive rate. The finding of an endometriomas on imaging studies can alone be highly predictive, though. 4. Excision of endometriosis can improve fertility rates, particularly with the excision of an endometrioma. 5. NSAIDs, COCs, GnRH analogues, and progestins are all great alternatives to surgery for managing endometriosis-related pain Show Notes Theme music by Evan Handyside

July 2021 Journal Club I'm joined by Emmie Sturgess, DO, an OBGYN, MFM, and friend of the show to review relevant articles from the major OBGYN journals. I promise it's not as boring as it sounds... Show Notes Theme music by Evan Handyside

Welcome to Beloved Holistics Radio, a podcast for the holistic OBGYN! Expect summaries of ACOG's practice bulletins, important voices with birth keepers and birth warriors, and discussions around the most up-to-date research and publications. www.BelovedHolisticsRadio.com

Practice Bulletin #183, Published October 2017 w/ co-host Sara Rosser, CPM (@sararosser) 1. PPH is defined as 1000 mL for either vaginal or cesarean birth. 2. Go with your gut in diagnosing PPH, and do it fast! You can't rely on vital signs or lab work to make the call to action in the acute setting. 3. Uterine atony is the most common cause of PPH. Manage through uterine massage, uterotonics, tamponade, and UAE. Opening up her abdomen to place compression sutures, ligate the uterine vessels, or perform hysterectomy are last resort! 4. Remember the triad of the amniotic fluid embolism: respiratory decompensation, hemodynamic instability, and DIC. 5. As soon as you feel that she's lost too much blood activate your institution's transfusion protocol. Remember that you can never get pre-screened blood fast enough when you actually need it. Show Notes **Visit our friends at The Labor of Love Co. to send a pregnant person in your life a curated maternity or postpartum care package!** Theme music by Evan Handyside

Practice Bulletin #175 - Published December 2016 (Reaffirmed 2020) w/ co-host Sara Rosser, CPM (@sararosser) 1. US may be harmful if overutilized. 2. Important uses include pregnancy dating/viability, fetal growth, and amniotic fluid assessment. 3. US pregnancy dating is most accurate in the 1st trimester. If significant discordance exists between US dating  and LMP dating, it may be appropriate to adjust due date. 4. Fetuses at risk for FGR should be monitoring by serial growth ultrasound. It's not recommended to repeat growth ultrasound more frequently than q2 weeks. 5. Growth-restricted fetuses can be monitored through umbilical artery Doppler velocimetry as a means of avoiding bad perinatal outcomes. Show Notes **Visit our friends at The Labor of Love Co. to send a pregnant person in your life a curated maternity or postpartum care package!** Theme music by Evan Handyside

June 2021 Journal Club I'm joined by Emmie Sturgess, DO, an OBGYN, MFM, and friend of the show to review relevant articles from the major OBGYN journals. I promise it's not as boring as it sounds...because...I mean...come on...WINE. Show Notes Wine pairing: 2016 Primitivo di Manduria from Antico Sigillo Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

Practice Bulletin #129 - Published September 2012 (Reaffirmed 2016) 1. In any hypoestrogenic state, resorption begins to overwhelm building, leading to decreased bone density. 2. Treatment is warranted if T-score ≤ 2.5 on DXA scan or if patient has history of vertebral facture or other type of fragility fracture 3. FRAX tool can be helpful in determining usefulness of treating patients in the osteopenic range (T-score < - 1 to ≥ -2.5). It predicts risk of osteoporotic fracture over next 10 years . 4. Bisphosphonates are first-line therapy for all-comers, though raloxifene is also reasonable first-line in younger postmenopausal women. 5. HRT is a great alternative to bisphosphonates in younger women at risk for osteoporotic fracture: ~35% decreased risk of hip fracture (estrogen alone or estrogen + progestin) Show Notes Wine pairing: 2017 Tempranillo from Baron de Ley Varietales Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

Practice Bulletin #132 - Published December 2012 (Reaffirmed 2017) 1. The clinical diagnosis of APS is made through a careful clinical history that takes into account thrombotic events, history of pregnancy loss, and development of preterm preeclampsia. 2. Lab studies to detect specific antibodies can confirm your diagnosis, but these lab studies are not indicated when clinical criteria are not met. 3. The three relevant antibodies on your board exam are: lupus anticoagulant, anti-β₂-glycoprotein, and anticardiolipin 4. The worst consequence of APS is thrombosis. 5. In pregnancy, thrombotic risk is EVEN higher. APS patients with history of thrombosis should be treated with prophylactic heparin throughout pregnancy until 6 weeks postpartum. Show Notes Wine pairing: 2018 Sonoma Zinfandel from Seghesio Family Vineyards Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

Practice Bulletin #128 - Published July 2012 (Reaffirmed 2016) 1. "Normal menstruation" is classified by ACOG as: 5 days of bleeding with cycle length of 21-35 days 2. PALM-COIEN is a classification system for abnormal uterine bleeding. 3. Get good at SIS and hysteroscopy! A meta-analysis found intrauterine cavitary anomalies in roughly 50% of women with AUB 4. Fibroids tend to present as heavy periods. Polyps tend to present as intermenstrual bleeding. Adenomyosis presents with painful and heavy periods. 5. Accuracy of blind endometrial biopsy is great if (a) an adequate sample is collected and (b) the endometrial process is global. A blind EMB can miss cancer if less than 50% of the endometrium is involved. Show Notes Wine pairing: 2018 Cabernet Sauvignon from Los Vascos Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

Practice Bulletin #169 - Published October 2016 (Reaffirmed 2016) w/ co-host Sara Rosser, CPM (@sararosser) 1.  Multifetal gestations have overall increased risk of morbidity for both mom and baby. 2. Chorionicity is an important piece of information for managing these pregnancies. Monochorionic pregnancies carry higher risks than dichorionic pregnancies. 3. Outside of dx of cervical insufficiency: available data doesn't support cervical cerclages, bed rest, tocolytics, or pessaries decrease morbidity or mortality associated with preterm birth in setting of multifetal gestation. 4. NIH recommends administration of corticosteroids for any pregnancy, irrespective of GA, at risk of birthing from 24-34 wga within 7 days 5. Unless monoamniotic, twin pregnancy is not a preclusion to vaginal birth Show Notes **Visit our friends at The Labor of Love Co. to send a pregnant person in your life a curated maternity or postpartum care package!** Wine pairing: 2017 Red Blend from King Estate Winery Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

Practice Bulletin #156 - Published December 2015 (Reaffirmed 2018) w/ co-host Sara Rosser, CPM (@sararosser) 1. Women with obesity are at increased risk for fetal congenital anomalies, c-section, preeclampsia, fetal macrosomia, childhood behavioral/developmental issues, and other bad outcomes. 2. Pre-conception weight loss to normalize BMI improves maternal and neonatal outcomes. 3. Weight loss while pregnant is not recommended. 4. There are a variety of special considerations intrapartum and postpartum for women with obesity. 5. If your patient undergoes c-section, a thick subcutaneous fat layer should be well-irrigated and approximated with sutures in multiple layers if necessary. Show Notes **Visit our friends at The Labor of Love Co. to send a pregnant person in your life a curated maternity or postpartum care package!** Wine pairing: 2017 Bourbon Barrel-Aged Cabernet Sauvignon from Ménage à Trois Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

Practice Bulletin #146 - Published August 2014 (Reaffirmed 2019) 1. When pregnancy goes beyond 41 wga, there are increased risks for mom and baby, but absolute risk is overall still very low.  these risks are still low in absolute.  2. Pregnancy dating by LMP combined with early ultrasound is far more reliable than LMP alone. 3. "Membrane sweeping" decreases the chance of a pregnancy going beyond 41 wga, but consent your patient first! 4. If fluid checks out, particularly if BPP is otherwise reassuring, it's reasonable to continue pregnancy  5. IOL at or beyond 41 wga does not improve fetal or neonatal outcomes apart from a possibly lower risk of meconium aspiration syndrome. NNT = 410 to prevent one perinatal death. Show Notes **Visit our friends at The Labor of Love Co. to send a pregnant person in your life a curated maternity or postpartum care package!** Wine pairing: Dark Side Red Blend from 7 Moons Wine Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

Practice Bulletin #126, Published March 2012 (Reaffirmed 2016) 1. Rapidly dividing cells - like those in the gonads - are the most susceptible to chemo, so suppressing with GnRH analogues prior to chemo may be protective against ovarian toxicity, but data is mixed. 2. BRCA mutation carriers are at increased risk for both breast and ovarian cancers, therefore prophylactic BSO is recommended at age 40 or after childbearing is complete 3. 5 years of tamoxifen use decreases the annual risk of recurrence by 40% and annual mortality risk by 35% 4. Women treated for breast cancer are at higher risk for bone fracture because chemotherapy, ovarian suppression, and, especially aromatase inhibitors all lead to bone loss and osteoporosis. 5 .HRT has a bad rap historically due to concern that it may predispose women to de novo breast cancer or recurrence, but the findings have been mixed and generally not statistically insignificant. Show Notes **Visit our friends at The Labor of Love Co. to send a pregnant person in your life a curated maternity or postpartum care package!** Wine pairing: 2017 Perlita Malbec-Syrah from Bodega DiamAndes Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

Practice Bulletin #187, Published May 2017 (Reaffirmed 2016) 1. Neonatal complication risk is overall low (5%), including brachial plexus injuries, clavicle fracture, humerus fracture. HIE/death are also possible, but extremely unlikely. 2. The faster that a shoulder dystocia is resolved, the less likely HIE/death. 3. It's nearly impossible to predict shoulder dystocia, but risk seems to be higher with larger fetuses and diabetic mothers. 4. Insufficient evidence to conclude that early induction of labor when fetal macrosomia is suspected decreases the risk of shoulder dystocia. 5. Steps to resolving shoulder dystocia per ACOG: stop pushing, McRobert's maneuver w/ head traction, suprapubic pressure, rotational maneuvers, then posterior arm delivery. My advice? Get her on all fours way before any of the other maneuvers (Gaskin maneuver). Show Notes **Visit our friends at The Labor of Love Co. to send a pregnant person in your life a curated maternity or postpartum care package!** Wine pairing: 2017 Central Coast Red Blend from Smith & Hook Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)