You know how it feels. Your lower back is stiff when you get up each morning. Or your knees ache as you take a flight of stairs. You may be suffering from osteoarthritis, a degenerative joint disease.

When you have osteoarthritis, the cartilage in your joints has worn down. This means there is reduced cushion within your joints, and everyday movements become painful. You might feel discomfort in your neck, back, knees, hips, and hands.

But what can you do about it? There is no real cure for osteoarthritis, but there are treatments that can help relieve symptoms.

Medication

Your doctor may suggest any of these drugs, or a combination of them.

• Acetaminophen: This over-the-counter medication can relieve pain but does not reduce inflammation. A common brand is Tylenol. You should watch your alcohol intake while taking acetaminophen, because the combination can lead to liver damage.

• NSAIDs: These medications are nonsteroidal anti-inflammatory drugs, which reduce pain and inflammation. Over-the-counter brands include Motrin, Aleve, and Advil, but your doctor can prescribe stronger, prescription versions. With long-term use, you should watch out for any side effects, such as nausea, liver damage, and kidney damage.

• Prescription painkillers: Your doctor can prescribe stronger painkillers, such as codeine and propoxyphene, but these can be habit-forming. Be sure to take them only when needed.

• Cortisone: Depending on your situation, you doctor may suggest injections of cortisone directly into your affected joint. These can help relieve pain but should be done only a few times a year.

Pain Management

Depending on your mobility and overall health, there are a number of strategies you can use to manage the pain.

• Physical therapy: When you work with a physical therapist, he can evaluate your condition and devise a set of exercises and stretches for you. These will increase your range of motion, improve your flexibility, and make you stronger. While it may be daunting to move this much at first, you will actually feel better as you consistently do the exercises.

• Occupational therapy: An occupational therapist can look at your environment and help you find ways to make everyday tasks easier. For instance, if you have hip issues, he can recommend special chairs and toilet seats that are higher. If you have arthritis in your hands, he can help you find joint-friendly kitchen utensils.

• Gentle movement: Try a movement class such as gentle yoga, tai chi, or water aerobics. Anything that keeps you moving, in a low-impact way, can make you feel better. It can also keep your weight down, which is important, since that means less stress on your joints.

Surgery

If you have tried medication and pain management but they have not eased your discomfort, surgery may be an option for you. Discuss the pros and cons with your doctor.

• Bone fusion: This operation will help reduce pain and increase stability. However, the site where your bones are fused together will have no flexibility.

• Bone realignment: This operation can reduce pain by transferring the pressure from the worn-out part of your joint. It is used most often for people who can’t have joint replacement.

• Joint replacement: During this surgery, your damaged joint will be removed and replaced with a metal or plastic prosthesis. While recovery can take weeks or months, and requires a fair amount of physical therapy, joint replacement can eliminate your pain and improve your life. Be sure to discuss all the risks, including infection and blood clots, with your doctor. Common joint replacements are for hips and knees, as well as shoulders, fingers, and ankles, and they can last for 15 to 20 years.

To learn more about osteoarthritis and how to treat it, contact The Orthopedic & Spine Institute at St. Lucie Medical Center. Visit us online or call Consult-A-Nurse® at 1-800-382-3522. We’re here to help you live pain-free.

SOURCES

American Academy of Orthopedic Surgeons

Brigham and Women’s Hospital

The Treasure Coast is no different than other regions of Florida: we suffer from a critical shortage of available behavioral health patient beds. St. Lucie Medical Center’s new Behavioral Health Center is now helping to ease that shortage.

We are targeting an opening date in mid-September for Treasure Coast Behavioral Health Center. Providing adult acute psychiatric inpatient care, St. Lucie Medical Center will become a designated Baker Act Receiving Facility for parts of St. Lucie and all of Martin County, and will treat a wide range of adult patients with psychiatric disorders requiring hospitalization.

The newly-renovated 22-bed state-of-the-art unit will combine an environment of safety and comfort.

Upon opening, EMS will begin transport for serious psychiatric cases, and Baker Acts—those who pose a threat to themselves or others.

The clinical team will consist of psychiatric licensed professionals including a psychiatrist, registered nurses, clinical social workers, mental health counselors, licensed dieticians, and other mental health professionals.

The new Center will provide a wide range of therapeutic services, including medication management.

“Each patient will receive a private, confidential assessment designed to meet their specific needs. A plan of care will be developed and integrated into a clinical setting that is designed to promote and restore well-being.” ~ Joseph Pino, Chief Operating Officer, St. Lucie Medical Center

In spite of future projected growth, no new expansion of psychiatric beds has occurred in this region in many years.

As a result, there is a regular shortage of available psychiatric beds, and the residents of St. Lucie County are being transferred as far as an hour away for psychiatric care. Martin and Okeechobee Counties have an even more acute shortage due to no inpatient psychiatric providers. “We are committed to open a new 22-bed adult psychiatric inpatient wing at St. Lucie Medical Center to provide these much needed services to the Treasure Coast region,” Joseph Pino, Chief Operating Officer, said.

According to the NIH, 19% of the general public experiences a mental disorder within a given year.

St. Lucie Medical Center is working closely with physicians to develop the wing, investing close to $1 million to convert the existing floor to a new psychiatric inpatient program. The program area would include the creation of private patient dining and recreation areas, a close observation bedroom, consultation rooms, a 2-room seclusion suite, and secure rooftop outdoor patient patio areas.

The Center will accept most forms of insurance including Medicaid and Medicare.

On some days, your arthritis may hurt so much that you just want to sit on your couch. But do everything you can to fight that urge! You may think that exercise is too painful, but in fact, the right kinds of exercise can bring many benefits.

How Can Exercise Help You?

Moderate exercise can increase flexibility, reduce swelling and stiffness in the joints, and strengthen the muscles around your joints. When done regularly, exercise can help alleviate the pain you’re feeling. It can also help you maintain a healthy weight, give you more energy, make you sleep better, and fend off depression.

What Should You Try?

Before you start any exercise program, talk to your doctor. She may recommend that you consult with a physical therapist first. Through physical therapy, you can learn exercises and stretches to get you started. Then you can move on to other activities.

• Walking. Taking a daily walk is a great way to keep moving. Start by just going around the block and then see if you can work up to 30 minutes a day.
• Yoga. Practicing yoga will help you gain strength and flexibility, and it also calms your mind. You can try going to a “gentle” class or following a beginner’s DVD.
• Aquatics. Swimming is a terrific exercise for you, but there other water exercises to try as well. Water walking provides resistance and helps you build strength, without putting any pressure on your joints. See if your local fitness center offers water aerobics classes.
• Bicycling. You may find that enjoying a bike ride on a beautiful day increases your energy and improves your mood! Just make sure the bicycle is adjusted so there isn’t too much pressure on your knees. In bad weather, you can try a stationary bike.
• Strength training. When you feel ready, lifting light weights can tone muscle and make you stronger.

Take Your Time

Whatever you choose, be sure to start slowly and not push too much. If you experience pain, back off a bit and give yourself time to build up to more challenging exercises.

The medical professionals at St. Lucie Medical Center can offer you advice about an exercise program. Our Outpatient Rehabilitation facility is staffed by experienced physical therapists who can help you.

To learn more about arthritis and how to treat it, contact St. Lucie Medical Center. Visit us online or call Consult-A-Nurse® at 1-800-382-3522. We can help you find strategies to make each day a pain-free one.

SOURCES
Arthritis Foundation
The Johns Hopkins Arthritis Center

Lisa Lansden was in her mid 20’s when she decided to get a breast augmentation.

“I’ve always been interested in pageant competitions,” says the 2009 Mrs. American Dream, “and it’s something I enjoy. It was actually pageants that first inspired my work in philanthropy, and I felt I could complete better in the pageant industry if I had the implants.

“My cousin had recently had a breast augmentation and she’d visited seven different cosmetic surgeons before she finally chose Dr. Lansden.”

F. True Lansden, MD, is a board-certified plastic surgeon with Coastal Island Cosmetic and Reconstructive Surgery in St. Lucie West.

“My cousin said, ‘He’s the best,’” continues Lisa, “so I scheduled an appointment. I was so nervous I started getting blotches, but he came into the room, introduced himself, and we just started talking. He put me right at ease, and I felt like I could breathe again.”

“For Lisa, I performed a fairly standard breast augmentation with saline implants under the muscles through an inframammary incision [crease or fold incision, leaving an inconspicuous scar],” remembers the doctor. “That means the implants were place through an incision under the breast into a space under the muscle on the wall chest. She had a very nice result, very soft and natural.”

Today, patients have a choice of implants, says Dr. Lansden: “both saline and silicone gels offer the same complication risks, and although one of the benefits of saline is that they can be placed through smaller incisions, there are some new techniques that have reduced the length of incision required for silicone gels.

“Patients will have several choices to make, including the type of implants they want and whether they want them placed above or below the muscle, so I always go through all their viable options with them in depth.”

Lisa says that by the end of her consultation with Dr. Lansden, she was no longer nervous: “I had him do the surgery, and everything went like clockwork. It was really easy for me, I had a dynamite result, and I was back to work in four days.”

However, that was not the end of the story.

The rest of the story

Some years later, in the spring of 2001, recalls Lisa, she was working in real estate when a gentleman came into her office to return some property keys: “I looked up and said, ‘I know you! You’re Dr. Lansden!’

“He was just so nice and so cute. I liked his mild, easygoing manner. We both happened to be single, and it just worked out. We married, and I became Lisa Lansden.”

As Mrs. Lansden, Lisa has continued to keep up her competitive edge in pageant competitions.

“In 2006, my husband did my lower eyelids, and in 2007 he did my upper eyelids,” says Lisa, “and in both cases it took less than an hour, about twenty minutes for each eye. It was so easy; it was crazy easy.”

“Lower eyelid surgery has come a long way,” informs Dr. Lansden. “We used to simply remove sink and fat, but now that we understand the anatomy better, and the interplay between the muscles, skin, and fat, we’ve learned that we need to re-suspend and redistribute volume, rather than to remove it. Physicians who use the newer technique lift the cheeks and fill in the tissue between the cheekbone and the eyelid by repositioning the cheek fat back on the orbital rim.”

“I was really pleased, “reflects Lisa. “I can’t tell you how many people wanted to have their eyes done, once they saw what a good result I had.”

As the weather cools, kids return to school and afternoons are more sports-friendly. Students and adults alike often begin returning to their favorite outdoor activities. That also means that orthopedic surgeons often see an increase in sports injuries during the fall. With the right prevention and treatment, sports injuries don’t have to sideline patients from their activities.

Cool Weather Sparks More Participation

During the autumn, high-school and college athletes take to the fields as their seasons begin. Many are still growing, while others may not train properly for their sports. At the same time, adults begin to increase their activity level, returning to the greens, the courts, and the playing fields. As a result, doctors see an increase in a wide variety of injuries during the fall:

• Injuries to the elbow or lower back from golf
• Shoulder injuries from overhead movement in volleyball, baseball, softball, or tennis
• Tears to the meniscus during football
• Tendonitis in the wrist or elbow
• Tears to the anterior cruciate ligament (ACL)

Prevention is Key

Many sports injuries can be prevented through proper conditioning. Regular physical activity is the best way to prevent injuries, because it keeps the musculoskeletal system in better shape. Flexibility training and stretching before exercise can also prevent tears to the muscles, tendons, and ligaments. Meanwhile, following the rules of the game and wearing appropriate safety equipment also play a part in protecting you from injuries.

Even employing all these tactics, it’s still possible to get a sports injury, especially muscle strains, sprains, and tears. Most are minor and will heal on their own over time. Robert Sellards, MD, FAAOS, of Florida Orthopaedic Specialists, says “When you have an acute injury, you want to use RICE: rest, ice, compression, and elevation. Most [sports\ injuries can be treated without surgery.” Treating these injuries at home—and allowing for adequate recovery before getting back in the game—can prevent more serious injuries down the road.

Orthopedic Surgery Options

For more severe injuries, surgery may be necessary. “The most common sports injuries we see in the fall are shoulder injuries, and most specifically, rotator cuff injuries,” says Dr. Sellard. In many cases, these injuries require surgical repair, but the doctor will evaluate the extent of the injury using an MRI. Other prevalent injuries, especially for student-athletes, include damage to the cartilage and ligaments in the knees.

Many orthopedic surgeries now require only a minimal hospital stay, and patients will find that they have many options for their accommodations after surgery. A relaxed, comfortable environment stimulates healing. That’s why St. Lucie Medical Center has dedicated an entire floor to patients recovering from orthopedic surgeries. The new Orthopedic and Spine Institute, part of a recent $22.4 million expansion, resembles an upscale hotel, rather than a hospital wing. “It’s a very luxurious atmosphere. That would be the place to stay. It’s great,” says Dr. Sellard.

If you have questions about orthopedic care, please contact us at St. Lucie Medical Center. Visit us online or call Consult-a-Nurse® at 1-800-382-3522.

Our knees carry us everywhere we go, even working when we sit down. They are a vital part of an active adult’s independent lifestyle. Yet over time, these joints can wear down, causing pain, stiffness, and loss of function. Thanks to advances in medical technology, patients no longer have to let knee pain sideline them from their favorite activities. For many patients, partial knee resurfacing offers an excellent alternative to total knee replacement.

Who’s a Candidate?

Most patients who need knee replacements are older and suffer knee pain due to some form of arthritis. They are often the best candidates for partial knee resurfacing. Because the artificial joints used for this procedure are less robust than total joint replacements, partial knee resurfacing works best for patients who are not extremely active.

Partial knee resurfacing is also reserved for patients whose knees are only damaged in one location. The knee consists of three components: the medial (inside) compartment; the lateral (outside) compartment; and the patellofemoral compartment (the kneecap). If arthritis or other injury affects only one of these areas, partial knee resurfacing may be an option. Doctors may perform one of these partial knee resurfacing options:

• Unicompartmental knee resurfacing: During this procedure, the surgeon replaces the parts of the knee at the end of the femur (thigh bone) or tibia (shin bone).
• Patellofemoral knee resurfacing: In this surgery, the orthopedist replaces only the damaged sections of the trochlea (the groove at the end of the thigh bone) and the patella.

How the Procedure Works

A partial knee resurfacing begins with a three- to four-inch incision in the knee. The doctor then removes the damaged surface of the knee, working to preserve as much healthy tissue and bone as possible. Once the worn sections are removed, the doctor can place the artificial joint. Held in place with special medical cement, the new joint may be made of metal or a synthetic material. Your doctor can show you what the implant looks like, and how it works, before the procedure.

After the artificial joint has been placed, the doctor closes the incision, and the partial knee resurfacing is complete. Although recovery time varies, most patients are released from the hospital within a few days of the surgery. Patients should also attend physical therapy in the weeks following their surgery, to ensure proper rehabilitation.

Benefits of Partial Knee Resurfacing

Patients who qualify for partial knee resurfacing enjoy multiple benefits. The procedure doesn’t require any interruption of the main muscle that controls the knee, making it considerably less invasive than a total knee replacement. As a result, partial knee resurfacing patients usually experience the following advantages:

• Shorter recovery time
• Fewer complications
• Less postoperative pain
• Speedier return to daily activities
• Shorter incision, resulting in less scarring

If you’d like more information about partial knee resurfacing or other orthopedic procedures, please contact us at St. Lucie Medical Center. Visit us online or call Consult-a-Nurse® at 1-800-382-3522 for answers to your questions and free physician referrals.

Affecting over 27 million Americans, osteoarthritis (OA) is one of the most prevalent medical conditions in the country. Why so common? Osteoarthritis occurs when the cartilage between our bones breaks down naturally, making it difficult to avoid as we age. As our population ages—and our waistlines continue to expand, placing more pressure on our joints—osteoarthritis will undoubtedly become an increasingly common health concern.

Preventing Osteoarthritis

Experts note that once we hit a certain age, some symptoms of osteoarthritis are inevitable. However, physicians have also noted cases of the disease in younger and younger patients. The two main culprits: increased participation in competitive sports among young athletes and, at the opposite end of the spectrum, failure to maintain a healthy weight. Doctors recommend that patients of every age use these tips to help prevent the onset of osteoarthritis:

• Work on losing that spare tire. With every step, we place three times our body weight on our knees. Other joints also bear our body weight all the time. Reducing body weight eases stress on the joints. Remember that losing weight means not only changing your diet, but also increasing physical activity.
• Get fit the right way. Sporadic participation in physical activity, à la the “Weekend Warrior” can actually hurt your joints. The body must stay properly conditioned for exercise, which requires regular participation, along with strength building and flexibility training. A physical therapist can help you plan a workout that satisfies your competitive streak—and protects your joints.
• Go for low impact. Activities like swimming and cycling place less impact on the joints than, say, jogging or basketball. That makes them preferable because they reduce the risk of injury—and joints that have been injured are more prone to osteoarthritis. Meanwhile, low impact exercise still strengthens the muscles around your joints, providing extra protection.
• Don’t skimp on safety equipment. Especially in the hot Florida sun, it can be tempting to leave those safety pads and helmet at home. But injured joints are more likely to develop arthritis, making injury prevention crucial to risk reduction. Those knee, elbow, and wrist guards can prevent not only injury today, but also pain and swelling down the road.
• Pay attention to your body. If a specific motion or activity causes abnormal pain, or if joints get swollen or tender after a workout, it may be time to take a break. Repetitive stress damages both muscles and joints, wearing them down over time. Tailor your workouts and activity choices to respect your body’s limits. Rotating activities, such as doing weight training and cardio on alternating days, can also help prevent overexertion.
• Maintain proper posture. Your mother always told you to sit up straight! If you’re a slouch, it’s time to kick that habit. Sitting and standing with proper posture actually distribute the weight of your body more appropriately among your neck, back, hips, and knees. Shifting positions throughout the day (for instance, switching from sitting to standing tasks at work) also helps relieve joint stiffness.

If you have questions about osteoarthritis or orthopedic care, please contact us at St. Lucie Medical Center. Visit our Orthopedic and Spine Institute online, or call Consult-a-Nurse® at 1-800-382-3522 for answers to your questions and free physician referrals.

Expectant mothers often spend lots of time researching what to expect during their pregnancy, but what about after the baby is born? After delivery, a new mom’s body can seem just as mysterious and strange to her as it did in the early days of pregnancy. Anticipating these changes eases the transition into parenthood.

Physical Changes Begin Immediately

Just as early pregnancy cause many rapid changes, so does delivery. As soon as labor is over, your body begins to return to its pre-pregnancy state:

• The uterus begins to contract and return to its normal size. These contractions sometimes continue for up to a week after the birth, and can cause some abdominal discomfort. Many women find that a warm compress or heating pad soothe the pain.
• Hormone levels adjust. In the matter of a few days, progesterone and estrogen levels can vary by up to 90%. These drastic fluctuations may cause mood swings or sadness. If these feelings last more than a short time, contact your physician.
• If the skin developed blotches or other discoloration, these usually go away relatively soon after delivery. Other differences in complexion also usually disappear as hormones level out.

Labor Brings Its Own Changes

Meanwhile some body changes may occur as a result of the delivery itself. Knowing what to expect can help new mothers prepare for the physical changes:

• Starting during labor, the uterus will begin to shed its lining, called lochia. The entire process should be complete by the six-week postpartum checkup. The lochia will lighten in color and volume as time passes.
• Delivery causes aches and pains throughout the body, but especially in the back.
• Breasts may continue to enlarge. After birth, they will secrete colostrum, a thick, yellow milk that’s filled with nutrients for the newborn. Breasts may feel sore, but a supportive bra and cold compresses can help.
• Women who breastfeed will note a marked increase in appetite. It’s important to eat nutrient-rich foods that are not high in fat or sugar. On average, breastfeeding mothers need about 500 extra calories per day.
• The baby tummy often takes four to five months to go away, depending on the rate at which the uterus shrinks and the state of abdominal muscles pre-pregnancy. It can be tempting to jump right on the treadmill, but consult a doctor before starting any postpartum workout routine.

A qualified obstetrician can help you prepare for delivery and the physical changes that come with every stage of motherhood. If you’d like more information about pregnancy, please contact us at St. Lucie Medical Center. Visit us online or call Consult-a-Nurse® at 1-800-382-3522.

Having a baby is one of the most important and exciting times in a woman’s life – and a man’s. By bringing a child into the world, they are taking part in a ritual as old as humankind: creating a family.

Thanks to advances in medical procedures and research, pregnancy and delivery has evolved quite a bit since the days of our ancestors. However, all this knowledge and technology has failed to squash misconceptions about the process of being pregnant, and of giving birth to a child.

Here are five misunderstandings about pregnancy and childbirth that have persisted over time. If you are in doubt about what you should or shouldn’t do, it’s best to follow your doctor’s advice.

Myth #1: I need to eat for two (or three or four).

Fact: All you need to add to your diet while pregnant is about 300 extra calories a day. If you are overweight, your physician is likely to suggest reducing your calorie intake. There are some exceptions to this rule: if you are carrying multiple babies, if you are extremely thin or if you are very active, you may be instructed to eat more.

Myth #2: It doesn’t matter how I sleep.

Fact: It depends on the stage of your pregnancy. It’s fine during your first trimester, but after that, experts recommend you sleep on your side. Why? As the pregnancy progresses, if you sleep on your back, the baby puts pressure on a large vein carrying blood to the heart to get oxygen. This can make you tired and reduce blood flow to the baby.

Myth 3: Food cravings mean something is wrong.

Fact: Experts are divided on this one. Most believe pregnant women’s cravings to be caused by hormonal changes, not a lack of nutrients or minerals. Some say if a mother-to-be suddenly has a sudden urge for ice or an attraction to laundry starch, it could be a sign of an iron deficiency. But this has not been scientifically proven.

Myth #4: Abdominal cramping is normal.

Fact: Some discomfort is normal, but severe and constant abdominal pain is not, regardless of the stage of a woman’s pregnancy. See your doctor right away if you are having episodes of severe pain and cramping, especially if it is accompanied by fever, chills, a feeling of being lightheaded or dizzy, or is accompanied by vaginal bleeding.

Myth #5: An epidural slows down labor.

Fact: Scientists have found no evidence to back this up. If anything, they say, an epidural may actually speed up the birth of a woman’s baby, since it’s usually given when she is having difficulty and is in great pain. By providing pain relief to the woman, she may be able to relax some and this could make the birth happen more quickly.

The obstetric services team at St. Lucie Medical Center strives to make our patients’ childbirth experience as comfortable and enjoyable as possible. For more information, or if you would like a physician referral, call Consult-A-Nurse^® at 1-800-382-3522, or visit St. Lucie Medical Center online.

Pregnancy is an exciting time, and the right obstetrician makes all the difference in a new mother’s experience. Just like selecting any other health care provider, choosing an obstetrician requires consideration of multiple factors. With a little research, it’s easy to find the right obstetrician to guide you through pregnancy and delivery.

Factors to Consider

Many women select a gynecologist who also practices obstetrics. This can simplify the process, since the doctor and patient will already have a rapport with one another. However, if your gynecologist doesn’t practice obstetrics, it may be necessary to find another doctor. A great place to start is asking for referrals from family, friends, and other trusted health care providers. If you know you want to deliver at a specific hospital, call its referral service for a recommendation.

After gathering a list of potential obstetricians, think about other aspects of your pregnancy that can impact your healthcare needs during pregnancy:

• Medical history: Women who have preexisting medical conditions, such as diabetes, epilepsy, or hypertension, may need special care during pregnancy. Ask each prospective obstetrician about experience with any specific health conditions. Women who are at particularly high risk for complications may want to seek a perinatologist or choose a doctor who has privileges at a hospital with a neonatal intensive care unit (NICU).
• Compatibility: Comfort and communication are key to a successful obstetrician-patient relationship. Does the doctor make you feel comfortable asking questions, and answer your questions thoroughly, no matter how trivial they may seem? Does the doctor’s presence put you at ease and make you feel more confident about your pregnancy and delivery?
• Delivery preferences: Some doctors are strong advocates for natural childbirth, while others are more open to working with mothers who may want medical interventions like an epidural. Discuss your preferences, and gauge the doctor’s support of those choices. Ask how comfortable the doctor would feel if a midwife or other support staff assisted during labor. Ensure that the obstetrician willingly supports your delivery preferences.
• The single doctor or practice: Using an obstetrician who is the sole doctor in the practice means building a closer relationship. However it could also mean that prenatal visits get cancelled if the doctor is called to the hospital, and that someone else ends up delivering your baby if your doctor isn’t available. Meanwhile, using a practice with multiple physicians may mean less intimate relationships, but a greater likelihood of a familiar face during delivery.
• Hospital preferences: Every hospital has different services. Some may not even have an anesthesiologist available 24 hours a day, while others may have dedicated maternity wards with a full complement of support staff like lactation consultants or childbirth educators. Research hospitals near you, and weigh your options. Then look for an obstetrician who has privileges at the hospital where you want to deliver.

If you are seeking a highly qualified obstetrician, contact St. Lucie Medical Center. Visit us online or call Consult-a-Nurse® at 1-800-382-3522 for answers to your pregnancy questions and free physician referrals.