Fighting the Urge: Urinary
Incontinence and Menopause

However you decide to treat your
incontinence, know that you are not
alone and do not need to live with
the unpleasant effects of this condition

read more

More Organization Means
Less Stress

With spring approaching fast, now is
the time to tackle those spring
cleaning projects ...

read more

Oh That Aching Hip!

Here is what you need to know
about that nagging ache
in your hip.

read more

Endometriosis: The Often
Silent Condition

For many women, endometriosis isn't
a problem, but for others it can be
painful and cause complications.

read more

Surviving the Time Change

For many sleep-deprived parents,
it is the most dreaded day of the
year-the return of Daylight Savings.

read more

Endometriosis: The Often Silent Condition

Endometriosis is a condition many women experience during their childbearing years. It means that a type of tissue that lines your uterus is also growing outside your uterus. For many women, endometriosis isn't a problem, but for others it can be painful and cause complications.

What happens during endometriosis?

The clumps of tissue that grow outside your uterus are called implants. They usually grow on the ovaries, the fallopian tubes, the outer wall of the uterus, the intestines, or other organs in the belly. When you have endometriosis, the implants of tissue outside your uterus act just like the tissue lining your uterus. During your menstrual cycle, they get thicker, then break down and bleed. But the implants are outside your uterus, so the blood cannot flow out of your body. The implants can get irritated and painful. Sometimes they form scar tissue or fluid-filled sacs (cysts), making it hard to get pregnant.

What causes endometriosis?

Experts don't know what causes endometrial tissue to grow outside your uterus, but they know estrogen makes it worse. Women have high levels of estrogen during their childbearing years. It is during these years-usually from their teens into their 40s-that women have endometriosis. Estrogen levels drop when menstrual periods stop (menopause). Symptoms usually go away then.

What are the symptoms?

The most common symptoms of endometriosis are:

  • Pain: Where it hurts depends on where the implants are growing. You may have pain in your lower belly, your rectum or vagina, or your lower back. You may have pain only before and during your periods or all the time.

  • Abnormal bleeding: Some women have heavy periods, spotting or bleeding between periods, bleeding after sex, or blood in their urine or stool.

  • Trouble getting pregnant Infertility may be the only symptom some women have.

How is it treated?

There is no cure for endometriosis, but there are good treatments. Treatment choices depend on whether you want to control pain or you want to get pregnant. For pain and bleeding, you can try medicines or surgery.
If you want to get pregnant, you may need surgery to remove the implants.

Treatments for endometriosis include:

  • Over-the-counter pain medicines like ibuprofen (such as Advil or Motrin) or naproxen (such as Aleve).

  • Birth control pills. They are the best treatment to control pain and shrink implants.

  • Hormone therapy. This stops your periods and shrinks implants. But it can cause side effects, and pain may come back after treatment ends.

  • Laparoscopy to remove implants and scar tissue. This may reduce pain, and it may also help you get pregnant.

To learn more about women's health issues that may be affecting your life, check out one of our upcoming events. To see a list of times and dates, and to register, click here. To find a doctor who can help you, visit our online physician finder .

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More Organization Means Less Stress

To help you get organized this spring, Care Begins With Me has partnered with Closets by Kersten.One Care begins With Me member will receive $100 toward a closet organizing consultation with Kersten Letterman, a fashionista with a flair for organizing. And, all Care Begins With Me members can receive $45 off a closet consultation simply by mentioning this article. To find out how Kersten can help you, call her at 530.320.4929 or email her at

With spring approaching fast, now is the time to tackle those spring cleaning projects that you've put off all winter. One of the most stress-relieving things you can do inside your home is to improve your family's organization. Being organized makes it easier to keep your house tidy and clean every day of the year, reducing everyone's stress.

When everything has a place, your clean up time is reduced and your living space has more breathing room. One of the best - and easiest - places to start the organization process is inside your entryway. Whether your family enters your home through the front door or through the garage, be sure there is a place for bags, shoes, mail, keys and whatever else gets carried in when family members arrive home. Bowls or a small rack work great for keys; hooks can hold jackets; a basket or shelving system are good places to tuck away shoes; purses and bags can either get hung from a hook or placed inside a cabinet or closet.

Speaking of closets, always try to use the thinnest hangers possible - this maximizes your closet space. Rotate your coats and clothing according to season: It doesn't make sense to have your puffy ski jacket hanging front and center in the family coat closet once spring arrives! And for your nice leather boots, try this trick: roll up magazines to get them to stand upright in the closet. This saves space and can save your boots too.

Next up - take a good, long look at your junk drawer. Consider using a silverware tray or jewelry organizer to store all the little odds and ends that seem to end up in the junk drawer. Go through your junk drawer often, throwing out anything that doesn't work (hello, that free pen from the oil change place?) or isn't needed (the menu from the takeout place that closed a year ago). Keep only what you need and use. Whenever possible, find a new and more appropriate home for the items that end up in the junk drawer.

In the bathroom, get creative with how you store items you use every day, like make up and brushes. Find bottles or containers that come in a variety of sizes. Use a larger container for large make up brushes and a smaller container for lipsticks. Finding pretty ways to store these items will not only make your bathroom more eye-appealing but it will save you from digging through drawers to find your favorite lip gloss every morning.

If you have a spacious linen closet, consider yourself lucky. If you, like many Californians, do not have enough shelf space to store extra sheets, towels and blankets - get creative! First, try rolling your towels and storing them in a basket. This can save space and make an attractive display if the basket needs to sit out in the open. Next, consider a storage bench or ottoman for storing your extra linens. These can be pretty and useful when placed at the foot of a bed or in front of a sofa. Finally, if you get really desperate, consider investing in a space-saving vacuum bag - you can then store the bags filled with your linens under your bed.

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Oh That Aching Hip!

By Harry Khasigian, MD

As we age, all of our joints tend to experience a little wear and tear, which can translate to discomfort, pain and even loss of mobility. Fortunately the hip joint, which is the body's largest joint, is designed to withstand years and years of activity. However even the hip joint is not immune to damage and can eventually fail you. Here is what you need to know about that nagging ache in your hip.

How the Hip Works

First, it is important to understand where your hip joint is and how it functions. The hip joint is the connection where the head of the thighbone (your femur) swivels in a socket (called the acetabulum) inside your pelvic bones. True hip pain is actually in your groin - not on your side. A cushion of cartilage helps prevent friction in the socket but over time that cartilage can wear down, causing problems.

Causes of Hip Pain

Hip pain can have a variety of causes, including:
Osteoarthritis & Rheumatoid Arthritis: Arthritis leads to inflammation of the hip joint and the breakdown of the cartilage that normally cushions your hip bones. The pain worsens over time. People with arthritis also feel stiffness and have reduced range of motion in the hip.

Injury: Hip fractures are more common in the elderly or those with brittle bones. Muscle or tendon strain injuries usually arise from repetitive use or activity-related injuries.

Low Back Dysfunction: Problems in your lower back can cause pain in your hip joint.

Slipped Capital Femoral Epiphysis: SCFE a fracture through the physis (the growth plate), which is typically identified in adolescents.

Greater Trochanteric Tendonitis: Tendinitis is inflammation or irritation of the tendons, which are thick bands of tissue attaching bones to muscles. It's usually caused by repetitive stress from overuse.

Signs of Hip Problems

Symptoms of hip problems can include

  • Pain
  • Tenderness
  • Stiffness
  • Chronic swelling
  • Loss of flexibility/Decreased range of motion
  • Hip crunching or popping
  • Limping or lurching
  • Inactivity makes it worse
  • Loss of hip joint function

Typically an X-ray or MRI will help your doctor determine the cause of your hip pain.


Treatment for hip pain will vary depending on your diagnosis. Below are some common procedures.

  • Hip Arthroscopy
  • While arthroscopy of the knees and shoulders is common, hip arthroscopy is less widely known. It can relieve symptoms of many painful problems, including damage to the labrum, articular cartilage or other soft tissue surrounding the joint.

  • Total Hip Resurfacing
  • This is a good option for younger, more active patients. The benefits for hip resurfacing include bone retention, fewer dislocations than conventional hip replacements and fewer restrictions following surgery.

  • Partial Hip Replacement
  • This is also called hip hemiarthroplasty and is a surgical procedure in which only the femoral hip (the ball of the joint) is replaced. This is commonly used for traumatic hip injury like breaks and fractures.

  • Total Hip Replacement
  • In this procedure, the hip joint is replaced with a prosthetic implant. Typically patients undergoing total hip replacement are between 50 and 80 years old.

One type of hip replacement that is getting attention for its benefits to patients is the Anterior Approach Replacement. During this procedure, the surgeon makes an incision on the front of the leg (rather than the typical back or side), allowing him to work between muscles and tissues without detaching them. A high-tech operating table equipped with an
intra-operative x-ray allow for precise positioning of the implant. The benefit to patients is a lower likelihood of dislocation, smaller incision, less likelihood of pain and fewer restrictions during recovery.

Orthopedic experts at Dignity Health are currently performing this procedure. For more information or to register, visit our Orthopedic Events page.

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Surviving the Time Change

Dr. Richard Stack, Director, Mercy Sleep Center

For many sleep-deprived parents, it is the most dreaded day of the year - the return of Daylight Savings. This year, Daylight Savings returns on Sunday, March 10. On that morning, we all need to "spring forward" and move our clocks ahead an hour. While this means a lost hour for everyone, the move can be especially challenging for families with young children or parents who are already sleep-deprived because of a newborn.

Fortunately, there are steps you can take to make this transition easier for yourself and your family. First and foremost - be prepared. You can do this by adjusting everyone's bedtime a few days prior to the time change. So if your child (or you!) typically goes to bed at 9 p.m., try calling it a day 15 minutes earlier every day for the four days leading up to the time change. That way, once the time changes, 9 p.m. won't feel quite so much like 8 p.m. and your body will be a little more ready for sleep.

It is also important to try and keep everyone on their normal schedule in the days leading up to the time change and in the days following. Obviously life happens, but try to eat and sleep at the same times for that week or two and you will find that your body adjusts much better. If you are already tired and out of sync, the time change will only make things worse.

Sunlight can also help with the transition to Daylight Savings. Exposing yourself to bright light first thing in the morning can help your body's natural circadian rhythms reset. Try eating with the blinds open or taking the whole family for a walk right after breakfast.

While sunlight can help, alcohol and caffeine definitely do NOT help! Alcohol and caffeine can disrupt sleep anytime of the year and they can be especially counter-productive while your body is adjusting to the time change. Try to ease up on your normal consumption of both while you are preparing for and adjusting to Daylight Savings.

Finally, give your body time to adjust. Know that you will likely need two days to get back to your normal energy level and sleeping patterns - and give your children the same adjustment period. Everyone may be a little off or a little cranky for a couple of days, but with time (and sleep!) everyone will eventually adjust.

If you or a loved one is affected by chronic sleep problems, talk to your physician about whether a referral to the Mercy Sleep Center could be helpful. The Mercy Sleep Center has eight beds and sees 48-56 patients every week. It is located at 3808 Auburn Boulevard, Suite 54, and can be reached 916.979.0347.

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Fighting the Urge:Urinary
Incontinence and Menopause

By Dr. David Couillard, MD

Menopause brings with it a variety of unpleasant symptoms - hot flashes, mood swings, irregular periods... But did you know that urinary incontinence can also be associated with menopause? Unfortunately it's true and while it can be an embarrassing condition, it is important to know that you don't need to allow your life to be dictated by it. There are treatments that can help you.

What is Incontinence?

Incontinence refers to the involuntarily loss of urine from the body. You may feel a leak or just a drip, or the urine may come out in an uncontrollable rush. Incontinence can also leave you feeling like you need to go to the bathroom continually or as if your bladder is very full. Incontinence is one of the most common menopause symptoms, with as many as 40% of menopausal women experiencing it.

The Menopause Link

Estrogen is the hormone that keeps the urethra healthy and also stimulates blood flow to the pelvic area, which strengthens pelvic muscles. During menopause, a woman's estrogen levels drop, which can leave your pelvic muscles weakened. This weakness, combined with pregnancy, childbirth and surgery, can all contribute to an unwanted leak of urine. Replacement of estrogen alone never solves the incontinence problem but often can help other treatments work better.

Types of Incontinence

There are four types of urinary incontinence:

  • Stress Incontinence: Sudden pressure pushing on the bladder such as sneezing, coughing, laughing, and jumping can expose weakness in the urethral valve and cause leakage.

  • Urge Incontinence: Uncontrolled contraction of the bladder muscle can cause the urge to go to the bathroom and lead to leakage.

  • Mixed Incontinence: This type is caused by a mixture of both stress and urge leakage.

  • Overflow Incontinence: During this type, your bladder cannot empty completely due to a weak bladder muscle or obstruction. As pressure builds, leakage can occur.

Treatment Options

If your life is being affected by your incontinence, your first step should be to talk with your doctor to determine the cause of the incontinence and come up with a treatment plan. In the meantime, there are some things you can do on your own to try to decrease the leakage.

  • Diet: Because caffeine acts as a diuretic and a bladder muscle stimulant, it can make incontinence worse. Limiting your caffeine intake can help stop excess urination. Excessive fluid intake is also harmful as it stresses an overactive storage system.
  • Kegel Exercises: The same exercises that can help a pregnant woman prepare for delivery can help you strengthen your pelvic muscles but rarely decreases urine leakage.
  • Your doctor may also prescribe medical treatments, including:

  • Pessaries: Pessaries are designed to hold your pelvis up and off of your bladder, relieving pressure. Pessaries are easily inserted. However, they never fix the problem, but can be a conservative solution in those patients who are poor candidates for surgery due to health issues.
  • Bladder Slings: Bladder slings can be surgically implanted into your pelvis, providing support for the bladder. This is the most effective solution for stress incontinence.
  • Urethral Bulking Agents: Agents such as Coaptite or Macroplastique can be injected to support the urethral valve system.
  • Other Solutions: Other options including Tibial Nerve Stimulation, Botox bladder injections, biofeedback, electrical stimulation, and bladder reconstruction can also be used selectively.
  • However you decide to treat your incontinence, know that you are not alone and do not need to live with the unpleasant effects of this condition. Talk to your doctor to find a solution that will work for you.

    To learn more about women's health issues that may be affecting your life, check out one of our upcoming events. To see a list of times and dates, and to register, click here. To find a doctor who can help you, visit our online physician finder .

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