Many people have never heard the term “genetic counseling.”  Some people have heard about genetic counseling and associate it with hearing bad or scary news.  In reality, genetic counseling is about conversation, education, guidance and support.  It is about helping a woman feel empowered when it comes to her pregnancy and her health, as well as the health of her baby.  

What is a genetic counselor?
A genetic counselor is a healthcare provider who has advanced educational training in medical genetics and counseling. Prenatal genetic counselors specialize in helping women and their families understand medical genetic information as it relates to the health of a pregnancy or a future pregnancy.  There are many reasons that a woman might visit or be referred to a genetic counselor, such as:

• Having questions about available genetic testing options
• Having a prior child with, or a family history of, a genetic condition or birth defect
• Having a medical condition or an exposure (i.e. medication, radiation, etc.) that may increase the risk for pregnancy complications
• Having an abnormal genetic screening test result or ultrasound finding
• Having experienced several pregnancy losses

The Benefits of Genetic Counseling
After gathering information about family and medical history, a genetic counselor can help a woman decide what type of prenatal genetic testing is best for her, or if she needs testing at all.  While genetic tests can provide information about the health of a current or future pregnancy, genetic counselors are uniquely trained to discuss the benefits, risks and limitations of genetic testing.  They are also trained to help women determine whether or not the information from genetic testing will be helpful to them.  When a woman decides to undergo testing, a genetic counselor explains the results and discusses if additional tests are needed.

In most cases, genetic counselors offer reassurance that a current or future pregnancy will be healthy. However, when complications arise, the information and perspective received from a genetic counselor can be invaluable as expectant parents prepare for the birth of their child. With the help of the genetic counselor, parents can use the rest of the time before their baby’s birthday to:

• Learn more about the complication faced by their unborn child
• Meet with other specialists who may be involved with their child’s care after birth, such as neonatologists, cardiologists, pediatric surgeons, etc.
• Talk with family members and friends to help them prepare for their child’s birth
• Reach out to other parents who have been in a similar situation for support and guidance
• Contact a support group for parents of children who have the same complication
• Select a pediatrician
• Arrange for childcare

The goal of the genetic counseling team at WakeMed Physician Practices (WPP) – Maternal Fetal Medicine is to ensure parents feel supported when it comes to welcoming and caring for their child by connecting them with the appropriate information, specialists and resources.

Things to Think about Before Becoming Pregnant
The genetic counseling team at WPP – Maternal Fetal Medicine provides consultation to women who are pregnant, and we are also happy to meet with women who have experienced recurrent pregnancy loss or who have concerns about a future pregnancy.

Before becoming pregnant, it is important to think about your health and any factors that might affect a baby’s development.  Therefore, consider these things first before attempting to conceive:

• Know your family medical history and that of your partner as well.  Learn more by asking questions of your family members and doing research on conditions that may not be familiar to you.
• If you have a chronic medical condition, such as diabetes or epilepsy, ensure that it is well controlled before trying to conceive.
• If you take medication, talk to your doctor about the possibility of reducing the dosage and/or stopping use of unnecessary medication.
• If you are a smoker, get on a path toward quitting.
• Stop use of alcohol and illicit drugs.
• Ensure you are up-to-date with all vaccinations.
• Talk with your doctor about taking a prenatal vitamin that contains folic acid.

For more information on the genetic counseling services available through WakeMed Physician Practices – Maternal Fetal Medicine, visit our website or call 919-350-6002 (Raleigh Campus location) or 919-235-6433 (North Campus location).

Cheryl Dickerson, MS, CGC, is a genetic counselor at WakeMed Physician Practices – Maternal Fetal Medicine.

Congratulations Cheryl Palmer for being recognized as the February 2015 DAISY Award Recipient!

4 month old Braylen’s Mom wrote this about you:   

“The professionalism and compassion that she showed all of our family was a huge blessing.  The care she shared with us in teaching us how to take care of a premature infant was and is so much appreciated.  She truly is an amazing nurse.” 

A co-worker shared this about you in her nomination:

“The mother of one of our infant patients shared that she was unable to get her 3 older children school supplies.  Cheryl purchased a bag full of school supplies and left a card addressed to “Emma’s brothers and sister” in the patient’s room.  Cheryl is always a kind and loving person – both to families and co-workers.”

Thank you Cheryl “We are Proud You Are a WakeMed Nurse”!

Each month one outstanding WakeMed nurse is awarded a DAISY Award.  This award recognizes the super-human work that nurses do every day.  These nurses are nominated by their patients, patient’s families and their peers.  Nominate a deserving nurse today.  Please nominate nurses who have demonstrated superior clinical skill and compassionate care so they can be recognized as an outstanding role model.

• Cordon Bleu Ham Sandwich
  Inspired by Lloyd Hall, famous for his contribution to meat curing and preservation
• Homemade Potato Chips
  Inspired by George Crum, the inventor of potato chips
• Beignets
  Inspired by Norbet Rillieux, for revolutionizing sugar processing (and also a New Orleans native)
• Raw Vegan Kale Salad
  Inspired by Karyn Calabrese, an inspirational force in the raw vegan movement
• Shrimp Etouffee
  Inspired by Leah Chase, the queen of creole cuisine
• Famous Amos Chocolate Chip Cookies
  Inspired by Wally Amos, the cookie’s namesake
• Peanut Butter Cookies
  Inspired by George Washington Carver, who innovated more than 300 uses for the peanut

There is no time like the present to reflect lessons learned from frigid temperatures and winter weather.

Our emergency physicians have treated more than 240 patients with winter weather-related injuries – including falls, motor vehicle accidents, sledding accidents and traumas – since Feb. 16.

By and large, falls are the number one injury we see in our Emergency Departments during winter weather.   However, frostbite and hypothermia have also been very real concerns during this record-setting cold.   We’ve treated six patients for cold exposure (hypothermia, frostbite, etc.) over the past four days.  We’ve also treated injuries from three separate sledding accidents.

Arctic air and days of lingering snow and ice are not common occurrences in the Triangle, but never underestimate their impact on your health and safety. A few lessons learned from this week’s winter storm:

• Be sure to check on your elderly neighbors, friends and loved ones during cold spells and make sure they are adequately protected. We all need to take special precautions to ensure the health and safety of the community.
• Be careful in winter weather. Take your time, wear appropriate shoes or boots, use handrails when available, and remove or clean your shoes when you get back inside.
• Be prepared for inclement weather – both at home and on the road. (Car checklist: Booster cables, ice scrapers, first aid and tool kits, flashlights, batteries, blankets, bottled water and even a sack of sand or kitty litter (for generating traction in snow/ice)
• Sledding accidents: Sleds can be great fun, but they can also be extremely dangerous. Always sit face-forward and choose a hill that has a manageable slope with a long steep path that is free of jumps, bumps, and obstacles like trees, fences or mailboxes. And, wear a helmet!

Thank you Hurricanes Alexander Semin, Jiri Tlusty, Andrej Sekera and Jay McClement for  bringing so much joy and excitement into the entire Children’s Hospital yesterday.  You are welcome any time!

With insights from Melinda Cooper, RN, BSN, CIC, WakeMed Infection Prevention Nurse, and Dr. Chris Ingram, Infectious Disease Physician & Medical Director of WakeMed Infection Prevention

Caused by a virus, measles is one of the most contagious respiratory diseases known to us. It is preventable via vaccine. Measles is spread through close contact with an infected person, or a surface they have touched, and through the air. Coughing, sneezing, and infected nasal and throat secretions all spread the virus. Disturbingly, the virus can hang in the air or on surfaces for at least two hours. Measles is so contagious that if one person has it, 90 percent of the non-immune people close to that person will catch it (from the Centers for Disease Control & Prevention). Measles is also called Rubeola.

According to the Centers for Disease Control & Prevention (CDC), from January 1 to 30, 2015, 102 people from 14 states were diagnosed with measles. Most of these cases have been linked to a large, continuous outbreak that originated at California’s Disneyland/Disney California Adventure Park in December. A traveler from the Philippines brought measles to the park, and it spread. See weekly updates on this current U.S. outbreak from the CDC.

View a recent news story by WTVD ABC 11 about measles in North Carolina with comments from Dr. Mark Piehl, medical director of the WakeMed Children’s Hospital. 

Symptoms of Measles
Measles typically starts with a fever, cough, runny nose, and red and watery eyes. Red spots called Koplik’s spots develop in the mouth and then a rash begins to progress across the body, spreading from the head and face to the trunk and then to the arms and legs. The fever and rash typically last for around seven days but can last for longer. People who have been infected with measles can be contagious for up to four days before symptoms appear and up to four days after the rash appears.

Most deaths that are related to measles happen due to secondary complications caused by the illness, such as very high fever, pneumonia, encephalitis (swelling in the brain) and diarrhea (which can lead to dehydration). Complications are most common for unvaccinated children under the age of 5 and unvaccinated adults older than 20.

According to the World Health Organization, in developing countries where health care and nutrition are insufficient, up to 10 percent of measles cases result in death. Children in these countries can also go blind from measles because they have a Vitamin A deficiency.

Treatment for Measles
No anti-viral medication exists for measles so it is best to treat the symptoms of the illness until the body is strong enough to fight it off. This includes rest, lots of liquids and fever reducing medications (follow age-appropriate dosage instructions). Additionally, stay home and avoid contact with others to help prevent transmission of the disease. With any high fever or a fever that is accompanied by a rash, it is imperative that a person calls his or her doctor or child’s pediatrician to discuss next steps.

Prevention of Measles & the Measles Vaccine
A safe and highly effective measles vaccine has been in use for 50 years. It is also inexpensive, costing about one U.S. dollar to immunize a child.

“Of all the preventable childhood illnesses, I would say measles is the most serious and it is therefore extremely important for parents to vaccinate their children,” commented Dr. Chris Ingram, Infectious Disease physician and medical director of WakeMed’s Infection Prevention program. “Before we had a vaccine, measles killed children at an alarming rate. In the 1950s and 60s in the United States, up to ten children out of 1,000 would die from the measles. Or, they would die from or experience brain injury as a result of secondary conditions of the illness such as measles encephalitis.”

Dr. Ingram continued, “Data does not substantiate that the measles vaccine causes adverse effects, and any risks to children from receiving this vaccine are far outweighed by the great benefit to being vaccinated and avoiding illness.”

The measles vaccine (MMR), which also includes the rubella and mumps vaccine, should be given to a child at 12 to 15 months of age and then a second dose should be given at 4 to 6 years. It’s unusual but not impossible for a vaccinated child to catch measles. The first dose protects with 95 percent efficiency and the second dose protects with 97 to 99 percent efficiency. After receiving the vaccine, a child’s immunity does not fade.

Herd Immunity
Parents should vaccinate not only to protect their own children from measles but to help create “herd immunity” in their respective communities. Herd immunity results when a community of children and adults are vaccinated from an illness, making it difficult for people in that community to contract or spread the illness.

In 2000, the United States was declared measles-free by the CDC. This was in large part due to the strength, effectiveness and widespread use of the MMR vaccine. However, unvaccinated visitors from other countries coupled with a culture shift, mainly in parts of California, where many parents refuse to vaccinate their children have helped create new transmissions of the disease as well as the current outbreak.

The best advice – vaccinate your children! Help your own family and other families avoid this painful and potentially fatal illness.

For more information on measles:

• CDC: www.cdc.gov/measles/
• CDC on International Travel: www.cdc.gov/measles/travel-infographic.html
• WHO: www.who.int/mediacentre/factsheets/fs286/en/
• N.C. Dept. of Public Health: http://epi.publichealth.nc.gov/cd/diseases/rubeola.html

All WakeMed facilities and services are now officially live on Epic, a comprehensive electronic medical record system. This is a big change for us, so we appreciate the patience of our patients and family members during the transition.

We’re also excited to offer increased access to your health information via the WakeMed MyChart patient portal.  Using MyChart, many WakeMed patients can review test results, visit summaries and request appointments and prescription refills.  Our response time is only ½ a day, so skip the phone tree and message us via MyChart.  Learn more about what our implementation of Epic meant to you.

Of course implementation was not all hard work.  Our doctors and administrators found some time to have a little fun too.  WakeMed employees and patients, do you recognize anybody in this video?

1-29-15 Epicalators from WakeMed Health & Hospitals on Vimeo.

In most cases, there are more questions than answers when it comes to how a medication will impact a pregnancy, and the current FDA labeling system unfortunately does little to help expectant moms make informed decisions.  Additionally, the current labeling system provides limited information for women who are trying to conceive or who are breastfeeding.

This is all about to change in June of this year when a new FDA labeling system will go into effect.  Beginning in June, moms and providers will both be armed with more information to be able to make informed decisions about which medications are worth the risk preconception, during pregnancy and when breastfeeding and which are not.

Why is the current letter grading system of A, B, C, D and X a problem? Very few medications actually fall into the safest category (A) or the most unsafe category (X).  The vast majority of drugs fall between these two clear-cut grades into the gray area, and there is limited information provided for conception or breastfeeding, which are also critically important times in a baby’s development.  The reason for this is pretty simple – most drugs are understandably not tested on pregnant women because of the inherent risk.  The information we do have has mostly been gathered over time or from studies on animals.

While it is always best to significantly limit the number, duration and dose of medications before, during and after pregnancy, there are many instances when it is in the best interest of both the baby and the mother – especially when managing an acute or chronic disease or illness– to take a medication.  With the new guidelines, pharmaceutical companies will be arming physicians and expectant moms with all of the information available on research studies and actual medication usage by pregnant women to help us make more informed decisions together. 

Your best resource for medication information is always your physician, but if you are looking online for a good resource with information about medications and pregnancy, I encourage you to visit MothertoBaby.org.  This is physician-run site features the most current information available.  You can also call the MothertoBaby.org toll-free number (866) 626-6847.

Again, it is always recommended that you discuss your medications with your health care provider.  If you are already on medications and are thinking about getting pregnant or are newly pregnant, you should discuss whether your medications are safe and if they need to be continued with your physician prior to stopping the medication on your own.  Your health care provider can help to weigh the pros vs cons of any medication use during or around the time of pregnancy.  Working together, we can all strive for happy, healthy, moms and babies!

Dr. Seth Brody is an OB/GYN with WakeMed Physician Practices and is the medical director for Wake County’s first Women’s Hospital currently under construction in North Raleigh.  Learn more about the new hospital.

Dr. Mark Piehl, medical director of the WakeMed Children’s Hospital, clarifies pertussis (whooping cough) vaccine confusion for WTVD’s Caitlin Knute. Last year, WakeMed treated 18 cases of pertussis, a potentially deadly disease for babies and very young children. The best protection against the disease is vaccination and booster shots every 10 years. Even with vaccination and regular booster shots, you can still contract the disease but it is much less likely.