My Doctor Online The Permanente Medical Group

Take 400 Micrograms of Folic Acid Every Day

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If you are of childbearing age, take 400 micrograms (400 mcg or 0.4 mg) of folic acid every day, even if you are not planning to become pregnant. Since many pregnancies are surprises, this is good advice for all women between the ages of 18 and 45. The easiest way to do this is by taking a standard multivitamin daily.

Studies show that folic acid plays an important role in lowering the risk for certain birth defects (called neural tube defects), if it is taken before conception and through the first 3 months of pregnancy.

You can also get your folic acid in:

• Dark green leafy vegetables (spinach, Swiss chard, kale)
  
• Citrus fruits (strawberries, oranges, and orange juice)
  
• Whole-grain breads and cereals
  
• Legumes (beans, peas)
  
• Fortified breakfast cereals
  

Eat Healthy Foods Every Day

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• Eat whole grains, fruits, and vegetables daily.
• Cut down on fats like butter, margarine, sauces, gravies, mayonnaise, salad dressing, and sour cream and baked goods such as pastries, cookies, and crackers.
• Choose lean meats and poultry (chicken or turkey without skin).
• Don't eat large fish, such as shark, swordfish, tilefish, and king mackerel, because they contain high levels of mercury. The U.S. Food and Drug Administration advises that women of childbearing age, pregnant women, nursing mothers, and young children can safely eat 12 ounces per week of cooked fish. You can eat shellfish, canned fish, smaller ocean fish, or farm-raised fish. Eating safe fish is an important part of a healthy, balanced diet.
• Eat less fried food. If you eat out or go to fast food restaurants, try to select healthier options from the menu.
• Snack healthy. Choose fresh fruit, raw vegetables, yogurt, or popcorn (without butter) instead of high-calorie foods like chips, candy, or soda.
• Drink 8 to 10 glasses of fluid daily. This includes water, milk, and soup.
• Limit caffeine drinks (coffee, tea, and soda). Recent studies have linked caffeine use to an increased risk of miscarriage. Try switching to decaffeinated beverages. If you do use caffeine, limit it to 1 cup of coffee or 2 cups of tea a day. Don't forget that many sodas contain caffeine. They also contain the amount of sugar equivalent to a candy bar. If you choose soda, consider switching to the caffeine-free and sugar-free varieties.
• Some herbal supplements are not considered safe in pregnancy. Please talk with us about any supplements you are taking.
• DHA (also called omega-3 fatty acids, fish oil) is a necessary structural component of the brain and eye. One to 2 weekly servings of fish (as described above) will help you get the DHA you need. If you do not eat fish, talk to us about whether you should be taking a DHA supplement.

Maintain a Healthy Weight

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A big part of staying healthy is being at a healthy weight. If you are trying to have a baby (conceive), healthy weight becomes even more important.

• Underweight women may have a harder time getting pregnant and are more likely to have smaller babies who may have problems during labor and after birth.
  
• Overweight women may also have a hard time getting pregnant. Additionally, they are more likely to experience high blood pressure or diabetes during pregnancy and are more likely to have a C-section. Overweight women are more likely to have delivery complications affecting the health of the baby and mom.
  

Reaching and maintaining a healthy weight now, before trying to get pregnant, can reduce these risks. The best way to be at a healthy weight is by healthy eating and being physically active.

Be Physically Active on Most Days

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If you exercise for at least 150 minutes a week, or 30 minutes on most days, you are reaping the many health benefits of regular exercise. Continue to make exercise a priority so you can stay healthy for yourself and for your loved ones.

If you are not already physically active on most days, now is a good time to start. You will feel better overall, have more energy, stress less, and sleep better. Try to develop a regular moderate exercise program. You can begin slowly and build up gradually. A 5 or 10-minute walk is a good start. Try to set a goal of exercising at least 30 minutes per day on most days. If you have a health condition, please check with us before you begin any exercise program.

If You Smoke, Quit Now

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If you smoke, one of the most important things you can do to improve your health is quit smoking now. Smoking may make it harder for you to get pregnant. Women who smoke are more likely to have problems in pregnancy and childbirth, like premature babies or babies that are underweight. Once the baby is born, studies show that there is also an increased risk for SIDS (crib death) for babies exposed to secondhand smoke.

If you or your partner want to quit smoking, there is help. Tobacco cessation programs give you the tools you need to quit smoking. Learn more about our range of proven quit tobacco services at your local Health Education Center or call the Wellness Coaching Center to make a telephone appointment with a wellness coach at 1-866-251-4514.

Don't Drink Alcohol or Use Recreational Drugs

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Using alcohol or drugs like speed, heroin, or crack is harmful to your health. Using them during pregnancy can harm the baby. These drugs can cause a new baby to cry a lot or have problems eating, sleeping, or breathing. Later, the baby might have trouble learning. These drugs can also cause serious problems like birth defects or brain damage. They can even cause a miscarriage. There are programs to help you quit. Talk to us about what may be the best program for you.

Avoid Toxic Substances or Radiation

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Certain chemicals and radiation are bad for your health. If you are around certain chemicals that are found in the home or workplace, it could make it more difficult to become pregnant and may harm your developing baby. Take precautions to decrease contact with chemicals and radiation. Make sure you wear rubber gloves and work in a well-ventilated area. You can also try to:

• Follow safety recommendations for use of toxic chemical products (cleaners, solvents, pesticides, paint thinners).
• Avoid contact with products containing lead or mercury (these can also be found in certain foods).
  

Have Regular "Well Woman" Exams

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Regular "well woman" exams are an excellent way to take good care of yourself. We recommend that women have regular Pap tests, pelvic exams, and breast exams. Frequent screening for sexually transmitted diseases is also a good idea to protect yourself and your partner(s). If you have any unusual bleeding, pain, sores, or bumps near your vagina, please let us know. It is better to identify any health problems right away when they may be easier to treat.

Get Tested for Sexually Transmitted Diseases

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Diseases that are transmitted through sexual contact not only affect your overall health, they can affect your ability to get pregnant and can also infect and harm a baby. Some examples of sexually transmitted diseases (STDs) are chlamydia, gonorrhea, genital herpes, HIV (the virus that causes AIDS), hepatitis B and C, and syphilis.

You can have an STD even if you don't have symptoms. Here are some of the more common symptoms.

• Sores, bumps, or blisters near your vagina, rectum, or mouth
  
• Burning or pain when you urinate
  
• Pelvic pain 

If you have any of these symptoms, you should avoid having sex until you can see us for evaluation and treatment.

Get Vaccinated

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Some infections can be prevented by immunization. Before you plan to get pregnant, ask us whether you should be immunized against rubella (German measles), chickenpox (varicella), or hepatitis. If you are not immune, you may want to receive the vaccinations before you get pregnant. Being exposed to these infections during early pregnancy could harm your baby. We recommend that you wait at least 1 month after being vaccinated before trying to get pregnant.

Whooping cough (also called pertussis) is a contagious disease that can spread easily from person to person through coughing. When babies get whooping cough, it can be life-threatening. You can get a Tdap (tetanus, diphtheria, pertussis) vaccine before you are pregnant, during pregnancy, or after giving birth to protect yourself against tetanus, diphtheria, and whooping cough. Partners and families can be vaccinated at any time but preferably before the birth of the baby so they don't infect their newborn. It is safe for mothers to get the Tdap vaccine while breastfeeding.

If you are not sure if you or your family members have been vaccinated, you can find out by viewing your Preventive Services online or by contacting us.

Intimate Partner Violence

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If you think you're being abused or may be abusing someone else, you can get help by talking to us or:

• Contact the National Domestic Violence Hotline, 1-800-799-7233 or 1-800-787-3224 for hearing/speech impaired.

If someone has hurt you before, it may happen again. Sometimes abuse can start when you become pregnant or after you have a baby. Abuse can cause health problems for you and your child.

• Women who are abused while they are pregnant are not as healthy and often have more anemia, infections, and bleeding.
• Babies born to abused women have a higher risk of low birth weight, premature birth, and death.
  

Seek Genetic Counseling to Minimize the Risk of Birth Defects

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If you or any close family members (children, parents, sisters/brothers, aunts/uncles) have a history of birth defects or inherited conditions, you may have a higher chance of having a baby with such a condition. A genetic counselor can give you more information about the specific risks and possible tests you may choose to have. Getting your test results before trying to get pregnant will give you time to consider your options.

Manage Your Chronic Conditions

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If you have a chronic medical condition, it is important to discuss this with us before you start trying to get pregnant. We want to help you successfully manage conditions such as:

• Diabetes
  
• High blood pressure
  
• A seizure disorder
  
• Depression
  
• Other kinds of chronic illness  
  

It is best to have these chronic conditions under control before conceiving. If you take any prescription drugs, over-the-counter medications, or herbal remedies on a regular basis, please discuss this with us before you start trying to get pregnant.

Try to Avoid Taking Teratogenic Medications

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Teratogenic medications are medications that increase the risk for birth defects if used during pregnancy. Many of these medications are commonly prescribed:

The list of medications above isn't comprehensive, but it contains some good examples of medications to avoid if you think you might become pregnant.

Some medications can be changed before pregnancy, while others should still be used because the potential benefits outweigh the risk.

If you are of childbearing age and think you may be taking a teratogenic medication, please discuss this with us. Please do not stop any medications without talking with us first.

Contacting Me

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You can connect with me in a variety of ways, depending on the situation and what is most convenient for you at the time. I am available online, by telephone, or in person.

• For nonurgent questions or concerns, you can e-mail me using this site. You can also book an appointment online to see me in person.
• If your concerns are immediate, or you simply prefer to use the telephone, please call our Appointment and Advice line, which is available 24 hours a day, 7 days a week. Our advice nurses can give you immediate advice, and our telephone staff can send me a message or book an appointment for you. 

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How We Coordinate Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay current on your health status and to collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments as needed. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to a specialist

My specialty colleagues are readily available to assist me if I need additional advice about your condition. In some cases, I may contact them during your visit, so we can discuss your care together. If we decide you need a specialty appointment after that discussion, we can often schedule it the same day or soon thereafter.

If you are due for preventive screenings or tests

As part of our commitment to prevention, additional members of our health care team may contact you to come in for a visit or test. We will contact you if you are overdue for cancer screenings or conditions which may require monitoring.

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Convenient Resources for You

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As your personal physician, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available 24/7 so that you can access and manage your care where and when it is most convenient. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions and schedule appointments.
• View your past visits and test results.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at our medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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