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Caring For Your Child’s Teeth

While most parents are diligent about taking their children to the doctor for routine medical visits, many people don’t treat their children’s teeth with the same importance. Developing a proper oral hygiene routine, including regular visits to the dentist, is one of the most important habits parents can pass on to their children to help them have healthy teeth for life.

Dr. John Palm of Keystone Dental Care shares some information about how to properly care for babies’ and children’s teeth and how to prepare for their first dental office visit.

How and when should parents begin caring for their baby’s teeth?

Begin cleaning your baby’s mouth during the first few days after birth by wiping the gums with a clean, moist gauze pad, teeth wipes or washcloth. Gently wipe his or her gums after each feeding.

For children younger than 3 years, start brushing their teeth as soon as they begin to come into the mouth by using fluoride toothpaste in an amount no more than the size of a grain of rice. Brush teeth thoroughly twice per day with a small, soft-bristled toothbrush or finger brush. Supervise children’s brushing to ensure that they use the appropriate amount of toothpaste and remind them not to swallow the toothpaste. When your child has two adjacent teeth that touch side-by-side, you should begin cleaning between his or her teeth daily with flossers.

Introduce a pea-sized amount of fluoridated toothpaste for children 3 to 6 years of age. Do not do this until the child is old enough to spit out the toothpaste after brushing. Use only the recommended amount of toothpaste and tell your child to spit out—not swallow—the toothpaste.

Until you’re comfortable that your child can brush on his or her own, continue to brush your child’s teeth twice a day with a child-size toothbrush and a pea-sized amount of fluoride toothpaste. Allow the child to watch you brush, and follow the same brushing pattern to minimize missed spots. Typically around age 8, most children are able to brush on their own with minimal supervision.

Prevent baby bottle tooth decay: Don’t give children a bottle of milk, juice or sweetened liquid at bedtime or naptime. Don’t allow children to walk around with a sippy cup filled with sugary beverages all day long. Encourage water between meals, and limit milk and other drinks that may contain sugar to mealtime.

Avoid foods and treats that increase tooth decay: hard or sticky candies, gummy fruit snacks, multi-vitamins that are high in sugar and sweetened drinks and juice. Offer fruit rather than juice; the fiber in fruit tends to scrape the teeth clean, whereas juice just exposes the teeth to sugar.

When should the first dental appointment be scheduled?

The American Dental Association, American Academy of Pediatric Dentistry, and American Academy of Pediatrics all recommend that the first dental visit should occur within six months after the baby’s first tooth appears, but no later than the child’s first birthday. Baby teeth are vulnerable to tooth decay from their very first appearance, on average between six months and one year of age. Being proactive about your child’s dental health today can help keep his or her smile healthy for life. It is important to have his or her teeth screened by a dental professional at medical well-child visits. This service is offered at both Keystone Dental and Keystone Pediatrics Chambersburg.

What will be done at the first dental appointment?

Most initial office visits are to help acquaint the child with the dental professional. The first visit usually lasts 30-45 minutes. During the visit, you will be seated in the dental chair with your child on your lap if your child isn’t able to — or doesn’t want to — sit in the chair alone. The dentist will check the teeth, jaws, bite, gums and oral tissues to monitor growth and development. Once the exam is over, the dental professional will gently clean the teeth, which includes polishing teeth and removing any plaque, tartar and stains. The dentist will give you tips for good oral hygiene practices for your child’s teeth and gums. At this time, the dentist can provide or recommend information on baby bottle tooth decay, infant feeding practices, teething, pacifier habits, and finger-sucking habits.

If you have dental anxieties, be careful not to relate those fears or dislikes to the child. If your child cries a little or wiggles during the exam, don’t worry. It’s normal, and your dental team understands this is a new experience for your child.

How can parents prepare their child for their first dental visit?

Start early! To get your child ready for the visit, talk to him or her about what’s going to happen and be positive. Have your child practice opening his or her mouth to get them ready for when the dentist counts and checks their teeth. Reading books or watching videos about first dental visits may help your child be less fearful and more confident. Explain why it is important to go to the dentist. Build excitement and understanding.

Moms and dads can prepare, too. When making the appointment, it can’t hurt to ask for any necessary patient forms ahead of time. It may be quicker and easier for you to fill them out at home instead of at the office on the day of your visit.

Make a list of questions as well. If your child is teething, sucking his or her thumb or using a pacifier too much, your dentist can offer some advice.

Tips for a great visit

Be sure to schedule all dentist appointments for times when your child will be comfortable and in a good mood. Don’t schedule an appointment during naptime. Instead, pick a time your child is usually well-rested and cooperative. Make sure your child has had a light meal and brushes their teeth before their appointment so they won’t be hungry during their visit.

Think of the appointment as a happy and fun experience. If your child becomes upset during the visit, work with your dentist to calm your child. You’re on the same team!


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

Employee Spotlight – Monica Heinbaugh

Monica with her sons Jaxson and Abel.

The Keystone Health Employee Spotlight for April shines on Monica Heinbaugh, Lead Licensed Practical Nurse at Keystone Pediatrics Chambersburg!

Monica began working at Keystone in 2001. She had previously worked as a night-shift nurse for a year and was looking for a change that would allow her to have daytime hours without working weekends and holidays.

Almost 18 years later, Monica still enjoys her role at Keystone. She works in dual positions – part-time as Dr. Michael Colli’s nurse, and part-time fulfilling administrative duties.

“I get to work with the best family I could ask for,” she said. “And I love watching the families we see grow up. I have met some life-changing people here and I am so grateful!”

Monica’s job involves a variety of duties each day. When she’s not with Dr. Colli taking care of patients, she keeps busy with other responsibilities, including giving vaccines, doing the nursing schedule, doing vaccine inventory and management, charting, and attending meetings.

When asked about what makes her proud to work at Keystone, helping patients is at the top of Monica’s list.

“Seeing some patients who I remember as babies now graduating and becoming adults, and some becoming parents themselves makes me proud,” she said. “I like being able to help patients, especially kids who can’t help themselves and offering services, medical care, and education to those in need and knowing they are leaving with more than they came with.”

Monica was born and raised in Chambersburg and is now raising a family of her own here. She has two boys with her husband Brad – Jaxson, 7, and Abel, 2. Outside of work she keeps busy with trying new DIY projects, enjoys spending time with friends and family, and with her sons.

“These boys keep me on my toes,” she said. “We have soccer and baseball and love being outside!”

Thank you, Monica, for all that you do for Keystone and our patients!

What You Need To Know About Colorectal Cancer

March is Colorectal Cancer Awareness Month. Also known as colon cancer, this disease is one of the most commonly diagnosed cancers and is the second leading cause of cancer-related deaths in Pennsylvania and the United States.

The good news is, many of these deaths can be prevented by being proactive. Gregory Gibson, Certified Registered Nurse Practitioner at Keystone Internal Medicine, shares information about the disease, including what signs to look for and what testing options are available, in today’s Take Care article.

What is colorectal cancer?

Colorectal cancer (CRC) is a common and potentially fatal disease. Cancers are cells that overgrow and begin to invade other parts of the body, and this is a cancer that affects the lower part of the digestive tract. There are nearly 150,000 new cases reported each year with approximately 51,000 deaths yearly from this disease. This cancer can affect both sexes but it does affect men more than women. Environmental and hereditary factors are both contributors to a person’s risk for colorectal cancer.

What are some warning signs and symptoms?

Signs of colon cancer include changes in bowel habits such as diarrhea or constipation or other changes that last for more than a month. Bleeding from your rectum or blood in your stool is another possible sign of CRC. Other symptoms can include persistent abdominal pain or a feeling that you cannot completely empty your bowels when you go. Weakness, fatigue, unexplained anemia and unexplained weight loss may also occur but are less specific signs.

Who should be tested, and what testing methods are available?

The United States Preventive Services Task Force recommends that everybody over the age of 50 should be tested for colorectal cancer, and screening should continue until at least age 75. The US Cancer Society has suggested that screening should begin at age 45. People with a family history of colorectal cancer, inflammatory bowel disease (ulcerative colitis or Crohn’s disease), history of radiation treatments to the abdomen or pelvis, Lynch syndrome or familial adenomatous polyposis should consult with their primary care provider to see if screening should begin sooner.

There are several different options for screening of colorectal cancer. There are multiple stool-based tests that may be performed in the privacy of your own home such as FIT, FIT-DNA, and gFOBT. These tests need to be performed every year except for the FIT-DNA which may be performed every one to three years. These methods offer the advantage of not having to have any anesthesia and not requiring bowel preparation before being performed. Patients may also have a sigmoidoscopy performed every five years or colonoscopy performed every 10 years. Advantages of these tests are that they have to be performed less often, and during the screening some issues can be addressed without additional procedures. The disadvantages of these tests are that they require anesthesia and bowel prep before the procedure.

Why is it important to not put off screening?

The reason to not put off screening is because colorectal cancer does not always have signs and symptoms in the earlier stages or when it is just a precancerous polyp. Screening tests allow providers to find these abnormalities earlier and treat them before they have a chance to spread to other parts of the body. It is a missed opportunity to not screen for this cancer because we cannot screen like this for every disease. Screening has proven to be very effective over the past few decades at decreasing mortality rates from colorectal cancer.

Even if the screening may seem unpleasant to you, I assure you it is a much better alternative of finding you have colorectal cancer because you have not had any screening. Some of my own family and friends are still here with us today because of early detection. This allowed them to begin treatment early and they have overcome this diagnosis. They are still with us 20 years later.

What are the benefits of early detection?

If colorectal cancer is detected before it spreads to other parts of the body, the survival rate over a 5-year period is 90%. The mortality rate of this disease has decreased steadily since the 1980s partly because of the early detection of cancer through screening. Colonoscopies in particular are very useful. Not only do they detect colorectal cancer but they can see and remove growths, and biopsy them before they cause problems. The mortality rate for colorectal cancer is much lower when detected early.

We do preventative maintenance and screening on our cars, so why would we not do it for ourselves? Prevention is always preferable treatment. People need to play an active role in their healthcare. Your provider can make suggestions but unless you are an active participant in your healthcare and participate in screenings, disease can only be reacted to instead of prevented.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

Free Produce at Keystone Health

Join us on Thursday, March 28, to get some FREE fruits and veggies!

Third Trimester FAQs

For pregnant women, by the time the third trimester arrives many changes have already taken place. As the body grows and prepares to give birth, more changes are on the way – both physically and mentally.

Dr. Radha Rani Padhy of Keystone Women’s Care shares information about what women can expect during the last trimester of pregnancy, and when they should seek medical advice.

What kind of physical changes start to happen during this trimester?

During this trimester, the uterus gradually expands from the pelvis up to the rib cage. This can cause tremendous physical pressure and discomfort. In addition to lower back pain, there may be pressure on the sciatic nerves causing pain, tingling or numbness down the legs. Finding a comfortable position to sleep may become challenging. The best position is lying on the side, preferably the left side to allow for maximum blood flow. Body pillows may be helpful in maximizing comfort.

Hemorrhoids may develop, which are varicose veins in your rectum, and swelling of the fingers, face and ankles may become more evident. The skin across the abdomen may become dry and itchy from the stretching. Pink, reddish or purplish indented streaks may become visible reflecting stretch marks.

False contractions, known as Braxton Hicks contractions, may become more frequent. These are irregular and sporadic contractions. As unpleasant as the physical symptoms become, the highlight will be consistent movement of the baby. Get to know your baby’s patterns of movements, including the frequency and intensity. There may be a slight decrease in activity in the last few days before birth as the baby descends further down in the pelvis in preparation for delivery.

What kind of emotional changes may be taking place?

By this point, the fatigue of pregnancy may be overwhelming, leading to growing eagerness towards the estimated due date. Many women also experience feelings of apprehension about the birthing process. A good way of overcoming this is to talk with others who have had positive birth experiences. If you’re frightened and anxious during labor, your birthing experience may be more difficult. Educating yourself and asking questions about the process can greatly ease your qualms.

What are common tests that will be run during this time?

Prenatal visits become more frequent during this trimester. After 28 weeks of pregnancy, visits occur every two weeks and visits will be scheduled weekly after 36 weeks. These appointments are important as they include checking the position of the baby to see whether the head or the buttocks is facing the down towards the mother’s pelvis.

A group B strep test is performed, which is a swab of the vagina and rectum. Group B strep is a bacteria that is normally found in the vagina or rectum, but it can cause a serious infection for the baby if there is exposure during birth. If you test positive for group B strep, you will require antibiotics during labor.

If you pass your due date, the baby’s heartbeat may be monitored with an electronic fetal monitor. An ultrasound may also be performed to assess the baby’s breathing, movement, muscle tone and the amount of amniotic fluid. You may also be offered an induction of labor, which involves the stimulation of uterine contractions before labor begins in order to achieve a vaginal birth. Your provider will explain in detail all the modalities of induction available and individualize a plan appropriate for you.

What do healthcare providers generally recommend when it comes to over the counter medications and physical activity during this trimester?

As stressed throughout your pregnancy, always ask your provider before starting any medications. This includes prescription and over-the-counter medications. Daily exercise is still recommended (30 minutes at moderate intensity) if there are no medical or obstetric complications. However, avoid lifting heavy weights (greater than 20 pounds) and any exercises that involve lying on your back.

What warning signs should the expectant mother be concerned about? When should she call her doctor or midwife?

Babies establish movement and sleep patterns as the pregnancy progresses. It is important to be aware of and account for these movements. If you perceive decreased fetal movement, sit down in a quiet place and count your baby’s kicks. You should count at least 10 movements within two hours. If there are less than 10 kicks or you don’t feel any movement at all, call your provider immediately.

Toward the end of the trimester, it may be difficult to tell the difference between false contractions and true contractions. False contractions usually are irregular, don’t get consistently closer together, vary in length and intensity and dissipate with walking, changing positions or resting. They are mainly centered in the lower abdomen and pelvis. True contractions have a regular pattern that grow closer together, last at least 30 seconds, become longer and stronger and strengthen despite walking, changing positions or resting. They most often radiate throughout the abdomen and lower back. If you start experiencing contractions every two to three minutes lasting for one or more hours, or painful contractions with heavy vaginal discharge, call your provider immediately.

Other reasons to call your provider immediately during any trimester include: heavy bleeding or bleeding that lasts longer than a day, severe abdominal or pelvic pain (especially if accompanied by a fever or bleeding), a fever greater than 102 degrees Fahrenheit, a severe and persistent headache (especially with dizziness, faintness or visual disturbances), severe shortness of breath or chest pain, inability to urinate or painful urination, leg pain with redness or swelling, worsening swelling of the hands or feet, heavy or foul-smelling vaginal discharge and a low mood, loss of pleasure and thoughts of harming yourself or others.

What are common concerns that expectant parents have during this time?

Concerns about breastfeeding, scheduling difficulties with maternity and/or paternity leave and anxiety over becoming parents are common worries. The best way to overcome this anxiety is to be organized before the baby is born. Find a pediatrician or provider with whom you are confident and stock up on baby supplies that you will need immediately once you arrive home with your baby for the first time.

Buy a car seat as it is one of the most important pieces of equipment in the care of your baby, starting with the first ride home from the hospital. Car seats are required by law in every state. Correct and consistent use of them is one of the best ways to protect your child. You should also buy a crib as the newborn baby will spend more than half their time sleeping. When purchasing or borrowing a crib, make sure that it meets specific safety guidelines.

Fears about the birthing process are also normal. As you anticipate the day of your baby’s arrival, it becomes exciting but can also be very stressful. Knowing what to expect can help you have the most positive birth experience. Acknowledge that childbirth can be painful, so inquire about all the pain management options that are available. Address all your fears with your provider and ask as many questions as you need to be prepared. Remember that you are not alone. Childbirth can be a scary experience, but we are here to guide you through it every step of the way. As your provider, we take the utmost pride and pleasure in having a healthy mom and healthy baby.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

Second Trimester FAQs

For expectant mothers, pregnancy is usually accompanied by many questions. While patients should always feel comfortable asking their healthcare provider about any concerns that arise, knowing what to expect can be extremely helpful in easing fears and concerns for moms-to-be.

In today’s article, Dr. Radha Rani Padhy of Keystone Women’s Care answers some frequently asked questions related to the second trimester of pregnancy.

What kind of physical changes start to happen during the second trimester?

Major physical changes occur during this trimester, and by the twentieth week the uterus grows to be behind the mother’s navel and a small protruding belly is noticeable. The expanding uterus may cause some aches and pains, lower back pain and leg cramps. It’s common to have sharp pain on one side, usually provoked by sudden movement.  This pain results from the stretching of the round ligament that attaches the uterus to the abdominal wall.

Mild contractions, a feeling of slight tightness in the abdomen, may occur with physical activity or after sex, and vaginal discharge may increase due to hormonal changes. The highlight, however, is the beginning sensations of fetal movement as “butterflies in your tummy” between 16 to 20 weeks.

What are common concerns that mothers have during this time?

Naturally, many mothers have concerns about the baby’s development. Other common concerns include fears about the labor and delivery process, adjusting to their evolving body image and rapid physical transformation and childcare both at home and when parents return to work.

What kind of emotional changes are or will be taking place?

The unpleasant symptoms of the first trimester generally have resolved by this time, thereby causing a burst of energy and an improved mood. Use this to your advantage! Be productive and tackle your “to-do” list for the baby. Now is a great time to enroll in childbirth classes, to familiarize yourself with your employer’s maternity and paternity leave policies, to shop for maternity clothes, and to research breast feeding and how to best incorporate it into your lifestyle. Breast feeding is a wonderful way to bond with your baby and has been scientifically proven to enhance your baby’s emotional well-being.

Many patients also experience forgetfulness and difficulty concentrating. There is no such thing as a “pregnancy brain” or “baby brain,” but these symptoms are normal, no matter how attentive and organized you were before pregnancy. Simply focus on the positive aspects of the pregnancy and accept all the nuances.

What are common tests that will be run during this time?

Your healthcare provider will do a complete blood count to check for anemia or low platelets and a glucose test to check for gestational diabetes. Your ultrasound will check on your baby’s development including the heart, heart rate, kidneys, bladder, stomach, brain, spine and sex organs. This ultrasound will also check the placenta, amniotic fluid levels and any markers that may indicate an increased risk of a chromosomal abnormality (Down syndrome, Trisomy 13 and Trisomy 18). You may choose to find out the baby’s gender at this time.

Fundal height (the top of the uterus to the pubic bone) is measured starting at 24 weeks, and genetic screening will be offered to assess the risk of any chromosomal abnormalities. Remember, any abnormal result on a screening test will need to be confirmed on a diagnostic test to detect if a genetic abnormality truly exists.

A Tdap vaccine will be offered to protect the newborn from pertussis, also known as whooping cough, which can be life-threatening. It is also recommended that everyone 11 years of age and older who has not previously received a Tdap vaccination be vaccinated two weeks before coming into close contact with the newborn baby. This creates a circle of protection around the baby known as “cocooning.”

What do doctors generally recommend when it comes to over the counter medications, diet and physical activity during this trimester?

Expectant mothers should continue prenatal vitamins (ensure there is at least 400mcg of folic acid), and continue with 30 minutes of moderate exercise per day as long as there are no medical or obstetric complications. Always ask your provider before starting any medications, whether they are obtained over the counter or through a prescription. Quitting smoking can be an ongoing struggle. Always ask for help as it is readily available.

Sexual intercourse is okay at any time during pregnancy as long as you do not have the following conditions: are at risk for preterm labor, have unexplained vaginal bleeding, are leaking amniotic fluid, the cervix begins to open prematurely or the placenta partly or entirely covers the cervical opening.

What warning signs should cause concern?

As the uterus expands, it starts exercising its muscle mass which may result in occasional irregular and painless contractions that feel like tightening sensations of the abdomen. However, if you start experiencing more than six contractions per hour, contractions that last two or more hours or painful contractions with heavy vaginal discharge, call your provider immediately as these may be signs of preterm labor.

Other reasons to call your provider immediately during any trimester include: heavy bleeding or bleeding that lasts longer than a day, severe abdominal or pelvic pain (especially if accompanied by a fever or bleeding), a fever greater than 102 degrees Fahrenheit , a severe and persistent headache (especially with dizziness, faintness or visual disturbances), severe shortness of breath or chest pain, inability to urinate or painful urination, leg pain with redness or swelling, heavy or foul-smelling vaginal discharge and a low mood, loss of pleasure and thoughts of harming yourself or others.

What else should expectant parents know about this trimester?

This trimester is known to be the “honeymoon” phase of the pregnancy because of the heightened energy and optimism. Enjoy this phase before the queasiness and discomforts of the final trimester begin.

Now is a good time to take a vacation and spend precious time with family and friends. Go out and experience activities that you may not be able to do once the baby comes. Above all, enjoy your sleep as it will soon be in short supply.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.

Employee Spotlight — Mary Long

The Keystone Health Employee Spotlight for March shines on Mary Long, Certified Pharmacy Technician at Keystone Pharmacy!

Mary began working at Keystone in September 2013 after seeing a job opening online. She was familiar with Keystone and the pharmacy from taking a family member to appointments in the building. While she had worked at pharmacies in the past, Mary found that working at Keystone was different.

“I have been a certified pharmacy technician for over 10 years and Keystone Pharmacy has some of the most knowledgeable Pharmacists I have known,” she said. “I have learned a lot from them through the years and have become a better technician because of it. A lot of chain pharmacies are mostly concerned with the number of scripts you pump out in a day and less about the quality of patient care. Sadly, this is how I was used to operating but working here has taught me to slow down and take pride in what you do. It’s not just another customer – it’s a life.”

Helping Keystone’s patients quickly became Mary’s favorite part of the job.

“It’s a small community and a small pharmacy so you get to know the patients very well,” she said. “They like the fact that you know them by name. I appreciate that Keystone helps people in need who maybe cannot afford their medications, either with the 340B discount, reduced fee, or just finding a co-pay card for them.”

Assisting the customers, as well as her other duties, ensures a busy work day.

“I work 10:30 am-7 pm,” Mary said. “In the morning I usually run reports, reconcile third party claims, update inventory, cover lunches when needed and assist the pharmacist and technicians with anything they need. At 4:30 most of the daytime staff leaves and I go out front and input and fill scripts, wait on patients at drop off/pick up, complete our drug order for the day and close the register at the end of my shift.”

Mary also stays busy in her free time.

“I love to cook and bake, and I also love to paint. I’m not very good at it but I think it’s fun and relaxing.”

While she is not a Chambersburg native, Mary appreciates the perks of living in a rural area.

“I am originally from Upper Darby which is outside of Philadelphia,” she said. “My family and I moved to Chambersburg in 2009 so that my niece and nephews had a safer upbringing. I love all of the landscapes and the changing of seasons in Chambersburg. Spring in this area and spring in the city are totally different. There’s not much green grass in the city. My favorite time in Chambersburg is Christmas; I love how the square and downtown area is decorated and lit up. It reminds me of Christmas movies I used to watch as a kid.”

Thank you, Mary, for all that you do for Keystone and our patients!

March is Colorectal Cancer Awareness Month

Colorectal cancer (also known as colon cancer) is the second leading cause of cancer related deaths in Pennsylvania and the United States. If detected early, those diagnosed have a 90% survival rate. Early detection can mean the difference between life and death, and most colon cancer related deaths can be prevented.

At Keystone Health, we care about our patients and the community. That’s why, during the month of March, we are holding a Colorectal Cancer Awareness campaign to encourage those who are ages 50 -75 to get screened (in some cases people younger or older should also be screened – talk to your healthcare provider).

While colonoscopies are a very effective way to screen for colon cancer, there are other screening methods available. In many cases, colorectal cancer can be screened by using a simple at-home kit that can be completed in the privacy of your home and mailed to the lab in a self-addressed stamped envelope.

For more information on screening or to schedule an appointment to be screened (including take-home kits) please call Keystone Family Medicine at (717) 709-7999, or Keystone Internal Medicine at (717) 709-7970.

To read an article about colorectal cancer by Keystone Internal Medicine’s Dr. Kerry Whitelock, including what signs and symptoms to look for, click here.

First Trimester FAQs

Pregnancy is a life-altering event that results in many changes for the expectant mother, both physically and mentally. Especially for first-time mothers, pregnancy is accompanied by many questions and concerns.

Dr. Radha Rani Padhy of Keystone Women’s Care addresses some frequently asked questions about the first trimester of pregnancy in today’s Take Care article.

What kind of changes start to happen to a mother’s body during the first trimester of pregnancy?

An enormous transformation takes place this trimester, both psychologically and physically. Many women start to experience nausea, heartburn, fatigue, insomnia, constipation and frequent urination due to hormonal and physiological changes. Breasts many enlarge and start to become tender, tingly and sore.

Nausea and vomiting, most commonly referred to as morning sickness, may be the most significant change experienced this trimester and most often those symptoms lessen by the second trimester. Some tips for easing discomfort include avoiding greasy, spicy and fatty foods, eating small meals frequently, drinking plenty of fluids and including Gatorade or G2 in your daily fluid intake, incorporating ginger-enriched foods into your diet and paying attention to triggers such as certain foods and smells.

What are common concerns that mothers have during this time, and what emotional changes will take place?

Naturally, many expectant mothers worry about the baby’s health. They also may have concerns about adjustment to parenthood – both emotionally and financially, maintaining a work-life balance after the baby is born and the effect of concurrent medical conditions and medications on the pregnancy.

Moods can change considerably over the course of a single day, and emotions may range from exhilaration to exhaustion, delight to depression. This occurs due to the pregnancy-related physical stresses and hormonal changes in your body, and this emotional whirlpool can be overwhelming. The best way to cope is to discuss your emotions with your partner, family or healthcare provider.

What are common tests that will be run during this time?

A detailed health history will be taken and a full physical exam will be performed at the first prenatal visit. Prenatal tests will include testing for: blood type, HIV and STDs, a complete blood count to check for anemia or low platelets, immunity to certain diseases from previous vaccinations such as rubella, hepatitis B and chickenpox and a urine analysis to check for bladder or kidney infections.

Additionally, an ultrasound will be performed to determine the baby’s gestational age and estimated due date. Genetic screening will be offered to assess risk of chromosomal abnormalities (Down syndrome, Trisomy 13 and Trisomy 18). Be aware that screening tests only evaluate the risk. If they come back abnormal, additional testing will be needed to confirm whether the abnormality truly exists.

If the mother has certain health conditions, her pregnancy may be deemed as high-risk. In that case, additional tests may be ordered and a referral to a specialist in maternal-fetal-medicine may also be given.

My advice for prenatal appointments is to be as honest as possible with your health history so that you can get the best care tailored specifically to you. Ask many questions and educate yourself about all the tests that are being ordered and why, and discuss your fears and concerns about pregnancy and childbirth with your healthcare provider. Your relationship with your provider should be one of honesty and transparency, which is a two-way street.

What do doctors generally recommend when it comes to over the counter medications, diet and physical activity during this trimester?

A daily prenatal vitamin with at least 400 mcg of folic acid is recommended. Adequate folic acid will reduce the risk of developing defects in the neural tube, which gives rise to the brain, spinal cord and spinal nerves.  Some over the counter medications are allowed during pregnancy, and others are not. A list will be given to you at your first prenatal visit. If you are unsure about any medications, always ask your provider before use.

30 minutes or more of moderate exercise per day is recommended in the absence of other medical or obstetric complications. Stop smoking and do not drink alcohol while pregnant. Always ask for help as quitting is not easy. Other things to avoid include hot tubs and saunas and recreational activities with a high risk of falling or a high risk of abdominal trauma.

What warning signs should the expectant mom be concerned about and when should she call a doctor?

During this trimester the placenta starts to grow and secure its attachment to the uterus. Sometimes this results in minor bleeding which usually is normal.  However, if you experience heavy bleeding or bleeding that lasts longer than a day contact your provider immediately.

Other reasons to call your doctor immediately are: severe abdominal or pelvic pain (especially if accompanied by a fever or bleeding), nausea and vomiting with inability to eat or drink, a fever greater than 102 degrees F,  a severe and persistent headache (especially with dizziness, faintness or visual disturbances), severe shortness of breath or chest pain, inability to urinate or painful urination, leg pain with redness or swelling, heavy and steady watery vaginal discharge and a low mood, loss of pleasure and thoughts of harming yourself or others.

Pregnancy can be an amazing and frightening experience at the same time. Remember to always ask questions and address your fears and concerns as they arise. Planning ahead for and maintaining regular prenatal appointments helps to ensure the pregnancy is continuing in a healthy manner and to detect any problems as soon as possible.

Most of all, enjoy this precious experience and always maintain a positive outlook. Pregnancy is a matter of mental health as much as physical well-being. Never hesitate to ask for help, no matter how small you may think that the problem might be; don’t think you are alone. It is not only our job as your provider to take care of you, but it is our utmost pleasure to do so. We all have the same goal: a healthy baby and a healthy mom.


This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.


Employee Spotlight – Andrea Schvartz-Mazie

The Keystone Health Employee Spotlight for February shines on Andrea Schvartz-Mazie, charge poster at Keystone Women’s Care!

Andrea started her career at Keystone in February 2011 when she was hired as a receptionist, and after a year transitioned to charge posting. She was familiar with Keystone from taking her daughter to Keystone Pediatrics, and she had also heard good things about the company from her neighbors.

“I liked what Keystone stood for and I benefitted from the reduced fee program as a patient,” she said. “I am proud of what we do here – always helping not only within the community, but with anyone that needs help and guidance.”

While charge posting is the main part of her job, Andrea enjoys being a team player and helping out wherever she can. She is bilingual and is always happy to translate for our Spanish-speaking patients when needed.

“A typical day for me is coming in, running my lists, and posting while helping the receptionists check in patients,” she said. “I also help translate prescriptions for the pharmacy and for patients that need help while being at the pharmacy. Every once in a while I help through the phone at Keystone Urgent Care with their check-in process.

“I love what I do. Posting is fun and translating is fulfilling. It makes me proud when I do my work with little or no mistakes and when I get to help a patient – whether it is translating in our practice, Urgent Care, or the pharmacy.”

Andrea speaks Spanish thanks to her upbringing in Argentina, where she lived until she was a teenager.

“My father is Italian and my mother has a Ukrainian background,” she said. “I moved to northern Virginia when I was 14 years old and finished growing up there.”

She enjoys the small-town feel of Franklin County compared to northern VA, and is glad she and her husband settled here.

“My husband Hal and I have known each other for 25 years and have been married for 20 years,” she said. “We have four amazing children together, with our last one at Frostburg University. We also have two super cute grandchildren!”

In her free time Andrea enjoys reading – especially her favorite author, John Grisham, and also likes works by Aaron Sorkin. She relaxes by listening to instrumental music mixed with nature sounds, and enjoys exercising as well.

“I used to do Zumba for fun and to stay fit,” she said. “Now I usually just walk with my dog, Nina, during the good weather. She is a big, strong rescued puppy. It has always been my dream to have an animal shelter, and/or a big building as a children’s shelter.”

Thank you, Andrea, for all that you do for Keystone and our patients!