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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!

Text Message Scheduling Now Available

We are pleased to announce Keystone Health is now using text message scheduling services to make it easier for our patients to communicate with us!

No more waiting on hold – we value your time and want to make scheduling appointments as quick and easy as possible.

Going forward, patients who are signed up for texting will receive a text message asking them to confirm their appointments with us. If you receive a text, please reply to let us know if you will attend your appointment or if you need to reschedule. Appointments at many of our practices are in high-demand, and knowing in advance that you need to reschedule will allow us to offer that appointment time to another patient who needs to be seen.

Additionally, you can text us to request an appointment, and will receive reminders when you are due to be seen.

It’s easy – when you need to reach us, just text the number you would normally call. We will be happy to help!

(Note: our text line is to be used for non-urgent issues only. If you need to reach a triage line, please call the office. For medical emergencies, visit the nearest hospital or dial 911.)


Dr. Yvette Brown wins Teacher of the Year Award

Dr. Yvette Brown, Medical Director and Obstetrician and Gynecologist at Keystone Women’s Care in Chambersburg, PA, has received the 2018 College of Medicine Affiliate Site Teacher of the Year Award. Each year, clerkship directors identify one faculty member and recognize that member for their excellence and commitment to the education of medical students.

Joanne Cochran, President and CEO at Keystone Health, said “We at Keystone are very proud of Dr. Yvette Brown. She exemplifies all those qualities in the ideal physician: loving, caring, sharing, giving, dedicated, and non-judging. We are blessed to have such a woman of high standards and exceptional integrity as part of our community network of physicians.”

Dr. Brown received her award on February 5th at an awards presentation at the University Conference Center in Hershey, PA.

For more information about Keystone Women’s Care, click here.

Cervical Cancer – Facts and Prevention

January is Cervical Cancer Awareness Month. This year alone, approximately 13,240 women in the United States will be diagnosed with this invasive cancer. If you are a woman between the ages of 21-65, getting screened regularly is important – it could save your life.

Cathy McAfee, Certified Registered Nurse Practitioner at Keystone Community Outreach, shares some important information about this disease in today’s Take Care article.

What are the symptoms and signs of cervical cancer?

Most women with pre-cancer show no symptoms. Symptoms usually don’t begin until the cancer cells become invasive and spread into nearby tissue. This is why regular screenings are so important.

When symptoms do occur, they can include: abnormal vaginal bleeding (such as bleeding between periods, after sex, after menopause, after a pelvic exam, etc.), menstrual periods which are longer or heavier than usual, an unusual or increased vaginal discharge, pain during sex and persistent pelvic and/or back pain.

These symptoms can sometimes be caused by things other than cervical cancer (such as an infection), but if you experience any of the signs above it’s important to see a healthcare provider as soon as possible. The earlier the cancer is caught, the less time it has to advance and spread.

If diagnosed, what are the treatment options?

Treatment options depend on multiple factors including a woman’s stage of cancer, reactions to possible side effects and her overall health. Treatments include surgery (removal of the cancerous growth, a hysterectomy or other surgical procedures), radiation therapy and chemotherapy.

What’s the outlook for someone who has been diagnosed?

Survival rates depend on multiple factors, including the stage of the cancer when the patient was diagnosed. When detected at an early stage, the 5-year survival rate is 92%. If the cancer has spread to surrounding tissue, organ or lymph nodes, the 5-year survival rate is 57%, and if it has spread to a distant part of the body, the rate drops to 17%. This is just another reason to pay attention to the signs your body gives you, and to have regular visits with your healthcare provider.

How can women protect themselves from this disease?

The answer to protecting yourself from cervical cancer and avoiding the pain and heartache of this preventable disease is to be proactive! It can most often be prevented by having regular screenings. There are also steps you can take to lessen your chances of developing pre-cancer. These steps include: delaying your first sexual intercourse until your late teens or older, limiting your number of sexual partners, avoiding sexual intercourse with people who have had many partners and not smoking.

Another way to be proactive is to receive the HPV vaccine if you are age 45 or younger. This vaccine helps prevent cervical cancers caused by HPV. Talk with your healthcare provider about the appropriate schedule of vaccination because it may vary depending on your age and vaccine availability. If you are a parent, this vaccine can be given to both boys and girls starting in their adolescent years.

If you are a woman who is due for a cervical cancer screening, I hope that you will make time to schedule an appointment with your healthcare provider as part of your New Year’s resolution. It could save your life!


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.

Help End HIV Stigma


Even though it’s been over 30 years since HIV was first diagnosed, there’s still an unfortunate barrier to fighting this virus. That barrier is stigma. The Let’s Stop HIV Together campaign raises awareness that we all have a role to play in stopping HIV stigma. When we support people living with HIV, we make it easier for them to live happy, healthy lives.

How can you make a difference? There’s many small ways to make a big impact.

If each of us commits to making positive changes in our families and communities, we can help end HIV stigma and work together to stop HIV.

For ideas of how you can get involved click here.

For information about Keystone Health’s HIV Program, including locations for free HIV and STD tests, click here.

Remember, we all play a role in reducing stigma!

Employee Spotlight – Maria Perez

The Keystone Health Employee Spotlight for January shines on Maria Perez, Office Manager/Assistant Director of the Keystone Farmworker Program!

Maria began her career at Keystone in 1999. She took a year off in 2006 when the Director of the program, Mary Englerth, went to Guatemala to do medical missions work. When Mary returned in 2007, Maria rejoined Keystone and has been here ever since.

“Mary is an awesome lady,” Maria said. “I like working for her and for Keystone. I’m proud to work for a company that cares for its employees and its patients.”

During the growing season when there are the most farmworkers in the area, Maria spends her days answering phones, setting up appointments, calling patients, assisting Program Directors Mary Englerth and Vanessa Rice, going to camps to deliver medications and register patients (including the outlying camps in Western PA, Berks, and Columbia counties), and checking on patients to make sure they are doing well. During their “off-season,” Maria spends her time running reports, collecting information, and preparing for the next growing season.

“My favorite part of the job is working with the patients,” Maria said. “I like knowing that this program’s goal is to meet their needs.”

When she’s not at work, Maria enjoys spending time with her family. She lives in Hanover, PA with her husband and has three grown sons.

“I have a beautiful family,” she said. “My husband works in Spring Grove as a supervisor at the paper mill. He’s also a full-time pastor at a Hispanic church in New Oxford. My oldest son also works at the paper mill and is married to a wonderful lady. They have three children; my handsome grandsons are the apples of my eye.

“My middle son works as a teacher at Vida Charter School. He is married to a wonderful lady, who works for WellSpan, and my youngest son is 21 and he lives in Cincinnati, OH. He works as a parking valet and is planning to go back to college.”

Maria’s hobbies include creating flower arrangements, and her favorite book is The Bible. She enjoys walking and riding bikes with her grandsons when the weather is nice, and visiting downtown Chambersburg – especially the square and the Hispanic market in Southgate.

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


Keystone Health Offers Free Pap Tests in January

January is Cervical Cancer Awareness Month.

For most women between the ages of 21-65, Pap tests are one of the most important steps in keeping themselves healthy and protecting themselves from cervical cancer.

During the month of January, Keystone Health is offering FREE Pap screenings for women who are due for this important test. Show or mention the coupon below at Keystone Community Outreach (located at 455 Lincoln Way East, Chambersburg) and receive a Pap test free of charge. Each patient who is due for this test and completes an appointment will receive a $5 gift card!

Call (717) 709-7908 to schedule your appointment.

For more information about the importance of cervical cancer screenings, visit this blog post by Keystone provider Cathy McAfee.

Coping With Grief During The Holiday Season

The holidays are associated with family and friends in every cultural and ethnic group. This is the time of the year that is filled with joy and enthusiasm. However, there are some people who may not be able to fully enjoy the happiness that the holidays can bring — those who are grieving the loss of a loved one. Dr. Jagdeep Kaur, Psychiatrist at Keystone Behavioral Health, wants those people to know that while experiencing grief during the holiday season can be especially difficult, there are healthy ways to cope and remember your loved one.

Coping with grief

The pain of loss is hurtful and exhausting. Coping with grief in healthy ways is necessary for sound body and mind. We cannot forget the loved ones we’ve lost, and we should not try to forget them. But we need to understand that in this universe, things happen in a cyclic pattern. The same principle applies to life as well. We are not going to be on this earth forever. There is an end to everyone’s journey but that does not minimize the pain of grief. We should draw strength from the memories of lost loved ones. From my personal experience, I can tell you that crying is a common emotion when memories of your loved one come to mind. And that’s okay. You can cry. Tears are holy water and that makes crying a healing process. Allow yourself to feel the emotions fully. Sit with these feelings and find out what comes up.

Healthy coping strategies during the holidays

I have a few suggestions to ease the pain of loss which can be especially helpful this time of year.

  1. Anticipation: Visualize your holidays with and without your lost loved one. Allow yourself to feel your emotions. Try to replace negative emotions with positive feelings.
  2. Memory: Do something special alone or with other family members/friends in the memory of the lost loved one. Do it for you, not to please anybody else.
  3. Purpose: Have a meaning and purpose in your life. Strive towards your purpose while surrounding yourself with love and happy memories of your loved ones.
  4. Share: Share your thoughts and feelings with people that you feel comfortable with.
  5. Take care of yourself: Do what feels right to do for your wellbeing.

When to consider professional help

The hurtful feelings of grief can last for 3-4 months or longer. Usually, the first year after losing a loved one is difficult. If the feelings of grief are affecting you to the point that you are not able to function as normal in your daily life, it is time to seek professional help. Start by having a conversation with your medical doctor so that you will be referred to an appropriate professional.


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.

HIV and AIDS – Facts and Prevention

December 1 was World AIDS Day. According to the Centers for Disease Control and Prevention, more than a million people in the United States are living with HIV. It is estimated that one out of five Americans with HIV do not know they have the infection. Dr. Raghavendra Tirupathi, medical director of Keystone Infectious Diseases and Keystone Health’s HIV program, and physician at Keystone Internal Medicine says it’s important that everyone educates themselves about HIV facts and prevention.

What is HIV? HIV, or human immunodeficiency virus, damages a person’s body by destroying specific blood cells which help the body fight disease.

What is AIDS? HIV, if left untreated, can develop into AIDS — acquired immune deficiency syndrome. At this stage of the HIV infection, a person’s immune system is severely damaged and has difficulty fighting disease and certain cancers.

How is HIV/AIDS spread and not spread? HIV is not spread by saliva, kissing, shaking hands or sharing utensils. It is not spread through insect bites, air or water. HIV is transmitted through sex with either a man or woman without the use of condoms. HIV can also be spread through using IV drugs or having a partner who uses IV drugs. Pregnant women can pass HIV to their baby by pregnancy or through breastfeeding. Getting tattoos or body piercing does present a potential risk if obtained from an unlicensed facility or if performed in an unsterile way.

Who should be tested? Everyone between the age of 13 and 64 should be tested at least once in their lifetime, even if you don’t think you are at risk. For those who have had more than one sexual partner in the last six months, have a history of sexually transmitted disease in the last year or have a history of IV drug use, you should be tested at least once every year. For those who have high-risk sexual behaviors, multiple partners, have sex in exchange for money, or use injection drugs, testing is recommended every three to six months.

Free Testing Available In Franklin County, free and confidential HIV testing is provided on a walk-in basis at these locations: Keystone Internal Medicine (830 5th Ave Suite 201, Chambersburg) and Keystone Community Outreach (455 Lincoln Way East, Chambersburg). The completely confidential testing is very quick—it only takes a few minutes and results are ready in less than half an hour. This non-invasive test is done by simply swabbing the gums—no blood is involved. No appointment is needed; you can simply walk in during business hours.

Know your status Getting tested is the only way to know your status. If HIV is detected early and treated, you can expect a higher quality of life and a longer life. And the good news is there is help available in our community for those who are HIV positive.  The Keystone Health HIV Program provides medical and support services to HIV positive individuals.


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.