GynoFiles

"I never get angry, says a Woody Allen character in one of the director’s movies, “I grow a tumor instead.” So how does this apply to uterine fibroids? Drs Wise, Palmer, and Rosenberg of the Sloan Epidemiology Center at Boston University have shown that stress can make a woman more at risk to grow uterine fibroids. And they now have published the newest findings out of the Black Women's Health Study, and Dr. Wise has concluded that depression can increase the presence of uterine fibroids. Internal stress can play havoc with our health in many ways. Stress can have internal  consequences as stress  can alter the immune system, it can alter our pituitary gland control of the adrenal glands, and can alter our ability to repair aging of our organs. Stress in very early life, caused by abuse, can have a stress effect that spans our entire life. It is true that those who experienced childhood stress also were more likely to smoke, to be physically inactive, and to become alcoholics...

Gynecologic Surgery often will require your gyno to place you in what is called trundelenburg position, and thus you are basically head down for a variable amount of time. This position can be strenuous to be maintained, and in fact too long and you can get nerve strains or damage, eye injuries, more trouble with anesthesia as breathing can be more difficult with your organs pressed against your diaphragm, and even hair loss has been reported from surgeries with too much trundelenberg! 20 degrees of tilt  is usually sufficient for the gyno to preform surgery. Dr. Virginia Mason at Virgina Mason Medical Center in Seattle actually strapped her iPad onto the bed, and used the clinometer app to measure just how tilted her patients were. She tried to see if complications were really less in a less tilted group, but that has not been studied quite enough yet to affect current guidelines. But one thing the group agreed, the iPad app made it easy to see exactly how tilted their patients...

Patients who are faced with medical procedures can find themselves suddenly anxious about completing these procedures. They may find themselves so tense and nervous about medical tests or treatments that they have chest pains, racing heart, headaches, numb extremeties and/or sleep difficulties. There are ways to handle this on your own with yoga and breathing, but in severe cases it's important to let your gyno know so that they can help. Part of anxiety is lack of education and knowledge. If you don't understand fully what the procedure is, or why you would need it, filling in this knowledge gap will go a long way to relieving acute procedure anxiety. It is not something you should refrain from telling your gyno about, they encounter this problem frequently, and there is no shame in addressing anxiety.

Molluscum Contagiosum A common viral infection, that produces these non-painful bumps often located in the genital region is called M olluscum contagiosum . It is a virus that will often resolve without treatment, and it's often seen in children. These firm bumps, that appear whitish can occur anywhere on the body, and many will actually occur on the abdomen, under your arms, or even on your back. Oddly it's from the same viral family that gives small pox, but it is a very harmless virus, unlike small pox (which is thankfully eradicated!).  People do catch it by skin to skin contact, and it's often seen in children. Apparently the virus is hearty enough to survive on items not human: towels and other things that kids might share! So it's not just sexual contact that causes these viruses to spread, but the gynos often seem them here, as in this picture. Some will not resolve without treatment, and the medications used for warts will often work on the molluscum as we...

Getting ready for surgery is a process that has some basic principals. Each procedure has it’s own special considerations, and individual gynos will have their own instructions for you as well. Patients with medical problems have the most important steps for preparation. Many times getting ready means getting appropriate preoperative testing so that your chance of healthy recovery is maximized. Heart and lung diseases are the most common source of complications after surgery. It is important to let your gyno know about any medicines or therapies that you take. That would include vitamins and herbs that you take. Some anesthesia physicians require that you are off these sorts of medications for a couple of weeks. Since the pelvic organs are so close to the bowel and the bladder it’s important to let your gyno also know of any problems, changes, or concerns you have with those functions. There are times that we have thought that patients have bladder problems, and actually they have cys...

D and C surgeries are very safe tests. They can be a way to stop heavy bleeding, diagnose cancer, or to allow a mom with a miscarriage to proceed to planning her next pregnancy. This common simple operation helps us to figure out period problems and other gynecologic disorders. The  Dilatation and Curettage or a "D and C". When we didn't have an ultrasound, and pap tests were not as accurate as they are now, D and C was one of the few diagnostic tools in the toolbox; but still D and Cs can be very valuable tools. Although most modern gynecologists do not perform D and Cs (other than for miscarriages) without also performing a hysteroscopy (actually looking inside), we still perform many D and Cs. So when talking to our patients and recommending performing a D and C, the question comes up what type of harm may come from the procedure. As for any operation, it is possible for the D and C to cause infection, bleeding or actual pain. It is possible to also get scarring of ...

Operations have risks as well as benefits, and there are risks as well as benefits from not going ahead with the surgery that is recommended. But improving safety has been a goal of surgeons and it;s helpful on the patient end to do what you can to enhance safety. Going into an operation, well rested, well nourished including consistent multivitamin with iron use over the past days, weeks or months, in optimal physical exercise shape always are beneficial. But many women approaching surgery have no luxury of the time, the fortitude, or the health to make those first tips work. But there are other simple things. A basic check up with your primary care physician is important. The American Society of Anesthesiologists (ASA) has recommendations for what tests each person needs. Many surgeons believe in a pre-procedure bowel clean out. That helps in two ways, it makes it safer if, hopefully not, but if there is a bowel injury; but it is also a way that the bowel can collapse an...

Have you had a C-section or an abdominal hysterectomy or a gynecologic surgery done with a transverse cut not so unlike a smiley face incision in your lower abdomen? That incision is named for it's champion, Dr. Johannes Pfannenstiel, and is called a Pfannenstiel Incision. He realized that for many pelvic procedures the incision was better visible exposures for the surgeons, as well as more stable incision because of the different directions the underlying layers go. He also did recognize that from an aesthetic point of view it was valued by his patients, and that was important to him. Dr. Pfannenstiel was born on June 28th 1862, in Berlin. Although he was a wonderful surgeon, ironically he succumbed to an infection after he pricked his finger during an operation, and died at the young age of 47.

Examination of a Retroverted Uterus The tipped uterus is called a retroverted uteus, and often they are retroflexed as well (bent back). The Hodge Pessary was designed to push the uterus more forward in the pelvis, and thus correct the positioning. In texts fro the turn of the 20th century (1900s!) they thought they could actually sew the uterus to the abdominal wall to correct this. And eventually some even tried to suspend by shortening the round ligaments, which really doesn't work as they are pretty stretchy and can shorten back up. And the uterus that is tipped from birth rarely causes symptoms that need treatment.  The Hodge Pessary Hodge Pessary in place Correcting Retroversion In the 1900s women were treated with ventro-suspension of the uterus which sewed the uterus to the anterior abdominal wall

Your gynecologist may have stood you on your head before for a better peek at the cervix at the time of a pap smear or at your pelvic organs at the time of abdominal gynecologic surgery, but did you know that tilt-table-head-down position had a name? The name is Trundelenburg Position. Originally described as "Elevated Pelvic Position" it was published as an insightful breakthrough in 1890. He realized quickly that in vaginal surgery or bladder surgery this position also provided wide views that were very beneficial. In gynecology we only know him for the famous table position, in fact us gynos call out all the time, " more trundelenburg please" to get the nurses or assistants to tip the table in that direction, but just a bit steeper, and so forth. It is a very useful position, although recent gyno surgeons have cautioned that too steep a Trendelenburg position can be quite difficult for the patient leading to various complications such as sliding and damage to th...

Supporting your menstrual cycle monetarily may mean that you are due for a menstrual makeover. Working off that large insurance deductible? Only have a set budgeted amount for your contraception? There is no reason you and your gyno cannot talk strategy about what is going to be the most cost=effective contraceptive alternative for you out there. And the factors that weigh into those treatments vary from woman to woman. If your periods are heavy, maybe you need to factor in the cost of tampons and pads as well! And maybe if you are going to try for a baby in 6 months to a year, that will be a factor as well, what is cost effective for a few months may not quite be the same as what is cost effective for the long haul. And what about method switching. It turns out this may be the most cost effective strategy of all! Who would have thought that! For instance, what about the woman with those terrible cramps and clots. If you are just going to treat your heavy periods for only one year i...

Relative Positions of  Our Pelvic Organs The bladder begins it's life high in the pelvis. If the bladder wall weakens if the nerves get a bit warn, if you pressure your bladder with too much fluid or too many dietary irritants you can have problems with that rush to the bathroom known as Overactive Bladder . Overactive Bladder or (OAB) can be associated with stress incontinence, which is defined as leaking urine when you cough or strain. If you do have both it is defined as mixed incontinence. Defining what is too many trips to the bathroom is somewhat arbitrary, we all pee a lot, what's too much? Over 8 times per day. You really should be able to hold your urine for at least two hours, even in midday after a normal meal. And having sudden, strong desires to urinate, that you cannot control, or even after you think you just emptied your bladder. This extremely strong urge that you cannot control is not a normal state. Not everyone has incontinence with OAB, although with ...

If you had an ablation and are still bleeding, my most common consultative question is why. First of all, what procedure did you have, how long ago, what was the diagnosis you were given when you had your procedure and then we look deeper into what is going on now. In fact, the most important aspects of your case are going to be what is happening with your body now. For instance: do you have a structural cause, specifically are you ovulating regularly, and having still heavy but otherwise bleeding at regular intervals. What if you have been diagnosed with overly thick uterine lining like the diagnosis of endometrial hyperplasias, or do you have glands within the wall of the uterus a condition called adenomyosis, or bleeding disorders, or infections? Have you newly been placed on medicine for another condition that will actually be acting like a blood thinner? If never stopped bleeding, that is perhaps directly related to the procedure. So there are many reasons, and a few blood t...

After surgery it is important to have proper lung health. This is most true after long and complex surgeries, but it can be true for shorter surgeries like hysteroscopy, breast biopsies, endometrial ablations, or D and C. We know that some complications are therefore related to the procedure you are undergoing, other complications are related to factors that are most certainly under your own control! If you are a smoker gynos would like to see you not smoke for the two weeks leading in and out of your surgery, although they are not always planned so conveniently! Procedure related complications can result even if the incision stayed well away from the chest wall. Incisions lead to chemical signals that send nerves through a central path way via nerves in our organs and muscles that in turn issue reflexes that can inhibit deep breathing. And pain can prevent a woman from taking the deep breaths she needs to take to keep her lungs properly inflated and safer from infection. So when yo...

A new study questions whether surgery could be safer at certain times during the menstrual cycle. A researcher who follows menstrual cycle variances has found another conundrum for her data base and sent me a link to look over. In a small study in Turkey it was found that at certain times of the menstrual cycle blood pressure responses to intubation (tube placement in general anesthesia) varied dramatically depending upon the phase of the menstrual cycle. They felt that the blood pressure responses were smoother during the early menopausal phase, and it is true during the very earliest time the levels are lower. The authors are quick to point out that they didn't actually measure the hormone levels of the study subjects nor did they measure the levels of the adrenaline and adrenaline-like substances (catacholamines) that would affect these things. It is very likely that healthy women with very normal blood pressures will not have a medically relevant change in their blood pres...

http://gynogab.blogspot.com/2009/07/fix-my-uterus-metroplasty.html Uterine shape is fairly typically the same from woman to woman. It is that classic, well, uterus shape, triangular on the inside, and described as egg shaped when considered as a whole. But women's wombs come in all sorts of sizes and shapes. These are known as uterine anomolies, and the most common are called bicornuate uterus but there are various combinations of doubling of the uterus that are seen. This change in shape is nothing you grow once you have a normal uterus, but it happens when you are a developing fetus, mostly because of failures of fusions from the lower segment  to the upper uterine segment, or a failure of fusion of the left to the right during fetal life. What is left may be a uterus shaped like a heart, or a double, or a half a heart. In rare cases there is no uterus at all. About 4% of the fertile population has such a uterus, and about 12% of the infertile population has these kind of...

When you slide onto the operating theater table, are you worried about shivering, whether you shaved your legs or how hungery you  are, of course not, well, ok, may be a little, but you are worried about how your scar will look! Of course. And if your surgeon could perhaps nip tuck just a bit, why not, well, that's a different subject. But in thinking about just why those incisions either turn out for the better, or slightly worse, there's a lot to think about. But there are some things we notice. Like, why are those nice little across incisions, such as for C-sections so tantalizing when placed in the transverse direction along the lower abdomen and yet so terrible when that direction is transected in a vertical incision? Dr. Kark Langer, after slaving away many hours studying cadavers in rigor mortis he discovered that certain lines of cleavage pull apart when you cut them, and these run horizontally, and he presented these carefully worked out channels  to the Royal Acada...

Well they should. Dr Ester Sternberg director of integrative neural immune program and chief of neuroendocrine immunology at National Institute of Mental Health and NIH has been quoted to say that stress reduction allows the brain to release natural pain relievers. So if as you awake your surgeon or anesthetist whispers soothing words, your transition into the world of the awake will be smoother. I just love when research imitates life. Has no one seen moms cooing their babies awake! But it's a great tip and one that we like to remember and help our patients with. The greatest satisfaction after surgery is when patients say that they feel well!

With early diagnosis and appropriate treatment few women need to suffer from Pelvic Inflammatory Disease (PID) . However, the end consequence of PID may be permanently damaged fallopian tubes. This is an ultrasound single view picture of a medical condition of the fallopian tube called a hydrosalpinx. Essentially it is a tube destroyed by a prior infection. After the infection leaves, it is sealed at one end and it accumulates fluid pockets and is no longer a free passageway for sperm and egg to meet up. Our fallopian tubes are normally open at the far end the ruffled enlarged portion which is called the fimbria or the fimbriated end. The fimbria act like fingers to pick up the egg and lead it into the tube where it would get fertilized. If disease has lead to scaring of the fimbria it becomes sealed at one end. If there is no passage out for the normal tubal fluids that are secreted, or a passage out for any infection that may have occurred there there, or a p...

Over dinner gynecologists talk about the size of their: TUMORS! And after that the discussion turns to current guidelines like whether to use uterine morcelators . This one was not cancerous, extremely large. After considering risks and benefits it was removed through an abdominal incision so that it could be removed intact. Intact removal of tumors is the safest if any malignancy or borderline malignancy is suspected. At Women's Health Practice we offer surgery and gynecologic second opinions