Women's Health News

Swine Flu News

2009-04-26T21:14:00.000-07:00

For those of you who are interested in reading up on the new updates on the swine flu. Please check out this blog - swine flu news . Keep in mind that the number of cases here in the US have been very small so there is no reason to be alarmed.

Incisions (part I)

2009-04-14T16:11:00.000-07:00

Staples or Sutures

Skin incisions are used by surgeons to gain access to vital internal anatomy. In the early days of surgery, a good exposure to perform internal surgery required a long skin incision. When laparoscopy was introduced to the United States in the 1970’s the small laparoscopy skin incisions could be covered with a band-aid. Popular press of this era referred to laparoscopy as “band-aid surgery”. Long incisions were still needed for cesarean deliveries and removal of large ovarian cysts.

After finishing internal surgery, the skin incision must be closed. The surgeon has two choices: staples or sutures. Metal staples can be applied rapidly and with ease using special prepackaged staple devices, sometimes called “staple guns”. Metal staples have the disadvantage of requiring removal with a second special tool. several days later.

Sutures are the second choice to close skin incisions. They are available in dissolving and permanent material. A popular dissolving suture of the past was “cat gut” suture. It was not made from cats but from other domestic animal’s tissue. If a suture is placed under the skin it does not have to be removed. . By using a continuous stitch, closure can be accomplished rapidly. (It helps to have genes from a long line of quilt makers as I do).

Hospital stays are increasingly short for newer surgical techniques. Removing the need for patient to return just for staple removal is an advantage of suture skin closures.

When patients look at their skin incision scars, are reminded daily of their past surgical experience. Minimizing this scarring with good surgical techniques with attention to skin closures, by staples or stitches, is an important concern for surgeons and patients.

Reference:

http://johnmarlowmd.com/womenshealthnews/2009/04/14/incisions-part-i/

Rock J, Jones H.: Surgical Textbook: Te Linde’s Operative Gynecology

Lippincott Williams & Wilkins 2008.

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Cancer of the Ovary

2009-03-30T17:46:00.000-07:00

Screening tests for cancer of the ovary remains a challenge for today’s medicine. Ovarian cancer is the most lethal of all gynecologic malignancies and was responsible for over 15,000 deaths in 2008. Tragically, seventy percent of these women were in the advanced stage when diagnosed.
There has been little improvement in the past several decades to reduce this statistic. Cervical cancer, in contrast, has had a dramatic reduction in death rate. The combination of improved cytology, HPV testing, colposcopy and recently a vaccine for the high-risk papilloma virus have combined to achieve this result.

The Obstetrics and Gynecologic Journal for 2009 highlighted the current state of tests available for detecting early cancer of the ovary, specifically the combination of a blood test, Ca 125, and transvaginal ultrasound. Dr. David Mutch of Washington School of Medicine reviewed a large prospective multiinstitutional study concerning ovarian cancer screening. The original research article followed his editorial.

Of the 39,115 patients in the 4 year study assigned to the screening arm of the study, greater than 70% of the patients were in the advanced stage of cancer when diagnosed. Dr. Mutch noted that based on these data, screening the general population for ovarian cancer with the combination of these two tests will not be beneficial.

The problems in developing a screening test for ovarian cancer are numerous. This cancer has a low incidence: 1 in 2500 women in the postmenopausal population. Another problem is the that the ovary, unlike the cervix, is not easily accessible. It is deep in the protective pelvic ring so that early changes may not be easily felt. Laparoscopy gives us access to the ovary but requires a surgical procedure. The Green Journal study above found the ration of surgery to detected ovarian cancer to be 20 to 1. Stated another way, there are many false positive tests using Ca 125 and transvaginal ultrasound.

Breakthroughs in developing screening test for ovarian cancer continue to be an unattained goal. Ovarian cancer is an understandably frightening prospect for all women and their families. It is hidden from early view and frequently fatal. Given sufficient priorities, scientifically and financially, it is an attainable and important challenge.

References:

http://johnmarlowmd.com/womenshealthnews/2009/03/30/cancer-of-the-ovary/

1. Jemal A, et al Cancer Statistics 2008. CA cancer J Clin 2008; 58:71-96
2. Mutch DG: Ovarian Cancer. Obstet & Gynecol Vol 113, No 4, April 2009:772-774 3. Partridge E, et al Results From Four Rounds of Ovarian Cancer Screening in a Randomized Trial. Obstet & Gynecol Vol 113, No 4, April 2009: 775-782

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Inadequate Sex Education

2008-02-27T09:44:00.000-08:00

An editorial in the February 2008 American College of Obstetrics and Gynecology Journal , Obstetrics and Gynecology, explored the consequences of inadequate sex education in public schools. An accompanying study stated that nearly one in three sex education teachers in Illinois were not adequately trained. The authors recommended that doctors fill the gap in their adolescent patient’s knowledge and skills concerning sex.

Sex education by physicians is an important part of health care for all ages

In spite of explicit discussions of sexuality in TV, the internet, print, and movies, knowledge of sexual matters remains an important ignorance in America. To paraphrase Will Rogers,( New York Times 1930), “everybody is ignorant (of sexual matters)... only on different subjects”

The tragic sexual plague of our generation, HIV/AIDS, reminds us that sexual intercourse today for some carries with it the risk of death to one or both partners. Knowledge of this disease is one of the shields against its spread.

A common condition in young women related to sexual activity is viral HPV infections. Untreated high risk HPV carries the risk of death also, from cancer of the cervix. Vaccination to prevent cervical cancer is now available. Education directed at boys who are partners in the spread of this disease is minimal today but will increase if the vaccination is approved for use in males.

Sexual issues for seniors that deserve education include decreased hormones and treatment options, adjustments to loss of a sexual partner, loss of libido, disability, depression, erectile dysfunction and management of medication sexual side effects.

Sex education by physicians takes time. Each individual’s needs are unique. Physicians, experiencing decreased compensation for their time are pressured to shorten their face to face contact with patients. The casualty may be physician education concerning sexuality. This is unfortunate for doctors, patients, and the future health of our society.

References:

http://johnmarlowmd.com/womenshealthnews/2008/02/27/inadequate-sex-education/

Maureen G Phipps, Consequences of Inadequate Sex Education in the United States:Obstet Gynecol; Vol 111 No 2 Feb 2008 p.254.
Lindau, Tetteh, Kasza, Gilliam. What Schools teach Our Patients About Sex: Content, Quality, and Influences on Sex Education; Obstet Gynecol Volume 111 No 2 Feb 2008 p256.

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Hysteroscopic Myomectomy for Abnormal Uterine Bleeding

2007-10-01T13:58:00.000-07:00

Abnormal uterine bleeding is one of the most common reasons women see gynecologists. Fibroids are a leading cause of this bleeding. When fibroids grow close or enter the endometrial chamber, the uterine bleeding can be severe. This results in a progressive deterioration in the patient's quality of life. It may also affect her fertility for those attempting pregnancy. A new treatment for this serious condition is hysteroscopy myomectomy. More and more gynecologists are being trained in its use.

Polena and associates reported on 235 patients undergoing outpatient hysteroscopy myomectomy. The median follow-up of 84% of the patients was for 40 months. A successful outcome was reported in 94% of these patients.

In the old days, hysterectomy was the principle treatment option for these patients. This is no longer the case. Hysteroscopy myomectomy is an effective outpatient option for women with submucosal fibroids and excessive uterine bleeding.

References:

http://johnmarlowmd.com/womenshealthnews/2007/10/01/hysteroscopic-myomectomy-abnormal-uterine-bleeding/

Polena, et al Long term results of hysteroscopic myomectomy in 235 patients. Eur J Obstet Gynecol Reprod Biol 2007:130:232-7

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Newer Treatment for Pelvic Endrometriosis

2007-01-24T09:24:00.000-08:00

Pelvic endometriosis is present in a high percentage of patients with chronic pelvic pain. Laparoscopy confirmed the diagnosis in 78-87% of patients diagnosed presumptively by symptoms and office examination.

The first line treatment for endometriosis includes nonsteroidal anti-inflammatory drugs (NSAIDs) and oral contraceptives. A newer treatment that is of interest to patients not desiring to become pregnant is a hormone releasing IUD.

This treatment is reported to reduce menstrual flow, inhibit ovulation and reduce pelvic pain. Endometriosis is a very disabling gynecologic problem and new treatments are welcome by patients and physician alike.

References:

http://johnmarlowmd.com/womenshealthnews/2007/01/23/newer-treatment-for-pelvic-endrometriosis/

Grow DR, Hsu AL. The Female Patient Vol 31 2006: 62-68
Ling. Obstet Gynecol 1999: 93 (1): 51-58
Petta. Human Reprod 2005: 20(7): 1993-1998

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Sexual Function after Hysterectomy

2007-01-18T10:54:00.000-08:00

One concern of patients having a hysterectomy is the effect this surgery will have on their quality of life, specifically their sexual functions. Kuppermann et al addressed this concern in an article published in the Journal Obstetrics and Gynecology. The study compared sexual functioning and quality of life in patients having a total hysterectomy, removing the cervix, with patients having a hysterectomy leaving the cervix in place (supracervical hysterectomy). Comparisons were made with similar studies in Britain and Denmark

The findings of these studies all agreed that there was no significant difference in sexual function or quality of life between the two groups of patients. This is reassuring to patients facing these surgeries. Sexuality is an important issue and deserves more research today.

Reference:

http://johnmarlowmd.com/womenshealthnews/2007/01/17/sexual-function-after-hysterectomy/

Kuppermann M, et al, Sexual functioning after total compared with supracervical hysterectomy: a randomized trial. Obstet Gynecol 2005:105:1309-18

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Scientific Advancements in Treating Alzheimers

2006-12-22T08:08:00.000-08:00

Alzheimer's is a devastating disease that robs us of our past while preserving our presence. Our love ones afflicted with this disease are lost day by day, subtracting fond recent memories first and then memories of long ago. After one's unique personality is gone the final blow takes the now empty body that supported these memories. We can only hope that with strong leadership in science and finance that new treatments to prolong our memory bank will be found for our most precious organ, our mind.

Great strides are being made towards finding a cure for this terrible disease, thanks in a large part to the spot light created by the efforts of Nancy Reagan and her family. One project is seeking spinal fluid markers for Alzheimer's, expediting the diagnosis process. This would be useful for research and earlier treatments.

Reference:

http://johnmarlowmd.com/womenshealthnews/2006/12/20/scientific-advancements-in-treating-alzheimers/

http://www.alzforum.org/new/detail.asp?id=1498

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Public Figures and Advancements in Medicine

2006-12-22T07:54:00.000-08:00

Prominent public figures promoting research can be a powerful force. Katie Couric made colonoscopy less frightening by her unique television appearances. Because of her commitment and courage many new cases of cancer of the colon will be diagnosed and treated at a curable stage.

Betty Ford has been effectively leading the parade for new breast cancer diagnostic centers. Mammography is now being performed across the nation in new breast care centers thanks to her leadership.

President Reagan's Alzheimer's disease has focused our attention on diseases that affect our memory.

References:

http://johnmarlowmd.com/womenshealthnews/2006/12/16/public-figures-and-advancements-in-medicine/

http://www.johnmarlowmd.com/

Cognitive Decline in Aging Women

2006-12-20T09:10:00.000-08:00

As our life expectancy expands sometimes our memory capacity does not. In an article in the November/December 2006 journal Menopausal Management author Dr. Barbara Sherwin explores this subject.

In her review she lists possible protective factors. Initiation of estrogen therapy at the time of menopause for 2 or 3 years, moderate alcohol consumption, aerobic physical activity and involvement in cognitively complex leisure-time activities such as reading, doing crossword puzzles and playing board games may be protective.

As we enter middle age and beyond, we all face the possibility of short term memory loss. New treatments for memory loss are needed. The segment of the population who are at greatest risk are expanding in number. Hopefully this will translate into greater public interest and therefore greater political pressure to fund research and find effective treatments.

Reference:

http://johnmarlowmd.com/womenshealthnews/2006/12/12/cognitive-decline-in-aging-women/

http://www.menopausemgmt.comb/issues/15-06/issue.html

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