About Dr. Elia Fanous

Dr. Elia Fanous joined MacArthur OB/GYN in 2005. He is a board certified obstetrician and gynecologist by the American Board of Obstetrics and Gynecology.

Got fibroids? Got polyps?… Get Symphion!

What is Symphion?

It is a hysteroscopic (very small camera/telescope that goes into the uterus) tool used to remove fibroids and/or polyps without having to cut or remove any part of the uterus. Also, it’s an outpatient procedure, so you can go home the same day.

So, what are fibroids?

wud_myosure02These are very common non-cancerous tissue growths in the uterus. The size and number of these fibroids is variable… can be a single fibroid or multiple fibroids, and can range from very small to the size of a cantaloupe. They can be found on a stalk inside or outside the uterus. They can also be found in any layer of the uterus: in the muscle wall (intramural), under the outer layer (subserosal), or just below the inner lining of the uterus (submucosal).

 

So, what are polyps?

wud_myosure03These are small protrusions of the uterine lining (endometrium) that grow, become fragile, and start to bleed. Here is a picture of two polyps and the Symphion device.

 

 

 

So, are polypectomies and myomectomies safe? Effective?

With a hysteroscopic approach or with Symphion, the complication rate is less than 1%. The procedure is 90% effective in reducing heavy bleeding and recurrence rates at 2 years are less than 10% for fibroids and less than 3% for polyps.

What are the steps of the procedure?

  1. Your doctor will gently open your cervix and insert a very slender camera into your uterus.
  2. After visualizing the polyp or fibroid, a slender wand-like device is passed through the camera/telescope into your uterus. This wand suctions and cuts the fibroid or polyp into very small pieces and removes the tissue.
  3. Once the polyp/fibroid is completely removed, the wand and camera are removed. Nothing is left in your body after the procedure.

What’s the recovery like and what can I expect after the Symphion procedure?

Some women have mild cramping, for which most only need over the counter pain medicine. Most women are back to normal activities within a day or two. You are unlikely to have any complications, but call your doctor immediately if you have any of the following:

  • Fever > 100.4°F
  • Increasing pain not relieved by pain meds
  • Nausea, vomiting, dizziness, shortness of breath
  • Bowel or bladder problems
  • Greenish vaginal discharge

When will I know how well the procedure worked?

This varies for every woman, but plan to give your body approximately 3 months to fully heal. By then you and your doctor should be able to tell what your cycles are going to be like.

What Grandma DON’T KNOW About Birth Control

Weeding out myth and ridiculous to uncover the truth

[blockquote3]Grandma says: “Birth control gives you cancer.”
Doctor says: “Nope!”[/blockquote3]

Now why would anyone take the doctor/provider’s word against that old wives’ tale / urban legend without an explanation? I submit to you that your doctor really cares to take good care of you and not expose you to anything harmful where the risk outweighs the benefits. I know this is not enough to convince grandma, so hear me out. But first, we’ll let grandma give her side of the story.

First of all, what type of cancer? It’s easy to say, but explain please… C’mon grandma explain it to me. Well, she can’t.

For the most part, hormonal birth control works by preventing ovulation… the process were the egg is released in search of the baby-making sperm. Barrier contraceptives (condoms, etc…) keep the sperm from meeting the egg but do nothing to prevent ovulation. Back to hormonal birth control (pills, patch, vaginal ring, Depo-Provera shot, etc…) which prevent ovulation. These are very low dose in general, and act by decreasing hormones that come from the brain and act on the ovary. Since the ovary is not stimulated, it does not ovulate. Here’s an interesting fact that grandma don’t know. Scientific theory has it that monthly ovulation (being off birth control) may increase risk of ovarian cancer. Each month a cyst forms, ruptures, and damages the ovary. The ovary then has to fix itself over and over and over again. At some point an error occurs in the repair process and may lead to cancer. So, preventing ovulation prevents this constant monthly repair and decreases the chance of a cancer inducing error occurring. It’s actually been shown that a woman who takes birth control for a total of 15 years or more, will decrease her risk of ovarian cancer by 90%. Booyah grandma! How do you like ‘dem apples.?!

[blockquote3]Grandma says: “Birth control makes you infertile.”
Doctor says: “Wrong again granny.”[/blockquote3]

Again, most birth control is so low dose that it’s out of your system pretty quickly. The only common birth control that takes a while to get out and may delay ovulation is Depo-Provera… so it may take longer to get pregnant after Depo, but it doesn’t make you infertile. As for the other forms of birth control, the return to fertility is fast… sometimes too fast leading to an unplanned surprise. 🙁 As a matter of fact, many fertility doctors and I myself use birth control for a few months prior to a patient trying to conceive. These help to control and regulate hormones such as insulin and testosterone, which may be elevated in certain patients. When elevated, these hormones prevent ovulation and conception. So by regulating these hormones, fertility can actually be increased in the few months after coming off birth control. So for infertility patients, I usually use birth control in the few months before starting fertility drugs. Grandma means well, but she don’t know, don’t show, or don’t care about what went on in med school (okay fine, I stole that line from Boys in the Hood).

[blockquote3]Grandma says: “Birth control makes you fat.”
Doctor says: “mmmmmm well maybe.”[/blockquote3]

Most forms of birth control weigh less than 5-10 pounds before they’re used. Does birth control go in your body and expand a thousand fold like Elven bread (Lord of the Rings)? I haven’t seen a study on this, but I’m pretty sure the answer is no. So why the weight gain?

Well, the Depo-Provera shot can make you hungry… which leads to eating more… which leads to weight gain. Will power / diet control, exercise, and good genetics can minimize weight gain. The textbook says Depo-Provera causes an average yearly weight gain of 5 pounds. I’ve seen many woman gain more and some who gain nothing at all. I’ve even seen a few lose weight while on the shot.  So, granny might be right when it comes to “the shot” or Depo-Provera causing weight gain.

Other forms of birth control, including the patch, vaginal ring, and pills have not proven to be associated with weight gain. As a matter of fact, one study found that married women on the pill gained weight while single women on the pill lost weight. So, other than “the shot,” there is no proof that the other forms of birth control cause weight gain.

Lesson Learned

So when someone gives you an opinion, whether it be wise ol’ grandma, a know it all friend, or a nosy neighbor, you can do one of two things. You can nod and smile all the while ignoring them in your head and then ask your provider. Or you can, in the most sarcastic of tones, ask them where they went to medical school… wait for the silence… wait for it… and respond with a “that’s what I thought,” then ask your doctor. I prefer the latter, which if you didn’t know already, I’m sure you do now. 🙂

Remember, The Truth will set you free. Now give granny a hug and a kiss.

Scholarship in Memory of Dr. David Wollenman

Dr. David Wollenman was an icon for obstetrics and gynecology here in Irving, TX for over 33 years and brought over 7000 babies into this world. He brought cutting edge surgical techniques to Irving that he learned through experience and at continuing education programs. It was largely due to his influence that we have many of the continuing education goals and current practices here in Irving. He passed from this world in July 2011 after battling against an aggressive form of brain cancer. Because of his love for the Irving area, the medical field, continuing education and medical advancements, and just because of the person he was, MacArthur OB/GYN is honored to sponsor a scholarship in his memory.

The scholarship is awarded to an Irving ISD graduating senior with academic achievement with an emphasis in math and science and current or previous participation in a teen pregnancy program. This year, the scholarship was awarded to Jennifer Consuelo-Martinez.

Jennifer attends Jack E. Singley Academy and will be graduating in the top ten percent of her class. She plans on attending college after graduation and wants to pursue a Bachelor’s degree in Law Enforcement or Criminology.  She also hopes to work with the Irving Police Department while in college. After finishing college, she is planning on enrolling in the police academy and continuing her journey to becoming a police officer.

The road here has not been easy for Jennifer, but she has done a great job. Living in a single parent home with limited resources for most of her life, she has fought the odds and done well. Her biggest challenge, and where she has shined the most, has been in her becoming a teen mother. Her daughter is precious to her and she wants to be a role model for her. She gives much credit to the Irving TAPPS program in helping to guide her with the day to day needs for her as a mother and for her baby.  She credits TAPPS with helping her become a good mother and helping her to stay on track towards reaching her goals.

Jennifer has been involved with many school activities in addition to taking care of her daughter. She elected president of the Criminal Justice club and the captain for her police explorer post. Over the last 4 years, she’s done more than 300 hours of community service including career day with elementary schools, feeding the homeless, helping Army Veterans, Big Brothers and Sisters, police training, crime watch parties, and even dressing up as McGruff the crime stopping dog. Jennifer thinks of others first and seeing a smile on other peoples’ faces really makes her day.

Dr. Wollenman is the reason I ended up here in Irving, so he has forever impacted my life. He was a mentor to me and to many, and I can’t say enough great things about him. I am so grateful to have known him. He would have been happy to know and see Jennifer get this award and to help her get closer to her goals.  I too am proud of this wonderful young lady and am happy that MacArthur OB/GYN has been able to give her this scholarship, while honoring Dr. John David Wollenman.

HTA Endometrial Ablation for Menorrhagia

Endometrial Ablation may be an alternative treatment option for pre-menopausal women with menorrhagia (excessive uterine bleeding) due to benign causes, for whom childbearing is complete. Menorrhagia is frequently treated by performing a hysterectomy. The HTA® System is designed to ablate the endometrial lining of the uterus without the need for surgery.

Ask yourself the following questions:

  1. Does your period last longer than seven days?
  2. Do you use more than 3 pads or tampons per day?
  3. Do you pass clots during your periods?
  4. Does your heavy bleeding affect your work, social, athletic or sexual activities?
  5. Has medication (birth control pills) failed to help your heavy bleeding?

If you answer yes to any one of these questions, you are likely suffering from heavy menstrual bleeding or menorrhagia.

Endometrial ablation is a procedure to treat abnormal uterine bleeding. The procedure is intended to destroy all or most of the tissue that is responsible for menstrual bleeding (the endometrium). After the procedure, patients may never bleed again, or if they do, their bleeding is generally reduced. Not all patients experience a satisfactory reduction in bleeding so all treatment options should be discussed with your doctor. In general, approximately 50% of women that have the ablation have no more menstrual cycles. Of the 50% that do continue to have a cycle, most have little bleeding and are satisfied with their results. The overall satisfaction rate is approximately 95%.

What are the reasons for undergoing the procedure?

If heavy bleeding during your periods is affecting your quality of life and you believe your options are to wait until menopause or to have a hysterectomy, there may be other choices for help without major surgery.

Intended Benefits of the Hydro ThermAblator® System (HTA® System):

  • A potential alternative to hysterectomy or other major surgical procedures.
  • An outpatient procedure usually performed in the office with only local anesthesia.
  • Decreased recovery period and generally fewer significant harmful side effects.

What is the HTA® System and how does the procedure work?

The Hydro ThermAblator System (HTA System) is a device that allows your gynecologist to perform endometrial ablation on an outpatient basis. This procedure involves your doctor inserting a probe into your uterus that includes a tiny telescope for viewing the lining of the uterus. Heated saline is circulated and is intended to destroy the lining of the uterus, even in a partial septate uterus or one with intra-mural fibroids ≤ 4cm, to eliminate or reduce bleeding to normal levels or less.

First, your cervix will be slightly dilated to allow the introduction of the telescope through the vagina, through the cervix and then into the uterus. This gives your gynecologist a view of the inside of your uterus to assure proper positioning. Then, your uterus will be filled with room temperature saline solution to gently clean and flush the uterus. The fluid will be heated to 90º C(194°F) and circulated in the uterus for ten minutes in order to treat the endometrium (lining of the uterus).

When the treatment is complete, the uterus will be flushed with room temperature saline to cool the uterus and the probe. All of the saline will be removed after the cooling phase is completed. Your uterine lining has been treated and will slough off similar to a menstrual period over the next few weeks.

Your gynecologist will do some pretreatment tests that may include a Pap smear, an ultrasound, endometrial biopsy, and/or a hysteroscopy (look inside the uterus with a tiny telescope) to see why you are having excessive menstrual bleeding.

Your physician will give you pain medication before the procedure to reduce cramping during or after the procedure. With the new technology and advancements available at MacArthur OB/GYN, most ablations are done in our office with only a local anesthesia injection.

After the procedure, you may experience some cramping that should go away by bedtime. You will probably have a pink or yellow watery discharge for a few weeks after your treatment. If you experience two days of heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours after the procedure, call your physician.

Most women should be able to return to normal daily activities the next day. You should speak with your physician about the resumption of sexual activity. You should not use tampons for up to seven days after the procedure to reduce the potential risk of infection. Your monthly menstrual bleeding may be heavy for a few months after the treatment as a part of the healing process, and should improve after a few months.

You should not have this procedure if you desire pregnancy in the future. Endometrial ablation, however, does not prevent you from becoming pregnant and such a pregnancy would be high risk for both mother and fetus. Contraception or sterilization should be used after this treatment since pregnancy can still occur. Please discuss the different options with your physician. Also, all procedures carry risk. Ablation risk factors include bleeding, infection, damage to organs (uterine perforation, etc), and are something you should also discuss with your doctor.

Scholarship in Memory of Dr. David Wollenman

Dr. David Wollenman was an icon for obstetrics and gynecology here in Irving, TX for over 33 years and brought over 7000 babies into this world. He brought cutting edge surgical techniques to Irving that he learned through experience and at continuing education programs. It was largely due to his influence that we have many of the continuing education goals and current practices here in Irving. He passed from this world last year in July after battling against an aggressive form of brain cancer. Because of his love for the Irving area, the medical field, continuing education and medical advancements, and just because of the person he was, MacArthur OB/GYN is honored to sponsor a scholarship in his memory.

The scholarship is awarded to an Irving ISD graduating senior with academic achievement with an emphasis in math and science and current or previous participation in a teen pregnancy program. This year, the scholarship was awarded to Elvira Mancillas of Nimitz High School.

Elvira, smiling big in the middle of the picture above, is standing here with some of the MacArthur group and Dr. Wollenman’s wife, one of his sons, and his two daughters. Elvira is more than deserving of this scholarship. She will be graduating in the top 15% of her class and plans on pursuing a career in nursing. Her goal is to become a maternity nurse. Elvira knows that goals don’t just happen, so she has a plan and is working hard to make her goal a reality. She plans on completing her prerequisites at Northlake and El-Centro before transferring to TWU to pursue her nursing degree. Elvira has taken Advanced Placement/Honors classes to help prepare for her upcoming education. She is a leader in school and has served as captain of her volleyball team. She has also been involved in track and field and in basketball. For those of you lucky enough to have known Dr. Wollenman, you know what a sports aficionado he always was… “I’m a homer,” he would always say when referencing his love for his local sports teams.

Elvira is one of eight children in her family and really understands what it means to work hard. Not only has she excelled in academics and athletics, but she has been able to hold a job in customer service relations for Pizza Hut. Having been her doctor, I can see how she’d be perfect in a job where people skills are needed. Elvira really is a people person and this will help her as a nurse. She says that perseverance is her main personal strength. I agree and think that she is just tougher than she looks. I took care of her and delivered her daughter just a little over a year ago. Elvira says that she did have to grow up quickly at age 17 when she had her baby girl. Undoubtedly she struggled, but she persevered, worked and is working hard, and has done so well for her and her daughter. I am really proud of her and was happy to hear that she was picked to receive this scholarship.

Dr. Wollenman is the reason I ended up here in Irving, so he has forever impacted my life. He was a mentor to me and to many, and I can’t say enough great things about him. I am so grateful to have known him. Also, I was fortunate to be Elvira’s doctor and deliver her baby. And I am proud of this wonderful young lady and am happy that our practice is helping her get a little closer to achieving her goals, while honoring Dr. John David Wollenman.

Football and Pedicures

I am a typical guy. I grew up playing football, baseball, and soccer. I used to change from one uniform into another while my Mom drove me from one sporting event to another. I grew up watching all sporting events. All I wanted to know was which team belonged to the city closer to us and that’s who I would root for with all my might. As I grew up, I became a die-hard Cowboys fan. I would hang my Emmitt Smith shirt up every night before game day… and this was while I was in high school, college, and medical school. I now hang a Cowboys flag in front of my house. My family believes that the Cowboys will provide me with my exit from this world via stroke or heart attack over some ridiculous and unimportant play. My mom says, “they don’t pay you, so why do you care so much?” I don’t know why, but I do. She also says, “You have children now, so tone it down a little.” These are all very valid points, but the Mavericks in the playoffs… what sweet victory and revenge over the Miami Heat… The Rangers in the World Series… and on and on.

Yes, I am a very typical guy. But I have learned that things change and so did I after becoming the father of twin girls.

Ella and Emma mean more to me than anything I could have ever imagined. I also have a 2-year-old son named Jacob, and although he is a big momma’s boy, he is the most precious thing ever. So, I have toned it down a notch and have tried to keep things in perspective. I am here for them now. All the other stuff is just stuff. I may be a typical guy, but now I am a typical guy who helps his girls weed through the Barbie Dolls at Toys R Us. I help my girls pick out their clothes on occasion, and allow them to tell me what I should wear. They are five years old now and have had a better sense of style than I do… and they are not afraid to tell me either. I know all about hair conditioner, detangler, and how to brush their hair. I paint toenails and fingernails… And yes, daddy puts on two coats and puts on a coat of sparkles. One day, I had done a C-section, a hysterectomy, and then a mini mani/pedi… the latter the hardest by far. I posted this to Facebook with a picture of Ella’s toes. I got the most responses on this post than any other. Yes, I have changed and now I am more complete.

So, I have learned that life changes and you have to adapt and change for the good of those who depend on you, and those little angels do more for you than you can ever do for them. I never understood how my parents felt, but now I do. Your children need and want you to do these things with them, and as trivial as a mini mani/pedi may seem at the time… it’s not. They need you and you need them. It’s wonderful.

So, I – an avid sports fan, an OB/GYN, a typical guy – had twin girls and changed. Three years later I had a little boy and continued to change. All this being said… the first phrase I taught my girls to say at one year old… you guessed it, “Go Cowboys!! Touchdown!”… and Jacob… he also knows who to cheer for, “Touchdown Cowboys!!”

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