Pearls for Preventing Pregnancy

Back in 1850 BC, men and women would use a pessary of crocodile dung and fermented dough to prevent pregnancy. In second century Rome, they concocted a highly acidic mix of fruits, nuts, and wool that was placed at the cervical os to create a spermicidal barrier. Now, I don’t know about ya’ll, (yes, it seems I’ve converted my Minnesota oooo’s to the southern drawl) but crocodile dung and acidic wool doesn’t exactly scream romance to me. Thankfully, with advances in technology, we are afforded much more modest (and probably less smelly) forms of contraception. As consistent in this day and age however, we are bombarded and overloaded with choices, making it difficult to decide which method works best for each individual. Below are some pearls to help you decide.

Can you be trusted to take a pill every day?

If you are like me, and have a bottle of dusty multivitamins in your medicine cabinet from the 90s, taking a birth control pill everyday may not be in your best interest. Missing doses decreases the efficacy of this method, and you may need to have a backup plan in place. On the other hand, it is an easy and effective form to use.

Is your BMI over 30?

The birth control patch is a fine alternative to the pill, containing the same hormones and requiring work only once a week, but it is not as effective at certain weights. It can also irritate the skin, so if you suffer from sensitive skin, might be best to stay away.

Are you afraid to put things in your vagina?

By things I mean rings, namely, the NuvaRing. Many women shy away from this effective method of contraception because they feel icky about putting things ‘up there.’ Let me put it this way, it’s the process of putting things ‘up there’ that’s fueling your search for birth control, so stop being a baby (we are taking contraception here…) and don’t be afraid to get to know your body, it is not as scary as you think.

Are you trying to lose weight? Planning on trying to get pregnant soon?

The Depo shot is proficient and efficacious, consisting of only one shot every three months. Sounds like a dream, right? Well, unfortunately, this is the ONLY form of birth control that has been correlated with weight gain. But let me be clear – the shot itself is NOT going to make you gain weight; the shot may stimulate your appetite, which may make you feel hungry, so you stop at the local McDonald’s and order a Big Mac with extra cheese, and THAT is what will make you gain weight. The Depo also can cause demineralization of your bones, so it is important to be on calcium and Vitamin D while using this method. Finally, it can take up to 10 months for a female to return to fertility after being on the Depo shot, so if you are looking for short term contraception, this may not be the way to go.

Do you mind having foreign objects in your body?

I mean, let’s think about it, people put braces in their mouths all the time. Pacemakers save lives and IUDs prevent birth. The intrauterine device (IUD) comes in two forms; Mirena and Paragard. The Mirena has the hormone progesterone in it, and can be kept in the uterus for up to 5 years; the Paragard has no hormone and can be left in for up to 10 years. Let me repeat, UP TO 5 or 10 years. That means that if you want to have all of your children two years apart, you can remove the IUD in 2 years, and you return immediately to fertility. Let’s talk hypothetically here, let’s say you just gave birth to your first child; you were in labor for 36 hours straight, and can’t even stand that thought of going through all that again. The Mirena or Paragard offer stupendous opportunity for you to enjoy your newborn with the peace of mind knowing that you won’t have to deal with the morning sickness, back pain and heartburn until you are ready. (I am obliged to report that there is a 0.2% failure rate) The IUD can also be helpful for those without any babies, who simply do not want to take a pill, change a patch, or pull a ring out of their vagina, but still want to have contraception. I also want to throw out there that about 20% of females report no menstrual periods on the Mirena, which I think, would be just fabulous.

Are you breastfeeding?

Your choices during this time are limited to progesterone-only forms of contraception. This narrows it down the progesterone-only pill, Depo shot, Implanon, or IUD. It should be noted that the progesterone-only pill is incredibly sensitive to missed doses, down to the hour upon which it was taken. Something to think about during the period of your life when you get the least amount of sleep.

Let’s recap. There are 6 different forms of contraception for women:

The pills, patch and ring all have estrogen and progesterone in them. The Depo, Implanon and Mirena have progesterone only, and the Paragard has no hormone at all. You should not be taking contraception with estrogen in it if you have a history of uncontrolled high blood pressure, a history of blood clots, a history of classic migraines with aura, or are breast feeding. It is important that you speak to your doctor to decide what is best for you. None of these forms protect against sexually transmitted diseases, only condoms and abstinence do that. And possibly trying to use crocodile dung for birth control.

Gardasil (The HPV Vaccine): For Your Information

Most of you have probably heard something about HPV (Human Papillomavirus). The importance of being well informed about the HPV virus and Gardasil cannot be understated. I encourage all my patients to be an active participant when it comes to their body, especially on topics of preventive medicine like HPV and Gardasil. The HPV/Gardasil topic touches on many important issues like adolescent/young female gynecologic care, disease prevention, and future long-term health that you as a patient can really take charge of and dictate.

HPV (Human Papillomavirus) is a common virus that is spread by skin-to-skin contact during sexual activity. Unlike other sexually transmitted infections, HPV-infected individuals are almost always without symptoms, so most who are infected don’t even know they have it! In fact, according to the CDC (Center for Disease Control and Prevention), the most common newly diagnosed sexually transmitted disease is genital HPV. Over 14 million new cases of HPV were diagnosed during the last year. To compare, the second most common newly diagnosed STD was Chlamydia with only 2.8 million new cases. In fact, newly diagnosed HPV was more common than Chlamydia, Trichomonas, Gonorrhea, Herpes, Syphilis, HIV, and Hepatitis B combined! The risk of acquiring HPV by age 50 for women is over 80%, and the most susceptible females are from ages 18-24 with infectivity rates more than 40%! In short, most women will be infected with HPV at some point in their lives.

So what’s the big deal you might ask? Well now we know that HPV is a known cause of certain cancers as well as non-cancerous conditions in both females and males. In females, these include cervical cancer, vaginal cancer, vulvar cancer, anal cancer, as well as genital warts. In males, penile cancer and genital warts have been linked to HPV. Even certain oropharyngeal cancers have been associated with the virus. The virus has the ability to actually infect body cells and change them in such a way that they transform into cancer.

Specific HPV genotypes are more dangerous than others. For example, HPV types 16 and 18 are known to cause ~70% of all cervical cancers and 50% of precancerous cervical lesions. In addition, 90% of all genital warts are linked to HPV types 6 and 11.

Luckily, a vaccine against HPV was created to combat these specific HPV genotypes. It is called Gardasil. The Gardasil vaccine is a powerful preventive tool in the fight to stop the spread of HPV. It is effective against the specific types of HPV that are known to cause majority of cervical cancer and genital warts, specifically HPV types 16, 18, 6, and 11.

Here are some important points that will hopefully answer any remaining questions you have about Gardasil.

Who can get the Gardasil vaccine?

Gardasil is a licensed, safe, and effective vaccine for all young women and men aged 9-26. Why those specific ages you might ask? Well, all of the original Gardasil trials were performed on thousands of people worldwide between these ages. Therefore, it has been approved for this age range only.

What is the recommended schedule for the vaccine?

3 injections are recommended over the course of 6 months. The first dose is given, then the second dose is given 1-2 months after. Lastly, a third dose is given 6 months after the first dose.

When is the absolute best time to get the vaccine?

The optimal time to get the vaccine is actually around 11 or 12 years old because the potential benefit is the greatest at that age. The reason for this is that the HPV vaccine works best before any sexual activity has begun. Higher antibody titers are produced in this age group too. Also remember, it IS possible to get infected during your first sexual contact.

How effective is Gardasil?

Gardasil is very effective as evidenced by its nearly 100% efficacy in prevention of primary infection from HPV types 16 and 18. In fact, a recent study by the CDC has shown a 56% decrease in the HPV strains covered by the vaccine in the first four years after the vaccine’s introduction in 2006. The vaccine is highly immunogenic and has shown maintenance of protection for at least 5 years after vaccination. It also has great immune memory with great potential benefit lasting even beyond 5 years.

What if I already have an abnormal Pap smear, genital warts, or tested positive for HPV?

Gardasil does not treat or get rid of an already established HPV infection or any cervical abnormality that has already occurred. However, even if you have been infected with the virus, you can still obtain some benefit from the vaccine. Plus, most of the time you don’t know exactly which HPV type you may have and most of the time young women tend to clear the HPV infection all by themselves anyway! So evidence of prior HPV infection does not preclude you from getting the vaccine or deriving any benefit from it.

Is Gardasil safe? Are there any side effects?

The FDA has licensed the HPV vaccine as safe. Thousands of people worldwide were tested and no major side effects were seen. Minor side effects do include pain at the injection site, headache, and nausea.

Do I still need Pap smears?

YES! You still need regularly scheduled Pap smears. Getting the Gardasil vaccine does not mean you can skip your cervical cancer screening (which should begin at age 21). Again, the vaccine does not treat pre-existing HPV infection. Plus, there are a small number of other HPV types can also cause cervical cancer that Gardasil does not cover.

What other things can I do in addition to vaccination to prevent HPV infection?

There are other ways to prevent or decrease the risk of transmission of HPV infection. First of all, protecting yourself is the most important thing and avoiding high risk behaviors is key. These include trying to limit your number of sexual partners and avoiding sex during early ages (13-18 years of age) when one is most susceptible to HPV. Using condoms whenever possible has also been shown to help prevent transmission (although not all skin-to-skin contact can be prevented by condoms).

Hopefully, this information has been helpful and informative. HPV is an incredibly prevalent disease, but we have the unique opportunity to still control its spread with the Gardasil vaccine. I encourage everyone to pass this information along to your family and friends (especially teens and their parents). Prevention of any disease involves action and self-motivation by patients, but even more importantly, it requires education and knowledge. So spread the word about Gardasil because HPV is spreading fast as well.

Look Into Their Eyes

When I look in the eyes of a pregnant teenage patient, I see my wife. My wife was a teen mother. She was a teen mother who beat the odds. She is NOT a statistic. She is an example of the tremendous potential that lies before each and every teen facing the challenges of teen pregnancy. Pregnancy did not stop her from succeeding. My wife tells the story of riding her bicycle to her doctor’s appointments. She raised her child, graduated high school and worked her way through college and nursing school. Her determination created a successful life for herself and Jaclyn, her daughter. This is what I see when I see young pregnant patients — potential and opportunity. I know that as a doctor I can make a difference that not only helps them but also the lives of their children. For this reason, I dedicate my time and energy working with teens in the office and educating Irving ISD teens about teen pregnancy.

In 2003 I joined  MacArthur OB/GYN, a medical practice in Irving, Texas. I began seeing a large volume of young teenagers in my practice and was surprised at the prevalence of sexually transmitted disease, teen pregnancy and an overall lack of knowledge regarding sexual health. I reached out to the local school nurses and offered myself as a resource. Over time this relationship evolved. Navigating through a politically charged issue like teen pregnancy was a challenge, but after gaining the support of Irving ISD administration I began giving lectures and presentations on Teen Pregnancy and STD prevention. I have spoken to countless Irving ISD students over the past 10 years providing information about sexual choices, personal responsibility, sexually transmitted diseases and pregnancy prevention.

I work closely with the Teenage Pregnant and Parenting students program, TAPPS, a district wide program that meets the needs of pregnant and parenting students. While the national high school graduation rate for teen parents hovers around 40%, the graduation rate for our TAPPS students is over 90%. By creating a partnership between the TAPPS program and MacArthur OB/GYN  we extend the reach of the program beyond the four walls of the classroom. The physicians at MacArthur OB/GYN not only care for the pregnancy, but also work with the student to make sure they are enrolled in the TAPPS program. We enroll them in the YWCA Nurse Family partnership which provides mentorship, prenatal and parenting education. We schedule visits around the school day. We empower the students to be ready to parent and aggressively educate on contraception to avoid a second teen pregnancy. We have demonstrated that identifying the pregnant students and meeting their specific needs can change lives. We see successful pregnancies and help the students achieve success in the classroom. The payoff for these efforts will be seen for generations to come.

In addition, I have served on the Irving ISD Health Advisory council since 2004. We evaluate and recommend programs on sexual health to be adopted by the district. Teens rate sexual health information as the number one issue they want to learn about in health class. Through our efforts we have implemented evidence based, effective and factual information on sexual health district wide.

In my school presentations I give fact based information from a health perspective. The students understand the type of diseases, the methods of transmission and how to avoid them. We also discuss the impact of teen pregnancy. Beyond the health information, I relay a message of individual responsibility. I empower the students to understand that they have choices. Teen pregnancy and STDs are not inevitable but rather a decision that they have control over.

During the presentation I always ask the students to write me a letter in 10 years telling the story of their life. I paint a realistic picture of what most of their stories will be. Statistically speaking the outcomes are not pretty. The sad truth is most of the young students in the office will not have an inspirational story to tell. I challenge these young people to be different. I challenge them to overcome the statistics and to tell me a story like my wife’s — one where they lifted themselves up, overcame the obstacles and created a wonderful, successful life for themselves and their child. At the end of an office visit a few years ago a patient of mine said “I have 4 more years.” I was not sure exactly what she meant. She clarified that six years before  she was sitting in a high school auditorium listening to me speaking at Union Bower High school. She was telling me in 4 more years she will write me a letter telling me how she has graduated college and nursing school. You could see and feel the pride and determination as she told me this. Knowing that my words stuck in her head motivating her to succeed caused me to tear up on the spot. Students like this reinforce to me the importance of having health care providers meet the special need of these young patients. Community leaders must continue to work with the school district to impact the lives of young people. I am not naive. I know that teen pregnancy will continue to be a challenge in Irving, Texas and across the world. But I also know that a health care provider can touch lives. Each day we can serve as one stepping stone helping a young patient along the pathway to a successful life. The physicians at MacArthur OB/GYN are committed to playing our part. Together we can make a difference.

The New Face of HIV

For too long, the public face of HIV has mirrored that of Andrew Beckett, the character played by Tom Hanks in the movie Philadelphia. In this movie, Andrew is a frail appearing gay man fighting in a law suit against his employer who fired him due to his disease. They assumed that due to his weakened appearance and visible sarcoma skin lesions that he was a victim of HIV infection. During the 1980’s, this was the face of HIV. It was as easy to notice as a disheveled and dirty homeless person or someone fighting the battle of addiction to crack cocaine or heroin. There were floors within the hospital known as the “AIDS” floor filled with people fighting for their lives and losing their battles far too often to a premature death. Every so often, you would hear about the new diagnosis of a famous person like Magic Johnson, or a death like Rock Hudson, Eazy E or Arthor Ashe. Lately, HIV has been out of site and out of mind. This article’s purpose is to bring it back out to the forefront of reader’s minds.

Since the first recognized case in June 1981, there have been ~1.7million people in the United States who have been diagnosed and ~619,00 people have died. Every 9.5  minutes, someone in the United States, not the world, is infected with HIV. That means, in about the time it takes you to read this article, someone in the United States has been infected with HIV.

So what should you do to protect yourself?

  • Use latex or polyurethane condoms for latex allergy consistently with water based lubricants to prevent condom breakage. Polyurethane condoms are available in Trojan Supra or Durex brands.
  • Receptive anal sex without a condom greatly increases the risk of HIV transmission so use a condom with lots of water based lubricant.
  • Male circumcision reduces transmission of HIV.
  • Get tested every year regardless of your marital status and every 3-6 months if you have more than 1 sexual partner.
  • Know your partner’s HIV status.
  • Be monogamous.

One in five people living with HIV is not aware of their being infected. Patients with HIV are now healthier, maintaining a healthy weight and having less opportunistic infections. They are living longer and living more normal lives and, therefore, appear more normal which increases opportunity for spreading the disease. So, to see what the new face of HIV is today, you should look in the mirror. The face of HIV in America today looks like and me. Be safe my friends.

It All Started in a Grocery Store in 1994

It was January of 1994, and I was working hard in a group of Family Medicine doctors, as the only OB/GYN. There were 15 of them, and only one of me – I was outnumbered, and was unable to make my own decisions about my practice and my life. My wife, Maura, met a very nice lady named Ann McEwen at church, and Ann happened to be married to Paul McEwen, who happened to be a medical practice advisor/manager.  Thus, the dream began to become reality. I would meet Paul at his house in Bedford, and we would discuss how we wanted to start the future MacArthur OB/GYN. We talked for hours at a time, and there was this tall kid at his house, named Michael, who was always around with a basketball.

We approached Irving Community Hospital, and spoke to the administrator, Mike O’Keefe, who was very happy to see me come to Irving.  My first day was June 1, 1994, and my first delivery was that day. There was an emergency, and I went to L&D, and said “I don’t know you, and you don’t know me, but we need to do a C-section right now”, and we ran back and did it.

My first office was on the corner of Shady Grove and MacArthur, in an old converted grocery store- I think it was a Kroger. My office was in the bakery section. I shared the office with 3 other doctors and the Adult Day Care. It was 6-7 minutes drive to the hospital, as long as you did not get stopped by the train at Rock Island. If you did, it was a 10-15 minute wait. I got caught by that train several times, and even missed a delivery or two because of it. I stayed in that office as a solo OB/GYN until 1999. Those were the days of LDRP rooms, where you labored, delivered, recovered, and then postpartumed in the same room. As I moved out of that office to 3626 N. MacArthur, across from the Arts Center, Dr. Joseph Kilianski and Dr. Robert Zwernemann joined me in the practice. We quickly became one of the busiest practices in Irving.  After 2 years, Dr. Kilianski left, and Dr. Diane Hughes joined us. We were starting to grow at that point, and then I was lucky to get Dr. Jeff Livingston to join, just as Dr. Zwernemann left the practice. We were able to get Dr. Colette Dominique to join the following year, which helped us grow even more. Dr. Hughes left the practice shortly thereafter.

Paul McEwen, my dear friend and office manager passed away unexpectedly on November 18, 2002. He was like family to me and my wife, and a great help to me personally. That tall kid, Michael, with the basketball at his house, began working at the office and quickly took over as manager and advisor of the practice. He, along with Dr. Livingston and Dr. Dominique, got us started with the EMR, electronic medical records. At first, it was a nightmare to me, as when we had tutorials, the two of them were in the front of the room going “let’s go, go, go…”, and I was in the back going “where is the ON button?”. After a few weeks, and a few long days, I finally “got it!”, and now, I can’t imagine medicine without the EMR- it makes it so much faster to write up a chart. We actually became a test site for Intergy/SAGE.

We really began to outgrow the space at 3626 MacArthur, and when we added Kim Sakovich, WHNP, my sister-in-law, we were needing to expand quickly. Michael, the tall kid, was also a dreamer, and more to the point, a visionary. This was very much like his father, Paul, who would be very proud of Michael. The practice was doing the most deliveries and surgeries at the hospital, which was now Baylor Medical Center at Irving. We looked across the street at another old grocery store (yes, it was!), at 3501 N. MacArthur, Suite 500. I can remember the first time we walked through the space – me, Michael, and Jeff. It seemed so big and there was no way we could fill that big of a space.  Michael, the magician, was able to make a deal for the space, and we built MacArthur OB/GYN. We started with 2/3 of the building, and McEwen and Associates took up some of the space.

Growth was the name of the game, and we all became very busy, indeed. After a couple of years, Dr. Elia Fanous joined us from another practice, and we soon had to expand into the rest of Suite 500. McEwen moved to Building 4, and grew as well. We then started doing more In-office procedures at that point, including ablations, hysteroscopies, Essures, and urodynamics. We quickly went from one sono tech, Joe Valine, who has been with me for 15 years – (he joined me right after I had done 5 sonograms on the L&D manager’s daughter-in-law, telling them it was a girl each time, only to deliver a BOY) – to now 3 sono techs. Dr. Kevin O’Neil joined us the next year, and we were really filling that unusually large space that we wondered if we could ever fill. We started doing robotic surgeries at the hospital, and now are among the top robot surgeons in the area.

The dream continued as we looked west to start a practice at THR Harris Methodist HEB Hospital. I had practiced there in the 90’s, but could not work there and Irving alone. Now that there were going to be 7 of us (Dr. Becky Gray joined us 3 years ago, too), we could expand to another hospital system. Michael and I looked very hard, but could not find another grocery store to renovate. Michael did find the space at 307 Westpark Way, and we got our foot in the door at HEB. We now take calls at each hospital and have diversified our practice. We have our Physician Assistant, Allie Rivard working with us. Recently, we added Dr. Reshma Patel to our staff of doctors at both hospitals. In the fall of 2013, Dr. Brian Enganno will be joining us, as well.

The cool thing about this practice is that we all bring a unique drive or quality to the office. We all have keen interests in different things, and we are able to play off each other and help each other grow as practitioners. We teach each other and assist each other – something very family-like.

  • Who knew in 1994 that someday two grocery stores would be the foundation for the premier OB/GYN practice in Irving, Texas?
  • Who would have thought that we would have all our records in a computer, rather than piles of charts on a desk?
  • Who could have imagined operating on a patient with a robot, and me, as the surgeon, being 15 feet away at a console?

At MacArthur OB/GYN, there are no limits to the imagination…the dream continues.

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.

What Exactly is a Pap Smear Checking For?

As gynecologists, we help our patients through some very personal experiences: the dreaded pelvic exam, birth control, miscarriage, pregnancy, menopause, sexually transmitted infections, and so on. Discussing your cholesterol with a stranger just isn’t the same as discussing a first pregnancy or starting birth control. It is a very special part of our job. The pap is something I talk about everyday. Most women understand that they need to “get a pap to get checked down there.” But what exactly is a pap checking for? And why do you have to keep getting them?

The pap is a screening test for cervical cancer. The cervix is at the top of your vagina, and it is part of the outer uterus. We use a small brush (imagine a small toothbrush) to collect some cells from your cervix. It goes to a lab, and a specialist looks at your cells under a microscope. If the cells look abnormal, we do more tests because we are trying to prevent or detect the worse case scenario – cancer. But most times the result is simply normal or abnormal cells, which isn’t as serious but still very important. These abnormal cells can persist and ultimately develop into cancer. We can surgically remove these abnormal cells to help prevent cervical cancer. This is the gist of the pap test, and this part is fairly clear to most women.

Explaining the role of HPV testing casts a fog on all of the above, and this is usually the turning point in the discussion. Recent research has linked the human papilloma virus (HPV) to cervical cancer. We now know that certain types of this virus is what causes the abnormal cells found on paps. More importantly, the HPV virus also causes most types of cervical cancer. This is very important for two reasons: the HPV test effects the way paps are managed by health care providers and it also stresses the importance of the HPV vaccine.

But before I can even answer why it is so important for the patient’s future, I am often confronted with a question regarding the patient’s past. How did I get this virus? The virus is passed from one person to another during sexual contact, i.e. genital skin-to-skin contact. This type of contact can include vaginal, anal and oral sex. This virus is so prevalent that if you have ever had sex, the chances of having this virus is over 80% for your lifetime. In contrast, less than 10% of American women have chlamydia per year. HPV is the most common sexually transmitted infection. It’s like “the common cold” of sexual activity. Almost everyone you know has had the common cold right? The kicker about HPV is that it is a completely asymptomatic infection; there are no sniffles or sore throat, no discharge or pain. This means you will never know who gave it to you (because almost everyone has had it!). That part is not important, so it is not worth interrogating your partner over it.

It can overstay its welcome, and hang around for years. You may have gotten it on prom night five years ago, or you may have picked it up from your fiancé. And unfortunately there is no treatment for it. No pills, no shot. We just have to wait for the body to naturally clear the infection, which it usually does in about 90% of young people within two years of acquiring the infection.

But all of this, while important, is a bit irrelevant to what we are going to do about your abnormal pap smear. That’s our job, to figure out what to do next. Your job? With regards to HPV and your pap smears, here are the take home points:

  • Don’t stress about a positive HPV test. There is no treatment for it, and unlike an acute gonorrhea infection, it doesn’t mean that you or your current partner have been unfaithful.
  • Most women who have or have had HPV do not actually develop cervical cancer. But most women who have cervical cancer have the HPV virus.
  • Stop smoking. Smoking is like a power bar for the HPV virus, it helps it grow, which is not what we want.
  • Use condoms, but remember that a condom does not cover the entire genital area, and HPV can still be transmitted through contact of the exposed skin.
  • Keep your follow-up appointments with us. Even if your abnormal cells are not severe enough to warrant a surgical procedure to remove them today, the cells may become more abnormal in 6 months, or they may be completely normal next year. And wouldn’t that be a relief?
  • If you are under the age of 26, get the Gardasil vaccine. It’s a vaccine that can prevent a cancer. How fascinating and amazing is that!

The Two-Year Old Rule

I’m often asked by my patients whether they can eat certain foods, drink alcohol, be around people who smoke or smoke themselves, etc.  Whenever I’m asked these questions, I apply what I call the “Two-year old rule.”  I ask the patient to imagine that their baby is already born and is two years old, sitting in a high chair.  Then I ask the question, “would you give the food, drink or cigarette to your two year old?”  Usually the answer is a chuckle and “no”.  Then I explain that a woman who is pregnant should assume that anything she puts into her body would probably make it to her baby.

When talking about foods, two important questions to ask are; is it healthy for the woman and her baby and, is there any chance of it making them sick?  Take ‘junk food’ for example.  While tasty, there is generally a lot of sugar and/or fat with little in the way of nutritional value (i.e. protein, vitamins, minerals, etc.).  I get the part about it being tasty, but why waste a meal on something that is only going to grow your hips and not your baby?  Another food category is uncooked or raw foods such as raw seafood or meat.  Eating these can increase your risk for food-borne illness. Besides making you very sick, even worse than bad morning-sickness sick; the bacteria can make your baby sick as well.  So save the sushi for after you deliver, and wash your hands really well when cooking with raw meat.

Next is alcohol.  We don’t know of a “safe” amount of alcohol that a pregnant woman can ingest and not harm her baby.  We know that ingesting an ounce of alcohol a day (1 glass of wine, 1 beer, or 1 shot) significantly increases a women’s risk of her baby having Fetal Alcohol Syndrome.  There is also some newer research that suggests this risk is present at even lower amounts of alcohol consumption.  So again, if you wouldn’t give a shot, beer or glass of wine to a 2 year old (and you shouldn’t) then don’t give them to your baby when you’re pregnant.

Then there is caffeine.  Found in all sorts of yummy things: coffee, tea, soda and … CHOCOLATE!  According to the March of Dimes, pregnant women should limit their caffeine intake to less than 200mg a day, which is about 1 twelve-ounce cup of coffee.  Milk chocolate has around 7mg of caffeine per ounce, and dark chocolate about 20mg per ounce but they also come with a lot of sugar (remember those hips).

Finally, there is smoking.  Short answer: DON’T.  I know that it is hard to quit (nicotine is more physically addictive than cocaine), but do it for yourself and your baby.  Again, the two-year old analogy: would you leave a two year old next to the tail pipe of a running car?  Basically it’s the same stuff as cigarette smoke.  Smoking increases your risks of preterm delivery, low birth-weight baby, and a baby with increased chances of having SIDS (Sudden Infant Death Syndrome), asthma, learning disabilities and other issues.  I’ll stop my rant about smoking for now, but here is a website with some helpful quit-smoking advice:

So while you are pregnant, just think ahead to when your little one is two, sitting in a high chair, covered in strained peas and carrots… I mean, sitting there like an angel daintily eating cheerios with their fingers, and be glad that you made those healthy choices during your pregnancy.

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.

Participating in Clinical Trials

As a physician, I believe that I wear many hats. Among them are: healer, teacher and student. Since joining MacArthur OB/GYN in 2011, I found that one way to combine these hats into one was by becoming a clinical investigator on the research studies that our office participates in. The impetus for MacArthur OB/GYN to join in these studies came from my partner, Dr. Jeff Livingston, who has a passion for educating patients.

So how does being a clinical investigator in a research study help my patients? For one thing, it offers patients the chance to receive a new treatment or therapy that may help their condition. The study may also involve following patients for an extended period of time and this outcome data may result new knowledge that results in large-scale changes to doctors’ clinical practice. Also, we are able to attract patients who may have been outside our practice; and helping more people in the community is definitely a good thing.

So what clinical studies are we participating in at this time? We are participating in 5 clinical studies, and they are:

  1. A study of a medication to treat Interstitial Cystitis/Bladder Pain Syndrome
  2. A Post-market study looking at the long-term outcomes of two types of sling procedures for urinary incontinence
  3. A study of a medication to treat endometriosis
  4. A study of a medication to treat uterine fibroids
  5. A study of a medication to treat yeast infections.

Each study has specific inclusion and exclusion criteria. In addition, patients generally receive the study medications for free and are compensated for their time. In order to participate, a patient may be identified by one of our doctors as being potentially eligible, or a patient can contact our office and express an interest in participating; in which case they would be scheduled to see one of the doctors who is either the Principle Investigator or Sub-investigator for the particular study.

Hopefully reading this will encourage you if you have one of these conditions (IC/Bladder Pain, Urinary Incontinence, Endometriosis, Fibroids, or Chronic Yeast Infections) to contact Veronica Almanza at 214-223-5479. She can explain the study to you in more detail and arrange a visit with one of our physicians. We are here to help.