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Hysterectomy

hysterectomyHysterectomy, the removal of the womb, remains one of the most common procedures performed in the United States. The most frequent indications are bleeding, or fibroid tumors.

Over the years the indications for hysterectomy have dropped precipitously.

Please get a second opinion if oyu are considering a hysterectomy.

Fibroid tumors are very common, most do not need removal, they are seen routinely on ultrasound and they are completly without symptoms, and may be left alone, or watched on some periodic basis with the simple ultrasound test. The ultrasound test has few downsides, most being, the cost and the inconvenience of the minor discomfort.

There are vaginal hysterectomies, ones done through the abdominal incision, a vertical, or a bikini cut. Many have good experience with laparoscopic or robot assisted laparoscopic hysterectomies.

Or even Robot assisted laparoscopic vaginal hysterectomies.

Confusing. Educate yourself.

Ask:

1) Does your cervix need to be taken out? Do you need a SupraCervical Hysterectomy?

2) Do your ovaries need to be taken out. Some women as they approach menopause, this may not be a bad idea.

Espanol Aborto

hispanic-women abortionNuestros Honorarios…

Los services se pagan el dia de la cita en EFFECTIVO, GIRO de DINERO del DOREREO, tarjectas de credito MASTER CARD, VISA o AMERICAN EXPRESS. (No aceptamos cheques personales, gracias).

SEGUROS COMMERCIALES COMO NEW JERSEY BLUE CROSS / BLUE SHIELD, muchos de lost HMO’s Y OTROS TIPOS DE SEGUROS SE PUEDE USAR COMO PAGO CON VERIFICACION POR NUESTRAS OFICINISTAS ANTES DE SU CITA. TAMBIEN ACEPTAMOS NEW JERSEY MEDICAID.

Nuestros Servicios…

Abortion centers es un centro de cuidado gynecologo que esta licenciado por el estado. Nos especializamos en abortos hasta las 24 semanas de gestacion como tambien en otros tratamientos ginecologos. Les brindamos el mejor ciudado medico mas un equipo de profesionales capacitados y atentos.

Nuestros Obstetras-Ginecologos estan certificado por la comision medica y tiene una vasta experencia en la provision de estos servicios a neustros pacientes.

Un Medico Anestesista administrara anestesia general. Tambien ofrecemos anestesia local.

Nuestro equipo de enfermeras y consejeras consiste de personas muy educadas y entrenadas que proveen ayuda, ciudado, y apoyo en una atmosfera sin prejuicios.

Tenemos lo ultimo en instrumentos diagnosticos y de cirugia, incluyendo maquinas de ultrasonidos.

Abortion centers esta aqui para oferecer cuidado medico de caliodad a las mujeres respetando la privacidad, dignidad y confidencialidad de cada paciente en un ambiente seguro, limpio, y con calor humano.

Todos las llamadas y cita son confidencial.

No es necessario el consentimiento do los padre.

En Preparacion de su cita…

El dia anterior de su cita no coma ni beba (esto incluye aqua y chiclets) desde las doce de la noche. Su estomago tiene que estar vacio por lo menos 8 de su cita.

Por favor tenga alguien con usted para hacerle compania y llevarla para su casa despues de su cita. Es perigoso que uste conduzca automovil para regresar a su casa cuando este recuperandose.

Por favor haga arreglos para el cuidad de sus ninos en su casa.

Usted y su acompanate deben de estar preparados para estar en la clinica de 3 a 4 horas. Triaga material para leer.

Por favor tome un bano la manana de su cita.

Si no puede aquidar a su cita, por favor llame y cancele para poder ofrecerle este tiempo a otra persona necesitada de nuestro servicios.

Que Puede Esperar…

Nuestra recepcionista la recibira cordialmente y le hara llenar un formulario sobre su salud.

En el laboratorio le haran analisis se sangre, factore RH, analisis de urine, y preuba de embarazo.

Un medico le tomara un ultasonido para poder determinar el tiempo de su embarazo.

Una cosejera le explicara el procedimiento del aborto como tambien hablara sobre metodos anteconceptivos y le contestara cualquier pergunta que usted tenga.

En el salon de operacion, usted sera atentida por un Ginecologo, un Anestesista, y una Enfermera.

Anestesia general y local estan disponible.

Despues del aborto usted descansara enun salon de recuperacion por lo menos una hora. Usted estara acompanada por una enfermera y una asistente.

Puede hacer una cita para regresar a la clinica de dos a tres semanas despues de s

vbacVaginal Birth after Cesarean Section (VBAC) has proven to be a safe method of delivery in a wide variety of pregnancies.  Sadly, with changes in insurance and malpractice laws, the threshold to allow such a health delivery, and circumvent unneeded additional Cesarean Sections is being sabotaoged by this environment.

Bottom line, mommies and babies suffer.

The literature continues to glean that all our sophisticated interventions seem to do much less than we expect.

Yes, Modern Obstetrics made tremendous strides over the past 80 years. Dropping maternal mortality rates from 1,200/100,000 to around 7/100,000.  But this was due primarily to control of hemmorhage, infection, and preeclampsia or toxemia of pregnancy.  Genetic screening has been a welcomed intervention as well.

Sadly we have not done what we expected for more.  Drop in preterm labor rates, decreased hypoxia or cerebral palsy,, or other diseases that we have just not been able to decrease despite our modern interventions.

There are more but beyond the scope of this note.

Back to VBACs.cesarean-vbac-rate-graph  

The graph shows it all.

What is going on here?

Doctor life style, poor management and timing of labor, premature amniotomies, poor epidural managemnt, and low tolerance to minimal risk of VBAC are partially to blame.  

Doctors are overworked and underpaid, and are unwilling to take the smallest risk of the right subset of patients.

VBAC when monitored, in the right setting (ie NOT a vertical incision on THE WOMB), when all the parameters have been looked is a safe and effective means of delivery.  There is no need to go back to the days of high section rates because we are afraid of a simple VBAC.

There should be a call to arms of advocacy.  Talk to your doctor. Show them the graph. Read up on this. This is a crime against women and babies that suffer higher levels of Transient Tachypnia of the Newborn as well as other phenomenon.

It is your body, make an informed choice.

It is the opinion of this author that very few women require to subject themselves to the intrabdominal procedure of a tubal ligation.

There are occasions where it makes sense, like a seventh baby at c-section, the tubal takes two minutes and then it is over. But one must be certain they want irreversible sterilization and the possibility of the rare, unproven post tubal syndrome.

Simply, the vast majority of couples who are done with child bearing may let the man get a vasectomy, a much simpler and safer procedure. Men must be educated as they feel they loose their “Maleness” when this occurs.

As well women who are unsure, or the man refuses the vasectomy, most often will tolerate one of the IUDs on the market and since they are approved for such along time – the Paragard 380T was approved for 10 years – it can always be taken out, with a high degree of success, everything else being equal in regards to their fertility. As well they last long enough to almost take the average women to menopause after enough childbearing.

So the options are significant to avoid the tubal ligation which is irreversible for the most part, unless you have lots of $$s and are happy with a below 50% success rate – I am not.

Major breakthroughs in healthcare are few. It is rare that the paradigm shifts in such a manner that our whole way of thinking about how we should address a topic radically changes. It appears this will begin to happen much more frequently as scientific breakthroughs occur at an expanding and much more rapid pace.

The HPV Vaccine may be seen as a wonderous breakthrough in science as soon as a generation has past and recieved it purported benefits.

One such example of this phenomenon is the recent approval by the FDA (Food and Drug Administration) of a vaccine for the Human Papilloma Virus. Strong evidence suggests that this intervention may grow into something just short of a panacea for cervical cancer (we know the drug manufacturers hope so!). At the same time, medical history will likely look back at this occasion as the time that vaccines were introduced to protect us from things that we never even dreamed were possible.

In the beginning of my medical career, the thought of a vaccine for a cancer seemed preposterous. Now it is reality. Only time will tell. This concept of the self correcting nature and the non dogmatic objective review of pier reviewed literature will be reviewed in an upcoming article on Science – How and why it works. However, for now we are relegated to make informed desicions as best as we can on the evidence that we have. That body of work is very strong and becoming more reliable everyday.

For over four decades the scientific community and the clinical community of basic science community and the clinical community of Obstetricians and Gynecologists, and ancillary health care professionals learned that women who had certain subtypes of HPV, were at much higher risk for bad changes in the cervical cells, and those bad changes occasionally led to the horrendous disease, cervical cancer.

In the beginning of the 1960’s we watched about 1/45 women over a lifetime DIE from this heinous illness. The introduction of aggressive cytology through pap smears with the microscope (colposcopically directed) biopsies of those sick cells led to an enormous decrease (almost 1/3, absolutely extraordinary) in the incidence of the precursor disease and the full blown out illness of cervical cancer.

HPV sadly became one of the most prevalent sexually transmitted diseases. Before the onslaught of AIDS the barrier free sexuality of the 60s and 70s facilitated the transmition of hordes of STD’s which still continues today, in not quite the same tsunami of spread.

If you desire more detailed information on these items, please say so in your comments. This will help guide the tone and theme of the site. It belongs to all of us, to make us all healthier. We benefit from that glorious communion. We will learn together how detailed, how medical, how general, we want these items to be and we will try and reach common denominator that suits the majority. We will not be perfect (who is?) but we will strive to the best education and information possible.

Very soon depending on who you are, you must engage your health care provider with the discussion: it is appropriate for me? my daughter? my significant other, to receive the HPV vaccine. This will be a difficult question. Wow, extremely difficult. Just imagine! Some of our daughters will be 11. The thought of vaccinating an 11 year old against a sexually transmitted disease is intuitively abhorrent, however, the reality is, a generation from not we may come close to eradicating one of the primary gynecologic cancers in women – using a vaccine. A cancer that strikes and kills women in their prime, as opposed to the other illesses whcih tend to have a higher prevalance as the individual gets older. This is not to be taken as it is a better cancer, but I suspect we are saddenned greatly when more of a potential life is snuffed, a mother taken from her daughter when she needs her most. The potential to rid ourselves of this monstrosity, now that is astonishing, I recommend you do your reading and education, as this is a big one.

Keep Women Healthy

The majority of the women in the world are treated as property. In the United States, wonderful achievements have been brought to fruition, and obstacles have been overcome.

Yet we have much to do.

Here you will finding a continually growing repository of current and informative thoughts on the present state of being a women and keeping women healthy.

We deserve this, as do men. We are different. We need to address these issues clearly. Objectivity may lead us to a path which allows awareness to overcome thousands of years of subordination.

We are mothers, daughters, wives, significant others, friends, professionals, laborers. We are a slice of the cross section of life. We must be healthy, we owe it to ourselves and mandate it to ourselves. We have achieved so much. Join me and learn.

Comments, posts, replies – all are welcome. Join us as we journey through life to be the most wonderful persons we can be.