(713) 791-9100
Facebook
Twitter
YouTube
Instagram
Complete Women's Care Center
✕
  • HOME
  • ABOUT
    • Our Practice
    • Our Mission
    • Our Practitioners
    • CWCC Testimonials
    • Schedule An Appointment
    • Videos
  • PREGNANCY INFO
  • FORMS
  • BLOG
  • CONTACT & LOCATIONS

Month: May 2013

Home 2013 May

What Is A Fistula And Why Don’t We Have Them Here?

May 30, 2013Gynecologyadmin

Many of our patients ask me about my work with the West Africa Fistula Foundation in Sierra Leone, and the first question they usually ask if “what is a fistula?”

A fistula is an abnormal connection between two organs, and in gynecology the most common fistula occurs between the bladder and the vagina. The bladder sits right on top of the anterior vagina (the wall of the vagina closest to the abdomen) and the two organs are separated by a thin but strong wall of tissue. When damage occurs to the area between the vagina and the bladder, a hole can form which then connects the bladder to the vagina. Since the bladder now has a hole in it, urine constantly leaks into the vagina and the patient is constantly wet with urine.

In the developing word where obstetric care is often not available, fistulas develop when a woman is in labor for prolonged period of time and is unable to deliver the baby. The baby’s head sits in the vagina sometimes for days, crushing the anterior vaginal wall and bladder together and permanently damaging the tissue. After days of labor the baby inevitably dies and eventually the head will collapse enough to come out. In some cases the patient is able to have a C-section to remove the dead baby, in others she simply has to wait for it to come out by itself which can take days or even weeks. After delivery, the patient with a fistula may also have nerve damage to her legs from the prolonged pressure and commonly has permanent foot drop. Fistulas between the rectum and vagina are less common but can also form this way, causing chronic loss of stool and gas. Obviously, having these kind of problems is a huge social disaster. The patients smell bad, are unable to work, usually lose their husbands and are ostracized by their own community. Remember they don’t have showers, laundry facilities, flush toilets or sanitary pads. They are modern day lepers.

Fistulas from obstructed labor have been completely eradicated in the Western world. As busy ob/gyns in the US, we have never seen a single case of an obstetric fistula. They just don’t happen, since medical care is available in cases where a baby simply will not come out after a prolonged labor and a patient would never be in the late stages of labor for days. The occasional fistulas that we see in the US are almost all caused by surgery. The most common fistula occurs after a difficult hysterectomy or C-section in which the bladder was inadvertently damaged. Other trauma or radiation for cancer treatment can also cause gynecologic fistulas but these are very rare.

Most obstetric fistulas are correctable with relatively minor surgery performed vaginally. Sometimes the hole is so big that after closing the hole, very little of the bladder remains. These severe cases may need to be addressed with a major surgery diverting urine away from the bladder to a new pouch made out of intestine that then drain though the abdominal wall. For most women with a fistula in Africa, help is only available from Western charity organizations such as WAFF since local doctors are not trained to perform the surgery and patients don’t have money to pay for treatment. I will be back in Sierra Leone later this month. Please visit WAFF’s website at www.westafricafistulafoundation.org to learn more about my work with WAFF and learn more about this completely preventable problem.

Did you learn something from this post? If so let us know! What topics would you like to see discussed in future posts? Please send feedback regarding this post to shs@cwcchouston.com.

I Am Single And Want A Family… What Are My Options?

May 23, 2013Gynecology, Obstetricsadmin

The world has certainly changed for women in the past 50 years. As we have moved closer to equality with men in the workplace and have been allowed to pursue our career goals, we may sometimes find that time slips by and suddenly we are 35 with a great career but no prospects for a long term partner in sight. Many of our patients struggle with a sense of panic at the thought of not having children and ask us about their options.

First, waiting for Mr. Right may still be a good option, depending not only on your chronological age but also your “ovarian age”. While no single test is perfect, some simple blood tests will give an indication of your ovarian reserve and will give a better sense of the degree of urgency with which to pursue fertility. Some women remain fertile longer than others, and we can help to estimate where you fall on this continuum.

Secondly, harvesting and freezing of your eggs may be a viable option. Similar to a routine IVF (in vitro fertilization) process, patients undergoing egg freezing will be given hormone injections for several day to stimulate egg production. The eggs are then removed with a needle guided by ultrasound (under anesthesia). Rather than being fertilized by sperm right away, these eggs can be frozen indefinitely and thawed and fertilized some time in the future. At that time, the fertilized embryo is then placed into the uterus, and maternal age is of no significance (assuming we are still otherwise healthy), since as we age the frozen eggs remain the age at which they were retrieved. Since eggs become more difficult to fertilize and more likely to result in embryonic abnormalities as we age, harvesting and freezing eggs works better the younger we are.

So if one is considering egg freezing it is best to do it sooner than later. Unfortunately we usually don’t start thinking about egg freezing until we are in our late 30’s. At this point the eggs may already be of low quality and their chance of successful fertilization may not be high. This is also an expensive choice, with the initial cost being close to $10,000 as well as an annual storage fee and an additional fee at the time of fertilization and transfer of the embryo into the uterus. We recommend discussing this option with Dr. Laurie McKenzie of Houston IVF for more information.

A third option is pursuing pregnancy with a sperm donor. Donors generally are anonymous (we can direct you to a sperm bank where you can “shop” for a donor) but may also be a friend or known party. In order to conceive with a donor, we arrange for the chosen sperm to be delivered (usually frozen) to one of our partner male fertility labs where it is thawed and processed on the day of ovulation. Our part is to help you to determine when that day is, so the planned conception is accurately timed. Depending on your situation we may use ovulation induction medications such as Clomid to enhance success. On the predetermined day, the processed sperm are drawn into a syringe and inserted into the uterus with a small catheter in our office. This process is call IUI (intrauterine insemination).

Another option of course is accepting that having children is not a requirement for happiness and that if fertility is not in your future, that may be OK.

If you have questions about your age and how it relates to your choices for fertility, we would love to talk to you about it in more detail! Just let us know.

Did you learn something from this post? If so let us know! What topics would you like to see discussed in future posts? Please send feedback regarding this post to shs@cwcchouston.com.

Is Caffeine Really Bad For Me?

May 20, 2013Living welladmin

As a lifetime caffeine addict, like many of us I have attempted to rationalize away the fact that caffeine is a very powerful and addictive substance. Like most addicts, I am only really aware of this fact when I give it up and notice what a huge difference it makes. Having now been caffeine free for 3 weeks I look at the poor souls in the long Starbucks drive-through line anxiously awaiting their next fix, and self- righteously wish they knew what I know now. That stuff is bad for us and it is making us sick. Caffeine is so prevalent throughout our culture that no one wants to admit that it is a potent drug that stimulates addictive behavior not unlike a number of less socially acceptable substances.

I decided to quit for a couple of reasons. One reason was that I was acting like an addict and I don’t like to be dependent on things. I would wake up wanting a cup of coffee, then would have one and would want another one. If the coffee wasn’t available as planned I would get anxious, and would go out of my way to find one. It might make me late for work or to drop my kids at school, but the caffeine came first. The pleasure was very short term and always followed by the desire for more. After about 3 cups of something caffeinated the craving would go away, but the effects would no longer be pleasant.

That was the other reason to quit; I wasn’t feeling good and was pretty sure it was related to my caffeine intake. If I had too much I would be jittery and anxious. A few hours into the afternoon I would get a headache and start to feel tired. I had rules though, I never drank coffee in the afternoon or I would not be able to sleep. So I suffered through the afternoon feeling progressively more tried and cranky. As little as one diet coke after noon and I could not fall asleep. Then I would be more tired in the morning and rush for the coffee pot even faster.

Quitting was much easier that I thought. I like having a hot drink in the morning so switched to decaf tea. (For purists, yes, there is a tiny amount of caffeine in decaf tea. Less than 1/20 of a cup of coffee, so close enough to zero for me.) Having the hot drink fooled my addictive side into thinking I was still getting something. For a few days I had some mild headaches but nothing serious and it passed quickly. Within a couple of days I was much more energetic in the afternoons, was less grumpy and slept much more soundly. The lack of cravings in the morning made me realize how strong they had been previously and every time I passed a Starbucks without going in I realized how often I had made those stops.

I think we should ask ourselves if we want to be addicted to substances that change our behavior and our personalities, and why this is so socially acceptable when other similar substances would never be considered OK. When you see a line of 12 cars waiting at a coffee drive through at 11 am on any given day, it is hard to disagree that this is powerful stuff that they are selling. And the bottom line is that like all drugs, it doesn’t make you feel good. Not for long anyway, and not without a price.

Caffeine won’t kill you, probably, but I am sure that half of my patients who come in complaining of feeling tired and grumpy are suffering from caffeine side effects. If you are feeling tired in the afternoon, are anxious, jittery, grumpy or have trouble sleeping, I challenge you to give up caffeine and see what happens. Chances are you will become a religious ex-caffeine addict like me. No one wants to be a slave to anything, get your freedom and your mental health back and ditch the Starbucks!

Did you learn something from this post? If so let us know! What topics would you like to see discussed in future posts? Please send feedback regarding this post to shs@cwcchouston.com.

Challenge And Happiness

May 16, 2013Living welladmin

Being a parent makes me think about the lessons I want my kids to learn and the character traits that I hope they develop. One of my greatest hopes is that they will have the ability and desire to take on challenges and allow themselves to be vulnerable to failure. No doubt this is easier for some people that others and is somewhat ingrained our personalities, but I believe that anyone can learn it, and that everyone can benefit from it.  The experience of completing something really difficult and scary is a primary builder of self esteem, and allows one to develop the essential belief that “I can do hard things”. It takes practice.

Once we can establish a pattern of attempting challenges, experiencing setbacks and failures along the way but ultimately being successful, the belief that “anything is possible” and “I can do that” is the logical progression.  It is not long before the prospect of challenge and vulnerability is exciting, knowing the potential reward (pleasure) that lies on the other side.

One year my son decided for the first time to play a particularly challenging piece at his recital from memory. In the middle he forgot where he was and stopped for what seemed like an eternity. My heart sank as I anticipated his shame and embarrassment.  I knew he wanted to get up and run away, but he composed himself and started back up again from the beginning.  The pride he felt afterwards was enormous and the lesson he learned added an important piece to his growing character.  Now he loves playing at recitals. He knows he might make mistakes but also knows that he can handle it, and he anticipates the fantastic feeling that comes after doing a great job at something scary and difficult.

Believe it or not I am still terrified every time I do a triathlon. But the feeling of literally jumping into your fears (with triathlons, the swim is first) and finding that you can overcome them is just too good to pass up, so I keep signing up to get my fix.  The IronMan triathlon was the ultimate symbol for this whole theory. Why on earth did I ever think I could do an Ironman? I questioned this occasionally, right up until I was standing at the edge of the water.  What it came down to was faith, a faith in myself that came from getting through lots of hard things before. I was pretty sure, without much evidence, that I could face anything the race threw at me.

The IronMan really is just an exaggerated and condensed metaphor for life. It teaches that things that seem on their face to be impossible may really be just a series of quite doable events strung together. One simply masters one small problem at a time without being distracted by the enormity of the whole.  There are plenty of small “failures” in an IronMan. At the start of the race you know there will be problems. You might lose your goggles, have a flat tire, fall off your bike, have diarrhea or get injured on the run. As each problem occurs you calmly assess it, regroup and adjust your tactics then move on without looking back.  The fact that there will be inevitable “failures” doesn’t stop you from jumping in.

It is human nature to want to run away when things are hard and there is a significant chance that we will fail, or embarrass ourselves. Whether it is sticking to a weight loss program, taking on a new responsibility at work or showing up for the first time at a dance class, opportunities to develop our courage are everywhere.  While I don’t recommend trying things that truly endanger your health or finances, the one thing that I hope to inspire in my kids and my patients is the courage to take risks. Courage and calculated risk- taking should be a way of life, and requires practice.

I am certain that the root of any of the success in my life is my affinity for challenge and the deep seated faith that either I will succeed or will learn something valuable by trying.  We have all heard the saying “the road to success is paved with failure”, and this has certainly been the case for me. I just never defined myself by the failures.  Another great saying that sums this idea up is “Think you can or think you can’t; either way you’re right”.

Did you learn something from this post? If so let us know! What topics would you like to see discussed in future posts? Please send feedback regarding this post to shs@cwcchouston.com.

I Am Ready To Get Pregnant.. Now What?

May 5, 2013Gynecology, Obstetricsadmin

Now that you are ready to conceive there are a few things to think about to make sure you and your baby to be are healthy. First of all, you will need to stop your birth control!. If you have been on pills or other hormonal birth control you have not been releasing eggs, and that process will need to return. It may return in a few days (we all know people who got pregnant after missing just 2-3 pills) or it may take a few months. So if you have an ideal time to conceive you may want to stop your pills a few months before that to give your body time to adjust to ovulating again. (If you do conceive a few days after getting off pills it is totally safe, so it is good to be prepared to be pregnant as soon as you discontinue birth control).

If you are a planner, we recommend waiting until you have a cycle on your own, off pills, before trying for pregnancy. This will make it easier for you to plan when to try (see below) and to know when you conceived. In the meantime, start taking a prenatal vitamin or any supplement containing at least 400 micrograms of folic acid. Studies have shown that folic acid reduces the risk of neural tube defects or spina bidifa. Ideally we should take folic acid before we conceive. If you smoke, it is time to stop. If you take any prescription medications talk to us or your prescribing doctor about whether they are safe to continue in pregnancy. Moderate amounts of alcohol are safe until pregnancy is diagnosed; after that we recommend abstaining altogether. Normal activities and exercise are also healthy to continue. Excessive exercise associated with a very low body fat can alter ovulation patterns, but if your cycle is normal off pills that is a good sign that ovulation is occurring.

If you or your partner’s family history is significant for any abnormalities that affect babies at birth such as Down’s syndrome, heart defects, cystic fibrosis, sickle cell disease or other genetic disorders, talk to us before conception and we can evaluate your risk and offer appropriate testing. If you do not know if you have had chicken pox, or are not sure if you are immune to rubella (german measles) we can test for immunity in a blood test before you conceive. If you need a vaccination it needs to be given a month before conception. These are all good topic to discuss at a preconceptual visit, and we love to meet partners at these visits too!

In high school I remember being taught that we can conceive at any time of the month. While this is not bad information for teenagers to believe, in reality there are only a few days of each monthly cycle that we are fertile. We count the days of our cycle with day 1 being the fist day of bleeding. Assuming we are having cycles about 26-32 days apart, most women release an egg (usually one and occasionally 2 or 3) on about day 12-16. After the egg is released, if we don’t conceive we will bleed again about 2 weeks later. The most fertile day is the day before the egg is released, because the sperm are already present in the fallopian tube when the egg appears. The day of egg release is the second most fertile day. Since the egg only lives for about 24 hours, by the day after ovulation we are no longer fertile.

It is good to remember that sperm can live 3-5 days in some cases, so having intercourse on day 10 could still result in pregnancy if the egg is released on day 14. Taking all that into account, for a woman with normal 28-30 day cycles, she should attempt pregnancy from about day 10-16. It is not necessary to have intercourse daily as sperm live for at least 2 days, so every day will work as well and is less stressful for some couples. If trying for a week each month is not practical, there are some over the counter tests that can narrow down the day of ovulation a little more accurately. Ovulation Predictor tests are available for any pharmacy and test for the presence of LH (lutenizing hormone ) in the urine.

The day before ovulation LH sharply rises and can usually be picked up in the urine. Since this identifies the day before ovulation, it identifies the most fertile 2 days of the cycle (the day of the positive test, and the following day). If we are having cycles that are longer than 32 days or shorter than 26 days we may have ovulation dysfunction that could hinder fertility. If cycles are significantly short or long we would offer some blood testing to evaluate for ovulation dysfunction.

Providing your cycles are generally regular, we advise trying for 6 months at the time of ovulation before worrying that anything is wrong, Sometimes things just take a few months. If you have not conceived within 6 months, or as soon as you have a positive pregnancy test at home, give us a call and we will be happy to see you.

Did you learn something from this post? If so let us know! What topics would you like to see discussed in future posts? Please send feedback regarding this post to shs@cwcchouston.com.

Is It Normal To Leak Urine As We Get Older?

May 2, 2013Gynecology, Menopauseadmin

Urine leakage is inconvenient and embarrassing, and can prevent us from doing the activities that we enjoy. In past generations women were taught that is was part of life and simply had to put up with it. Thank goodness advances in medicine have made treatment options more effective and less invasive, so that we no longer have to tolerate this difficult problem.

There are two common types of urinary incontinence and many of us have a little of both.
STRESS URINARY INCONTINENCE or SUI applies to urine leakage that occurs when the abdominal pressure is increased, such as with coughing, laughing, or exercise. Typically this occurs after childbirth due to weakening of the supportive tissue under the bladder and urethra (the tube that carries urine from the bladder to the outside world). With loss of support, when we push down with our abdomen the pressure inside the bladder is higher than that in the urethra, which causes a leak. When adequately supported the urethra should sit inside the abdominal cavity, so that the pressure is exerted equally on the bladder and urethra and there won’t be a leak.

Treatment approaches center on strengthening the support under the urethra so that it does not shift downward with increasing abdominal pressure. Non surgical approaches include Kegel exercises, which involve voluntarily tightening the vaginal muscles in many repetitious sets to strengthen the tissue. Other methods involve electrical stimulation of the muscular tissue with the same goal. When non-surgical approaches are not sufficient, replacing the support with a synthetic piece of material called a “sling” can be very successful. Slings are placed through a small vaginal incision beneath the urethra . The surgery takes about 20 minutes in an outpatient setting and has a quick recovery. Slings should not be confused with other “vaginal mesh” procedures which have received negative attention in the media. Generally slings are very safe and straightforward and the success rate for SUI is very high and is generally permanent.

URGE INCONTINENCE or “overactive bladder” (OAB) is a problem many women experience as an uncontrollable urge to urinate when on the way to the bathroom, perhaps when the keys are in the door or unbuttoning the pants. The problem happens when the brain sends a message to the bladder to contract, which is normal when it is time to urinate, but the message is sent too early and is difficult to control voluntarily. Treatments for OAB center on bladder relaxing medications which prevent the overactive muscle contractions. The downside of these treatments is that they do have to be taken daily, and may cause mild side effects such as dry mouth, dry eyes and constipation. Often dietary changes can help as well, with common culprits being acidic foods, alcohol and caffeine.

Other less common causes of incontinence occur from neurologic damage due to diabetes or other diseases, physical damage from surgery or radiation causing a hole on the bladder (a fistula) and damage to the sphincter mechanism between the urethra and bladder.

Before treatment is started we generally recommend testing the bladder to see which of these problems is present. The test involves placing a catheter in the bladder and filling the bladder with fluid to simulate fullness. A pressure sensor on the catheter can detect OAB since the muscle will contract involuntarily. Coughing and bearing down will illustrate when SUI occurs and will measure how much pressure it takes to leak. Bladder emptying is then observed to make sure it occurs normally. This test is a but uncomfortable but not painful and takes about 45 minutes.

Let us know if we can help you with urinary incontinence, life is too short to leak!

Did you learn something from this post? If so let us know! What topics would you like to see discussed in future posts? Please send feedback regarding this post to shs@cwcchouston.com.

Categories

  • Cosmetic Gynecology
  • Gynecology
  • Living well
  • Menopause
  • Obstetrics
  • Pediatric & Adolescent Gynecology

Recent Posts

  • Love in the Workplace
  • Response To Recent Study Linking Hormonal Birth Control To Breast Cancer
  • What’s The Latest On Zika?
  • What Is Non-Surgical Vaginal Rejuvenation
  • If My Tubes are Tied, What Happens to the Egg?

Archives

  • October 2018
  • December 2017
  • January 2017
  • December 2016
  • October 2016
  • August 2016
  • January 2016
  • December 2015
  • June 2015
  • June 2014
  • February 2014
  • January 2014
  • November 2013
  • October 2013
  • September 2013
  • August 2013
  • July 2013
  • June 2013
  • May 2013
  • April 2013
  • March 2013

Browse Our Site

  • Home
  • About CWCC
  • Pregnancy Info
  • Forms
  • Blog
  • Contact & Locations

Pregnancy Resources

  • Pregnancy Info
  • FAQ – Pregnant Patients
  • CONSENT – 1ST TRI SCREENING
  • PDF: Milk Supply
  • PDF: Postpartum Info
  • PDF: Pregnancy Loss
  • PDF: Cord Blood Banking

Medical Center

7900 Fannin Street #3000,
Houston, TX 77054
713.791.9100

Tanglewood Office

5757 Woodway Suite 101
Houston, TX 77057
713.791.9100

Pearland Office

2950 Cullen Blvd Suite 201
Pearland, Texas 77584
713.791.9100

Search Our Site

Facebook
Twitter
YouTube
Instagram

Site Design: LOUD! Creative