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Love in the Workplace

October 18, 2018Living welladmin

Once a month at Complete Women’s Care Center (CWCC) we have an all-staff “Brilliance Meeting” and share appreciation and talk about something that feels important. Here’s what we talked about this month, and it applies to all of us!

At CWCC we have talked for a while about a model credited to the authors of “the 15 Commitments of Conscious Leadership”, in which there is a very simple horizontal line which we are challenged to place ourselves above or below in different situations. The point is not to always be above the line, but to recognize honestly where we are, and pause before we act from below the line, considering if we are ready and willing to shift up. Sometimes we are not ready or willing, and that’s OK, so long as we don’t do harm.

Above the line are the characteristics of our aspirational best self; openness, accountability, valuing people’s opinions and differences, curiosity, compassion, generosity, respect, patience, letting go of being right…here we understand that we create our own reality by our own thoughts, speech and actions and don’t blame others, we know that the world is our ally and everything is set up to teach us something, and we know that we are enough.

Below the line we cling to being right, talking badly about others, we are closed-minded, blame others for everything, feel the world is happening “to me” and have no power. We are a victim, clinging on to our own stuff and taking everything personally, driven by a scarcity mentality of not enough, never enough, and with certainty that the world is out to get us.

I have lived and practiced with this model for several years and recently began to think about it in an even more simple form. There are lots of ways of describing the state of being above and below the line – consciousness and unconsciousness, awareness and delusion or trance, a presence or lack of presence – but one that I like the most is LOVE and FEAR. If we break all these things down into their most basic form, that basically covers it.

Why is LOVE important in the workplace? First of all, let’s try to define it. More than a feeling, love is a group of actions that embody those above the line principles. It’s acting in a way that cares and is genuinely interested in the well-being of the other and seeing them as a 3-dimensional and unique individual who matters as much as anyone else. And that could be self -love too. When we practice self-love we are acting from above the line towards ourselves.

Love doesn’t just play a role in business; it is the key to business. Business is simply about relationships, and all healthy relationships are based in love. This is not romantic love, of course, as we don’t have to fall in love with our patients and coworkers and we don’t even have to like them sometimes – but we need to deeply care about them, recognize them as unique and valuable and important, and give them our full time and attention when we are together.

Why do over 750 new patients come to see us every month instead of going some other place? And why do the vast majority of our patients come back? And conversely what is the nature of pretty much ALL of our patient complaints?

I believe the answer is LOVE, or in the case of complaints when we fell short and patients felt a lack of love and did not feel important or cared for. Our mission statement talks all about love- seeing each person as unique and valuable, empathy, compassion, meeting people with a welcoming smile, giving them the best care possible and continuously educating ourselves. Our capacity to communicate love and compassion to our patients is the single greatest differentiator from our competition. That’s why they come here.

We have told people what our values are in our mission statement and they come to us because they share those values. People are attracted to people who make them feel seen, valued and alive. People remember how you made them FEEL. When we promise to deliver something and don’t do it, people feel disappointed, they feel unloved.

So this “exceptional experience” that we are promising/aspiring to deliver at every encounter is an act of love. It starts on the phone or with the first interaction, recognizing that we are talking to another human being, someone just like us, with the same hopes, fears and desire to be happy. And with a bunch of history that we don’t know, but safe to assume it has included both a lot of pain and a lot of joy. And we have no idea what happened in her life that month, day or morning, but we listen deeply to what she is saying and what she is not saying, pick up on cues of body language if she is in front of us, then use our heart, our intuition, to try to give her what she needs to feel loved. To do that, to really listen with our whole body, we have to be present. That goes back to my favorite subject of mindfulness- having your head and body in the same place. We can’t deeply listen to the person in front of us if we are thinking about our grocery list or worrying about month-end or an argument we had this morning. Our mind is in the past or future, and love can only exist in the present moment. We owe our patients our presence. To be actually there with them, in tune with their needs, on the phone, at the front desk, or in the exam room, delivery suite or operating room.

One author, whose name I can’t recall, suggested that there are 4 basic things that each person is continuously subconsciously asking:

Do you see me?

Do you care that I am here? 

Am I good enough for you? 

Can I tell that I am special to you?

Our job is to continuously be anticipating those questions and answering them for our patients. These questions are all based in fear; fear of not being seen and not being good enough, and on a primal level of not surviving since we depend on each other to stay alive. This is a fear that all humans share on a basic level. Love eliminates fear. Love lets us know that we are good enough exactly as we are, and we are cared for.

What happens to these questions when we don’t look at a patient in the eye and smile at the front desk, if they hear us sigh, if we don’t call them by their preferred name when we call them back, if we make them wait a long time in the exam room in a cold and scratchy gown, or if we don’t get their results back as soon as we promised, or bill for the wrong charges then don’t correct it the first time we call? What story will the patient make up based on these questions? How are we making her feel? What emotion do many people feel when we answer these questions with a NO? If they are pretty self-aware and mature they may just feel disappointed. If they are less mature they may feel anger, rage, or lash out. We may have hit their primary childhood wound, they might tell all their friends and write all over the internet, but more importantly, we have made them feel terrible and reinforced an old story about not being good enough. That is creating harm, which we promised not to do. It’s a big deal.

I love this question that came from one of my teachers Vinny Ferraro (look him up online or in YouTube).  In every situation, the universe is asking me “How can I be a better lover?” This can apply in the romantic sense with our partners and is a great question to ask in that setting, but more in the day to day interactions. How can I bring love to this situation? Especially if it is a difficult situation or conflict? How can I add love and not fear? How can I make things better, not worse? How can I put water on this fire and not gasoline? How can I create this magic alchemy (making gold out of base materials)? We see this all the time when a team member calms an angry patient and makes them happy. This is not easy, and it takes courage and strength to face someone who is angry with an undefended heart. But we can’t engage in love or connect with a defended heart. We have to be vulnerable, and trust and have faith that love always wins. I have yet to be able to win over an angry patient by applying these principles consistently. Sometimes it takes time to get through their armor, but you will get there if you stay in your own shoes and don’t waver from returning anger with love and compassion. Nelson Mandela famously wrote that he approached all of his guards during his 27-year imprisonment with love. No matter what they brought him, he returned love. Inevitably the guards could no longer do their job and kept being replaced. They simply were unable to hate him when they were consistently facesd with love.

Be careful to give love without conditions. If I come home and do something really nice for my husband because I am afraid to tell him that I have to go out of town next weekend, or because I need to prove to myself that I am loveable or good enough, that is adding conditions, and robs me of the opportunity to experience real altruism or generosity. We don’t calm a patient so that we can get a superstar or kudos from our supervisor; we do it because it’s the right thing to do, because we are acting from love, which is our true nature.

So what about each other?  People are people 24/7 – we don’t stop being people when we come to work and start being human when we leave. What if we treated each other this same way? To recognize that each of us is unique and special and that each of us is asking those same four questions.

What if your co-workers consistently treated you as a real person, more than your title or uniform, and listened to you in a way that made you feel special and important? What if we gave each other a unique and valuable experience every day and that was as important as what we offer our patients?

My guess is that it would dramatically improve engagement, reduce turnover, and improve happiness, it would make work purposeful and meaningful, and give you a reason to get up in the morning. If work has lost that shine for you, making things better has to start with you. If you are waiting for someone else to go first, you are below the line, living in fear. Fear that you will look foolish or that your sentiments won’t be received well, or that you will lose power. Shifting above the love means going first, doing the right thing no matter what the outcome, being vulnerable, saying “ I Love You” by your actions, first. And when you give love from a genuine place, it is extremely unlikely that you will not be received well.

I challenge you to give appreciation, not “you did a good job” or “thanks for all you do” but something really specific. Give superstars to your peers. If you think something positive, say it out loud. “I like the way you walked that patient to the front today”, “I liked the way you helped me room that patient” – whatever it might be. Little miracles are going around all day all around us and we get numb to them. We just spontaneously throw together a team to deal with a half day power outage – boring! A baby just came out of that woman’s body – how ordinary!

I challenge you to wake up to the little miracles going on all around you- our patients, your coworkers, this conversation. Go first. Say I love you with your eyes and your body language. A happier, more engaged and loving workplace starts with YOU!

Response To Recent Study Linking Hormonal Birth Control To Breast Cancer

December 8, 2017Gynecologyadmin

Many of us have read about a recent study published in the New England Journal of Medicine suggesting that hormonal birth control slightly increases the risk of breast cancer.  While this is new information that has not had time to be fully evaluated by the American College of OB/GYN, we recognize how scary this information sounds on its face, but also want to highlight that the study showed a very small increase risk for women in their teens, 20s and 30s.

It’s also very important to understand that birth-control, in preventing pregnancy, lowers a number of other risks associated with being pregnant, and to also take into account that birth-control pills and other hormonal birth control methods that prevent ovulation significantly decrease ovarian and uterine cancer risk. Weighing all of that information together, we do not plan to make any abrupt changes in our prescribing patterns,  and suggest that each individual patient speak with her physician about her particular risk, and make an informed decision based on balanced information.

As the attached article highlights:

That may sound scary (but) the  illness is fairly rare among women in the age group studied.
“A 20 percent increase of a very small number is still a very small number,” says Mia Gaudet, an epidemiologist with the American Cancer Society. The risk contributed by hormonal contraception, she says, is similar to the extra breast cancer risk contributed by physical inactivity, excessive weight gain in adulthood, or drinking an average of one or more alcoholic drinks per day.

As more information is revealed about the study we will let you know what we find out.

If you would like to discuss this further with your provider please make an appointment and we would be happy to discuss the best option for you.

https://www.npr.org/sections/health-shots/2017/12/06/568836583/even-low-dose-contraceptives-slightly-increase-breast-cancer-risk-study-finds

What’s The Latest On Zika?

January 6, 2017Gynecology, Obstetricsadmin

Many have our patients have expressed concern about the Zika virus outbreak which has been in the news recently. The Zika virus spreads through infected mosquitos and less commonly spreads via sexual transmission. The CDC (Center for Disease Control) issued a travel alert for people traveling to countries where Zika virus transmission is ongoing. There is currently no evidence of widespread, sustained local transmission of Zika at this time.  The CDC website www.cdc.gov will keep an updated list of countries where transmission has been confirmed.

Since little is known about Zika virus in pregnancy, but pregnancy complications have been reported, we are advising our patients to postpone travel to these areas. If travel cannot be avoided, precautions to avoid mosquito bites should be taken. These measures include using an EPA-registered bug spray with DEET, covering exposed skin, staying in air-conditioned or screened in areas and treating clothing with permethrin.

If you are pregnant and have traveled recently to an area with ongoing Zika virus transmission, please let your provider know. The most common symptoms of Zika are fever, rash, joint pain, and red eyes but many infections do not cause symptoms. The need for testing and additional fetal ultrasounds and consultation with maternal-fetal medicine specialist and possible amniocentesis will be determined for at-risk patients since the virus can affect fetal growth and development.

Until more is known, pregnant women with male sex partners who have lived in or traveled to an area with Zika virus should either use condoms or not have sex during the pregnancy.

There is currently no antiviral treatment or vaccine for the Zika virus, therefore avoiding exposure is highly recommended for our pregnant patients and those desiring pregnancy in the near future. We will continue to monitor this evolving situation and adjust recommendations as needed.

Recent guidelines were issued regarding family planning. If a woman has been diagnosed with Zika or has symptoms of Zika after possible exposure, the CDC recommends she wait at least eight weeks after her symptoms first appear before trying to get pregnant.

If a man has been diagnosed with Zika or has symptoms of the illness, he should wait at least three months from those first signs before having unprotected sex, according to the public-health agency. That longer waiting period reflects the length of time the virus has been found in semen.

The CDC and World Health Organization (WHO) have both released recommendations that women with suspected or confirmed Zika infection continue to breastfeed according to established feeding guidelines. The presence of Zika virus has been reported in breast milk, but there have been no reports of transmission to infants via breast milk.

As new guidelines emerge, we will be updating our website to reflect the ongoing changes.

What Is Non-Surgical Vaginal Rejuvenation

December 5, 2016Cosmetic Gynecologyadmin

 

What is Non-Surgical Vulvo-Vaginal Rejuvenation?

 

Many of you have been hearing the latest buzz in the media about non-surgical “vulvo-vaginal rejuvenation” so look no further to find the answers to the most popular questions about this procedure!

Due to childbirth and the natural aging process, changes occur “down there” which affect feminine wellness, both aesthetically and sexually. It’s no secret that passing a baby’s head through the vaginal canal once (or several times) permanently stretches the vaginal tissues and surrounding pelvic floor muscles, and even patients who have had C-sections after a long labor, particularly if they pushed for a while without success, can experience the same tissue damage. In addition to childbirth, aging, weight loss and natural anatomic variation can also cause an appearance of laxity of the external genitalia that can reduce self-confidence.

While these changes are natural, we are lucky to live in a time when we can choose to improve some of these natural processes to enhance our sense of well-being if we wish to. Similar to non-surgical treatments like botox, other dermatologic anti-aging treatments and covering our gray hair, taking steps to improve our sense of well-being and revive important aspects of our full lives as women is something we believe that each woman should have the right to choose for herself.

Let’s talk first about vaginal relaxation, which is something that many women experience as a challenge for their sexual well-being after childbirth, and often gets worse with age as muscles naturally weaken and blood flow and hormonal support of the tissue changes. When it comes to vaginal intercourse, stimulation for both parties is caused by friction, and friction is obviously reduced when the vaginal canal becomes more relaxed. Exercises commonly called “Kegels” which basically work out the pelvic floor muscles are highly recommended and can be quite helpful, but often do not achieve the desired results. Kegels done correctly are also quite time consuming; like working out any other muscles a good Kegel program would include 3 sets of 10-20 reps of strenuous pelvic floor contractions 3-5 times weekly, forever. Personally I have tried this (and continue to try…) and have had a difficult time remembering or frankly wanting to do it. Other than Kegels, options to improve vaginal relation include surgical vaginoplasty (surgically tightening the vagina), which is an excellent choice for women with a higher degree of relaxation (for example after 3 plus vaginal deliveries, or with medical complaints such as pelvic pressure, urinary leakage or difficulty passing stool due to pelvic prolapse), or non-surgical treatment with ThermiVa.

ThermiVa treatment uses radiofrequency energy to gently heat the tissue of the vagina and external genitalia to stimulate blood flow and collagen formation, which improves vaginal and vulvar tone over time. Each treatment takes approximately 30 minutes (20 minutes internally and 10 minutes externally) and is done in the office without any anesthesia or downtime. I have had this procedure done myself and can verify that it is not painful (just a sensation of pressure and warmth) and involves absolutely no recovery. In fact you can exercise and even have intercourse the same day. Since new collagen formation takes time, 3 treatments are recommended at 4-6 week intervals to achieve optimal results, and results last for 6-12 months, so a touch up treatment every 6-12 months is also recommended. While final results do take time, immediate improvement can be often be seen in the appearance of the external genitalia as a result of increased blood flow and tissue swelling which improves the appearance of laxity. (Immediate before and after pictures can be seen on the ThermiVa website at www.thermi.com).

Patients who might consider ThermiVa would be experiencing vaginal relaxation with intercourse and/or not like the appearance of laxity of their external genitalia, and may be as early as 8 weeks postpartum. If you have recently had surgery or a baby, as soon as you are cleared by your doctor to have intercourse then the procedure would be safe to do. It is also safe in patients who have had incontinence procedures such as slings, patients with IUDs and patients who have had hysterectomies, and in patients who plan to have more children. Even patients who have had surgical vaginoplasty can benefit from annual treatment to keep the tissues healthy. Patients who should not have the procedure include those who are pregnant, those with high degree prolapse or medical complaints that would need surgery to correct, patients with implanted electrical devices such as defibrillators, patients with an active vaginal or urinary tract infection, and patients with collagen vascular disease such as lupus. We (and probably you) also prefer not to perform the procedure during the menstrual cycle.

While many less qualified doctors offer ThermiVa we feel that this is a procedure that should only be offered by highly trained gynecologists who can make sure that it is not being used in the wrong patient and to offer alternative treatments if necessary. At CWCC patients considering ThermiVa are seen by a Board Certified Ob/Gyn Physician for an exam and consultation prior to scheduling treatment. Based on the exam, if treatment is indicated all questions will be answered by that physician and then treatment will be scheduled with one of our highly trained Women’s Health Nurse Practitioners or Physician Assistant. (Some offices have the procedure performed by a medical assistant or other non-licensed nurse; we don’t think this is best practice). Treatment is not offered the same day as the consult, which allows for minor preparation such as shaving, cleaning, and treatment of vaginal or bladder infection if necessary. Also some patients coming in for a consult are not good candidates and we will advise you not to have the procedure if we don’t believe you will get good results. We would advise patients to be wary of offices that offer this procedure without such careful pre-procedure planning, or offices that offer the procedure without an exam by a qualified physician (such as a dermatologist or plastic surgeon).

Thousands of ThermiVa procedures have been done throughout the world over the past 2 years and a great deal of data has accumulated documenting the efficacy of this procedure (for the right patient) including several studies in serious medical journals, one even documenting actual tissue change on biopsy illustrating more youthful appearing cells after ThermiVa. While we are recommending this for vaginal and vulvar relaxation, patients have also sometimes reported improved vaginal moisture, improved orgasmic function, and reduction in mild stress and urge incontinence, which are all likely functions of improved blood flow and collagen production.

Some of you may have heard of a different non-surgical vaginal treatment called MonaLisa. This is quite different and is only indicated to treat postmenopausal vaginal dryness. MonaLisa is a laser procedure that is quite painful, requires topical anesthesia, and has much more risk of complication and downtime. While it is a great option for some women who cannot take estrogen (for example breast cancer patients) it is in no way a substitute for ThermiVa, it is a totally different animal. At the current time we are not using Monalisa at CWCC as we are waiting for more date to accumulate regarding its safety and efficacy before we offer it to our patients.

ThermiVa is not covered by insurance so we know you all want to know what it costs. Treatments are only offered in a set of 3, since good results can only be expected after 3 treatments, and we want you to have good results. The exception to this is the annual touch up, or for patients who have documented having other treatments done elsewhere by another provider. If you have been treated by another provider and it has been more than 3 months, we would recommend stating over with a new set of 3 treatments since optimal results will be lost with prolonged intervals between treatments. A set of 3 treatments costs $3000.00 and single annual touch-up is $1000. The initial 30-minute consult with your physician is $100.00, and we will deduct this amount from your package if you decide to proceed after the consult. So you can expect to pay $100.00 for the initial consult and $2900 for the package. Since there is a significant investment in time and disposable parts for each procedure and for the ThermiVa machine itself, we require payment in full prior to the first procedure.

So that’s the latest on non-surgical vulvo-vaginal rejuvenation! If you have further questions or comments please email me at shs@cwcchouston.com, or to schedule a consult to ask more in person, give us a call at (713)791-9100.

 

 

If My Tubes are Tied, What Happens to the Egg?

October 23, 2016Gynecologyadmin

Several times a month patients remind me that somewhere in high school health class, a myth is perpetuated about the function of the egg in relation to the menstrual period.

Many of us are taught at an early age that each month we release an egg (this part is true), and if no conception occurs, the egg comes out with the monthly cycle (not true). This misconception leads some of us to wonder what happens to the egg if the tubes are tied, or if we have no period due to an IUD, an endometrial ablation, or a hysterectomy. In reality the egg is a single cell, visible only under a microscope. While we generally release an egg each month, the egg travels into the fallopian tube awaiting fertilization, and if no fertilization occurs the egg simply dissolves. After all it is only one cell. So if the tubes are tied or we have an IUD, the same process still occurs. The egg is produced and simply dissolves since it is not fertilized. If we have a hysterectomy the same process occurs.

The hormones which are produced as a result of egg development and ovulation (egg release) usually cause the lining of the uterus to grow in preparation for pregnancy, and if fertilization does not occur the lining sheds. What we see coming out as menstrual bleeding is a combination of blood and uterine lining, not the egg itself. If we have had a procedure such as an endometrial ablation to get rid of the lining, have an IUD which reduces the formation of lining, or have had a hysterectomy, the hormonal signal from the ovaries will not be successful at causing lining to grow. The egg is still being released, the hormonal signal is still going out, but the uterine lining simply does not grow, so we don’t see bleeding. The egg is still being produced and is dissolving every month without coming out, as it usually does.

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.

Isn’t it bad not to have a period on birth control pills after endometrial ablation? Don’t we have to have a period to stay healthy?

October 18, 2016Gynecologyadmin

A period happens when our body sheds the lining that was prepared to accept a pregnancy, when pregnancy does not occur. After we ovulate (release an egg) the uterine lining grows ready to accept an embryo, and if no pregnancy occurs then the lining sheds and the cycle repeats again.  When we are on birth control pills we do not release eggs, so this process is halted.

On birth control pills we don’t really have a true period, but we do bleed during intervals when we stop taking the active pills (most pills have a 4-7 day pill free interval at the end of the pack allowing our hormone levels to drop and the lining will shed).  Sometimes the lining gets so thin on pills that there is no lining there to shed and no bleeding occurs during the pill free interval. This is perfectly healthy. When the pills are stopped for a few weeks, the lining will come back as we start to release eggs again.

Some pills are packaged with no pill-free interval, so we don’t have a period at all. That is fine as well, since over time the lining gets very thin and there is simply nothing there. In comparison, if we are not on the pill, not having a period means there is something wrong with our hormones that is preventing ovulation.  But when we are on the pill, not having a cycle is great. Similarly after endometrial ablation we may not have periods at all, since the lining is destroyed permanently and hopefully will never grow back even though our hormones are still normal.

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.

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