UNDERSTANDING THE DIFFERENT TYPES OF HYSTERECTOMY

This article will hopefully explain to patients the different ways a hysterectomy can be performed by the gynecologist. I have been performing hysterectomies as well as laparoscopies for 36 years in private practice and this operation is the ultimate melding of the two procedures. Hysterectomies have been performed for many decades, mostly abdominally and vaginally. I was trained back in the 1970’s, but over the last few years, the laparoscopic approach added more choices for the surgeon and the patient. The different types of hysterectomies (with or without the removal of the ovaries) being done today are as follows:

Total Abdominal Hysterectomy: This type of hysterectomy is performed with a large incision, laparotomy with usually a 2-3 day stay in the hospital.

Total Vaginal Hysterectomy (VH): This type of hysterectomy is performed completely vaginally with no visible incisions and requires a 1-2 day stay. It is considered one of the minimally invasive hysterectomies.

Laparoscopic Assisted Vaginal Hysterectomy (LAVH): This hysterectomy is performed vaginally with laparoscopic assistance and usually requires a 2 day stay. This procedure is minimally invasive surgery. This surgical procedure designed initially to convert a difficult hysterectomy perhaps done abdominally into a safer and easier vaginal hysterectomy. Most of the operation is done initially through the laparoscope down to the cervix and then the rest of the operation completed vaginally. I performed this operation for many years before advancing on to total laparoscopic procedures below.

Laparoscopic Supracervical Hysterectomy (LSH or LSCH): This hysterectomy is performed laparoscopically only with just the removal of the body of the uterus and leaving the cervix behind. It is minimally invasive surgery. The uterus is morcellated through the laparoscope or can be pulled out through an abdominal incision. Unfortunately, the FDA has placed a warning on the use of the morcellator, so this operation has not been performed very much lately.

Total Laparoscopic Hysterectomy (TLH or LTH)
Straight Stick: This hysterectomy involves the complete removal of the uterus via laparoscopic surgery. The hospital stay is one night. All of the surgery is done laparoscopically with the surgeon manually manipulating the laparoscopic instruments while standing at the operating table. This procedure is considered a minimally invasive hysterectomy, TLH or LTH. It is one of the newest and ultimate ways to perform a total hysterectomy with shorter hospital stay and return to normal activity. It required my extending my training further up the ladder to be able to perform this operation. I performed these for a few years until moving on to the next procedure. I still perform some of these.

Robotic Assisted or da Vinci Total Laparoscopic Hysterectomy: This procedure of hysterectomy is the one I mostly do today. It required further training for me, going beyond my experience doing “straight stick” total laparoscopic hysterectomies. This procedure has become the ultimate procedure of hysterectomy for me and some gynecologic surgeons. It requires a one night stay in hospital and uses very small laparoscopic incisions. I like this procedure for a lot of reasons, but the main one is that I get to operate in 3D and see the operating field some much clearer.

I will close this article by adding one other little new addition to the hysterectomy. Most of the gynecologists are now removing the tubes completely with the knowledge that perhaps as many as 70% of the ovarian cancers may originate in the distal tube. Also, the type of hysterectomy to be performed depends on many variables including the patient’s physical findings and desires as well as the doctor’s training and recommendations for what’s best and safest for the patient. Not all patients are good candidates for vaginal hysterectomy, LAVH, LSCH, or TLH. I hope this has been informative.

JimMcBride, MD

Minimally Invasive Surgery (MIS)?

What are the two different types of minimally invasive surgery in Gynecology?

1.Laparoscopes: used in the belly for laparoscopic surgery. This type of surgery can be used to remove the uterus, to excise ovarian tumors or cysts, remove uterine fibroids, perform tubal occlusion or even reunite interrupted tubes, among several other procedures.
2. Hysteroscopes: used in the uterus and vagina for hysteroscopic surgery. Can be used to remove abnormal growths inside the uterus, or to do a number of different procedures on the uterus and vagina.

What is Minimally Invasive Surgery (MIS)?

Minimally Invasive Surgery is a type of surgery that uses special tools that are designed to decrease the size of incisions and reduce how much the body´s tissues get damaged. It involves the use of a “scope”, a viewing device that allows surgeons to look inside the body without opening it up all the way. The scope consists of a thin tube with a tiny camera and a light on the end. The camera sends pictures of the inside of the body to a TV screen. When doing MIS, the scope is usually placed through a 5-10mm incision inside the umbilicus, and also 2 or 3 more incisions are made on either side of the abdominal wall to introduce laparoscopic operating instruments like clamps, scissors, and stitching devices. While looking at the picture on the screen, the surgeon uses those tools to do the operation.

A Stress-Free Heart is a Healthy Heart

Stress.  We have all felt it at one time or another, but many people feel stress too often. Some even feel it as part of their daily lives. Stress can contribute to numerous conditions like heart disease, stroke, immune disorders, gastrointestinal problems, eating problems, sleep disturbances and sexual problems. Learning to reduce your stress can help you live a happier, healthier and maybe even longer life.

Mental Health America offers the following tips for reducing or controlling stress:

Set realistic goals— Do not take on everything and learn to say no. If you feel overwhelmed, try eliminating an activity that is not absolutely necessary. Ask yourself, “What really needs to be done? Is the deadline realistic?” No one is perfect, so don’t expect perfection from yourself or others. And ask for help if you need it.

Set aside time to meditate— It only takes about 10-20 minutes to benefit from meditating. These few moments of quiet reflection may bring relief from stress, as well as increase your tolerance to it. It is simple to do: sit quietly, listen to peaceful music, relax and try to think of pleasant things or completely clear your mind of all thoughts.

Slow down— When you start to feel overwhelmed, try taking one task at a time. Make a list of things you need to do and prioritize the items. Once you have tackled something, mark it off the list. This can bring about feelings of accomplishment and confidence.

Be active— Regular exercise is a great way to reduce stress, and it benefits both the body and the mind.

Find a hobby— What do you love to do? By setting aside time for your favorite hobby, you will remove yourself from life’s stressors. Whether it is trying out a new recipe, planting in your garden, or playing pool, you will be giving your brain a welcome break.

Learn to be more flexible— You don’t always have to be right. By being flexible when issues come up, it will be easier to find the middle ground. If you feel strongly you have the best solution, discuss your point of view in a respectful way and take the time to listen to other people’s perspectives.

Let go of perfection— When you expect too much from yourself or others, you may end up feeling frustrated, let down and disappointed. Remember that each person, including you, has shortcomings. But remember that you also have beautiful qualities to share with the world.

How to Turn Prediabetes into No Diabetes

If you have been diagnosed with prediabetes, it is important to understand what that means. Simply put, it means you have an elevated blood sugar, but you don’t qualify for a diagnosis yet. And if you take measures to change your life, you may never have to be diagnosed. According to WebMD, there are 7 steps anyone with prediabetes should take now:

1. Exercise. This doesn’t mean exercising two hours a day every day. It simply means become a more active person. Walk the dog twice a day, walk with friends, take a yoga class, etc. Physical activity lowers blood glucose levels and reduces body fat.
2. Lose a few pounds. Losing just a small amount of weight can make a huge difference. The Diabetes Prevention Trial found people who were prediabetes and lost 5 to 7 percent of their body weight would lower their odds for a diabetes diagnosis by 58 percent. To put this in perspective, if you weigh 200 pounds, to reach 5 percent weight loss would mean losing 10 pounds, which would lower your risk.
3. Visit your Doctor Regularly. Regular check-ups will help you keep focused on the goal of lowering your diabetes risk.
4. Eat Healthy. This doesn’t have to be rocket science. There is no magic trick to eating better. Eat lots of fruits and vegetables, ditch the junk food, raise your fiber intake and choose whole grains over processed grains. Don’t forget to cut the high-calorie surgery drinks as well.
5. Have a Support System. Changing your lifestyle isn’t easy. It is helpful to have a friend or family member who is committed to exercising with you.  You can also join groups in your community that all have the same goal of achieving a healthier way of life.
6. Get some Sleep.  Not getting enough sleep will make losing weight difficult because it increases stress hormones in your body that, in turn, cause the body to store fat.
7. Get Your Mind Right.  A positive attitude will be the factor that tips the diabetes scale in your favor. Try your hardest every day to stick to your plan, but know that everyone is going to slip up. So don’t dwell on it, and try better tomorrow!

Make sure you speak with your physician about the steps you are going to take to keep diabetes at bay. It will be good to have your doctor on board with your new lifestyle, and he/she will provide support and guidance.

http://www.womanshealthgroup.com

Prostate-Specific Antigen (PSA) Test

1. Normal PSA

   • For most men who are healthy, doctors consider the normal PSA level to be under 4 nanograms per milliliter (ng/mL), but there is no specific normal level.

   Abnormal PSA

   • Most doctors consider a PSA level above 4 ng/mL to be an elevated reading. A man who has an elevated PSA level should talk to his doctor about what other tests might be appropriate.

   Causes for Elevated PSA

   • Since the PSA can indicate diseases in the body, doctors refer to it as a biological marker or a tumor marker. The causes for an elevated PSA level can include prostate cancer, benign prostate enlargement, inflammation, infection, age or race.

   PSA False Positives

   • The PSA blood test can reveal elevated PSA levels, even when no cancer is present. The National Cancer Institute reports that only 25 to 35 percent of the men who had a biopsy following an elevated PSA level had prostate cancer.

   PSA False Negatives

   • It is possible for a man to get a normal reading in a PSA blood test and still have cancer present in the body. Prostate cancer usually grows slowly and can exist for some time before symptoms are evident.

   PSA Testing

   • Prostate cancer screening is recommended by the American Urological Society, the American Cancer Society and the American College of Physicians for men over the age of 50. For men who are considered to be at high risk (black men or men with a family history of prostate cancer), it is recommended that testing start between the ages of 40 to 45.

 http://www.ehow.com/facts_5104428_normal-psa-level.html?ref=Track2&utm_source=ask

LUPUS

Lupus is a chronic autoimmune disease that ravages different parts of the body.An estimated 1.5 million Americans and at least 5 million people worldwide have  lupus.

No two cases of lupus are alike. Common symptoms include joint pain, skin rashes, overwhelming fatigue and fevers that last for days or weeks. Most people with lupus don’t look sick

Lupus can impact any organ or tissue, from the skin or joints to the heart or kidneys. Two leading causes of serious illness and death from lupus are kidney disease and heart disease.

Lupus usually develops between ages 15 and 44 and it lasts a lifetime. It can strike anyone, but 90 percent of the people living with lupus are females. Men, children and teenagers develop lupus too.

While the causes of lupus are unknown, scientists believe hormones, genetics (heredity) and environmental factors are involved—more research is needed to better understand the role of these factors in people with lupus.

Lupus can be difficult to diagnose. There is NO single blood test to diagnose lupus, and its symptoms mimic those of other diseases, vary in intensity and can come and go over time. More than half of those afflicted with lupus suffered at least four years, and saw three or more doctors before obtaining a correct diagnosis of lupus.

http://www.lupus.org/webmodules/webarticlesnet/articlefiles/5013-LAM_FactSheet.pdf

What is infertility?

Infertility means not being able to get pregnant after one year of trying. Or, six months, if a woman is 35 years of age or older. Women who can get pregnant but are unable to stay pregnant may also be infertile.Pregnancy is the result of a process that has many steps. To get pregnant— A woman’s body must release an egg from one of her ovaries (ovulation). The egg must go through a fallopian tube toward the uterus (womb). A man’s sperm must join with (fertilize) the egg along the way. The fertilized egg must attach to the inside of the uterus (implantation). What causes infertility in women? Most cases of female infertility are caused by problems with ovulation. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods. What things increase a woman’s risk of infertility? Many things can change a woman’s ability to have a baby. These include— Age Smoking Excess alcohol use Stress Poor diet Athletic training Being overweight or underweight Sexually transmitted infections (STIs) Health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency information obtained from: http://www.cdc.gov/reproductivehealth/Infertility/

What is infertility?

Infertility means not being able to get pregnant after one year of trying. Or, six months, if a woman is 35 years of age or older. Women who can get pregnant but are unable to stay pregnant may also be infertile.

Pregnancy is the result of a process that has many steps. To get pregnant—A woman’s body must release an egg from one of her ovaries (ovulation).

• The egg must go through a fallopian tube toward the uterus (womb).
• A man’s sperm must join with (fertilize) the egg along the way.
• The fertilized egg must attach to the inside of the uterus (implantation).
• What causes infertility in women?
• Most cases of female infertility are caused by problems with ovulation. Without ovulation, there are no eggs to be fertilized. Some signs that a woman is not ovulating normally include irregular or absent menstrual periods.

What things increase a woman’s risk of infertility?

Many things can change a woman’s ability to have a baby. These include—

• Age
• Smoking
• Excess alcohol use
• Stress
• Poor diet
• Athletic training
• Being overweight or underweight
• Sexually transmitted infections (STIs)
• Health problems that cause hormonal changes, such as polycystic ovarian syndrome and primary ovarian insufficiency

http://www.cdc.gov/reproductivehealth/Infertility/

Colon cancer is one of the few cancers that most of the time can be prevented. Several screening tests can diagnose precancerous polyps and remove them before they turn into cancer.   A simple stool test done in your doctor’s office once a year starting at age 40 can test for blood in the stool.  At age 50 every woman should have a colonoscopy.  Early stages of colon cancer don’t usually have symptoms.  Later symptoms may include bleeding from the rectum or blood in your stool, change in bowel habits, stools that are more narrow than usual, and weight loss for no apparent reason. You may be at risk if you are over 50, smoke, overweight or obese, not physically active, drink alcohol in excess, eat lots of red meat, or have a family history of colon cancer.

Although this is a leading cause of cancer death for both men and women, if detected early, colon cancer can be more easily and successfully treated.   Prevention is as easy as being physically active for at least 30 minutes five days a week. Don’t smoke or have more than one alcohol drink per day. Eat a diet high in fruits, vegetables, and whole grains and maintain a healthy weight.

If you are at average risk, start getting screened at age 50.  If you are high risk start your regular screening earlier.  The best time to get screened is before you have any symptoms.

For more information please visit :                                             http://preventcancer.org/prevention/preventable-cancers/colorectal-cancer/