Sunday, November 7, 2010

How do you do it all?

How do you do it all?
This is a question I commonly get from patients when we’re kibitzing about our personal lives. Occasionally, when someone finds out that I have a busy life at home with 3 kids (ages 7, 5 and 4 as well as an 18 year old step-daughter), a husband that runs his own business, one cat (although I never change the litter- still going with the excuse that is not good for me ever since I was pregnant), and one puppy MJ that’s 9 months old, they ask me how I can do all of that at home and still work full time as a doctor. Of course, this question truly is a compliment and makes me feel like Superwoman.
Seriously,its taken ten years in private practice and seven years of being a Mom until I finally got in a groove this year. My secret is that I don’t even come close to doing it all myself. I grew up in a family of teachers. My mother, father, sister and brother are all teachers. Growing up in our house we lived frugally and watched every penny. My mom had a large garden and cooked dinner every night from home. In fact, I probably remember the few times we ever went to a restaurant. We went to Taco Bell when I made my 8th grade Confirmation and went to Beni Hana when I came in 4th in the city spelling bee. My dad did all the projects and fixing of things around the house himself. What I’m trying to get at here is that all the work that goes into raising a family and maintaining a house was done by my parents. I attempted to follow in their footsteps when I started my own family. Actually, I really didn’t have much of a choice initially because I had so much debt from student loans. So for the first few years of being a working mother, I did everything myself: shopping, laundry, dinners, cleaning. My husband did his share of the work as well. As our debt decreased and our bank account and family grew, we were able to get more help around the house.
Finally, this year I feel like I’m just now starting to get it together. I have a great “nanager” which is a nanny and house manager. She does all the stuff that I don’t want to do, which in my case is pretty much anything domestic: cleaning, dishes, laundry, litter box cleaning, grocery shopping, cooking, and organizing my house. I’m really blessed to have found someone that can take great care of my children, house and pets.
Certainly, this story would not be complete without mentioning what an amazing husband I have!!! And I’m not just writing this so I can still have my nanager that I lobbied, begged and pleaded and asked for for many years. My husband also grew up knowing the value of a dollar and initially he had a hard time paying for something that both our parents did themselves . Anyway, Kevin or Casey (we both have name issues- but that’s another story) does at least 50% if not more of the parental duties. He regularly does the morning shift and gets the kids dressed, fed and driven to school. Now granted, my kids are usually in tears after the constant reprimanding and threats and are most often tardy, but he gets them to school almost every day. This allows me to just take care of me in the morning before I’m off to work. I’ve learned that if I don’t get my exercise in before I go to the office, then it doesn’t happen. So I usually work out in my basement first thing in the morning. My latest motivator has been P90X and Insanity DVDs.
Kevin also is the one who stays home with the kids should an illness or inclement weather interrupt our daily plans. He also meets up with the “nanager” on days that I am on call and spend the night in the hospital. On those special evenings when Mom doesn’t come home, Dad usually gives the kids a special treat of pizza at Cici’s pizza and allows at least one of our offspring to sleep in my spot. However, lately by the time the alarm clock goes off, our bed is filled with 3 kids, a dog AND a cat. And I wonder why I’m always tired!
H owever, even with all these “helpers”, I still manage to screw up quite often, both at home and at work. There have been a few times where one of my children missed a birthday party because I just forgot, was in tears because Mom forgot to send them in pajamas on “breakfast at school day” . As it relates to my job, I have gone to the wrong office in the morning and started my day off being an hour behind schedule. Another perfect example of my craziness, is how I have just dropped the ball trying to keep up with this blog. You can tell from the date of my last post and this one. The whole back to school thing just sent me over the edge.
So thank you to all of you kind ladies for just suggesting that what I do is impressive, because many days I feel quite overwhelmed and just trying to make it.

Saturday, April 24, 2010

Why can't I get pregnant

Most women spend many years of their life trying NOT to get pregnant and then a fair amount of them won't be able to conceive when they want. Don't tell my mom, but this is what happened to me. I'm not the most patient person, so when I wanted to have a baby at age 34, I wanted to conceive the first time I had sex with my husband. I was certain this would happen- afterall, I'm a Gynecologist. I know all the tricks! As you can probably guess, this didn't happen to me!! SOOOOOOOOOOOOOOOOO frustrating!!!! Especially when I do this job- with pregnant women and babies and talking about getting pregnant is what I do all day long. Even my husband and family members would tell me, "try not to think about it.... it will happen in time." Yeah right- easier said than done.

Certainly, I'm not alone in feeling this way . This is a common condition as 15 percent of the couples in the United States who are trying to conceive are not able to do so.

So, the big questions raised is why? The following is a general overview of the tests that I usually order when a patient comes to see me for infertility.

EVALUATION OF INFERTILITY IN MEN — A healthcare provider (not me ! I don't do men anymore- usually the family practitioner) usually begins with a medical history and physical of the the dad to be. I WILL give the father to be an order for a semen analysis and a specimen cup. . A man should avoid sex and masturbation for two to seven days ( do you think its possible?) before providing the semen sample. Ideally, a sample should be collected in a clinician's office after masturbation (yes, they have special rooms with magazines and movies to help ; if this is not possible, the man may be allowed to collect a sample at home in a sterile laboratory container. The sample should be delivered to the lab (usually University Pointe in West Chester) within one hour of collection. The cost of this test is about $65
If the initial semen analysis is abnormal, I will often request an additional sample; this is best done one to two weeks later.


Medical history — A woman's past health and medical history may provide some clues about the cause of infertility. I will ask about childhood development; sexual development during puberty; sexual history; illnesses and infections; surgeries; medications used; exposure to certain environmental agents (alcohol, radiation, steroids, chemotherapy, and toxic chemicals); and any previous fertility evaluations.

Physical examination — A physical examination usually includes a general examination, with special attention to any signs of hormone deficiency or signs of other conditions that might impair fertility. I will also perform a pelvic examination, which can identify abnormalities of the reproductive tract and signs of low hormone levels.

Blood tests — Blood tests can provide information about the levels of several hormones that play a role in female These hormones include follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin.

Tests to evaluate ovulation — Ovulation (the release of an egg from an ovary) is essential for fertility. Abnormalities of ovulation can often be determined from a woman's menstrual history or hormone levels such LH or progesterone

Menstrual history — Amenorrhea (absent menstrual periods) usually signals an absence of ovulation, which can cause infertility. Irregular menstrual cycles can be a sign of irregular ovulation.

Basal body temperature — Monitoring of basal body temperature (measured before getting out of bed in the morning A woman's temperature usually rises by 0.5ºF to 1.0ºF after ovulation.
Hormone levels — Levels of luteinizing hormone (LH) rise abruptly approximately 38 hours before ovulation. This hormone surge can be detected using an over-the-counter home urine test. However, this kit fails to detect the hormone surge about 15 percent of the time. Therefore, sometimes I may recommend a blood test to confirm ovulation- the progesterone test.

Tests to evaluate the uterus and fallopian tubes — Uterine abnormalities that can contribute to infertility include congenital (present from birth) structural abnormalities, such as a uterine septum, fibroids and uterine polyps.

Scarring of the fallopian tubes can occur due to pelvic inflammatory disease, endometriosis or scar tissue from prior infections or surgery.

Hysterosalpingogram — Hysterosalpingogram (HSG) is used to help identify structural abnormalities of the uterus and fallopian tubes. It involves inserting a small catheter through the cervix and into the uterus. A liquid dye is injected through the catheter, which fills the uterus and fallopian tubes. An x-ray is taken after the dye is injected, which shows the outline of the uterus and tubes . An abnormally shaped uterus or blocked fallopian tube would be visible on the x-ray. I always tell patients that this test hurts- it's quick, but it hurts.

Pelvic ultrasound — This is used to measure the size and shape of the uterus and ovaries, and to determine if there are structural abnormalities (such as fibroids or ovarian cysts). If abnormalities are seen, further testing may be needed.

Laparoscopy — During laparoscopy, a thin, lighted tube is inserted through a small incision in the abdomen while the patient is asleep under anesthesia. . Laparoscopy allows me to detect damage and obstruction of the fallopian tubes, endometriosis, and other abnormalities of the pelvic structures. This is the best test for diagnosis of endometriosis or pelvic adhesions (scarring). Furthermore, endometriosis can be treated during laparoscopy, which can help to improve pregnancy rates. However, laparoscopy is not routinely done during an evaluation of infertility.

EMOTIONAL SUPPORT DURING INFERTILITY EVALUATION — The process of trying to become pregnant and the inability to do so can lead to a variety of emotions, including anxiety, depression, anger, shame, and guilt. I personally became obscessed with trying to get pregnant. It takes over all your thoughts!! Some experts suggest relaxation techniques, stress-management, coping skills training, and group support. Those options are great but what I've found is that patients and myself feel so much better when we (patient and doctor) are DOING something to help speed up this process. Because, in my experience the best way to make this all well and good is to get pregnant!!!!!


Thursday, March 25, 2010

What to Do About Heavy Bleeding???

Do you miss work or limit your activities because of your periods?
Do you ever soak through your clothes? (see entry #2- I know I have and even had my male partners tell me I have blood on my clothes. UGH! )
Do you stay close to a bathroom during your periods? (well, I stay close to the bathroom all the time :)
Does bleeding limit your intimate time with your partner? (I wish that was my only excuse)
Do you need to take iron to keep from becoming anemic?

It is not normal to have your menstrual periods control your life!! There's too many contenders for that positon- kids, husband, job- you get my drift. Heavy menstrual bleeding (menorrhagia) is a common problem for women. The worst cases of excessive menstrual bleeding can cause severe anemia and even require blood transfusions.

When you know all your options up front you can make a more informed decision about which is right for you. Here's just a general overview of what I can do to treat your heavy bleeding but we'll have to talk about the specifics for your medical history, age and future plans for childbirth. And certainly, we may need to do some tests first (like an ultrasound) to see which option is best for YOU. Several factors will be important to your decision, including whether or not you plan to have children in the future and whether you want ongoing therapy or a one time treatment.

So here's a list of some options to fix this common problem:

1. Medicines: The simplest treatment is the use of hormones such as birth control pills or progesterone pills. Most bleeding caused by hormone imbalance can be treated with medications. However, many women are unable to use this option due to side effects or other medical problems. Also, some women simply just don't want to take a birth control pills.
Some prescription "cousins" of ibuprofen may decrease heavy flow, but may lengthen the time of bleeding.

2 Progesterone IUD: The Mirena® progesterone IUD (
may decrease bleeding. This IUD was recently FDA approved for the treatment of heavy bleeding. Prior to this FDA approval, physicians were just using it "off-label" for menorrhagia. It can, however, cause irregular bleeding and occasionally have some other side effects of moodiness, acne, and pain .It is a good option for women that want to conceive in the future as you can become pregnant within 1 month of its removal.

3. Endometrial ablation: Endometrial ablation is a quick (about 2 minutes) office procedure, that will usually eliminate or greatly decrease bleeding. After the procedure, over 95% of women will be satisfied with the results. Approximately 60-70% will no longer have any more periods. Another 20-30% will have very light periods only using a pantiliner throughout the period. Approximately 10% will fail the procedure and choose to manage bleeding as they have been doing, use hormones to control bleeding or opt for other surgical treatments.
It is also very important to understand that you should not become pregnant after an ablation.

4.Hysterectomy: This is the only procedure that guarantees permanent elimination of any bleeding. In my opinion, itt usually makes sense to consider less invasive alternatives before having major surgery. A hysterectomy is the removal of the uterus and cervix but not necessarily the removal of the ovaries. When a hysterectomy is the best option for you, I want you to have the LEAST invasive- which means FASTEST recovery- option. So then you can get back what's more important- family, friends and job. Who has 6 weeks to recover from a sugery these days? Laparoscopic hysterectomy ( is the most common way that I choose to remove a patient's uterus and cervix. This surgery usually takes 45-60 minutes to perform and you would stay in the hospital for 10-23 hours.Most patients are back to work in 2 weeks sometimes even sooner.

Hope this overview helps, but come talk to me about your specific situation and we'll talk about what's the best for YOU!

For more reading, here's a reputable website

Saturday, March 20, 2010

Are You Nervous Going to the Gynecologist?

Have you ever gone to your Gyno and then while you were waiting to see her, you realized you forgot to shave your legs? Or forgot to trim things up "down there"? Have you ever gone to the doctor after a workout or at the end of the day when that fresh feeling has left? Or the worst one yet- you were bleeding? What is she going to say about how much weight was gained since last year? OMG! You are wondering.- what is the doctor going to think? Will she assume you're unkempt and unsanitary?

Are you kidding? At least this gynecologist has her own personal hygiene and bodily functions to worry about.

It's not an uncommon morning for me to slug down a few cups of coffee, get ready for work, make breakfast, kiss my kids goodbye about 3 times each, and then before I'm out the door- dash upstairs to brush my teeth and then dribble toothpaste on my outfit. No prob. I'll just wash it off with a washcloth- only to get to the office and realize it didn't quite come out. How unprofessional!

Or then there's the time when I was pregnant and nauseated and had to deliver a baby in the middle of the night. ie empty stomach. After the baby was born, I had to run and vomit in the trash can. I felt so bad. What kind of Obstetrician gets sick at the sight of a placenta and blood? Of course, there's another story I have relating to my vomit and that's when I threw up on myself in the car on the way to work- pregnancy #1 that was.

Its a good thing my patients don't know the real reason why I often wear scrubs to the office. Sure, many times its because I'm doing an in office procedure , but lately its because I've gained a few pounds and most of my clothes don't fit.

I've also been in the office with that white coat on and had one of my male partners, Dr.Silver, to be exact, tell me that I had blood on my lab coat. He just assumed I must have sat in blood after a procedure or something. I just let him go on believing this while I whispered to my nurse what really happened and how she would be a lifesaver and find me a new pair of scrubs and lab coat. I need to get that endometrial ablation myself!!!

I used to have a partner, Dr. Freeman, now retired , who liked to tell a lot of jokes. This is not a good thing to do in the office setting to a woman who has had 3 kids and poor bladder control. Now I've got that problem taken care of- so laughing is now permitted in my office.

So- the moral of my story is: in case you are worried what I am going to think about your unwanted hair, added pounds or menstual blood, rest assured. I've been there, done that. I'm a woman just like you. So don't worry, I'm not thinking about those things, I'm thinking about what I need to do to take care of you and your health.

what makes you wanna do this job?

Many times when I am doing a pap smear or a pelvic exam, a patient will ask me: "What made you ever want to go into this field?" Well, I thought this would be a good way to open up in my first blog. So- here's a few of the reasons why I decided to become a Obstetrician/Gynecologist

1. Bringing babies into the world is absolutely amazing!!!! There is nothing like it in the entire world and in my job, I get to be a part of it. It is such an intimate moment in a family. I love it!!!

2. I love taking care of women. I feel like I can relate- after all, I'm a woman and unfortunately- or fortunately - I've had many of the "female medical problems myself"- such as painful, heavy periods, PMS, infertility, polycystic ovarian syndrome, gestational diabetes, abnormal mammogram and a breast biopsy. More of that stuff later........

3. I enjoy the continuity of care that being an Ob/Gyn affords. It's great to take care of a woman for her yearly exams, then see her through a few pregnancies and watch her and her family develop. I love being there for her as her doctor and the lasting relationships this leads to.

4. I like to do Gyn surgery. And in womens health- it is such an exciting time to be a gyn surgeon. There are so many new surgical instruments and ways to do things to ensure my patients a better outcome and quicker recovery. I really pride myself on staying current in what's going on in the gyn surgery field.

5.Procedures are fun. Not just surgeries, but excising a painful abscess (its kinda satisfying like squeezing a big zit. Gross- I know) LEEPs, IUD insertions, polyp removals, and endometrial biopsies.

6. I love to teach. When I was a college student, I couldn't decide if I should be a high school biology teacher or a doctor. Obviously, you know what I chose. But now I get to do both. Not only do I get to inform women about all the stuff I learn to keep them healthy, but now I have started teaching other doctors. Often I have other doctors watch me do certain procedures or I go to their place and help them with their first cases. I also do speaking engagements for physicians. I am also going to get back to teaching medical students and residents (I used to do this before I had kids)

But the main reason why I just love my job- I feel that I am making a difference in women's lives..... Hopefully, with this blog, I can make an impact in yours too.