Happy Mother's Day

I hope everyone had a memorable Mother’s Day, spent with those who mean the most to you. I was fortunate to spend the day not only with my children, but my mother as well. I had some quiet introspective time after opening the gift my daughter Taylor made for me – after I wiped away my tears.

This was certainly not my first Mother’s Day, and it was not spent doing anything out of the ordinary, just spending time with the woman I call mom and the children who call me mom. Perhaps because of the significant changes I am making to my career path this year seemed extra special to me. I have spent much time contemplating the balance of my life recently.

My career as on Ob/Gyn is what defines me. I devoted a significant portion of my life becoming the doctor I am today. I love what I do and am proud that my continuing education keeps me on the cutting edge as a physician. Taking care of a girl from her late teens as she grows into womanhood, through pre-conceptual counseling, pregnancy, labor and delivery, eventually into menopause and beyond is such an amazing, personal bond that I treasure. There is nothing quite like helping someone become a mom. Giving up Obstetrics still pulls at my heartstrings, but helping someone become a mom isn’t limited to labor and delivery. Preparing a woman preconception, successfully overcoming her infertility and seeing the new mom with her newborn at her postpartum checkup are equally important.

I may be defined by my profession, but being Taylor, Avery and Andrew’s mom is who I am. I may change the direction of my career, but nothing will ever alter the plain, simple fact that I am and always will be their mother. Although as they enter their teens, they may try to disclaim me as a liability to their popularity, I will always, always be there. For the time being, while they are small, I am still their go-to person, their buddy and I treasure every moment. Being their mom makes it all worth it.

Fun in the Sun with Pirates and Princesses

My hardworking husband scored a free trip to Disney for the family so that is how we are spending our Spring Break. I am totally loving spending time with Casey and the kids in such a fun venue! The sunny 85 degree weather is pretty amazing too. Sitting down here poolside is so calming, especially right now when I am being pulled in so many directions gearing up to open my solo practice. I admit I do feel guilty about getting away when there is so much to be done before July 1st, but I will return focused and ready to get right back to work.

I wish I could bottle up some of this serenity and bring it home with me. In fact I already have found my own little bit of Feng Shui to add to my new office environment. We all know how bringing the oriental art of elemental balance into your life creates harmonious vibes as well as the effect pheromones have on our general feeling of wellbeing.

Time for a quick show of hands - who’s been to Disney recently? It’s ok you can admit it, I love it here too! When you were here, did you notice how different attractions had their own unique aroma? The Main Street Confectionary has a melt in your mouth caramel apple fragrance, while the Old Key West Resort has a glorious Island Breeze drifting through. My kids’ favorite is the “A Bug’s Life” theatre’s stinkbug scent. Seriously. It smells like a stinkbug.

I am going to incorporate scent into my office space. Sorry no stinkbug scent in the office, you have to go to Disney for that one. I’m torn between creating my own signature scent that you would come to associate with my office or changing scents to embody the current season. Spring flowers, Ocean Breezes, Caramel Apple and Evergreen for example. What do you think? I would love for you to leave a comment with your thoughts.

Disney World aficionados know that every Disney employee right down to the ticket tearers and teens who scrape gum are so genuine and pleasant. They are known for their total package of customer service and although I probably won’t need anyone tearing tickets or scraping gum in my office, I do want my staff to provide that same level of quality service.

Ouch! Just came back down to reality with a hard thud! We couldn’t make the meal plan that came with the trip work for us so we are buying our meals. I feel like such a mean mom telling the kids “No” and then “No, you can’t have that either” “Or that”. Oh the whining is not encouraging my Feng Shui.

To (O)B or not to (O)B, that is the Question...

Shakespeare said “To (O)B or not to (O)B, that is the question”…

…and it is not an easily answered question. I love obstetrics; it has been so personally rewarding! There is nothing more amazing than delivering a baby and being part of such a special moment in a family. Even after 15 years of practicing Obstetrics, it still just amazes me how we can grow a human inside us in less than a year.

However, after much deliberation, I have decided to specialize in my new practice on gynecology, gyn surgery and bioidentical hormones and supplements. This was not a decision I arrived at quickly. I will miss the OB part but I just couldn't figure out how to make it work in my future solo practice. No one wants to spend a long time waiting for the doctor, myself included! It's annoying and I don't want to be "that" doctor. There doesn't seem to be a good way to do deliveries in a solo practice without having to reschedule hours of patients when I would leave to do a delivery and that isn't how I want it to be.

I am sad about giving up Ob, but my true passion lies in teaching, gynecology and minimally invasive gynecological surgery. Medical advances and technology breakthroughs occur with such speed, especially in women’s health, and I pride myself with staying on the cutting edge of new research. I believe that in today's rapid advancement of surgical techniques, it requires all of my focus to be a leading surgeon. There is so much new information every day about hormones, new devices to improve patients outcome with procedures, and things I can do to help my patients feel better and lead a healthier life. Taking this path is a major career change for me and I am anxious about it. Starting a business is never easy and I am so nervous about the response to my new direction. I have a vision of how I want my practice to be: warm, inviting, and personal. It will be focused on a more holistic approach to women's health and needs.
At the risk of sounding repetitive, as a woman I understand all too well many of the problems women are faced with from
my own personal experiences and I want to really be more able to incorporate that understanding into patient care.

To be perfectly honest, another part of this decision lies in my wish to be the best mom and wife I can be. It has been difficult covering the entire hospital and call for 11 doctors. I can't provide the care I want to give my patients and I wasn't really doing a good job at home either. I have two daughters, a son and a step daughter who give me a very busy (actually crazy) family life. Having to stay in the hospital for 36 hours straight several times a month and having lots of evening meetings with my partners AND trying to keep up with continuing education courses and traveling the country
teaching other doctors didn't leave much time for my family. I hope to soon correct that void I've given to my family (and my patients) Even with offering the early morning, evening and Saturday appointment times, I will gain considerable time with my family which is priceless.

Having done Obstetrics in the Cincinnati area for 15 years I have cultivated relationships with other Ob's who have a
myriad of backgrounds and different methods of approaching patient care. My patients are not just a number to me, I feel
a personal connection with each one. I will be providing pre-conceptual counseling and first trimester care. During that
time, we will discuss which nearby Ob would be the best for you personally. I will look forward to seeing you again
postpartum, hearing your birth story and meeting your new arrival.

My New Practice, An Enduring Dream

A New Practice, an Enduring Dream
I hope 2011 is shaping up to be a great year for everyone so far. For me personally, I am so excited to announce the realization of a lifelong dream: my very own medical practice dedicated to the well-being of women in the Cincinnati area, opening in July. This practice will be all about education, prevention, and the very latest in treatment options in a serene and relaxing environment. Most of all, it will be about caring and taking the time to listen to your questions and concerns.
I love being a physician. I feel it is a true calling. As both my parents were teachers, I have that same desire to impart knowledge to my patients for their greater good. Teaching is a passion of mine, whether instructing patients on their healthcare or teaching other OBGYN physicians nationwide on the latest procedures in minimally invasive gynecology. One of the most wonderful things I am looking forward to in this new venture is practicing the kind of caring, holistic medicine I believe all women deserve, with the very latest innovations and treatments.
I know through years of experience as a doctor how stressful going to the gynecologist can be. All the time, I see how anxious some patients get. Let’s face it; it is no one’s favorite activity. To make your visit more relaxing, we have designed our office to feel more like you are waiting for a spa treatment than your yearly exam. Our friendly, caring staff welcomes you with our quick, paperless Digichart EMR system, to update your patient information, and then lets you unwind with a beverage of your choice: a flavorful cup of hot coffee, soothing herbal tea, or a cool bottle of water. Sit back on one of our plush couches, enjoy the soft colors and lighting, and feel the calm around you. As a bonus, we even have wireless Internet for you to surf the web while you wait for your exam.
An amazing new feature of my practice will be a state-of-the-art Patient Education System, or PES. This interactive tool involves a large screen TV and a patient hand-held remote accessed in the privacy of your exam room as you wait to be seen. You can easily find out information about your particular concern or condition, to help you better prepare any questions for me before your exam. This innovation is to help you feel more empowered as a patient and be more involved in your health care decisions. As I always have, I will continue to take the time to listen to you, answer your questions, address your concerns, and hopefully reassure you during your appointment.





I am inspired by my patients every day. This new practice is a result of that inspiration. Please take a moment to go on my new website, www.dramybrenner.com and sign up for our email list. As the grand opening of my new practice draws closer, you will receive updates and useful information about scheduling your first visit. I can’t wait to see you there.

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.

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.


EVALUATION OF INFERTILITY IN WOMEN

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 fertility.es. 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!!!!!


W

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 (www.mirena-us.com)
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 (www.gynecare.com) 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 http://www.uptodate.com/online/content/topic.do?topicKey=gen_gyne/4741&selectedTitle=1%7E147&source=search_result#PATIENT_INFORMATION