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On breastfeeding & breast cancer survivors

When I was a surgical resident, I donated 150 ounces of breastmilk to a woman I’d never met, a woman who had undergone a bilateral mastectomy for cancer. It was an easy decision – I had more than I could use, she had none that she could provide. This experience became a major one in my decision to specialize in breast surgery. The dichotomy of breasts fascinated me. Breasts are highly sexualized, yet the source of comfort and food to babies. Breasts can make life-sustaining milk, and they can develop a cancer in up to 1 in 8 women that can be life-threatening. It is no wonder that society’s relationship with breasts and breastfeeding is complicated.

I have had many patients (too many) in my practice who were young and pre-childbearing, or even pregnant or breastfeeding at the time of diagnosis. Most experience the same terror that Ms. Wax-Thibodeux felt. Many choose bilateral mastectomies, prioritizing their health and a minimization of future risk. I also care for young women with benign breast disease, that still require surgical biopsies. I do discuss the potential impact of any surgery on breastfeeding. For a lot of women, this is a side effect they hadn’t even considered. It often does not ultimately change their mind about their own most appropriate surgical choice, but there can be a pause. A moment where they consider what that means, when they reconcile themselves to that consequence, when they have the moment to grieve. Unfortunately, I suspect that not all of my colleagues do this. I wasn’t ever trained to discuss it. We spent more time, significantly more time, discussing ...

What you should know about Long Acting Reversible Contraceptives or IUDs

Does it seem that more of your friends are using IUDs or contraceptive implants?  IUDs, intrauterine devices, and contraceptive implants are becoming more popular in the United States.  In this post, we will discuss these birth control methods and why they are gaining in popularity. 

IUDs are plastic devices that are placed in the uterus by a healthcare provider.  There are three products available in the U.S.:

Dealing with vaginal dryness

One of the more annoying situations that many of my patients have been in is having painful intercourse due to vaginal dryness. In general the cause of dryness of the vaginal tissue is lack of estrogen. This can occur postpartum, especially in women who are breastfeeding a baby, and it can occur just before and during menopause.

When estrogen is in the body, one of the effects of estrogen is to ...

Importance of planning pregnancies with Multiple Sclerosis (MS)

A recent study addressed the outcomes of pregnancy in women with MS who were taking fingolimod (Gilenya). Of 66 pregnancies on the medication, 41 attempted to carry the pregnancy to term. 26 of the 41 had healthy newborns. There were, 9 miscarriages, 24 elective abortion, 4 ongoing pregnancies and 1 with an unknown outcome. Of the elective abortions, four were for fetal malformations. There were 5 cases with abnormal fetal development in the 66 pregnancies. Poor fetal outcomes were found in 14.6% of the pregnancies. This contrasts with a 3% rate of poor outcomes for most pregnancies.

This paper highlights the importance of care in planning pregnancies in MS. It is now known that women with MS have ...

Reducing visits to the operating room for breast cancer patients

Swedish Cancer Institute has changed the way early stage breast cancer patients are cared for by adopting new surgical margin guidelines.  These guidelines will reduce the need for taking women back to the operating room if cancer cells are found at or near the specimen edge, also known as the margin. Following extensive review of the data, this new guideline was established by breast experts from the Society of Surgical Oncology and the American Society of Radiation Oncology and has been endorsed by the American Society of Breast Surgeons and the American Society of Clinical Oncology.
 
Many women with early stage invasive breast cancer opt for breast conserving surgery, known as lumpectomy or partial mastectomy. For 20-25% of these patients, a second surgery or re-excision was performed because the margin was not considered adequate based on previous practice guidelines. The latest peer reviewed evidence shows disease control is excellent when surgery is combined with whole breast radiation with or without hormonal therapy and/or chemotherapy, regardless of the margin width.
 
The Swedish Cancer Institute’s multidisciplinary breast cancer team reviewed and approved these guidelines for our program. We believe by reducing the need ...

Managing pain during labor

One of the most common concerns women have during their pregnancy is how to manage pain during labor and delivery.  Labor pain may be more or less intense than you expected, or may hurt in a different way. It is hard to predict how any labor will go or how anyone will respond to pain.

Labor pain is due to contractions of the muscles of the uterus and by pressure on the cervix. This can feel like strong cramping in the abdomen, groin, and back. Some women experience pain in their sides or thighs as well. Women can also feel pressure on the bladder and bowels by the baby's head and the stretching of the birth canal and vagina. Some find the hardest part is not the contraction itself, but the fact that the contractions keep coming.  

One of the best ways to alleviate fears for women is to learn about the available strategies for coping with pain. There are both medical and non-medical tools that may be a good match for you.

While you are deciding, think about what appeals to you most. Ask your health care provider these questions:

Information on emergency birth control

Oops, the condom fell off or broke. Oops, you went away for the weekend and your birth control pills stayed home. In the past, women ran the risk of an unintended pregnancy when birth control was not used or failed.
 
Emergency birth control has been available for many years, starting with medicine approaches that were not approved by the Food and Drug Administration. In 1999, Plan B, levonorgestrel pills taken by mouth, was approved for use by prescription and in 2006 was approved without prescription for women 18 years old and over. It was approved for those 17 and older in 2009 without prescription. In late February, 2014, FDA approved over the counter sales of generic emergency contraceptives without proof of age.
 
Another  ...
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