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My experience with female urinary incontinence and pelvic prolapse

I am an OB/GYN who has been in practice now for 20 years in Seattle. My early training had a strong emphasis on vaginal reconstructive surgery, but I was always frustrated with our poor success rate in repair of pelvic prolapsed and urinary incontinence. As my practice has evolved I have continued to focus on urinary incontinence and new techniques for treating pelvic prolapse. In the recent years there have been some very exciting new changes.

Urinary incontinence in women

Many women are bothered by urinary incontinence. Recent studies have shown that this is worse if you have had a vaginal delivery, but some of women have either wide pelvic openings or poor tissue elasticity that can lead to this without ever having had a vaginal delivery. This is an embarrassing problem and can be very inconvenient, with many women carrying a change of clothes or wearing daily pads. In the elderly this can lead to slips or falls and even broken hips. For women who have had children, this may keep them from exercising or playing with their children for fear of leakage. Many women suffer in silence because this is too embarrassing to share even with their doctors.

Today we have several ways ....

Activity after open or laparoscopic abdominal surgery

Every patient who visits my office with a surgical condition has several decisions to make and has a lot of information to absorb and understand.

I typically spend much of our time together describing the condition itself, why I recommend surgery, how I will perform the surgery and any risks involved in the procedure. While this is all critical to anyone’s understanding of their treatment plan, once the decision has been made to proceed with surgery, many patients’ concerns quickly turn to their recovery and what to expect after surgery. Most patients want to know when they can get back to walking, lifting, exercising, and their normal daily routine. While every patient and procedure is different, some generalizations can be made to help you know what to expect.

General abdominal surgery can broadly be separated into two categories: 1) open surgery where a large incision is made through the abdominal wall and 2) laparoscopic (or robotic) surgery where the procedure is preformed through multiple small incisions. Both types of surgery are used for a wide array of surgical problems.

The recovery from these two types can be different. Every patient should ask their surgeon wound care questions, dietary restrictions or signs of possible complications specifically related to their recommended procedure. There will be activity restrictions in the early postoperative period for all surgical procedures.

Many people wonder why we limit activity after ..

A New, Effective Oral Treatment Option Before Chemo for Men with Advanced Prostate Cancer

Discussing a new, effective oral treatment for men with advanced prostate cancer prior to receiving chemotherapy:

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Increasing Your Child’s Comfort with Nitrous Oxide

You may be familiar with “laughing gas” as something you find at the dentist’s office but did you know it can also be used when your child is a patient at Swedish? Laughing gas is a mix of nitrous oxide and oxygen, but you might hear your pediatric nurses just call it “nitrous.” In pediatrics, we use it to help a patient relax and feel more comfortable during certain procedures such as IV placement or urinary catheterization.

Once your doctor or nurse has determined that your child is a good candidate for nitrous (without any contraindications such as conditions where air may be trapped in the body, pregnancy, or impaired level of consciousness), your nurses and certified child life specialist (CCLS) will explain the process: Your child will choose a flavor for the inside of their mask used to administer the gas. They will be on a stretcher or bed and have a saturation probe attached to a finger to monitor their oxygenation. One nurse will administer oxygen, then the nitrous, gradually increasing the amount until your child is suitably relaxed for the procedure, while remaining responsive to directions. Another clinician will perform the procedure, e.g., place the IV. A doctor is also available.

As a parent ...

Flu information

As you hear more about flu impacting our community, you may wonder what you can do. Here are answers to some of the frequently asked questions about the flu from King County Public Health.

Also, during the month of January, Public Health – Seattle & King County is offering free flu vaccinations for people without insurance or who cannot afford to pay. For dates, times, locations and more information, click here.

Flu prevention

  • Flu vaccination is the single best way to protect yourself and your loved ones from flu. Health experts recommend flu vaccine for all people 6 months and older, especially for pregnant women and other high-risk persons.  Make sure everyone who lives with or cares for an infant younger than 6 months and with pregnant women gets vaccinated to protect the infant from getting flu.
  • You can also take these everyday steps to protect yourself against the flu:
    • Wash your hands often with soap and water, or use alcohol-based hand cleaners.
    • Avoid touching your eyes, nose, or mouth. Touching these areas spreads germs.
    • Try to avoid close contact with sick people.
  • Help stop the spread of flu:
    • Cover your nose and mouth with your sleeve or a tissue when you cough or sneeze.
    • Stay home from work and school if you are sick until at least 24 hours after your fever is gone, and avoid close contact with others.

How to get flu vaccine

  • Flu vaccine (shots and nasal spray) is available at many healthcare provider offices and pharmacies. You can use http://flushot.healthmap.org to help locate it near you.
     

  • To find free or low-cost flu vaccine in King County call the Family Health Hotline at 1-800-322-2588 or visit www.parenthelp123.org.

Flu illness and symptoms

  • For the majority ...

Eczema season

"It's eczema season" is an often repeated phrase for me lately.

This time of year, I always find myself seeing more patients with eczema. The common presenting complaint is a persistent rash that itches so much that it disturbs sleep. The dry, itchy patches of skin are commonly seen on the back, sides of the torso, arms and legs, but can happen almost anywhere. People with a history of allergies, asthma, or childhood eczema are even more likely to develop eczema in the fall or winter.

There are a number of contributing factors to the increased incidence of eczema in the winter:

Furnaces run more, drying out the air inside homes and buildings. We wear more clothing, increasing the friction on our skin. Hot water feels better, so we tend to spend more time in the shower or bath.

That last one sounds counter-intuitive, but ...

What is the Utility of Serum Tumor Markers in Lung Cancer?

Should serum tumor markers be used to guide treatment decisions for lung cancer?

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