Winter Update 2015
We wish you and your family a very Merry Christmas and a Happy New Year! We would like to express thanks to all of our faithful patients and extend a warm welcome to our future patients. If you are looking for regular gynecologic care or are struggling with infertility or other difficult reproductive problems, we are privileged to serve you. Give us a call today to schedule an appointment! We look forward to working with you to achieve your goals. (865)777-0088.
Goodbye Niki and Hello Camille
Many of you may have noticed that our sweet Administrative Assistant, Niki, has been missing. She recently relocated to Florida with her husband to spend time with her ailing mother-in-law. Please join us in welcoming Camille. Camille is a Tennessee native. She is married with one son and enjoys church activities, her son's sporting events, and sewing/embroidery. Although, Niki can never be replaced, Camille will be taking over Niki's responsibilities. She can assist you with appointment scheduling, medical records, and insurance claims just to name a few. Just let her know how she can be of assistance to you, and she will be happy to help.
Insurance and Demographic Changes
Please remember that insurance changes take effect after the first of the year. If your insurance is changing or you have new contact information, please make sure that information is up to date prior to any appointments you have with our office after the first of the year. This will ensure a smooth transition for both you and us into 2016!
- January 22nd is Women's Healthy Weight Day
- January 25th is IVF Nurse Day
- January is Cervical Cancer Screening Month
- January is Birth Defects Prevention Awareness Month
- January is Thyroid Awareness Month
- February 6th is National Wear Red Day
- February is American Heart Month
- March 30th is National Doctor's Day
- March is National Endometriosis Awareness Month
Ouch! My Bladder Hurts!
Interstitial cystitis (IC) or bladder pain syndrome (BPS) is a condition that can mimic a urinary tract infection (UTI). The presenting symptoms typically consist of pain, urinary urgency, frequency, urination in the middle of the night, and voiding only small volumes. In order to meet the criteria for diagnosis of IC, the symptoms must be present for more than 6 weeks' duration in the absence of a urinary infection or other identifiable causes. IC affects approximately 3.3 to 7.9 million US women and the cause is currently unknown.
Performing cystoscopy or urodynamics primarily before proceeding with conservative treatment is unnecessary as there is no consensus on the diagnostic criteria for these procedures. In addition, potassium sensitivity testing is painful, and in lieu of benefits, the risk/benefit ratio of this procedure is too high to recommend for clinical care.
Treatment for IC/BPS follows a 5-tiered approach. First-line treatments commence with a more conservative approach and include general relaxation/stress management, pain management such as with NSAIDS or pyridium, patient education, and self-care/behavioral modification. Second-line treatments consist of physical therapy techniques and avoidance of Kegel exercises, medications such as pentosan polysulfate (Elmiron); amitriptyline (Elavil); cimetidine (Tagamet); and hydroxyzine (Vistaril); and bladder instillations with dimethyl sulfoxide; heparin; or lidocaine. Third-line treatments include cystoscopy with hydrodistension, pain management with care to minimize narcotic use, and treatment of Hunner lesions if found. Fourth-line treatments are Botox, neuromodulation, and pain management. Fifth-line treatments include cyclosporine A and pain management.
If at any point during the patient's care the diagnosis is questioned or treatments have been ineffective, referral to a specialist, including urogynecology or urology, may be appropriate.
We often treat IC at the Southeastern Center for Fertility and Reproductive Surgery. We typically start by ruling out infection with a urine culture. If this is negative, we recommend following an IC friendly diet, and we may implement medications such as Elavil, Tagamet, Vistaril, and Elmiron. If you have or think you may have IC or BPS, call today to schedule an appointment. (865)777-0088.
In November 2014, the FDA issued a warning against the use of laparoscopic power morcellators for the treatment of uterine fibroids due to the concern that if a patient had an undiagnosed leiomyosarcoma (cancer) that the tumor cells could be spread by the "mincing" action of the morcellator, thus leading to spread of the cancer.
A leiomyoma morcellation review group comprised of 46 members has challenged the FDA's warning and is requesting that the FDA modify the current guidelines to provide women the freedom to make informed decisions along with their physicians to choose the procedure that is most appropriate for the individual woman.
Based on the literature review, the FDA estimated that 1 out of 458 women having surgery to remove a fibroid would be found to have a leiomyosarcoma. The review group did not agree with that statistic and challenged the method of the literature search and the studies that were reviewed by the FDA. The data that were reviewed by the review group members found that the prevalence of leiomyosarcoma is more consistent with 1 in 1,550 (0.064%) women. Other recently published data found prevalence rates of 0 to 0.051%, according to the review group's analysis.
The review group does not discount the seriousness of leiomyosarcoma, but they feel that the overall risks and benefits should be considered and that the patient's age and risk of leiomyosarcoma should be taken into account. They also recommend better techniques, such as the use of containment bags and copious irrigation of the pelvic and abdominal cavities to minimize the risk of spreading cancer cells or missing retained tissue. Although morcellation of an undiagnosed cancer can spread cancer cells, by allowing women to avoid the higher morbidity and mortality associated with open abdominal surgery, morcellation can also save lives!