Honest answers to women’s health issues

By Dr. Tammy McCarus

We’ve had such a great response to our general GYN FAQ’s that we’ve made “Ask Dr. Tammy” a regular feature. In this issue of Ask Dr. Tammy, we cover how to do self-breast examinations to the latest vaccines that are available for women’s health.

1. What are the early warning signs of breast cancer?
Early signs of breast cancer include small lumps or bumps that you feel when examining your breasts. Also, nipple discharge, especially if it is bloody, can be another early warning sign. All that being said, typically early breast cancer is picked up by a mammogram, when there are no signs of a problem evident to you, the patient. Examine your breasts at the same time of month every month, and just after your menstruation. Make sure you get your mammogram at the appropriate time.

2.What are the early warning signs of the various forms of pelvic cancer?
The most common forms of pelvic cancer include cervix, ovarian and uterine cancer. There are very few warning signs for these cancers, but any abnormal vaginal bleeding should be addressed by your gynecologist. Sometimes this can be the only warning sign of either cervical or uterine cancer. Ovarian cancer is the most worrisome of these malignancies, and unfortunately, it rarely gives any warning signs. Thorough annual pelvic exams are the best way to detect abnormalities, especially at an early stage.

3. What criteria should a woman use in selecting an OB/GYN?
When choosing an OB/GYN, take your age into consideration. Are you still of childbearing years or are you beyond that? Are you perimenopausal or menopausal? Many OB/GYNs have dropped obstetrics as a part of their practice. Calling the physician’s office and asking some pointed questions may help you narrow the field. Ask how much time is allotted to a new patient appointment. Also, ask if the physician will be taking your history and performing your examination, or is that passed on to an associate or other type of allied health practitioner?

Your lifestyle may also play a role in choosing a GYN. Finding a doctor with office hours that can accommodate your work and family schedule is important. Lastly, don’t forget about insurance. You will want a doctor within your plan, so you can make the most of your coverage. If you are not satisfied with the choice of physicians on your plan, you may want to call your insurance provider and ask about options for going “out of plan.”

Remember your OB/GYN may be the only physician you see on a routine basis. You will be confiding in this individual all aspects of your personal life, and so being comfortable with him or her is important.

4. What are some accurate, current research tools that a woman can use to find out information on her body?
The best available research information is found on the Internet, where most of the major medical publications post their findings. Most subjects can be easily searched by typing in the subject matter or medical problem. For patient resources or surgical information try www.mayoclinic.org or www.ethiconendo.com.

5. When a woman decides upon elective surgery such as breast augmentation, what advice would you give?
Any and all surgeries must be discussed thoroughly and completely with the surgeon who will perform the operation. All questions about the procedure and the recovery should be answered. Weigh all the risks and benefits. Never be afraid to seek another opinion if you are unsure. Remember all surgery involves risk, and although very rare, serious complications, even death, can occur with the simplest of operations.

6. When major surgery is needed, how do you ask your doctor about the latest technologies and their abilities regarding these new technologies?
If you are told you need a procedure, for example a hysterectomy, you should ask your physician about the various methods available to perform that operation. You should ask your doctor what method he or she would prefer for you and why. If you feel you need more information, go to the Internet and type in hysterectomy options.” You will be given a list of the methods currently available.You can then share that information with your doctor.

Most surgeons are accustomed to having patients ask them “How many of these have you done?” or “What have your results been?” This is no time to be shy, so speak up and ask the important questions.

7. Are men as susceptible to human papillomavirus, or HPV, as women?
Yes. The only difference is since men do not have a cervix, HPV cannot cause cervical cancer. They may only develop genital warts.

8. In the event that a woman has not gone for a GYN checkup in years, what should motivate her to get it done?
How will we be able to take care of our loved ones, how will we be able to enjoy doing the activities that bring us joy, how will we be able to enjoy seeing our children grow and succeed in life if we are ill, or worse? Could we ever forgive ourselves if an illness proved to be very serious, even life threatening, knowing that early detection and treatment could have cured us, maybe even with only minor inconvenience to our lifestyles? I think not! Those things should be motivation enough. If we take good care of ourselves, we are then able to continue to provide good care for others.

9. How do you know if a surgery did not go well?
As a patient, you should feel a little bit better each day after surgery until finally you are back to normal, or even better than before. Persistent pain, fever, swelling or bleeding are all signs that something could be wrong. Your surgeon needs to investigate.

10. How does a woman know which medical issues can wait and which need immediate attention?
Unless you went to medical school, don’t hesitate to call your doctor’s office with a question. Queries like this occur every day and are not a bother. This way, you can feel confident in waiting, if that is the advice you are given. Conversely, you may head off more serious problems if you are advised to come in and get checked out.

11. How real is the new vaccine for HPV?
This vaccine is akin to a miracle. If administered before a female becomes sexually active, it will prevent most cases of genital warts and the majority of all cancers of the cervix. Never before have we had a vaccine available that can stop a form of cancer or completely prevent it.

12. Are there any other cutting-edge GYN vaccines, treatments or procedures that women should be aware of?
There are countless new forms of birth control (pills, intrauterine devices, new methods of tubal ligation). There are wonderful new procedures for urinary incontinence, most of which are performed as an outpatient. New forms of hormone replacement therapy also are available.

13. Does obesity have any bearing on the outcome of my surgery?
Obesity absolutely plays a role in the outcome of any surgery.Obese patients suffer far more complications and adverse events than patients who are not overweight. Additionally, they present strategic difficulties to their surgeons simply due to their larger size. Postoperative complications can include blood clots, stroke, heart attack, pulmonary embolus, difficulty breathing, infection and poor healing of wounds.

Getting into better shape prior to any operation is highly advised, but not through starvation or crash diets. Your nutritional status should be optimized prior to surgery in order to give you the best chance at a desirable outcome.

Dr. Tammy McCarus is an obstetrician and gynecologist in private practice in Orlando, Fla. She is also the president of the Florida OB/GYN Society and the Medical Director for The Healing Continuum.com.