Month: November 2024

Feel like there are no options left? I am telling you that there are. Let’s discuss it right now.

What I am talking about is violence and abuse. Yes, that’s right, Violence and abuse, whether it be toward you, your kids, your relatives or whoever. It is everywhere and increasing every day. I am faced with an ever-increasing amount of patients who are facing this issue regularly.

So, what’s the worst that could happen? Well, someone could actually end up dead or permanently damaged in some way for one. Dead. Never coming back. Dead. Someone could end up permanently emotionally damaged and use that as an excuse to continue that style of behavior and life even into their next phase of life or worse, if they were an abused child or spouse, continue on to abuse their children or next spouse because that is the scenario they are familiar with or they are using that as their excuse. The things that I hear the most is ” I just don’t know what to do. or…That’s how I was brought up…or..That’s the same stuff I went through….or….It’s all I know.

These are the most heart breaking responses I ever here. I picture in my mind the terrified children or the terrified spouse or girlfriend. When there is abuse going on, everyone suffers, not just the person actually undergoing the abuse. It has wide ranging, awful ripple effects. Too often I am trying to work with someone that has already given up and just figures that there is nothing they can do and that is just the way that it is.

I am here to tell you that that is not true. Despite what you think, there are always possible options, if you chose to take them. They require fortitude, strategy, secrecy, and sometimes heartbreaking techniques, but they can be done. I refuse to believe that there is no option. Before I go any further, I need to tell you that I personally have had more than my fair share of abuse and violence in my past. I had to keep secrets that no one should have to keep. I had to live through things that no one should have to live through. So, I get it. There is no easy way out. Finally, as an adult I try my best to live a healthy life and be a good parent to my kids and be a good wife to my husband and break the former cycle. I am telling you there is a way to make it stop and move forward, even if there is no one that you currently know who can show you.

First, before you even get started you have to give yourself a moment of calm to begin planning. You need to have a relocation plan, even if it is to a safe house or local shelter. You need to set aside a separate source of funds. You need to get your papers in order. You need to be willing to stop and accept and sacrifice yourself or worse, your children as if you somehow deserve it. NO ONE deserves abuse. NO ONE! You need to value yourself and your kids enough to get the heck out of there before something irreparable happens. If it is safe to do so, you need to stand up to that partner or spouse and say look, my poor heart may love you for the rest of my life but my children and I cannot live with you another day if this crap keeps going on. If it is not safe to do that, then just get the heck away while you can and figure the rest out later. Nothing is worth risking your life, your childrens’ lives, or your mental health to stay.

I am telling you that it can be done. You can get away. You can begin to live a healthy life again. Please do not use your experiences as an excuse to re-enact the same poor behaviors to others or your kids. Please do not inadvertently teach your children that abuse is ok and that there is nothing you can do. I am living proof that it is possible. Here is the link to the National Domestic Violence Hotline. Please use it if you need it. They offer support in over 200 plus languages.

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1-800-799-7233

Dr. Katz

Gastric Bypass. I am a total fan, but you have to realize what your role is to play.

Gastric bypass surgery is performed with the goal of enhancing weight loss. There are multiple different types. There is the classic Roux-en-Y gastric bypass which bypasses and reconnects the connection between the stomach and the small intestine. There is the sleeve gastrectomy which removes about 80% of the stomach that leaves a tube-like pouch that can’t hold as much food. It also reduces the production of a hormone called ghrelin. Ghrelin is a hormone that regulates appetite. The is the biliopancreatic diversion with duodenal switch. This is usually a two-part surgery that takes place all at once. The first part is the sleeve gastrectomy and then there is a second part that involves the closing off of the middle section of the intestine and attaching the main part to the duodenum. This surgery is usually reserved for the folks that have a bmi over 50. There are two other types but these three are the main ones.

Can these surgeries help produce miraculous results? Yes? Can they be long lasting? Yes. Unfortunately, can those awesome effects disappear and reverse over time? Also yes.

There are multiple things to consider before pursuing gastric bypass surgery. There are potential malabsorption and vitamin issue complications. There are potential anemia complications. There is the possibility of having huge leftover rolls of skin that will require additional surgeries with large scars. There is the possibility of initial success with eventual reversion back to obesity, even after undergoing that surgery. Yes, those pouches can be re-stretched eventually with overeating.

So, what kind of things do you have to consider to have long-term success after making such a huge decision? The first thing to consider is that this is a very big decision with lifelong consequences.

You need to realize that this is not the perfect magic wand that you are hoping for that does not require any change on your part. You need to be the person that has actually tried everything to lose weight consistently for at least 6 months. Despite me hearing patients say that a lot, it is not often true or they haven’t been counselled appropriately about the changes that their body would respond to before resorting to surgery.

You need to be psychologically ready to change your relationship with food permanently, BEFORE having the surgery or you are at risk of going back to your same habits and being obese once again. Remember what I said, these pouches can eventually be re-stretched.

Having said all of this, if you do fit that category and have actually tried all the things and have actually changed your mental relationship with food, then I say go for it and good luck to you!

Dr. Katz

Feeling bloated all of a sudden? Don’t ignore it!

Have you ever suddenly noticed that your pants don’t fit right or that your skirt is now bulging out just over your abdomen and nowhere else. Do you now have a baby bump that is not an actually baby bump? Don’t ignore it.

Except for the rare possibility that you just ate 20 pounds of food at one sitting, there should be very few benign reasons why your abdomen should suddenly puff up like that. Yes it is possible that you could be really constipated or gassy and just need to fart it out, but unless your stomach is really rumbling that is not really possible.

So, what are the causes of increased bloating? Let’s go over a few

First, hormonal changes can cause bloat. As our progesterone and estrogen levels fluctuate, it can lead to water retention and bloating. Estrogen in particular can cause increase in fluid retention, especially when it is out of balance.

Second, insulin resistance is a popular cause of bloating. The eternal spare tire that you cannot get rid of no matter how much diet and exercise you do. You see, in a normal healthy body, you eat the perfect type of food for your body type at least three times a day and the pancreas then secretes just the right amount of insulin to break down the food into just the right amount of glucose to then get inserted into your muscles to give you energy. When you are insulin resistant, as the result of a crap shoot genetic gift from a relative or through the natural changes of aging and menopause, there are several issues. The first is that you are probably not eating right for your body type. You are probably over carbing because that is what you crave. Or, you are meal skipping especially in the mornings because your stomach is just not ready for food. In either case, the pancreas is over secreting insulin because it sees the extra carbs and freaks out, or it stores insulin because it thinks you are starving. On top of that, your body is not using the insulin it makes because your tissues are insulin resistant. This means that all that extra unused insulin just sits in the abdominal tissue, then calls in its friends fat and salt and water and blam! The extra bloat that won’t go away. If this goes on for enough years, eventually your pancreas goes on strike and you become diabetic instead.

Third, something more serious could be going on. Abdominal bloating seemingly out of no where could be due to fluid in the abdomen. This is called ascites. This could be due to liver disease, heart conditions, kidney disease, pancreatitis, infections or even cancer.

Fourth, and most serious, it could be due to a growing tumor in your abdomen with no symptoms to tip you off except for mild decrease in appetite, constipation, or bloating.

The bottom line is, bloating out of nowhere with no specific justifiable reason should not be ignored. It can be the sign of something serious so when all of a sudden those pants don’t fit or that skirt is too tight. Get it checked out!

Dr. Katz

Please, just leave the pelvises to me.

closeup photography of pink rose flower

Hey there folks. Dr, Katz here. I have been an Obgyn for the last 28 years. I have delivered thousands of babies. I have performed thousands of surgeries. I have done thousands of paps. All of these things are essential parts of the specialty that I was specifically trained for. I was also fortunate enough to have gone through residency at a time where Obgyn was temporarily reclassified as primary care so I also have training in internal medicine, er, icu, pediatrics, and family medicine. As a result, I know how to diagnose things outside the scope of regular Obgyn practice, but, at the same time, I realize that I am not the expert in those areas so I know when to refer when necessary.

Sometimes, I feel like the same does not apply to obgyn care. There are a lot of family physicians and internists out there that still do the occasional pap when they have to or if the patient does not want to visit an actual obgyn.

Most of the time you get lucky and the pap would have been normal regardless so no harm done. But, then there are those other times when the patient has been getting “normal” paps for years by their family doctor and then they come and see me and actually have an invasive cancer that could have been caught earlier. Thank goodness these times are rare, but they happen nonetheless and are preventable.

To me, this says don’t dabble. You are potentially putting someone’s life at risk, even if unintentionally. I know that a lot of people think that doing a pap is a no brainer and that is the complete story as far as Obyn. I tell ya. It’s not true. There is an art to it from the performing of the procedure without harming the patient and actually knowing what you are looking at and being able to pick up on the subtlest of cues that something is off. Obgyn stuff is that sneaky. You usually don’t get any symptoms until something is already bad. Then, it can be too late. However, if you just stop into the Obgyn once a year, a lot of that is both preventable and/or treatable.

I know how to treat blood pressures and treat a multitude of various diseases, but I know I am not the expert so I refer appropriately. I think that every patient needs a primary care physician and an Obgyn because they both care for different necessary aspects of health. I think that both are necessary to achieve total health and well-being. I think we are different specialties for a reason. All I’m asking is, please leave the vaginas and the pelvises to me. I promise I won’t let you down.

Dr.Katz

My patient just told me ” My other doctor said I am just going to have to get used to being fat. She has done everything.”

Umm what? Giving up on your patient? You have done everything? Really? Not according to what I’m seeing. Usually when I dive in and explore the issue, there are all kinds of stones still unturned. The last time I checked, the ONLY circumstance when you might even have a chance of giving up is when someone is dying of terminal cancer within days. Other than that, no excuses. You are still on the line to help. You are a doctor for chrissake.

I am one that tends to never give up myself. That is what I am actually here for, to help and give knowledgeable advice on the issue and how to try to solve it, not just to give up. Mind you, I have rules though. I make it clear to the patient from the beginning that whatever we are working on is a team effort. I make it clear that it will take effort from both of us. I try to empower them to be the captain of their own healthcare team and be an active participant. There will be no randomly missed appointments and non-compliance with reasonable expectations. I have to have at least that for us to work together for your benefit.

I get it, sometimes you have those patients that have hit rock bottom, are ready to quit and give up themselves. But, I am willing to bet that if you look deeply enough, you will be able to discover the reason why and help them get past it and move toward better health. It can be done folks. It really can. You giving up is not an option. I just can’t bear to hear that anymore.

Bottom line, I am right here, ready to listen, ready to problem solve, ready to be a part of your team. C’mon down and lets see what you need! I bet we can come up with something together!

Dr. Katz

I actually thought there was a baby in there!

I can remember the very first two female patients that walked in my door of my obgyn office over 20 years ago. Both had uteruses that were such giants that I actually got out my fetal monitor to make sure there was not an undiagnosed 5 month pregnancy in there! Needless to say, there were no fetal heart tones to be auscultated in either case. Both women were suffering from gigantic fibroids, heavy bleeding and severe anemia. There were no babies or good news to tell.

What is a fibroid you ask? The first thing to understand is that the uterus is made of layers: the serosa, the myometrium, and the endometrium. The serosa is like the outer “skin” of the uterus. The myometrium is the inner muscle layer. The endometrium is the intracavitary layer where the menstrual flow comes from and the fetuses are nurtured. Sometimes a cell or two of the myometrial layer gets big ideas and starts growing on its own independent of the control of the rest of the myometrium, sometimes resulting in giant balls of mostly, but not always, benign tumor cells. Theses giant balls of cells can sometimes cause diffuse and intense pelvic pain and pressure. More often, they cause heavy bleeding and resultant anemia which can be life threatening.

Back in the day, the options to treat them were not the greatest. The first thing to determine was if the patient desired future fertility. IF they did, the medical option available was lupron, which is a gnrh agonist and hormonal oncologic that can be taken monthly by painful injection for up to 3 months to attempt to shrink fibroids or up to 6 months to treat endometriosis. The idea behind it is to shrink the fibroids or the endometriosis to allow an opportunity for future fertility or pain reduction. The side effects are awful. It is like instant medical menopause with hot flashes, bone loss, arthralgias, etc. And, there is no guaranty it will work. Nowadays we have some pill form options which are somewhat easily tolerated, but still some of the same side effects and still no guaranty that they will work.

The other option for fibroids back in the day was myomectomy. This was usually done with an open large laparotomy incision and the fibroid or fibroids were cut out and an attempt was made to sew the uterus back together. This left the potential for scarring and the potential for uterine rupture during future pregnancy, in addition to the chance that fibroids would grow back. The other option was complete hysterectomy with or without possible pre surgery shrinkage with lupron, which constituted of a large incision laparotomy procedure as well, but at least the fibroids could not grow back.

A slightly less invasive option was a uterine artery embolization procedure. This was usually performed in interventional radiology where catheters are placed into the uterine arteries and particles are injected to block the blood flow, causing the fibroids to necrose and degenerate after the blood supply is cut off. This is a painful process and has a risk of infection and blood clots and risks to future fertility and may lead to premature menopause.

Nowadays we can do so much better than this! We now have the Acessa procedure! The Acessa procedure is an amazing laparoscopic radiofrequency procedure that is minimally invasive. It involves delivering radiofrequency energy with multiple treatments to radioablate the fibroid multiple times to facilitate shrinkage. This is done using a laparoscope with an ultrasound probe inserted into the abdomen and a radiofrequency Acessa probe inserted directly into the fibroid under direct visualization and you can literally watch the fibroid being treated at the exact moment it is being treated. You can do multiple treatments at the same time of multiple fibroids. It will then cause slow regression of the fibroids over time, with maximal effects at 6 months. It tends to be a procedure with relatively little pain, except for the pain from the laparoscopy itself. It does not involve any large incisions or scars. Fertility is also preserved and there is no disruption to the integrity of the uterus so future risk of rupture is minimal. Thus far I have seen it be a win win for patients. Best news yet, we have it readily available right here where I practice in Monroe, Michigan.

Fibroids got ya down? Cmon and see us and look into an Acessa procedure. It could be life changing without the down time or disfigurement.

Dr. Katz

Hey there doctors! Guess what? It’s actually a good thing when you have a knowledgeable patient interested in their health care!

It has come to my attention after being a patient A LOT lately, that for some doctors, having a patient who is knowledgeable, dares to ask a question, and is genuinely invested in their own healthcare is some kind of terrifying threat.

Huh? Why? Can anyone tell me why? To me, this makes no sense whatsoever. When I get that patient who asks questions and truly gives a crap about their own health care and wants to be involved, I personally feel like I hit the lottery! I am like O Happy Day! Let’s get you healed and healthier together. Let’s help make you the captain of your own healthcare team. Let’s surge you on to the path to wellness together!

The chances of success in this type of scenario are about a 100 times the chances if it’s not. When you have a patient that is willing to put the work in, is interested enough to ask the questions instead of just blindly following without understanding, that is like striking gold. That is awesome! That is the goal we should be trying to achieve! I just don’t understand why it doesn’t seem to be for most physicians.

But, knowing me. I have a few theories though and I would like to share them with you. Mind you these are just theories and I have no scientific documented proof, but I have had a hell of a lot of experience as a physician and as a patient and this is what I have seen.

I am worried that the physicians that seem so threatened by a patient that asks questions perhaps are just not confident enough in the care or the information that they are providing, or not providing as the case may be.

Well, this should never be the case. Be prepared at all times for questions and clarification. Know your patient so well that you can pre-anticipate what questions might be asked even before they are asked. Actually look at that chart before you enter the room. Anything you are unsure about? Look it up ahead of time and either be ready to talk about it or honestly admit that you don’t know,but are willing to help find someone who does.

It really is that easy sometimes. I get it. Not all conversations are easy. I am just saying that you have to put the pre work in to make things go as well as possible. Sometimes you are giving potentially horrendous news. There is nothing easy about that. It is not the patient’s job to reassure you, it is your job to reassure and support them. This news may make your day a lot tougher emotionally, but it may be changing their entire life all at once. It’s about the patient and your purpose is to help the patient so you gotta just pick up your bootstraps and do it or find another profession.

The bottom line is, I am not one of those threatened by patients being involved or asking questions. I welcome it with full on joy! Bring on them questions!

Dr. Katz

IDGAF

Yes, I just saw this on a license plate the other day. A woman had it proudly emblazened on the license plate on the front of her car. You could tell that she was very pleased with herself, thought of herself as a true bad-ass.

I had some different thoughts about it. You know what those initials mean, right? It means I don’t give a fuck. I..don’t…give…a…fuck. I think to her, that means no one is going to tell her what to do or command her to give an opinion on anything. For her, that is stating some sense of power.

I see it differently. First, why “say” something like that out loud and not even use the words, just the initials? Why not spell it all out? Is she afraid of getting in trouble? Can she not even say it? That sounds like cowardice to me.

My impression is that when someone says that, they think they are making a power statement, but what they are really saying is that they refuse to make an investment of any sort in any idea or belief. They refuse to hold anything of importance enough to take stock in it or stand up for it. They are stubborn and weak at the same time. They are not actually taking control of anything. They are actually giving up on everything. They are refusing to put the work in. It’s a no win situation.

To say you don’t give a fuck/don’t care about anything means that you are giving up on the world around you. You are determined to not participate or find joy in anything. This is no way to live. I don’t understand it. I get that you get down after life has thrown you a crap ton of curve balls. Sometimes things get pretty shitty. I get it. I have been there. I have survived multiple cancers, almost lost my husband to heart disease and faced potential financial ruin multiple times…and I still give a fuck! If I can do it, you can too.

Dr. Katz