Tag: anemia

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

We are all tired.

Hey everybody. Show of hands…who seems to be tired all the time lately? I bet there is a ton of you. No matter how much sleep you get, no matter how well you eat, no matter how much caffeine you drink, that thick blanket of fatigue just never leaves lately. But why? My guess is that this persistent exhaustion isn’t actually just physical, it’s emotional as well. I mean sure, I am one of the believers that constant mask wearing puts you at risk for CO2 retention and respiratory acidosis, which can cause fatigue, but I know that is not the whole story.

So, why are we so exhausted? There are ten basic causes for fatigue that are the most common. Some of them we do to ourselves and some of them we have no control over. Let’s review.

The first one is poor diet. If you eat a diet full of refined sugars and carbs, you will be totally wiped out because all you get from that is short energy bursts followed by crashes. Likewise, if you are trying to diet and you are not actually getting enough calories to keep your body going, you will simultaneously just drain your own energy reserves throughout the day. On the other hand, if you eat a well balanced diet with no meal skipping, you will stay fueled the whole day!

The second one is using electronics before bed. I am totally guilty of this one. I mean, who is not filling their heads with the latest anxiety-causing social media right before they want to go to sleep? Sometimes it is the only time that we feel like we can “catch up” on the world right? Did you know that using electronics before bed turns up your fight or flight response which increases your pulse and blood pressure for several hours? It also decreases your melatonin levels. Both of those things are sure to keep you up longer. Ideally, you should aim to “unplug” at least three hours before bed time to give yourself a fighting chance.

The third one is sleep apnea. Sleep apnea happens when you literally stop breathing multiple times during the night, even if you don’t know that you’re doing it. This happens because your airways close while you are sleeping because of extra soft tissue. Not sure if this applies to you? Ask your bed buddy, if you have one, if you are keeping them up at night with your intense snoring. If the answer is yes, talk to your doctor about it and get treated.

The fourth one is anemia. If you are anemic with low hemoglobin, your red blood cell count is low and they are not getting enough oxygen and therefore you are tired all the time. The most common cause of anemia for women would be iron deficiency from menstrual blood loss. Some symptoms of anemia might be skin pallor, elevated pulse, fatigue or weakness. If you think you are anemic, talk to your doctor before self treating.

The fifth one is diabetes that is undiagnosed or poorly controlled. Diabetes causes excess sugars to stay in the bloodstream instead of going into the muscle where they can be used for fuel. As a result, you stay fatigued all the time. Some symptoms of diabetes could be frequent urination, excess hunger, excess thirst, and fatigue. If you think you might have diabetes talk to your doctor.

The sixth one is dehydration. We are all racing around lately without stopping just to try and keep up with the world around us. One sign of dehydration could be darkening of your urine when you go to the bathroom. If you notice, start increasing your fluids and see if it changes. We need to take the time to drink water frequently throughout the day. Experts say that we should aim for at least 3.7 liters(15.5 cups) a day for men and 2.7 liters( 11.5 cups) per day for women. How many of us are even close to that? I better get drinkin!

The seventh one is too much caffeine intake. I think that the world in general is guilty of this nowadays. There is no dietary recommendation for caffeine. It can be found in some medications, chocolate, caffeinated teas and sodas, and energy drinks. While caffeine can give you a temporary boost, it doesn’t last. How much caffeine is too much depends on the person. The effects of too much caffeine include increased blood pressure, elevated heart rate, premature heart contractions, and headaches. With caffeine, it really is a vicious cycle. You start drinking caffeine because you are tired. The caffeine then makes your body race and you get more fatigued. Then you find yourself “needing” more caffeine. Then when you try to wean yourself off of caffeine, you can get ridiculous headaches as it washes out of your system. In an ideal world, I would say don’t even try it in the first place. Mind you, I am saying this as I am sipping my dollar sized McDonald’s coffee.

The eight one is a chronic infection of some kind, most commonly a bladder infection. If you have been recently treated for a bladder infection and have no other symptoms except a lingering fatigue, go back to your doctor and get rechecked. You could have some infection left over.

The ninth one is thyroid issues. The thyroid is that little gland in your neck that literally has it’s fingers in multiple body functions, not the least of which, your metabolism. If your thyroid is underactive(hypothyroid), that could slow your metabolism and make you feel really sluggish. It could also affect your skin and make it difficult for you to lose weight. If your thyroid is really underactive, you might even notice a bulge in your neck and have trouble swallowing. If you think you have thyroid issues, call your doctor and get checked.

Last, but definitely not least, depression and stress are a major cause of fatigue. At least 25% of people suffering from depression report fatigue and a loss of appetite, in addition to the classic depressed mood that we think of. This is the one that I think is really affecting all of us right now with the the state of the world like it is. Depression causes feelings of sadness, anxiety or hopelessness for an extended period of time. People who are depressed often have sleep problems, which only add to the fatigue. Stress stimulates our flight or fight response which overtaxes our metabolism and can leave us feeling worn out and tired. Who doesn’t feel all of those things right now? The world is just not the same. We feel out of control. We feel like the joy has been sapped out of all our favorite things. We are spending a lot of energy looking for someone to blame for how things are instead of using our energy to deal with it. In my practice alone, the percentage of patients that I am helping with depression has risen 75%. This is a real problem and we need help.

So, we have talked about the causes. For the first nine, the strategy is fairly obvious: treat the underlying condition and the symptoms should resolve. Correct the lifestyle slip ups and the symptoms should get better. The last one, depression and stress, is a much harder mountain to climb. There is no one strategy that works for everyone because it is not a straightforward issue. You know what my first suggestion is going to be: talk to your doctor! Clue them in to what is going on with you and maybe they can help. Talk to your family and your friends. Maybe they are feeling the same way! Support each other the best we can! Seek counselling and therapy. I know that I personally have a list of counsellors ready to help at my office at any one time. Don’t try to tackle it all on your own! There is no harm, no foul, and no defeat in seeking help. The real battle is lost when you don’t take advantage of the resources around you and something terrible happens. Then the consequences spread like ripples on a pond, not only affecting you, but everyone you care about as well. Make sure you take the time to realize your own importance, especially now. No one can do that for you. I will make you a promise right now, we doctors are here for you.. We understand and we are tired too, but we will always be here.