Tag: Pap

Hormone safety= actual exam and proper follow up

First I want to shout out a huge hurray that we have finally refuted/retracted that study from decades ago that hormones were bad. Personally I ignored it anyway because I knew it was done wrong, in the wrong age group on women that already had preexisting risks of all the complications mentioned. I refused to let women suffer and kept on prescribing, in the right patient, with the right risk profile, and with the proper follow up. And, guess what? No one got cancer or got harmed or died. Sounds good right?

So, nowadays, well, actually this has been going on for awhile, everyone thinks that they can easily become hormone experts and prescribe whatever they want to anyone. They are literally handing them out like candy on Halloween. It sounds good, but here’s what they are missing. They are not examining anybody, which the patient incorrectly perceives as a bonus. They are not doing any ultrasounds on those with an intact uterus to see what is going on in the pelvis. And, most of them are relying on some outsourced lab to tell them what to prescribe in the first place and ending up putting patients on doses that are way above what is recommended. To top it off, they are not following up or screening them properly in any way and potential harm risks are missed.

I am going to say once again, how potentially egregious this approach is. Yes, I know I have said this many times, but it bears repeating. I keep seeing patients over and over again who have been going to these non-hormone experts and getting all kinds of hormones and then they finally end up seeing me, probably only because they are tired of paying cash not for an exchange in the quality of care. Then, I need to sit them down and explain how an exam and an ultrasound are necessary so that I can pre-evaluate for any risks or problems before we even start. I get it, I am not ready to provide the instant fix without any patient responsibility or any responsibility from me. Yes, that is true. I am determined not to intentionally cause harm. I also, tend to not rely on anyone else’s information and obtain my own before proceeding. This is sadly a problem for some because they perceive that a limited amount of time and investment and efficiency alone should be their own qualifying characteristics of good care.

I need to please ask all of you to reconsider before using these non-hormone expert alternative options. They are often expensive for one. Also, they are often actually dangerous. Just in these last three months alone, I have had a return of patients from the past who left to pursue these alternative options, only to return over ten years later to seek care from me again, and find out that they now actually have cancer that was missed while they were never getting examined or followed up properly. These are heartbreaking and preventable situations. I feel saddened as I need to tell them what is actually going on because they had been previously convinced that everything was good and paid a lot of money too. Nonetheless, despite these sad and potentially frightening situations, it is my job to protect and care for them properly. It makes me end up being what they see as the bad guy, when in reality I am the one trying to rescue them before it is too late.

I just need to say it one more time. Please reconsider before going to one of these places for hormones or women’s care. If it is a well-meaning primary care provider who doesn’t know better not to give estrogen alone to a patient with an intact uterus or a fancy beautiful place that requires no actual physical exam or ultrasound, please reconsider. By using these resources, you are, in fact, putting yourself in potential danger.

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

Just gimme 20 min

Hi guys. Dr. Katz here. It has been a minute but my soapbox is begging me to climb back up so I’m gonna. There is just something I have to get off my chest.

The women’s health screening recommendations are trash lately. I mean, they completely suck. All this nonsense about spacing mammograms farther apart, forgetting about yourself after the age of 50, not needing an obgyn exam after having a hyst….all baloney and dangerous on top of that!

First of all, why would we ever recommend something that would decrease our awareness of our own bodies? How does that make any sense? How does that empower us or increase our chances of using our powers to evoke good in the world? I tell ya. It doesn’t. Those recommendations are based on statistics and costs, not people and patients. Those statististics and recommendations are based on how much it would cost to save the lives of 5 or 10 or 20 extra women. Well I say, what is the cost of a human life? Can you really put a cost on it? To me, every single life out there is precious and worth preserving. There is no cost too heavy to at least attempt to save it. For all these small numbers of difference in lives spared, I find these numbers to be at least ten times higher just in my practice. In the last month alone, I have had to give bad news to at least ten women that was preventable or at least treatable at a much earlier stage if someone had been looking. These women were not doing anything wrong. They were not being non compliant. They were just following these recommendations that their physicians were following. None of them even had symptoms serious enough to warrant their seeking medical help. That’s just how sneaky obgyn issues are!

I have something to say to these academicians who make these recommendations. When you are ready to sit down face to face to one of those patient whose diagnosis you missed and tell them how it was too costly to bother with them, then we can talk. If you can’t, and I suspect you can’t, then I am going to continue to ignore those recommendations and advise women to be seen on a yearly basis. You can’t even use insurance coverage as a reason because most insurances are still covering the yearly exam, even with no copay! Why are we wasting the opportunity to make good use of our awesome preventative resources? Why?

Bottom line. I am a fan of the yearly check-up. Just c’mon in will ya?

Stop confusing women would ya? Just let me take care of them.

What am I talking about? I am talking about gynecological care guidelines. Most recent guidelines from the USPSTF recommend pap smears every three years from ages 21 to 65 if using just the pap smear or every 5 years between 30 and 65 if using the pap smear and HPV testing. These recommendations are based on epidemiological data and costs. The few issues that may be caught before the age of 21 and after the age of 65 are too few and far between to be considered economical to screen for.

I have a problem with this in both the translational sense and the practical sense. With regard to the translational sense, these recommendations have the tendency to confuse adult women based upon terminology. Most women equate getting their pap and their annual check up as one and the same. They are not! In my office, the pap smear is about a 10 second clip of what I do. It is just one small piece of the puzzle. The real meat and bones is in the head to toe exam that I offer which allows me to check for anything that could be wrong in all body parts. You see when you tell most women they don’t need a pap but every three years, if at all, they think sweet! I am off the hook for any gynecologic exams for three years at a time and they don’t come in at all. In the practical sense, this lack of clarification is both irresponsible and potentially deadly. Obgyn is blessed to have some of the best preventative tools in the business but we become crippled by these recommendations because the patients don’t show up. Add to that the fact that insurance companies jump on the bandwagon and start trying to refuse to cover paps/annuals and these women are potentially really screwed. In the practical sense,, the thing is that most gyn conditions do not present with symptoms until the condition is pretty advanced. A little itch on the vulva could actually be a vulvar cancer. A little feeling of fullness in the abdomen could actually be an ovarian tumor. But, unless someone is looking(i.e me), the patient doesn’t know, the condition goes unrecognized and the situation goes from simple and treatable to serious and deadly. In addition, I would challenge the academicians that sit behind the desks and formulate these recommendations to sit down with the patients whose diagnosis you missed and explain to them how it’s ok because the cost/returns ratio was just not in their favor to justify screening. I am not sure that quoting guidelines will help the patient or the family feel any better either.

The bottom line is that I am a fan of the annual exam, whether or not the pap is performed. It is definitely the most bang for your buck way to be watchful for your patients. It really goes back to the OPPOSITE of the old adage: what you don’t know or can’t see CAN hurt you! Have a great day everybody!

Dr. Katz