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The Important of Estrogen Replacement after Surgical and Natural Menopause

November 11, 2016 2 comments

Last night the Portland OB/GYN Society, of which I am the current president, had the honor of hosting Dr Philip Sarrel to speak on the important topic of replacing estrogen in women who have experienced surgical menopause at an early age.   His talk was fantastic, and illustrated the extreme importance of replacing estrogen in any woman who has experienced an unnatural loss of estrogen early in her life, and the ongoing benefit of estrogen replacement after menopause as well.   I encourage you to review this video, which describes the findings of his research and his point of view, which I entirely agree with.

What was truly striking to me was the number of women who have had their ovaries removed at an early age.  It saddens me, as I know that in many cases this is because of pelvic pain and endometriosis.  While oophorectomy often does improve and in some cases even eliminate endometriosis pain, with proper resection of the the disease we can often achieve substantial and even complete pain relief while preserving ovarian function.

This is definitely worth a watch.

Categories: Gynecology, Uncategorized

A Political Letter

November 9, 2016 7 comments

Nicholas Fogelson, MD

140 NW 14th Ave

Portland, OR 97206

11/9/2016

Dear President-Elect Trump,

I am writing to reach out to you, something I have never been inspired to do for a president-elect in the past.   First, congratulations on your hard fought victory, and to your family.  It was a surprise for many of us.

While it was probably a happy morning in your campaign and family, it was a pretty dark morning in my household.   Our family was very supportive of Secretary Clinton, and felt that she was the best choice for the president.  In particular, my wife was a ardent supporter, making hundreds of calls of the Secretary’s behalf.   As a Canadian, she was quite looking forward to a continued progressive movement in our country.

We have lived through disappointing elections before, but this one is different.   Unlike the general discontent we felt when Bush defeated Gore, today there is a lot of fear.   Fear not that the country will not go in the political direction we wanted, but fear that the country will go into hell itself.  The person you presented yourself as during the campaign was not a person who seemed to be able to be an effective President.  Particularly your presented views on muslims, your seemingly sexist and misogynistic comments towards women, and your views towards Mexicans as well.  These things just don’t seem to be what our country should be moving towards, no matter whether you are a Democrat or Republican.

It has been my feeling and hope that during the election you have created this image for the pure purpose of galvanizing a certain segment of society and achieving the victory you now have.  It is my true hope that now you are President-Elect, that these incredibly difficult positions can be shed and you can focus on a productive and positive future for our country.  It is my hope that these things we saw were actually a very purposeful act, a charade of sorts, and not truly who you are as a person.

My wife and I are both physicians.  I am a sub specialist surgeon in the care of women with endometriosis.  For the first time in our lives, we are literally considering whether or not the United States is where we want to live our lives.  If you end up being a relatively effective conservative president that pushes Paul Ryan’s agenda more or less, we will go on being Democrats who probably vote against you in four years.  But if instead you normalize racism, promote a military stance that invites nuclear war, and make it generally acceptable for people to be awful human beings, we would have to consider leaving.  And it wouldn’t just be us.  It would be a lot of people like us, people who can’t associate with the values you promoted during the campaign.  And that would be a terrible thing for our country.

I truly wish you and your family the best, and for success in your presidency.  You will now be the most powerful person in the world.  I’m sure that already this weighs on your shoulders.  Though I voted against you, you are now my President.   Please be worthy of that title.

Sincerely,

Nicholas Fogelson, MD

Portland, OR

Surgical Video: Robotic Endo Resection with Superficial Rectal Resection

 

Dr Nicholas Fogelson of Pearl Women’s Center in Portland, OR demonstrates resection of severe bilateral pelvic endometriosis with superficially invasive anterior rectal wall disease.

Dr Fogelson is available for clinical consultation through Pearl Women’s Center in Portland, OR. 503-771-1883.

email: info@pearlwomenscenter.com
email: drfogelson@gmail.com

Birth Control Pills and Depression

October 7, 2016 1 comment

This week a study was published in JAMA Psychology drawing a connection between the use of birth control pills and depression.   This was picked up in the popular press, and briefly we were hearing about it in the news and radio.  I first heard about on my way to work listening to NPR.   The message I got was that a study was just published that showed  a link between the use of birth control pills and the development of new depression.

photolibrary_rf_photo_of_birth_control_pillsToday I read the actual paper that led to this media frenzy, and not surprisingly the media got it at least partially wrong.

Skovlund et al reported the following

“A total of 1 061 997 women (mean [SD] age, 24.4 [0.001] years; mean [SD] follow-up, 6.4 [0.004] years) were included in the analysis. Compared with nonusers, users of combined oral contraceptives had an RR of first use of an antidepressant of 1.23 (95% CI, 1.22-1.25). Users of progestogen-only pills had an RR for first use of an antidepressant of 1.34 (95% CI, 1.27-1.40); users of a patch (norgestrolmin), 2.0 (95% CI, 1.76-2.18); users of a vaginal ring (etonogestrel), 1.6 (95% CI, 1.55-1.69); and users of a levonorgestrel intrauterine system, 1.4 (95% CI, 1.31-1.42). For depression diagnoses, similar or slightly lower estimates were found. The relative risks generally decreased with increasing age. Adolescents (age range, 15-19 years) using combined oral contraceptives had an RR of a first use of an antidepressant of 1.8 (95% CI, 1.75-1.84) and those using progestin-only pills, 2.2 (95% CI, 1.99-2.52). Six months after starting use of hormonal contraceptives, the RR of antidepressant use peaked at 1.4 (95% CI, 1.34-1.46). When the reference group was changed to those who never used hormonal contraception, the RR estimates for users of combined oral contraceptives increased to 1.7 (95% CI, 1.66-1.71).”

In summary, women who used birth control pills were more likely to also use antidepressants.   They concluded that women who use birth control use antidepressants more often, and thus they may be more likely to be depressed.

Here’s what I think about this.

Read more…

Truelearn Question of the Month for October

TrueLearn-Logos-OB-GYN TrueLearn is a web based platform for learning material to improve performance on standardized medical exams, with platforms for specific specialties as well as general medical boards.  In OB/GYN TrueLearn offers question banks for CREOGS, ABOG boards, as well as general OB/GYN question banks.  In each case, the online questions exactly simulate the computer environment you will see when you actually take the test as well.

TrueLearn also allows you to track your performance over time, as well as compare you performance to other doctors and students preparing for the same exam, both on a global level and specific to each question.  It’s a great too that will no doubt be of tremendous use to the thousands of students and physicians who take OB/GYN related exams each year.

Each month, we do a TrueLearn Question of the Month, both on the blog and on the podcast.

Academic OB/GYN readers and listeners can also get a 10% discount on the product by using the promo code “ACADEMICOBGYN” when they order.

 

A 37 year old G6P2042 female patients arrives for her annual screening visit.  She has no new complaints or problems.  She has a family history of breast, uterine, fallopian tube, pancreatic, lung, colon, liver, and prostate cancer.  Which of theses cancers listed is NOT associated with BRCA 1 mutation?

 

A. Breast tumors

B. Fallopian Tube Tumors

C. Lung Tumors

D. Peritoneum Tumors

E. Prostate cancer

Read more…

Categories: TruLearn Questions

On Hysterectomies and Oophorectomies for Endometriosis

September 25, 2016 Leave a comment

As many of you know, I spend a fair amount of time involved in social media outlets, particularly with efforts to support and educate women struggling with endometriosis.   Women with this condition are fortunate to have access to a variety of very active and vigorous advocacy and education groups, and in these groups there is a lot of great information.  At the same time, I occasionally note in these groups that there can be some dogmatic views, and at times I think that there is some incomplete information being passed around.  Perhaps the biggest area I see this in when the topic of hysterectomy for endometriosis is discussed.

Typically the exchange goes like this:

“I have been struggling with endometriosis for X years and have Y symptoms, and my doctor has recommended a hysterectomy.”

Very quickly (within minutes) there will be the response

“Hysterectomy does not treat endometriosis”

or even
“HYSTERECTOMY DOES NOT TREAT ENDOMETRIOSIS!!”

This always rubs me the wrong way.   This is not because it is wrong, but because it is incomplete.  Read more…

Three Problems, One Solution: A New Way to Pay for Medical Education

September 10, 2016 2 comments

 

Case 1:

A middle aged man named called Joe decided in mid life that he would become a doctor.  A former boxing instructor, Joe felt compelled to learn medicine to help his fellow man.   Already in his 30s, he worked hard to develop the prerequisite education to enter medical school, which he did in the late 1990s.

I met Joe in my first year of medical school.  He was a very bright guy and had a great sense of humor.  He was a bit different than most of us, and not just in age.  I remember him asking me once “why would we use anti-hypertensives to treat hypertension.  I mean, if a person’s blood pressure is that high, maybe that’s what their body needs it to be at!”.  I remember thinking it was a strange way to think, given that allopathic medicine pretty much presumes that letting the body do whatever it will may not actually be the best course for long term health.

Joe did reasonably well through the first two years of medical school.  In his third year he had moderate success, and sometimes struggled with having a different outlook on what medicine should be that the attending physicians that were instructing him.  Over time, this became a bigger problem, and Joe eventually made the decision that being an allopathic physician wasn’t what he wanted to do for the rest of his life.

Read more…

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