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Thoughts on Hemodynamic Instability, Laparoscopy, and Ectopic Pregnancies

As a young physician, I was taught that when a patient presents with a ruptured ectopic pregnancy and was hemodynamically unstable, the corimagesrect course was to perform a laparotomy for immediate control of the bleeding.  At that time (around the year 2000), complex laparoscopy was not really in wide practice, a
nd a physician who suggested that they could control bleeding laparoscopically as quickly as they could via laparotomy would have been met with skepticism.  In some cases, a physician suggesting a laparoscopic approach to the problem might be blocked by the atten

ding anesthesiologist, who often holds veto power over certain surgical decisions.  The idea was that the bleeding needs to be stopped quickly, and the way to do that is a laparotomy.

But over time, our ability to do things quickly and effectively via laparoscopy has changed, and I think our understanding of hemodynamic instability in young women has changed as well.

Read more…

Academic OB/GYN Podcast Episode 38 – The Endometriosis Podcast Launch

January 12, 2017 1 comment

Cross Post of Episode 1 of our new project The Endometriosis Podcast!   Dr Fogelson and new co-host Libby Hopton discuss new literature on endometriosis and answer question from the endometriosis patient community.  Topics include endometriosis research production, BPA and endometriosis incidence, outcomes after resection of bladder endometriosis, and more!

Sponsored by TrueLearn.  For a 10% discount on your order use the code “academicobgyn”

 

Academic OB/GYN Podcast Episode 38 – The Endometriosis Podcast Launch

 

A Holiday Message from Nicholas Fogelson and Academic OB/GYN

Merry Christmas and Happy Holidays from Nicholas Fogelson and Academic OB/GYN!   Dr. Fogelson is available for clinical consultation at the Pearl Women’s Center in Portland, OR at 503-771-1883.  He is a better gynecologic surgeon than he is a rapper.  And he’s not completely terrible at rap so there’s that.

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.

 

 

Dr. Fogelson is a gynecologic surgeon and endometriosis specialist who practices at Northwest Endometriosis and Pelvic Surgery in Portland, OR.  Call 503-715-1377 for clinical consultation.  http://www.nwendometriosis.com

 

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

 

 

 

Dr. Fogelson is a gynecologic surgeon and endometriosis specialist who practices at Northwest Endometriosis and Pelvic Surgery in Portland, OR.  Call 503-715-1377 for clinical consultation.  http://www.nwendometriosis.com

 

Surgical Video: Robotic Endo Resection with Superficial Rectal Resection

 

Dr Nicholas Fogelson of Northwest Endometriosis and Pelvic Surgery in Portland, OR demonstrates resection of severe bilateral pelvic endometriosis with superficially invasive anterior rectal wall disease.

Dr. Fogelson is a gynecologic surgeon and endometriosis specialist who practices at Northwest Endometriosis and Pelvic Surgery in Portland, OR.  Call 503-715-1377 for clinical consultation.  http://www.nwendometriosis.com

 

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 passionate 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 seconds usually) 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…

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