Body-mass index (BMI) is another way to find out whether you are at a healthy weight.

Most of us judge whether we are at a healthy weight by stepping on a bathroom scale.  Body-mass index (BMI) is another way to find out whether you are at a healthy weight.  BMI provides a reliable indicator of “body fatness” for most people, and is used to screen for weight categories that may lead to long-term health problems.

Body Mass Index (BMI), is a number calculated from a person’s weight (in pounds) and height (in inches).

A calculated BMI will help you determine your true weight status as either underweight, normal, overweight, or obese. These BMI ranges are based on the effect of weight status on disease and death. Generally, as a person’s BMI increases, so does their risk for a number of health conditions and diseases.

BMI Weight Status

Below 18.5 Underweight

18.5 – 24.9 Normal

25.0 – 29.9 Overweight

30.0 and above Obese

Having a BMI of 25 or higher may be an indicator of having too much body fat.  But there are other health risk factors that should be considered along with your BMI.  These risk factors include a high cholesterol level, high blood pressure, diabetes and mildly elevated blood sugars, or “borderline diabetes”. Another risk factor is a waist circumference of 40 inches or more in men or 35 inches or more in women.

BMI measures are not always accurate for everyone and in certain circumstances BMI should be interpreted with caution.

BMI is only applicable to adults 20 years old and older, and is interpreted using standard weight status categories that are the same for all ages and for both men and women.  For children and teens, the BMI is both age and sex-specific.

Women who are temporarily carrying extra weight due to pregnancy should not use BMI to determine health risk.

Athletes and body builders may also have a falsely elevated BMI as they typically have a large proportion of their body weight contributed by lean body mass (muscle tissue).

Most important factor that determines surgeon’s ability to perform any operation

Correct recognition of surgical anatomy is the most important factor that determines surgeon’s ability to perform any safe and effective operation.

Surgeon’s dexterity and availability of assistants, proper instruments and devices are also important but have only a secondary role in achieving a desired outcome.

The more surgical anatomy is complex and significantly altered by disease process, the more challenging it becomes to identify the correct tissue landmarks.

When surgical anatomy is not properly identified, complications such as unintentional organ injury may occur, blood loss may be higher, operation may take longer, infection may develop, blood clots may be formed, reoperation may be required, hospital stay may be prolonged, home recovery extended and return to normal activities delayed.

Surgeon learns correct recognition of surgical anatomy during medical school, residency and fellowship. Surgeon’s dedication and length and quality of the training programs are important in achieving such an intricate skill.

Unequivocal knowledge of three dimensional appearance of different organs, tissues, cavities, blood vessels is the quintessential prerequisite for a surgeon to execute a successful operation.

20 Methods of contraception. Which one is right for you?

Birth control has been used for thousands of years to prevent pregnancy. Today there are many safe and effective birth control – or contraceptive – methods available. And there is not one method that is right for every person. In fact, there are currently 20 methods of contraception!

  • Abstinence and outercourse
  • Birth Control Patch
  • Birth Control Pills
  • Birth Control Shot
  • Breastfeeding (Lactational Amenorrhea Method)
  • Cervical Cap
  • Intrauterine Contraception (IUC)
    • Copper-T IUD
    • Hormonal IUD
  • Diaphragm
  • Emergency Contraception
  • Female Condom
  • Female Sterilization
  • Fertility Awareness Methods
  • Implant
  • Male Condom
  • Spermicide
  • Sponge
  • Withdrawal (Pulling Out)
  • Vaginal Ring
  • Vasectomy

So – what are some things you need to think about when choosing a birth control method that will be right for you?

Ask the following questions:
How well does a particular method prevent pregnancy?
How easy is it to use?
Would you like to help control your bleeding patterns?
Do you need a prescription to use it?
Does it protect against sexually transmitted infections (STIs)?
Do you have any health problems?

Answering these questions will help with narrowing down your choices, and through discussions with your health care provider, you will be able to better choose a birth control method that will be most effective for you.

Ovarian Dermoid Tumor

Ovarian dermoid cyst (cystic teratoma) is a certain type of germ cell tumor. The vast majority (98%) of these tumors are benign (mature) and only 2% are malignant (immature). Dermoids derive from certain cells within the ovary that have the ability to generate different tissues such as hair, skin, bone, cartilage and sebaceous (greasy) fluid.

These tumors can expand and create large masses within the ovary. Due to its significant size, such ovary may undergo torsion (twisting) causing blockage of ovarian blood supply (ischemia) which results in severe pain and possibly loss of the ovary. Spontaneous leakage from or rupture of the dermoid may also happen generating severe inflammation inside the abdomen. Often, these complications necessitate emergency surgery.

Timely diagnosis of ovarian dermoid/s can preclude complications and prevent emergency surgery. Proper bimanual pelvic exam and pelvic sonogram usually are the most efficient means to detect ovarian dermoids. Sometimes CT scan needs to be done as well.

Elective (non-emergent) surgery is best suited to remove the dermoid without compromising the ovary and avoiding spillage of it’s contents inside the abdomen. Minimally invasive surgery, such as laparoscopy or robotically assisted laparoscopy further reduce these risks. Careful and precise extraction of the dermoid while preserving healthy ovarian tissue and avoiding abdominal spillage is paramount. If properly performed, such an operation is outpatient with a relatively short recovery of one to two weeks. Correct completion of such surgery should preserve future fertility.

Some more things to know about FEMALE SEXUAL DYSFUNCTION (FSD)…

In general, there are 4 kinds of sexual problems in women: Desire disorders, when there is no interest in having sex, or a decreased desire for sex than previously; Arousal disorders, when there is the absence of the feeling of a sexual response or difficulty in staying sexually aroused; Orgasmic disorders, when there is the inability to have an orgasm, or there is pain during orgasm; and Sexual pain disorders, which is when there is pain during or after sex.

There are physical causes for sexual dysfunction, as well as psychological causes. Physical causes include certain medical conditions such as vaginal infections or chronic diseases, such as diabetes and heart disease. Hormonal imbalances, fatigue, alcoholism and drug abuse, as well as the side effects from certain medications can affect sexual desire and function. Psychological causes include stress and anxiety, relationship problems, depression and a history of current or past sexual abuse.

Ideally, treatment of FSD involves a team effort between the woman, doctors, and trained therapists. Most types of sexual problems can be corrected by treating the underlying physical or psychological problems.

It is important that women and their partners understand that there are many elements of the treatment of FSD. For example, education about anatomy, sexual function, and the normal changes associated with aging, as well as sexual behaviors and appropriate responses, may help a woman to become less anxious about sexual function and performance.

The good news is that there is often great success in treatment for FSD. Depending on the underlying cause of the problem, the outlook can be quite good, particularly for FSD that is related to a treatable or reversible physical condition. Even FSD that is related to stress, fear, or anxiety often can be successfully treated with counseling, education, and improved communication between partners.

If a woman has concerns about FSD, she should feel comfortable discussing this with her health care professional. And, in turn, the health care professional should be able to discuss FSD with his or her patients and refer out if necessary.

Minimally invasive removal of Essure avoiding hysterectomy

One of the options for permanent sterilization is hysteroscopic intra-fallopian tube placement of two flexible coils made of a mixture of polyester fibers, nickel, titanium, platinum, silver-tin and stainless steel. Intentionally, after three months, these coils become embedded into lumen of corner of the uterus and lumen of the fallopian tubes. It is called Essure and is an effective permanent birth control device. Unfortunately, some patients develop persistent pain, and suspected allergic or hypersensitivity reactions which can be exhausting.

Removal of Essure coils is the only way to eliminate these quality of life disrupting side effects. Due to permanent embedding of these coils, both fallopian tubes and both lumens of uterine corners need to be removed. Given the complexity of the task, some of these patients, unfortunately, undergo unnecessary hysterectomies.

Robotically assisted laparoscopic removal of Essure coils containing fallopian tubes and lumen of uterine corners is bloodless, spares the uterus and is done in an outpatient setting without the need for overnight stay. Patients can return to normal activities in one week.

Surgical/procedural alternatives to hysterectomy

Hysterectomy, which means removal of the uterus (womb), should always be the last resort in surgical armamentarium. Some of the indications for hysterectomy include menorrhagia (prolonged and heavy menstrual flow) and symptomatic leiomyomata (fibroids). Though the vast majority of hysterectomies can and should be done in a minimally invasive way without overnight stay, it still constitutes a major surgical intervention. Non-hysterectomy interventions need to be considered and exhausted before deciding to remove the uterus.

Endometrial ablation, which means destruction of the uterine cavity lining, can be used to treat menorrhagia (prolonged and heavy menstrual flow). This procedure entails no incisions and no removal of uterus and takes less than 10 minutes to perform. Patients can go back to normal activities in 2-3 days. It is effective in about 75% of cases. The remaining 25% may need a hysterectomy later on.

Myomectomy, which means removal of fibroids, is done to treat symptomatic leiomyomata (fibroids). The vast majority of myomectomies can and should be done in a minimally invasive way without overnight stay. Preservation of the uterus is achieved. If they wish so, patients may get pregnant 3 months after myomectomy.

Uterine fibroid embolization (UFE) is done to treat symptomatic leiomyomata (fibroids). UFE is done in a minimally invasive way with only a small incision in the groin. Fibroids are not eliminated but their volume and activity are decreased. Uterus is preserved. UFE is effective in about 80% of cases. The remaining 20% may need a hysterectomy later on.

Female Sexual Dysfunction: It’s time to start a discussion with your healthcare partner.

Sexual expression is a normal and healthy part of human behavior. And yet women are not always comfortable discussing their sexual health. While research suggests that women (as well as men) have issues concerning their sexuality and sexual health, it remains a topic that people are hesitant to discuss with their healthcare providers. In turn, healthcare providers are working to better understand how to speak with our patients about their problems with sex, or “sexual dysfunction,” because most cases of sexual dysfunction are treatable. And how we treat these issues requires the understanding that there is a difference between male and female sexual response and that there are different causes of sexual dysfunction.

So how do you know if you have a “problem?” Most adults will encounter some problem with sex and some point in their lives. This doesn’t necessarily mean that you have sexual dysfunction. But if you don’t want to have sex, or it never feels good, please consider discussing your concerns with your gynecologist or other healthcare professional, which would be a confidential encounter. Sexual dysfunction is diagnosed through a conversation about your concerns and evaluation that may include a pelvic exam, and will likely involve a discussion about your attitudes regarding sex, as well as other possible contributing factors.

How we treat female sexual dysfunction, and how successful treatment is, will depend on the underlying cause. Treatment requires the involvement of the woman, engagement of her sexual partner, the involvement of her trusted provider who is interested in sexual dysfunction, and possibly the expertise of trained sexual therapists.

The Washington Post recently reported that while our culture is more sexualized than ever before, people are having less sex than in the recent past. And there appears to be no clear explanation for this “sexual slump.” If you are concerned that you may not be having as much, or the kind of sex you would like to be having, please contact your healthcare partner who can suggest ways to treat your sexual problem or can refer you to a sex therapist or counselor if needed.

Who is a candidate for Robotically assisted Laparoscopic Hysterectomy, Myomectomy, Excision of Endometriosis and Sacrocolpopexy?

Scores of women suffer from huge aching uteri, enormous painful fibroids, debilitating endometriosis and incapacitating pelvic organ prolapse. Many times they had prior abdominal surgeries and/or are obese.

In US each year hundreds of thousands of women undergo hysterectomies (removal of uteri), myomectomies (removal of fibroids), excision of severe (frozen pelvis) endometriosis and sacrocolpopexies (suspension of vagina). The majority are performed by laparotomy which is making a several inch incision through the abdominal wall in order to access the pelvic cavity. Such an incision cuts through skin, fascia and muscle. It requires a several day hospital stay and six to eight week recovery at home. It is also associated with more pain, higher risk of infection, creation of adhesions and scar tissue, weakening of the abdominal wall and hernia formation.

Fortunately, the vast majority of hysterectomies, myomectomies, excision of endometriosis and sacrocolpopexies can be performed using advanced robotically assisted laparoscopic surgery. Laparoscopy eliminates the need for the several inch long abdominal incision, thus significantly reducing the above mentioned unpleasant results and complications.

Every patient suffering from huge aching uteri, enormous painful fibroids, debilitating endometriosis and incapacitating pelvic organ prolapse is a proper candidate for such a minimally invasive surgery, regardless of the size of uterus, number/dimensions of fibroids, severity of endometriosis, extent of pelvic organ prolapse, history of prior abdominal surgeries or obesity.

These conditions present significant challenges for the common OB/GYN to perform such advanced robotically assisted laparoscopic surgery. Therefore, unfortunately, many patients are advised by their doctors, that they are not a candidate for the minimally invasive surgery. Many patients don’t seek a second opinion and end up undergoing the much more invasive surgery, laparotomy.

These patients should not be misguided from undergoing a minimally invasive surgery. Robotically assisted Laparoscopic surgery requires only four to five quarter of an inch to half an inch incisions, no hospital stay and 2-3 week recovery at home.

Benefits of outpatient surgery for hysterectomy, myomectomy and sacrocolpopexy

Traditionally, patients have recovered in the hospital for several days after a major gynecological surgery such as hysterectomy, myomectomy and sacrocolpopexy, Customary justifications for the inpatient stay included better pain control and immediate recognition and care of postoperative complications. However, the following benefits of minimally invasive surgery (MIS) virtually eliminate the need for open abdominal surgery (laparotomy):

Replacement of laparotomy by MIS results in significant pain reduction. Incisions are smaller and disruption of internal tissues is minimized. Pain medications may be reduced versus open surgery.

Early (same day) postoperative ambulation improves total body blood circulation and lung ventilation, greatly decreasing the incidence of clot formation (DVT) and pneumonia. Because outpatient surgery is “less involved” than inpatient surgery, patients released home just hours after surgery feel good enough to move around a bit. They sleep in their own bed, eat in their own kitchen, and use their own bathroom (instead of a bed pan). Obviously, they have no IV’s or catheters, which also helps with ambulation.

Patients are not exposed to hospital borne infections.  

Universal implementation of MIS (vaginal and/or laparoscopic and/or robotically assisted laparoscopic methods) instead of laparotomy can eliminate inpatient hospital stays for patients undergoing major gynecological surgeries, such as hysterectomies, myomectomies and sacrocolpopexies. The combination of less pain, quicker ambulation, fewer infections and the convenience and comfort of recovering at home result is a speedier emotional and physical recovery.

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