Pain Management For Office Based Surgery

I don’t normally write these little blurbs to ‘blow my own horn’ but in this case there’s a message I’d like to share.

Minimally Invasive Gynecology In this month’s Journal of Minimally Invasive Gynecology I wrote an editorial entitled “Pain management for office-based surgery: expanding our flight envelope. My motivation for writing this article was quite simple.  Gynecologists, as a group, are poorly educated and worse—in denial—about the simple issue of pain management for office-based procedures.

Much of what we do in an office setting—even minor things such as an IUD insertion, a biopsy of the cervix or uterine lining tissue, can be very painful for some women.  This doesn’t make these women “wimps”.  The simple fact is that women (like men) find some ‘procedures’ tolerable and others intolerable.

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Endomyometrial Resection (EMR)

I Know I Haven’t Written In Months…let’s Face It A Busy Practice And (can You Believe) A Three-year Old Son Will Throw Your Schedule Off A Bit. Time Has Accelerated A Good Deal With In The Past Few Years. In Today’s Article I Would Like To Discuss The Minimally Invasive Management Of Abnormal Uterine Bleeding—and Frankly How What Is Offered Here At The Center For Menstrual Disorders Is Unique And Superior– And Has Not Been Duplicated Anywhere Else In The World!

In November 1988—23 Years Ago– I Was The First Physician In Western New York To Perform Endometrial Ablation. Three Years Later, In 1991 Amy Daggett And I Invented Our Own Procedure—Endomyometrial Resection—which We Have Been Performing For 20 Years. In This Article I’ll Try To Explain What Endomyometrial Resection (EMR) Is And Why This Is The Most Successful Of All The Minimally Invasive Surgical Procedures For Treating Abnormal Uterine Bleeding In The World Today. Continue reading “Endomyometrial Resection (EMR)”

Being Smart about Spending Money for Health Care

The health care debate will rage through the summer and throughout the rest of the year. The final results will affect all of us but regardless of how it turns out there are things you can and should do right now that can lower your health care costs and the costs to the rest of us.

Understand the difference between “need” and “want”—you may want the latest birth control pill, anti-hypertensive, cholesterol-lowering agent but you don’t “need” it. Birth control pills have been around since 1960 and the remainder of these drug classes has been around for decades. There are plenty of generics available and they’re far cheaper. I don’t take name-brand drugs and you should think about doing the same.

Because you think you “need” to go to an emergency room for your sore throat or upset stomach or lower abdominal cramp doesn’t mean you should go there. Don’t take medical advice from friends—it’s often expensive, wrong and pointless. Numerous women go to emergency rooms every year because their mother told them that they may have an ovarian cyst—as if that were somehow dangerous or rare. Some ovarian cysts are dangerous—but very, very few. Continue reading “Being Smart about Spending Money for Health Care”

Office-Based Surgery and What it Means for You

My love affair with office based surgery began in 1976. That year an article was published in a distinguished medical journal by Dr. A Jefferson Penfield, from Syracuse, New York, who had performed over 1600 laparoscopies and tubal ligations in his small downtown office! Dr. Penfield had long ago recognized that women found the office environment less stressful and that by eliminating the intimidating environment of an operating room reduced the need for general anesthesia! The “Catch 22” goes like this: hospitals can provide general anesthesia. The bad news is that if you’re in a hospital you’re more likely to need it.

I tucked that in the back of my mind and in 1982, while at the Wilson Health Center, I wanted to learn more about Dr. Penfield’s method. Back then, as today, insurance companies were looking for ways to cut costs and so this seemed like something worth exploring. The day I spent with Dr. Penfield was truly a life changing experience. Instead of patients spending 4- 6 hours at a hospital for a tubal ligation or a laparoscopy they were generally in and out of the office in 60 or 90 minutes. The staff worked like a well-oiled machine – because they always worked together. How different from a hospital, where frankly, the staff can vary in a single day over the course of 2 or 3 cases. Patients seemed so much more relaxed in an environment in the relaxed atmosphere of an office.

In 1982 many physicians at local hospitals had not adopted laparoscopic surgery—mostly out of the natural fear of learning a new technique—and here was a gifted surgeon offering this alternative to women in his very own office.

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Old Fashioned Medicine – How I Remember It

A Tribute to Saul Solomon, M. D.

I wish there was more time—time to be a husband, a father, a friend and to be a doctor. I grew up in a different era. When I was 4 years and too sick to go to school our family doctor, Dr. Solomon, made house calls! He charged us 3 to 5 dollars but often accepted payment in the form of chicken noodle soup. And though he was often quite busy he managed to become an integral part of my family’s life.

When I turned 5 he drove me and my family to Beth El Hospital in Brooklyn (now Brookdale) and later took out my tonsils while my parents paced in the lobby. I stayed in the hospital overnight and he gave my parents—who never owned a car- -a lift back to their apartment on Sackman Street. The next day he discharged me and drove me home to my parents—I still remember the “ice cream reward” he gave me for being a good patient. Sounds unbelievable; doesn’t it? It really happened. I don’t know how he had the time to do all this but I remember feeling that our family was very special to him.

He saw us through my brother’s mental illness, my father’s prostate surgery, my mother’s hypertension and depression. And in 1971, during my junior year at Brooklyn College, he helped me pick a medical school—and that’ how I ended up at the University of Rochester. The story’s a bit more complex but let’s save it for another time.

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