Second Childhoods

I am not sure that the Baby Boomer generation will be having a second childhood.
At least to me, I didn't leave the first one behind. Fun, excitement, living in the moment, and pleasure have been our trademarks. I see us beginning to "retire" but I don't see us stopping. Now one thing is for certain, we worked hard. There were lots of us, and competetion was stiff for just about everything from parking space to college entry. And, then of course, we came of age during the first oil crisis in the 70's, where there were no jobs and the economy went south. Then we picked ourselves up and enjoyed the prosperity of the 80's and 90's. Those of us who did well may still have a nest egg. The rest of us will continue to work, for a while at least.

Now I remeber hearing about old folks who had second childhoods. They stopped being stern and grumpy and started to enjoy the simple things all over again. They laughed, played and felt at home with themselves. I don't think the Baby Boomers, a la Dennis Hopper's Amex commercial, have left that behind. Just look at any highway on a Sunday. Grey haired bikers, convertible couples, and fun seekers with arthritis are all over the place. Of course, I am in Florida, but just the same.................

I just came back from a trip to Epcot this weekend. It was terrific! Sun, fun, grazing at the Food and Wine Festival, thrill rides, whew! Then plopping myself in the Lazy River in a tube for a few hours and hot tubbing with my Margarita.. Now that's my childhood........................................

I looked at the 30 somethings with the twins in the strollers, saddled with their overstuffed diaper bags, and backpacks. No thank you, been there and done that. If I ever have a grandchild, there will be no stopping us. Remember Auntie Mame? That woman is ME. Just one adventure after another tasting the delights life has to offer. So I say no to a second childhood.

My advice - don't give up the first one.

Behind Closed Doors

Indiana University recently published  The National Survey of Sexual Health and Behavior.
Interesting reading for us gyn geeks. It seems that casual sex is bimodal, for those under 25 and those over 50. It's just riskier with a 50+ man. They only use condoms 25% of the time, while 18-19 year olds use condoms 80% of the time. Makes one wonder if the cougars know something.

This is not an unusual conversation I have with my over 50 patients. How to have that "how do we deal with std" conversation. See my earlier blog entries regarding herpes for some details.
It is now a fact, and will be a focus of public health efforts, that you should get the AIDS education along with your AARP card. Us old folks have been around the block. That means more time to accumulate little gifts that keep on giving. Again, see earlier blogs for the herpes virus heartbreak.

Now it seems that most of the sex is happening between ages 20-40. No big surprise. There is a progressive decline in reported sexual behavior with a partner after age 40 for women and men. The varieties of sexual behavior that was surveyed included solo and partnered masturbation, oral sex given and received by same and opposite sex partners, anal sex given and received , vaginal intercourse,  and condom use. It seems that most everyone has tried oral sex, but less than half anal intercourse.
Vaginal intercourse is still the mainstay of experience, however partnered masturbation was a surprise, at least to me. Non coital sex is an important part of the national repetoire.

The purpose of the study was to shed light on contemporary sex practices to focus on the future needs of public health campaigns. This surveys a  comprehensive statistically valid sample of Americans. The last such survey was about 1990. The survey was published in a supplement to the Journal of Sexual Medicine.

Until next time,

In the confessional : GYN 101

Hello out there

After a few visits, and sometimes just one, women approach me with their deepest concerns, fears, and secrets.  Frequently it starts out as a question, but as the conversation flows, the information is shared. 

This is a challenge for me. I am not a priest. But I do have an oath of confidentiality sworn or go to HIPPA Hell.

I have never revealed a confidence, as many women reveal their secrets of past lovers, current amours, pregnancies lost or terminated,, sexual practices, I sometimes wonder if I were meant to hear all of this.

There are days I don't think I get paid enough to listen, or to share advice mother certainly should have done years ago, but here I am. Somehow I manage to maintain an open nonjudgmental attitude and discern what my patient wants and needs from me by the telling. Mostly acceptance, sometimes affirmation, sometimes just someone to listen. Then there are those who want intimate advice regarding their sexual function, and need pointers. Good luck if they are looking to me for help. I am a pretty straight shooter. 

I once had a woman reach into her purse and pull out a split of champagne and two glasses for us to share. She was wildly in love, but with a married man. Until he left his wife and was free to date openly, secrecy was necessary. We had known each other for years, and she wanted to share her unbridled joy. 

We drank a glass, hugged, and a year later she was a married woman, pregnant with her first child.

When I go, so do the details. I never write this down, its too intimate for insurance companies, however I always remember.

Until next time,

Attack of the Machines

This is the week that was.

It's only Wednesday and I feel as if I have been catapulted into the next century. Cleveland Clinic uses a wonderful Electronic Medical Record. As with every other hot program, it gets updates and upgrades.

Welcome to Monday morning 8am. 40,000 Cleveland Clinic employees are faced with a tennis racquet in the face with our latest upgrade. Yes, we were given classes ( weeks ago ) yes, they delayed implementation to give us more time to prepare ( we blew it off ) yes, we had mandatory computer based training ( we glossed it over ).

Reality hit just when the coffee was starting to perk. I expect by Friday, we may have more than a few fried employees.

How bad can it be? It's like taking all of your ABCD type files and then going to a numeric system. All the information is there, go find it. I am sure someone thought this was a good thing, and that it solved lots of user problems. It's just that if you look at my desk, to the casual observer, it is messy. I know where every piece of paper is located, albeit several layers deep. The very moment someone cleans up the desk, poof! I need one of those papers that I now cannot locate. Sound familiar?

Just like thowing away that coupon you are never going to use, you suddenly need the next day.

Well that's what life has been like at our place this week. Work has expanded to the point where I think the patients are getting the Swiss Rest Cure during their office visit while I fiddle with the program to close the visit encounter ( four attempts at least until the darn thing lets me out! ). I pride myself on running on time. Not this week. There are casualties everywhere on my schedule. Lunch has been nixed three days in a row, bathroom breaks are a thing of the past. Forget coffee. Idle gossip is history.
I am a one woman automaton stuck with that computer screen in my face. Waiting for the point where I can finally log out of a patient visit!

Tomorrow I am thinking about bringing in some flowers, incense and a rice bowl to place before the screen of terror. Perhaps an offering will help. It's like my son told me the summer he worked at my old office: The copy machine used to look at me and say" Give me toner, and the blood of innocents. "

So It is not late but I feel wrecked. The best part is that I am on call all weekend. :)

Low Desire, The Sexual Doldrums

First, let me say that women and men are different. 

To some people this comes as a surprise.

Sometimes it seems we expect men and women to think and act the same. We are wired differently for different reasons. In the evolution of the species, Darwin theorized that there was survival of the fittest. That meant that stronger, healthier, smarter individuals lived and reproduced. Males needed to be at the ready in case they came across a receptive female.Females chose who to allow to father their offspring, selecting the best male according to her criteria.

Fast forward to modern times. Women no longer need men. We are independent, educated and earning.

Want a baby? Order out from the sperm bank. However, WE WANT MEN. To have and to hold.

You get the idea.

 Now to sex.

Research tells us that the biggest turn on for a man or a woman is a new partner. Remember those days? Hot , hot, hot! Then things settle down, and after 15 years nothing new has happened in your bedroom. You get the come hither and know exactly how the next 20 minutes of your life will be spent.He does this, I do that, etc, etc.etc. 

NO NO! Boring sex is not something we look forward to.

It is something we endure. 

Now, the truth is that most men are terrified of women, and sexual rejection is about as bad as it gets for them. They will stick with the tried and true forever. Do they like your meatloaf? Will they eat it every day of the week? Will you throw the pan out the window by Thursday? You betcha.

Women thrive on variety and men on constancy. We live at cross purposes. You have to be the one to initiate novelty into the bedroom. How are you going to do that? 

Be the new partner.

FIND THAT Twenty something that is hiding inside you. You know, the one with the red hair , high heels, and tight black dress. She is some woman! Bring her out and let her loose. 

My late husband loved his cars. A trip to the car wash was worthy of a date. So one Valentine's Day we are driving home from work and he turns into the car wash. He plunks down his money, and we drive in. The bubbles spray over the windows, and the next thing you know, my bra is hanging from the rear view mirror.

I nearly killed him right there. WHAT ARE YOU DOING??? He asked. WHOOPEE in the CAR WASH, says I. 

You know, he never got into a car with me again without thinking twice, what I might do next. :)

So find your muse, she is there inside you. If your run out of whack o ideas, there are whole books written for seduction scenes with titles like 1001 nights of Great Sex, etc. You get it. Make sure your man knows that the sun rises and sets in his pants, and you will be one happy girl. NO more boring anything. You have given him the big green light to spice things up.

After 3 pm

There are days when I think that Central Scheduling makes an announcement:

DO YOU HAVE A DIFFICULT PROBLEM?
DO YOU NEED EXTRA TLC?
ARE YOUR SYMPTOMS PSYCHOSOMATIC?
ARE YOU IN A HURRY?

THEN COME SEE OUR GYNECOLOGIST AFTER THREE PM!!!

 Heavens, it seems that way. I take pride that I take the time patients need during a visit. I run on time, almost all of the time, but there are days.........................

I retired from OB two years ago after about 4000 babies. Wheedoggies..that was a rollercoaster for me, the office staff, and my patients. When I entered the world of ambulatory GYN with Cleveland Clinic I thought the chaos was behind me. OH NO, not for me. You see, I am a gynechiatrist. That means that I dispense a healthy dose of psychiatry with each annual exam, consultation, and patient who is about to faint from fear.

This takes a certain amount of time, and finesse. Mostly I get it right the first time. Occasionally I have an abysmal flop, and read someone completely wrong. Oh well, lessons learned, apologies made, and then moving on.

Back to time. Lately I have noticed that the witching hour is 3pm. I suppose that the scheduling department starts at the 8am slot and fills accordingly. Somehow 3 pm and after is "bottom feeders only" time. That would be patients that need to get in "right away", have a time crunch for some other reason, or have kids they have to pick up in 30 minutes.

These patients come with predicatble problems.

For example, there are ladies who have seen three other physicians. All of  whom are of a single diagnostic opinion, offered all of the options, and they don't like it one bit. It is now going to be my job to figure out what they don't like, explain everything again, but this time they will get an explanation they understand ( or I die trying ). I help them get from confusion to a decision.

Other women haven't seen a doctor in years, and my name was on their insurance list. They decided to drop by for the afternoon. These good ladies have never heard of a primary care provider, let alone know what one does. They think everyone is Dr. Welby and does cardiac bypass surgery in the office while they have a pap. These folks need the Cliff Notes of managed care lesson, and I help them get a grip on reality.

Still others went to the family reunion last summer, found out someone's version of family medical history and have decided that their aches and pains are certain signs of the same thing Aunt Martha had just before she passed. They have had these symptoms for years, but today decided to "check out everything". These women get a lesson in what's inherited, and what's not.

Then there are the legions of the half informed. They come in and want "tests". Sometimes they want CAT Scans, MRIs, blood tests, ultrasounds, and all manner of breast imaging. When asked what diagnosis I should ascribe to the tens of thousands of health care dollars they propose to spend, they are not sure. I certainly should know. Doesn't everybody get "tests" ? They need some education in being a good steward of health care resources, and what sane health related maintenence entails.

So between the hours of 3pm and closing ( also known as TBD), I inform, assist, educate, reinforce, assure, diagnose, and explain my way through the day. By quittin time I am one pooped pup.

Until next time.................................:)

Fibroids! Fibroids EVERYWHERE what is one to DO??

This is a daily issue for me in practice. I see a woman for the first time. I take her history, she has had heavy bleeding on and off for years. No big deal for her. I do her exam and ZOWIEE! I discover the enlarged fibroid uterus. Sometimes about the size of a five month pregnancy. Now you know she knew about this.

If I don't find it, it doesn't exist.

Why do women want to hide their heads in the sand?

BECAUSE someone once said the H word.

Hysterectomy.

That is about as misunderstood and feared as Breast Cancer ( we'll go there another day ).

So, she has been suffering with heavy menstrual bleeding, urinating 15 times a day, constant pressure, having to put up with difficult bowel movements, and pressure, not to mention YOWSER cramps for YEARS.

All in the hopes that menopause will rescue her from the dreaded Hysterectomy.

NOW HEAR THIS.

Fibroids do not usually need the BIG H.

Fibroids are benign smooth muscle cell tumors of the uterus. The uterus is made up of the opening, the cervix which stretches ( dilates ) to allow a baby to be born, the lining ( the stuff that comes out as a period ) and the myometrium ( the muscle that is the body of the uterus that grows to accomodate the baby, and then contracts to deliver the baby ).

Fibroids can be on top of the muscle layer, in the muscle layer or protrude into the lining. At any rate many women will have them by age 40, and most don't need any treatment. They can be anywhere from the size of a corn kernel to a basketball. Most hang out and don't cause trouble. Some are some bad girls and cause bleeding and pain, not to mention the bulk symptoms of frequent urination, pressure and constipation. Oh, did I mention PAIN?
Yes, they can be bad.

So what is someone to do? There are many ways of evaluating and managing fibroids. Even when I practiced in rural America, I offered options.
So wherever you live, get the facts.

1. Women who no longer desire childbearing can have Uterine Artery Embolization.  Check it out with Dr. Google. It is a procedure done by a radiologist wherein the arteries feeding the individual tumors are injected with beads to reduce bloodflow and therefore shrink the beasts. No surgery, you get to keep your innards.

2. Myomectomy is for women who desire childbearing. It is done either as a traditional operation ( think C Section scar ) or as minimally invasive ( think through a Bic pen). We have some master gyn surgeons at Cleveland Clinic Florida who do these robotically. VERY SLICK. They remove the individual tumors and sew the swiss cheese back together. You keep the organs, you get to have periods and everything. They are good. No hysterectomy.

3. Removal of the body of the uterus only. This is called a supracervical hysterectomy. Hysterectomy is actually the name for removing the body of the uterus, not the ovaries, not the cervix ( that would be a total hysterectomy ). So you just get the part out that has the tumors. The advantage is shorter operating time and less blood loss. Great for women who never want children and don't want periods again. You keep the cervix and need Pap smears. You keep your ovaries and can continue to be as hormonal as you please. One day in the hospital and one week at home. EXCELLENT!

4. Sometimes hysteroscopy can help with a single fibroid that is in the lining causing heavy bleeding.

5. Sometimes the use of hormones or medication or a Mirena IUD will help for bleeding that is heavier than normal without much pain.


The Bottom Line is that you have OPTIONS. And OPTIONS are good :)

So the next time someone comes in with fibroids, hopefully they have read my blog and know I won't be recommending a hysterectomy any time soon................