Before you have a hysterectomy, READ THIS.

INTRODUCTION

There are 3 different types of hysterectomy procedures currently performed in the US. Based on your specific situation and needs, your surgeon will perform one of the following:

Vaginal Hysterectomy: An incision is made in the vagina and the uterus is removed through this incision. There is no incision visible on the abdomen.
Laparoscopic Hysterectomy: Several small incisions are made in the abdomen. A lighted instrument with a camera is inserted through one of the incisions. The uterus is cut into small pieces and removed through the incisions.
Open Hysterectomy: A larger incision is made in the abdomen and the uterus is removed through this incision.

Dr. Ashford has used the laparoscopic procedure for thousands of surgeries with great success. At Minnesota Women's Care, the minimally invasive laparoscopic hysterectomy has been favored for 5 important reasons:

1. Recovery time is much faster for the patient – allowing a woman to get back to her busy life with a minimal delay.
2. Recovery is much easier for most women because it is far less painful.
3. There is a significant reduction in blood loss over other procedures.
4. The complication rate for the laparoscopic procedure is much lower than it is for an open hysterectomy.
5. There is very little, if any, obvious scarring.

Though Dr. Ashford performs all types of hysterectomies, the majority performed are total laparoscopic hysterectomies. Now there is good news for women about the potential for supracervical hysterectomies (where the cervix is spared). For the right patient, this new procedure has great benefits – especially its 6-day recovery. 

BACKGROUND: THE FDA WARNING

In 2014, due to a warning from the FDA, many physicians and hospitals stopped using what is called an "electronic power morcellator" – the device that had been used to cut the uterus into small enough pieces to remove through the small incisions used in a laparoscopic hysterectomy. Though morcellation sounds graphic, it provides a way for women to be able to have MIS (minimally invasive surgery) when it would not have been possible before.

The FDA made this determination because they were concerned about cancerous tissue being spread throughout the abdomen. As a result, the laparoscopic procedure was not available to some women and the number of open hysterectomies increased dramatically in the US. For many women, this meant a return to the procedure of our grandmother's time – complete with a longer recovery, more pain, and more scarring.

Women who wanted to maintain their cervix AND have a minimally invasive surgery with a 6-day recovery had lost their option to have a laparoscopic procedure. Because of the advantage laparoscopic surgeries provides to his patients, Dr. Ashford looked for a solution. We're pleased to tell you there's great news regarding the return of Laparoscopic Supracervical Hysterectomy.


CONTAINED TISSUE EXTRACTION PROVIDES THE SOLUTION

In 2015, the FDA approved the use of a new device called the PneumoLiner. It is an abdominal bag used to contain the tissue during morcellation. Because it directly addresses the areas of concern noted by the FDA, it allows physicians to use the laparoscopic hysterectomy procedure again in situations where it is appropriate.

Here's how it works: during surgery, Dr. Ashford inserts the PneumoLiner bag into the surgical area through the small incision and the bag is inflated. The uterus is placed inside the bag before morcellation begins. The bag then provides a barrier between the uterus and other targeted tissue and the abdominal cavity during morcellation eliminating the concern the FDA expressed in 2014 about tissue contamination. Once morcellation is complete, the bag is securely closed and removed for disposal through the same small incision.

It's likely you have not heard about the PneumoLiner because it's very new. Physicians must undergo specific training to be able to use the procedure. It is a product that is significant to doctors who believe in minimally invasive surgeries. In other words, for Dr. Ashford – a firm believer in using surgical methods that decrease recovery time – the PneumoLiner is an essential tool.


DR. MELVIN ASHFORD: LEADING THE WAY

Dr. Ashford was trained to use the PneumoLiner by the inventor before training sessions became available in the US. He performed one of the first surgeries in the country using the product and was impressed with the results. His patient experienced less pain, less blood loss and was back to work in a week. It is exactly the kind of outcome Dr. Ashford seeks for his patients.

Since that time, Dr. Ashford has continued to use the PneumoLiner and to provide educational resources for other physicians and patients who are interested in the product.

VIDEO:
View a Laparoscopic Supracervical Hysterectomy (LSH) using the PneumoLiner system

Dr. Ashford recently performed a Laparoscopic Supracervical Hysterectomy (LSH) using the PneumoLiner system and recorded the surgery for others to see. The LSH, as it's known, is a laparoscopically performed hysterectomy where the uterus is detached from the cervix and then removed through a very small incision in the abdomen. This video shows exactly how the surgery works.
 

VIDEO:
DR. ASHFORD EXPLAINS THE IMPORTANCE OF THE PNEUMOLINER

After the FDA warning in 2014, many physicians who typically had performed minimally invasive surgeries were no longer able to do so. Dr. Ashford explains the importance of the PneumoLiner system and what it means for women who prefer laparoscopic supracervical hysterectomy surgery.

Dr. Melvin Ashford and the Minnesota Women's Care team are dedicated to providing women with the most advanced treatment options for OBGYN and Pelvic Floor Disorders. Dr. Ashford is board-certified in both OBGYN and Urogynecology (Female Pelvic Floor Medicine and Reconstructive Surgery (FPFMRS).

Phone: 651-600-3035
mnwcare.com

Post Baby: There's something different "down there"

You just had a baby, but something feels “off “down there. You’re not quite sure what to expect because you’re new to the whole postpartum process, but you’re certain that a bulge in your vagina is not normal. When the vaginal pressure does not ease up, you decide to check in with your doctor, only to find out that you have a type of Pelvic Organ Prolapse called Uterine Prolapse.

As scary as this diagnosis may sound to you, there are options available to relieve symptoms, or repair the prolapse.  You wonder how this prolapse happened. One day your uterus is snugly in place, and the next, you are suffering the unpleasant symptoms of pain, pressure and an aching lower back. A prolapsed uterus is a common occurrence after a vaginal birth, but even women who have never given birth can also develop a prolapse.

Basically when damage to the fascia (The wall that holds up the organs), ligaments and muscles of the pelvic floor occurs, it can cause the uterus to sag into the vaginal canal – leading to incontinence, and a feeling that something is “stuck” or “falling out.” These problems may worsen with age, as decreased estrogen causes the pelvic floor to relax even more.

Often times symptoms of this occurs after a delivery but will spontaneously resolve within 6 months.  Important, while the symptoms may resolve, the damage to the fascia, muscles and ligaments will not.  Women may feel well for years only later to have the bladder, rectum or intestines start to sag out of the vagina.  Others may later experience unwanted leakage of urine or stool.  For this reason, most women with pelvic floor damage following a delivery should be seen, evaluated and started on pelvic floor rehabilitation. 

Fortunately, for women even when the symptoms do not resolve, you don’t have to deal with these meddling symptoms. There are many options available to address these concerns.  Note! Surgery likely will not be necessary!   Also remember you are not alone! Many other women are dealing with the inconvenience and pain of a prolapsed uterus, and you don’t have to suffer in silence. Make a list of questions and concerns and contact us.

Dr. Ashford is board certified in Female Pelvic Medicine and Reconstructive Surgery (FPMRS) and understands complex female anatomy.  In fact he is one of the few board certified OBGYNs also board certified in Female Pelvic Medicine and Reconstructive Surgery in the state of Minnesota.  We are able to offer a range of effective treatment options when problems occur.

You’re in good hands – during your pregnancy and after at Minnesota Women’s Care.  Don’t hesitate to call us to talk about your options to find relief for your symptoms – and help that “bulge” disappear.  Minnesota Women’s Care  651-600-3035.  www.mnwcare.com

Atrophic Vaginitis

Atrophic vaginitis is a common problem in postmenopausal women.  It is the result of low estrogen levels in the vagina.  Without appropriate levels of estrogen the “good bacteria” (lactobacillus) counts decline sometimes resulting in elevation of bad bacteria.  This increases the likelihood of recurrent bladder infections.  Lubrication  of the vagina dramatically decreases with lower estrogen levels and the lining becomes thin and inflamed.  This leads to pain with intercourse.  Painful sex is often the leading symptom that prompts women to seek treatment. 

While atrophic vaginitis is most commonly a problem with postmenopausal women it may also occur transiently in breast feeding women.  It could also be a significant problem in women with a history of cancer following chemotherapy or pelvic radiation.  Both result in potential damage to the ovaries.

With declining ovarian function comes declining estrogen levels followed by atrophic vaginitis.

Initially women are able to manage this with :

1.       Vaginal moisturizers (Replens or Vagisil)

2.       Vaginal lubricant (glycerin-free versions of Astroglide, K-Y Intrigue, others)

3.       Vaginal Ph balancing gels ( Refresh, Luvena)

For some women this may be all that is needed.  For many the problem progresses and requires medical therapy.  The most common therapy is local estrogen cream, tablets or an estrogen ring that is placed in the vagina.   Local estrogen therapy is highly effective when used continuously and regularly.  For those who find the current treatment options ineffective or would like to avoid hormones and drugs; there are new and innovative procedures to combat this problem. 

Quick and painless in-office procedures that provide CO2 laser therapy or RF energy to the vaginal tissues to rejuvenate them are now available.  Two such procedures; Femilft and ThermiVA are offered at Minnesota Women’s Care.

Each procedure is provided through 3 short sessions separated 4 weeks apart.  It’s relatively painless and no anesthesia or painkillers are required.  Before a woman is allowed to take part in the procedure she must undergo the customary pelvic exam.  If all checks out alright the procedures can be performed.  They provide energy to the vaginal surfaces that result in increased collagen formation and lubrication.  Most women report decreased pain with sex, more enjoyable sex, decreased urinary leakage and less frequent bladder infections. 

For the woman suffering from this condition following menopause, radiation or chemotherapy Femilft or ThermiVA procedures can be a life line.  To learn more contact us at Minnesota Women’s Care 651-600-3035.

Tribute to Dr. Gino Tutera

Today I received an email from the wife of Dr. Gino Tutera announcing the passing of Dr. Tutera over the past weekend.   I only met Dr. Tutera 3 years ago and our relationship was more professional than personal but I must say that this news is received with great sadness.  This marks the passing of a great man with a big heart and the courage to challenge prevailing ideas in medicine with the right ideas.  He opened my eyes and provided me tools to help women in ways that I never could before.

Despite completing medical school with honors, being the executive chief resident of my obstetrical and gynecology residency program rand scoring in the top 1% in the country on my OBGYN training exams (CREOG);  I NEVER EVER heard of pellet therapy for women until I met Dr. Tutera. 

This is astonishing as hormone pellet therapy has tremendous benefits and has been around for 50 years!!   How could a studious OBGYN resident have not heard about this?  Pellet therapy is one of the most common HRT used in Europe and Australia yet many OBGYNs in the USA have never heard of it.

Dr. Tutera recognized 20 years ago when he started SottoPelle that hormones, vitamins and good nutrition are the key to WELLNESS.  Why wait until a person is sick to help them?  Why not help them when they are well to help them stay well as long as possible?  I thank God for Dr. Tutera and the men and women like him with the courage to think outside of the box.  This courage results in a better quality of life for us all. 

On this very sad day I want to say thank you Dr. Tutera.  Thank you for all that you have done to support the wellness of countless men and women in our country and the world.

Melvin Ashford, MD 

New Fertility Assessment Tool

Most women rarely look deeply into their menstrual cycle to understand the mechanics of reproduction. It is assumed that pregnancy will be easy to achieve; but the reality is that a women’s eggs have a finite period of function.  Women are born with all the eggs they will ever have.  This is different from men who make new sperm every day.  With time these eggs will decline in number and function.   The peak period of fertility is in a woman’s 20’s.   A slow decline begins in the early 30’s.   The decline becomes more pronounced after age 35.  Fertility is severely compromised by age 40.

Some women achieve pregnancy using their own eggs after the age of 40, but it is more the exception than the rule.  Quantifying the number and quality of a woman’s eggs for the potential of pregnancy has been very difficulty.  Recently a test combining 5 different tests has shown promise.

Determining the Likelihood of Success: Perfecting the Test

Success on this front had been elusive until fairly recently, when scientists conducted substantial clinical research which combined the capabilities of high-quality laboratory partners with data derived from well-controlled research studies to design the Ovarian Assessment Report (OAR). The OAR provides a comprehensive look at a woman’s unique ovarian reserve by assessing the status of several important reproductive hormones.  An Egg Supply Score  as well as an Egg Quality Score is provided.  This is powerful infomation especially for the woman delaying pregnancy.  For the first time in fertility history, through actionable results and physician consultation, a woman’s current egg supply can now be evaluated in a meaningful way.  Provided women with the power to make appropriate decisions regarding their reproductive plans.

Minnesota Women's Care is Expanding!

Over the next few months there will be a little dust around the office. The expansion will provide much needed space and will allow us to reduce wait times, add additional providers, and make the office visit even more comfortable.

The additional space will allow improved procedure room capabilities allowing more same day procedures to be performed in the office.  This means reduced out of pocket expenses for patients in a safe and more efficient setting.  We'll also be able to hold more patient seminars on site.  Husbands of pregnant wives can learn how to provide therapeutic massage techniques, pregnancy yoga classes will be back in force, women can learn about how to tame menopause and Dr. Ashford will be able to hold his incontinence seminars on site.  Full course and seminar offerings will be emailed to our patients.   We're excited and can't wait to unveil the new space.  More updates to follow....

Urinary Incontinence: One Simple Solution

Bladder symptoms are a nuisance and significant barrier to social activity for many patients.  For women who are not interested in surgery, medicines or procedures to control their leakage there is another alternative.  Femsoft inserts.    The insert does not cure urinary leakage but for women with episodic leakage in response to activities it may be a God send.  Women you only leak with dancing, running, exercise, horseback riding or other activities are ideal candidates.  Urinary incontinence can be controlled with this discreet insert without much fanfare. 

The Femsoft insert is a small disposable “plug” that the woman inserts into the urethra prior to urinary leakage provoking activities.  When the woman needs to urinate the insert is removed and discarded.  Because the balloon tip is soft and covered in mineral oil insertion is usually painless.   The insert is made of silicone and conforms to the shape of your urethra.  It forms a seal and prevents urinary leakage in response to cough, sneeze, laugh running, dancing, etc.  To remove it the woman simply grabs the end and pulls the device out. 

                                                                   

   

One simple solution for a difficult problem.   To learn more please call:  Minnesota Women’s Care 651-600-3035.