September 2001, Volume 1, Issue 2
Special Points of Interest
Women's Health Practice Achieves National Accreditation
Herpes Simplex Virus Type 2 Test Offers Immediate Results
Endometrial Ablation: An Alternative to Hysterectomy
Clinical Research Studies Currently Enrolling
__________________________
Suzanne Trupin, MD, FACOG
2125 South Neil Street, Champaign, IL 61820
PHONE (217)356-3736
FAX (217) 356-5849
www.womenshealthpractice.com
www.womenshealthpractice.medem.com
Women's Health Practice (WHP) is a full service private practice focusing on obstetrics, gynecology, infertility, and women's wellness care. Patient care with a strong commitment to education and advancement of women's health knowledge is the primary focus of the practice. The mission of WHP is to promote and assure high-quality, comprehensive women's health care, including reproductive choices, in a safe environment. WHP keeps abreast of the new technologies and medical advancements in order to offer state-of-the-art medical care to our patients. We participate in research studies, both at the University of Illinois and as a privately contracted concern.
Women's Health Practice Achieves National Accreditation
Women's Health Practice has been awarded the certification of accreditation by the Accreditation Association for Ambulatory Health Care, Inc. (AAAHC). The award means that Women's Health Practice has met nationally recognized standards for quality care set by the Chicago-based accrediting organization.
"We're pleased and proud to have achieved accreditation, " said Suzanne Trupin, M.D., F.A.C.O.G. We think accreditation is very important and has helped improve the quality of care we provide. We feel that our patients are the ultimate benefactors from our participation in the accreditation program."
In order to achieve accreditation, Women's Health Practice underwent an extensive on-site survey of its facilities and services. The survey team, composed of physicians, nurses, and administrators, evaluated all aspects of patients' care. The survey findings resulted in a favorable decision.
Not all ambulatory health care organizations seek accreditation and not all who undergo an onsite survey receive favorable decisions. In a letter to Women's Health Practice, the AAAHC President writes, "The dedication and effort necessary to achieve accreditation is substantial. Women's Health Practice is to be commended for this accomplishment."
The AAAHC conducts its accreditation program on a national basis and has accredited more than 1240 ambulatory health care organizations, including single and multi-specialty group practices, ambulatory and office-based surgery centers, college and university health services, health maintenance organizations and other managed care systems, dental group practices, community health centers, and occupational health centers.
AAAHC is a private, non-governmental, non-for profit organization. It receives professional guidance and financial support from the American Academy of Cosmetic Surgery, American Academy of Dental Group Practice, American Academy of Dermatology, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Family Physicians, American Association of Oral and Maxillofacial Surgeons, American College Health Association, American College of Obstetricians and Gynecologists, American College of Occupational and Environmental Medicine, American Society of Anesthesiologists, American Society for Dermatologic Surgery, Association of Freestanding Oncology Centers, Federated Ambulatory Surgery Association, Medical Group Management Association, Outpatient Ophthalmic Surgery Society, Society for Ambulatory Anesthesia, and the National Association of Community Health Centers.
Women's Health Practice, which was established in 1945, offers a comprehensive range of women's health services. Our focus is on gynecologic office practice, ambulatory office surgery, gynecologic surgery, obstetrics, and women's health research. Our mission is to promote and assure high-quality comprehensive women's health care, including reproductive choices, in a safe environment. Women's' Health Practice prides itself in patient responsiveness and availability, and relocated to a newly-designed, upscale facility in May 2000.
Ultrasound Case of the Month
A thirty-nine year old female with heavy periods came in for a gynecologic appointment. Uterine fibroids can be found in a variety of places in the body of the uterus or in the cervix. The picture on the left shows a marble-sized fibroid in the upper part of the uterus. The picture on the right shows a larger fibroid in the cervix. Most women with irregular or heavy bleeding need pelvic ultrasound, which can often reveal a diagnosis.
Herpes Simplex Virus Type 2 Test Offers Immediate Results
The herpes simplex virus type 2 (HSV-2), the virus most frequently associated with genital herpes, is a sexually transmitted disease (STD) affecting 45 million people in the U.S., although two-thirds of those infected are unaware that they have the virus. The POCkit™ HSV 2 Rapid Test, when used in conjunction with a physical exam and patient history, enables the immediate diagnosis of HSV-2 viral infection. The whole sequence of this blood test takes less than 10 minutes, and detects infection significantly earlier than other laboratory-based type-specific tests. If the POCkit™ test gives a negative result soon after a suspected infection, but genital herpes is still suspected, re-testing is recommended after 4-6 weeks.
Proper diagnosis of genital herpes can slow the spread of this disease and other STDs, such as HIV (AIDS). Most (80%) HSV-2 positive patients have symptoms of the disease; however, only 20% have the classical symptoms most commonly associated with genital herpes, namely genital blisters. Approximately 60% have atypical, unrecognized symptoms, often attributed to yeast infections or jock itch. The remaining 20% have no symptoms of the virus. Studies have shown that even if an individual has no symptoms, he/she is capable of spreading the disease to others. It is important to note that HSV-2 transmission can occur in the absence of "typical" symptoms or even any recognizable symptoms. In fact, most HSV-2 appears to be transmitted from infected, but undiagnosed persons or infected persons without attributed symptoms. Additionally, when people are sexually active and have genital herpes, they are at significantly greater risk of contracting the HIV( AIDS) virus.
Women's Health Practice offers the POCkit™ HSV-2 Rapid Test, an accurate, point-of-care test, which is at the forefront of diagnostic technology.
Endometrial Ablation: An Alternative to Hysterectomy
For some patients, endometrial ablation is an alternative to hysterectomy. If heavy or prolonged bleeding has been interfering with your health, well being, or quality of life, this procedure may be a possible option. Unlike hysterectomy, endometrial ablation is performed in an outpatient facility or same day surgery center under light anesthesia, and discharge normally occurs within 4-5 hours, or the procedure is performed in the morning and discharge occurs the same afternoon or the next morning according to the patient's choice. Most patients experience little or no pain and return to work within 1-4 days.
The goal of endometrial ablation is to reduce or eliminate offensive menstrual patterns. Medical research done by 1990 indicates 60% of patients will stop having more periods, another 35% will have 1-2 days of light menstrual flow, and for reasons that are unclear the operation will not help 5% of patients and eventually lead to hysterectomy as a final choice. Our practice statistics for the last 10 years are running more favorable rates with 80% of patients being oligomenorrheic (light periods), and 15% have no periods at all.
The operation is performed with an instrument called a "resectoscope", which is a small telescope placed through the cervix allowing the surgeon to see the uterine cavity. A special electrical attachment or special instrument called a "rollerball" is placed against the wall of the uterus. While looking through the telescope, the rollerball is moved up and down the wall (like a paint roller). Radio waves, similar to the waves used in a microwave oven, are released from the ball and "cooks" the lining of the uterus. Once the procedure is completed, the patient is awakened from anesthesia and observed in the recovery room for 1-2 hours before discharge. Within 3-6 weeks, the uterus will be healed. During this time, there are no restrictions and many patients return to full activity within 1-2 days. For several weeks, there can be blood-tinged, yellow discharge, which is part of the healing phase. On occasion, light periods will occur only to disappear after several cycles.
If you desire more children, endometrial ablation is not for you. Although this procedure is not meant to replace the sterilization operation, most patients will be unable to become pregnant. Thus, contraception options will be discussed. To date, few pregnancies have been found with someone who has had an uterine ablation, and the data will be changing on this. Only less than 10 pregnancies to term have been discussed in the medical articles, meaning pregnancy rates are 0.6%/1000 or less. Those who do become pregnant are at risk themselves: uterine rupture (from the operation possibly weakening the uterine wall), uterine bleeding (abnormal bleeding caused by the placenta). The developing fetus in a post-ablation uterus is also at risk from lack of nourishment because the placenta has no room to grow healthy attachments to the mother's circulation. It is felt without an endometrial lining it is to hostile for an egg to implant. It would be a similar method as an intrauterine device such that fertilized eggs never can implant. With ablation, fertility is reduced. As of yet, we have not heard of pregnancy occurring after operation, but this procedure should not be used for sterilization. In fact, barrier contraception after this procedure to ensure against unplanned pregnancy is recommended.
Following endometrial ablation, patients will need yearly exams and pap smears. As the procedure does not start menopause, menopause will come at the natural time of life.
Endometrial ablation can be an alternative to hysterectomy, and may be the safest choice to avoid a large laparotomy incision, avoid long anesthesia, and avoid a long hospitalization.
May I Have Specimen Please?
Routine testing of urine on annual visits for women has been abandoned over the past ten or twenty years, but it may be time to give at the office again! The June issue of Circulation, the Journal of the American Heart Association, found that as women age, and if they have blood vessel damage that is a precursor to cardiovascular disease, they have more albumin, a blood protein, circulating in their system. This can be detected because kidney blood vessels leak albumin and is found in greater amounts in the urine. It was noticed that women with this albumin had 4.4 times the death rate from cardiovascular disease. At Women's Health Practice, we urge you to have more intense cardiovascular screening. In combination with nutritional modifications, appropriate medication, and lifestyle alteration, cardiovascular screening can significantly reduce your chances for heart disease.
Clinical Research Studies Currently Enrolling
Birth Control: Looking for a new form of birth control? Participants receive study medication, study-related physical exams, and compensation for time and travel.
Urinary Tract Infections: If you think you have a urinary tract infection, you may be eligible to participate. Get your confidential screening by calling the WHP Research Department.
Endometriosis: Do you have a diagnosis of endometriosis? Study features include pelvic ultrasound, bone mineral testing, sexually transmitted diseases screening, and mammography if over age 35.
HGSIL: Have you recently been diagnosed with an abnormal Pap smear (HSIL/CIN I/II/HPV)? Eligible participants receive investigational study medication, study-related medical care, and compensation for time and travel.
If you are interested in participating in any of our clinical research trials, please contact the WHP Research Department at 217-356-3736, extension 118, for further information (including study inclusion and exclusion criteria).
ACLS Certification
Suzanne Trupin, M.D., F.A.C.O.G., Melissa Starwalt, R.N., Lynn Carr, R.N., and Jan Dedrick, C.M.A., successfully completed the national cognitive and skills evaluations in accordance with the curriculum of the American Heart Association for the Advanced Cardiovascular Life Support Program.
Congratulations on this achievement!
Check Out These Articles!
Suzanne Trupin, M.D., F.A.C.O.G., has been cited in numerous articles of well-known publications, including Cosmopolitan, WebMD, and Efit. Most recent articles include:
"When Your Periods Pause", Cosmopolitan, January 2001, page 120.
"How Soon After Having Unsafe Sex Can I Find Out If I've Contracted An STD?", Cosmopolitan, June 2001, page 126.
"Should You Come Clean About Your Sexual History?", Cosmopolitan, August 2001, pages 146-147.
