News
Council Approves Clinic's Expansion - Read Article
Advances in Women's Health Care - Urogynecology - Dr. Kendra G. Jones - Read Article
Managing diabetes is key to good pregnancy – Dr. William N. Vereen – Read Article
ADVANCES IN WOMEN’S HEALTH CARE:
Mirena® , Thermachoice, Laparoscopic Supracervical Hysterectomy (LSH), Essure®, Implanon™ - Dr. Kevin W. Hamburger - Read Article
Small incisions - That's just one of the benefits of laparoscopic hysterectomy - Dr. Mary T. Schneider - Read Article
Council approves clinic's expansion
Sioux City Journal article
By Lynn Zerschling | Posted: Tuesday, June 16, 2009
SIOUX CITY -- City lawmakers gave final approval to an agreement with Siouxland Women's Health Care to keep the medical clinic in Sioux City at 1000 Jackson St.
The clinic's doctors had considered relocating to Dakota Dunes, which has a growing medical community in southern Union County, S.D.
The Iowa Department of Economic Development has approved the city's application to use the Targeted Jobs Program to assist the clinic's expansion. Marty Dougherty, the city's economic development director, said the clinic will receive $717,000 in withholding tax credits over the 10-year life of the program.
Councilman Aaron Rochester reported, "We got phone calls from one of their competitors asking if the majority of its revenues is derived from surgeries done in Dakota Dunes. They said they are taking away revenues from Mercy (Medical Center) and St. Luke's (Regional Medical Center)," in Sioux City.
Dougherty replied, "The process we go through for the Targeted Jobs Program doesn't go into that kind of detail. I know they serve both hospitals. The majority of babies are born at both hospitals."
The intent of the program is to retain jobs in Sioux City and expand businesses, he said.
Councilman Jim Rixner stated, "This is good news. We are keeping a medical provider in Sioux City. ... Where they provide surgeries is an issue of competition among providers."
Siouxland Women's Health Care plans to spend $1.4 million on renovations and expansion, Dougherty said.
Advances in Women’s Health Care - Urogynecology
Dr. Kendra G. Jones, explains Neuromodulation
October 22, 2008
Urogynecology??? What is it? What benefits are provided to the women of Siouxland?
Urogynecology is an area of modern medicine that evaluates and treats women who have Urinary Incontinence or Pelvic Organ Prolapse. It is estimated that 1 out of every 3 women experience these symptoms on a regular basis, but are too embarrassed to talk about them. Many women are not aware these conditions are treatable and may just suffer in silence or put off activities they enjoy. With today’s advances in medicine, there are very safe, effective and minimally invasive treatments available right here in Sioux City.
Incontinence is defined as leaking urine involuntarily. There are two types of incontinence, stress and urge, and the cause and treatment for these two conditions are very different. A woman can have either stress incontinence or urge incontinence, or both. Stress urinary incontinence is characterized by leaking urine with movements such as sneezing, coughing, running/walking, or exercising. Urge urinary incontinence occurs when a woman leaks urine because she can’t make it to the restroom in time. When she has to go, she has to go NOW. A simple series of in-office tests called urodynamics, available at Siouxland Women’s Health Care, can be performed to help determine the type of incontinence.
Once we have determined the cause of the incontinence, we can help you decide on a treatment plan. Treatments for stress and urge urinary incontinence have improved tremendously over the last 15 years. In the past, women had few treatment options – medication or major, open surgery. Medications, though effective, had side effects such as dry mouth, constipation or low blood pressure when standing, causing women to stop taking them. Advances in pharmaceuticals have given us newer medications with fewer side effects. Urogynecology advances have given us better treatments for both types of incontinence.
For stress urinary incontinence, the physicians at Siouxland Women’s Health Care are doing TransVaginal Taping, or TVTs. A TVT is an outpatient, same day surgery in which a small strip of synthetic material is placed underneath the urethra. The material provides hammock-like support that keeps the urethra from leaking with activity. Women usually see an improvement within 1-2 weeks.
One of the newest services available from the Siouxland Women’s Health Care physicians is Neuromodulation. This procedure is used to treat urge incontinence, urinary frequency, and over active bladder. During the treatment, the neuromodulation system stimulates a nerve located in the ankle, sending messages to the nerves that control the bladder. These messages train the bladder to function correctly. The neuromodulation treatments take place in the physician’s office in weekly sessions for 30 minutes. Women usually see dramatic improvement in symptoms after 4-6 sessions.
Pelvic organ prolapse occurs when the connective tissues and muscles, which normally keep organs like the uterus, bladder, and rectum in their respective places, become weak and lose their strength. This weakening can be caused by aging, childbirth, menopause, trauma, or a predisposition to have more loosely packed connective tissue. Women with pelvic organ prolapse may experience a range of symptoms that include pressure and pain in the pelvic area or lower back, difficulty emptying the bladder or incontinence, bowel problems, or painful intercourse. Pelvic organ prolapse can be diagnosed by a traditional pelvic examination. Prolapses vary in severity and not all women with this condition have symptoms that require treatment. There have been many advances in the treatment of pelvic organ prolapsed, both non-surgical and surgical.
Mild cases of pelvic organ prolapse often respond to non-surgical approaches. One of these, the pessary, is a small silicone device which comes in many shapes and sizes and is put in the vagina to keep the organs from falling out. The pessary is a good option for women who are no longer having intercourse and prefer not to have surgery, or are not good surgical candidates. Another non-surgical treatment is pelvic floor physical therapy and involves seeing a physical therapist specializing in strengthening pelvic floor muscles with specific exercises. These services are available in the Siouxland area.
More severe cases of pelvic organ prolapse may need surgical intervention or pelvic floor reconstruction. In many cases, a woman’s own connective tissue can be tightened. In other situations, a mesh-like material can be used to provide a support framework to keep the pelvic organs from falling down out of place. These services are available at Siouxland Women’s Health Care.
Urogynecology is one of the newest areas of medicine available to the women in Siouxland. There can be life without urinary incontinence and pelvic organ prolapse. Sioux City has a tradition of being well recognized as a regional referral center providing the latest advances in technology and specialized medical care for the tri-state area. Our doctors at Siouxland Women’s Health Care are part of that tradition and would be glad to discuss any of these advancements in women’s health care with you.
Managing diabetes is key to good pregnancy
Siouxland Health Magazine, featuring Dr. William N. Vereen
By Nick Hytrek | Posted: Friday, September 05, 2008
Managing diabetes takes time and effort, a constant awareness of how your body is doing.
Add in a pregnancy and all the changes that causes in a body and the female diabetic can have an even harder time controlling her disease.
That's why it's important for women with diabetes to tell their physician immediately after finding out they're pregnant so that the doctor can begin monitoring the mother-to-be's health closely.
"Women who have diabetes and get pregnant, they're at a higher risk for all kinds of problems," said Dr. William Vereen of Siouxland Women's Health Care, 1000 Jackson St.
Among those risks: larger babies that are at higher risk for birth trauma, birth defects affecting the heart, miscarriage and still birth.
It's best for the female diabetic to plan her pregnancy, Vereen said, but that's obviously not always going to happen. His advice to women is to maintain control over the disease at all times so that once they're expecting, there will be fewer unexpected complications.
"If they're in poor control when they get pregnant, there's a higher risk for birth defects and miscarriages. It's important to get good, tight control before you get pregnant," Vereen said. "Most people who are diabetic know what they need to do."
In an exam early in the pregnancy, a physician or obstetrician can perform tests on the woman's kidneys, heart and eyes - all organs that can be affected adversely by poorly controlled diabetes - to get a baseline measurement of their functions to compare with tests that will be done later in the pregnancy to make sure they're operating at healthy levels.
Pregnant diabetics are more likely to have blood pressure problems. Their insulin and other medication levels may also need to be adjusted to keep up with the body's changes. Vereen said he routinely schedules diabetics for more frequent checkups so that the diabetes can be closely monitored. More ultrasound exams of the fetus also will be done to watch for any birth defects or other diabetes-related problems.
"You're at a higher risk and need more intensive management by yourself and your doctor," Vereen said.
In many cases, the disease can be easily controlled by the patient. She may just need to check her sugar levels more often or change her eating habits.
"Sometimes all it takes is your diet" to make sure everything goes OK, Vereen said.
Pregnant women also are subject to developing gestational diabetes, a form of diabetes that sets in with pregnancy. It happens when all the body's changes associated with pregnancy overwhelm the pancreas, which produces insulin.
"The stress and strain of pregnancy is too much for the pancreas to keep up with," Vereen said.
Vereen said his clinic screens all its patients at 28 weeks to check for diabetes. Many women aren't aware they've developed the disease because many of the same symptoms - frequent thirst, hunger and urinating - are common to pregnant women, diabetic or not.
"Sometimes diabetics aren't diagnosed until they're pregnant," Vereen said. "That's one thing about diabetes is you don't always feel bad."
Most of the time, the mother will see her sugar levels return to normal by her six-week post-birth checkup. Though the diabetes is gone, she should inform her family doctor about having had gestational diabetes.
"If you get gestational diabetes, you're at a higher risk to develop adult-onset diabetes later in life," Vereen said.
No matter if the diabetes was present before pregnancy or during it, most women can reduce their chances of a high-risk pregnancy simply by following their doctors' orders and managing their disease properly.
"They can reasonably anticipate a good pregnancy, I can't say a normal pregnancy because it's not. They've got a problem," Vereen said.
A problem, however, that can be greatly reduced with a little extra vigilance.
ADVANCES IN WOMEN’S HEALTH CARE:
Mirena® , Thermachoice, Laparoscopic Supracervical Hysterectomy (LSH), Essure®, Implanon™
May 22, 2008
By Kevin W. Hamburger, M.D. F.A.C.O.G.
Siouxland Women’s Health Care, P.C.,
Several new advances in women’s health care have been introduced locally to benefit Siouxland women. These include new methods of contraception, sterilization, and hysterectomy; as well as new treatments for heavy periods and urinary incontinence. These new techniques have the advantage of being less invasive, less painful, more cost effective, and easier on the patients. Other benefits include quicker recovery, less time away from work and family, significant cost savings for employers, insurers, and patients, as well as a wider selection of treatment options for the patient.
Many women suffer from heavy, painful periods. This can not only cause anemia, cramps, embarrassment, and limitation of activities, but also result in absence from work, and less productivity at home. Until recently, the only treatment options were hormonal therapy or hysterectomy. Now there are several minimally invasive, cost effective therapies to improve women’s lives. Some women will benefit from a progesterone-secreting intrauterine device (IUD) called Mirena® that will make their periods much lighter while also providing contraception. This can be inserted in the office and can remain in place for up to five years.
Another new option to treat heavy, painful periods is called endometrial ablation. This is a procedure done in the office under local anesthetic that burns away the inner lining of the uterus. The doctors at Siouxland Women’s Health Care use the Thermachoice uterine balloon catheter for this treatment. During this procedure a local anesthetic is injected into the uterine muscle. A balloon catheter is then introduced through the cervix and inflated with a sterile fluid. This fluid is then heated to 87 degrees Centigrade for an eight minute treatment. The procedure is computer controlled and monitored for safety. After treatment, the patients have very light periods, many needing only panty liners for protection. The goal is to make horrible periods much better. 30% of women have no periods after the procedure, with 70% having much lighter periods. Long term success rates are 95%, meaning that 5% later have a return of heavy bleeding requiring further treatment. But this also means that 95% avoided hysterectomy by having a procedure at the office.
For those women needing a hysterectomy for various conditions, a new technique called Laparoscopic Supracervical Hysterectomy (LSH) is now available. This procedure is done as an outpatient and uses the minimally invasive laparoscope to remove the uterus (and sometimes the tubes and ovaries). This differs from a traditional hysterectomy since the cervix is left in place. The advantage is that it is less painful and the patient can return to full activity much quicker. Not all conditions can be treated by this new method, but for patients who are appropriate candidates, it offers significant advantages. Many women go home the same day of the surgery and are back to work in a week rather than the traditional 6 week recovery time.
For those women desiring permanent contraception or sterilization, there is an exciting new procedure available at Siouxland Women’s Health Care. Traditional sterilization (getting the tubes tied) requires general or spinal anesthesia and incisions on the abdomen. A new technique called “Essure®” can be done under local anesthetic in the doctor’s office without any incisions. During this procedure, local anesthetic is used and a small fiber optic camera is inserted through the cervix. A small coil is inserted where the tubes enter the uterus. Tissue grows into these coils and blocks the tubes. There is very little discomfort with this procedure and many of the patients choose to watch it on the video screen in the procedure room. It takes 90 days for the tubes to be completely blocked, and at that time, an x-ray is taken to verify that the tubes are completely blocked. Most of these women are back at work the next day!
New options for contraception include Implanon™, an implant that slowly secretes progesterone and is placed under the skin of the arm. It can be left in place for up to 3 years. This is a great option for women who have trouble remembering to take a birth control pill every day or for those who cannot take an estrogen containing product. It is hidden, easy to use, and very effective. Other options include the Mirena® IUD, as mentioned previously, which can be left in place for 5 years and significantly lessens menstrual bleeding. There are also “extended-cycle” birth control pills which are administered so that a user has only 4 periods a year or less.
New treatments for urinary incontinence are also available. Urodynamic studies can be done in the office to determine the exact causes of urine leakage and direct the appropriate treatments. There are a multitude of treatment options for female incontinence. These involve both surgical and nonsurgical therapies as well as physical therapy.
Sioux City has long been a regional referral center for cutting edge, specialized medical care for the tri-state area. Our doctors are pleased to continue that tradition and would be glad to discuss any of these advancements with you.
Small incisions - That's just one of the benefits of laparoscopic hysterectomy
Sioux City Journal article featuring Dr. Mary T. Schneider
By Dolly A. Butz | Posted: Friday, December 07, 2007
Patients are experiencing less pain and spending fewer days in the hospital after undergoing a hysterectomy than they used to, according to Dr. Mary Schneider, who practices obstetrics and gynecology at Siouxland Women's Health Care, P.C.
A hysterectomy is a procedure in which a surgeon takes out the uterus and sometimes the cervix, Fallopian tubes and ovaries.
For three months Schneider has been performing a new minimally invasive procedure called a Laparoscopic Supracervical Hysterectomy. The laparoscopic approach removes the uterus through tiny incisions in the navel and abdomen with a laparoscope and small surgical instruments.
"To date our patients have been extremely happy with it," Schneider said. "I had a patient who did it as a same day procedure last week. She went home the same day and she's going back to work on Friday."
Lonnie Hill said she discussed the procedure with Schneider, who said she was a prime candidate for the laparoscopic approach.
"When she said is was newer and easier on the body, obviously that's what I wanted to do then," Hill said.
The key to reducing pain, Schneider said, is leaving the cervix in place.
"It makes a huge difference for recovery," she said. "We think it's just leaving that cervix in place that makes a big difference."
The traditional way of performing a hysterectomy is through an incision stretching from the belly button to the pubic bone. Schneider said since the procedure was painful and difficult to recover from, surgeons then decided to remove the uterus through a 4-6 cm horizontal incision low on the abdomen. The idea of a vaginal hysterectomy, removing the uterus through the vagina, followed.
"It still involved cutting through the pelvic floor in order to get the uterus out, which is where we think some of the pain fibers are," Schneider said. "All of those ways of getting (the uterus) out cause various problems."
Hill, who had never had surgery before the procedure, said she was a little nervous and anxious going into the procedure. Hill said she thought it might be painful, considering a part of her body was going to be removed.
The laparoscopic procedure begins at the top of the uterus where the surgeon disconnects all of its attachments to the other pubic structures. The cervix is left in place, allowing for support of the vagina. The surgeon also avoids cutting through the pelvic floor.
"We have an instrument that we use that helps kind of cut out the uterus and take it out of the abdomen without making a big incision," Schneider said.
Schneider said a tissue morcellator is used to remove the uterus. A harmonic scalpel cuts through the blood vessels and coagulates bleeding.
"There's much less pain involved compared to a traditional abdominal hysterectomy and quite a bit less pain compared to a vaginal hysterectomy," she said.
Schneider said a laparoscopic procedure is safer too.
"We stay a little bit further away from other vital structures by leaving the cervix in place," she said.
Hill went in for the procedure in the morning and was able to leave the hospital that same afternoon.
"It must be pretty new to the nurses. They kept saying, 'Are you sure you're not spending the night?'" she said. "The nurses were just amazed. 'Oh my god, look at you.'"
Hill said she was a little tired from the anesthesia, but didn't feel any pain.
"Basically it was non-existent," she said.
Schneider said most patients are hospitalized for no more than 24 hours and are back to work in about a week. She said patients who have undergone the procedure are pleased with the results. Schneider said leaving the cervix in place may help with post-operative sexual function as well.
Since the cervix is still in place, she said patients who have had the procedure cannot avoid regular Pap smears.
"If you're doing it for cancer or problems with Pap smears this is not the approach that you got to take," she said.