Dr Barron & Endo Featured on NBC-29

As the foremost local authority on Endometriosis, Dr. Barron’s was recently interviewed for SENTARA MARTHA JEFFERSON MONDAY on WVIR NBC29.  The segment aired on 6/17/19.

Click to watch the short segment!

Center for Advanced Gynecology and EndoWhat? team-up for school nurse education

The Center for Advanced Gynecology is thrilled to announce that we have joined up with EndoWhat? and their national School Nurse Initiative to educate high school nurses about the symptoms of endometriosis.

As  you may know, endometriosis is a disease that affects close to 1 in 10 women in our country and symptoms often begin as soon as young girls start to have periods.  When severe pain, nausea, vomiting, diarrhea and fatigue hit, the school nurse is often the first line of defense.  In the past, many girls have been told that their symptoms are normal and they will get used to them.  The consideration that severe symptoms can represent a chronic debilitating condition doesn’t come to mind. That is why it usually takes 4-11 years after symptoms begin for patients get a diagnosis.

Shannon Cohn, was one of those girls.  She grew up to become an international lawyer and later a director/producer of films for National Geographic and the Discovery Channel.  Several years ago she  “started thinking about how little things have changed since she first had symptoms at 16. What if a film could help stop the vicious cycle?”  EndoWhat? was born in 2016. Dr. Barron was first inspired by the film at a screening event in Atlanta in 2017.

From the film, Shannon and her husband Patricio Cohn (also a producer/cinematographer) created a non-profit and developed the School Nurse Initiative to use the film to promote endometriosis awareness where it counts.  Their advocacy, along with EndoWhat Co-founder Mary Alice Hatch,  led them to Capital Hill.  Support from Senator Elizabeth Warren (D – Mass) and Senator Orrin Hatch (R – Utah) (see the video) eventually led to funding for Endometriosis research through the Department of Defense for the first time ever!

Shannon Cohn, Sen. Elizabeth Warren, Mary Alice Hatch, Emily Hatch and Sen. Orrin Hatch in Washington, D.C. (from https://www.endowhat.org/research-funding)

We are pleased to be a small part of this amazing advocacy effort to raise awareness in Charlottesville and the surrounding Virginia counties.   Tina Clements has been heading up the efforts on our end by visiting with school nurses personally.  After reaching out to regional high schools, we plan to contact middle schools nurses as well.

Would you like to get a copy of the movie? learn more? Donate a kit to be sent to a particular school?

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ROSE Research Study on Endometriosis: Participants wanted!

#Endometriosis Awareness Month was created to raise awareness of the disease which affects an estimated 176 million women worldwide and up to 1 in 10 women.  Awareness, however, only goes so far if treatment is not advanced.  We strongly believe that high quality research is the only way to advance treatment!   If you’re one of the many women living with this disease, or have a close relative that does, you can help researchers learn more about the underlying causes of Endometriosis as well as develop better treatment options.  One such ongoing study is the ROSE study (Research OutSmarts Endometriosis) at the Feinstein Institute for Medical Research at Northwell Health.

Women with a diagnosis of endometriosis, over the age of 18, who are not pregnant or breastfeeding can become involved in the ROSE study. Each participant will be asked to:

  • Answer a health history questionnaire
  • Answer questions about how endometriosis impacts her life
  • Provide a DNA sample from either a blood sample (from the arm) or a cheek cell swab
  • Offer a sample of menstrual flow that can be collected at home using a simple procedure; this collection is optional
  • For women who are undergoing surgery or have had surgical treatment for endometriosis, allow ROSE study researchers to collect excess endometrial tissue samples (not needed for your diagnosis/treatment) removed during surgery

First-degree relatives (siblings, parents and/or children, both women and men) of women with endometriosis who do not have endometriosis are also being recruited. Each unaffected participant will be asked to:

  • Answer a health history questionnaire
  • Provide a DNA sample from either a blood sample (from the arm) or a cheek cell swab
  • Offer a sample of menstrual flow that can be collected at home using a simple procedure; this collection is optional

Women without endometriosis are being recruited to participate as control or comparison subjects through the Feinstein’s Genotype and Phenotype (GAP) Registry. Each non-diagnosed participant will be asked to:

  • Enroll in the GAP
  • Answer a health history questionnaire
  • Provide a blood sample (from the arm)
  • Offer a sample of menstrual flow that can be collected at home using a simple procedure

For additional information, please contact us at
ROSE@northwell.edu or (516) 562-ENDO (3636)

Interested in seeing what other research trials are going on for Endometriosis?  A place to start is the National Institutes of Health Clinical Trial Registry where there are 18 ongoing and planned studies currently listed.

The Endometriosis Summit will be LIVE!…

That’s right, The Endometriosis Summit: Patient & Practitioner Town Meeting will be LIVE on Facebook, thanks to the sponsor of Lumenis. Read more about it, share, and grab the initial feed on Lumenis’ facebook page… Link is live, streaming begins at 830am.

Image result for lumenis endometriosis summit gynecology photo images to share

If You Suffer with Dyspareunia, This May Be An Option For You

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Dyspareunia is pain that occurs primarily during sexual intercourse. It is not a disease but rather a symptom of an underlying physical or psychological disorder. The pain, which can be mild or severe, may occur in the genitals, the pelvic region or the lower back. Common causes of the condition in women can include: infections, endometriosis, pelvic floor dysfunction, ovarian cysts, fibroids, and interstitial cystitis. The list above is by no means exhaustive because painful sex has so many potential causes, both ones we know about and others we don’t. 75% of women will have painful penetration in their lifetime. Many women don’t tell their partners and internalize blame, countless doctors are powerless to help — and most partners want to help… but don’t know how.

When sex hurts, the brain remembers and can start to associate sex with pain — making it a scary experience. Treatment for dyspareunia is aimed at identifying and properly treating the underlying cause. Today, there are a number of growing treatment options for painful sex — sex therapy, pelvic-floor physical therapy, vaginal dilation, and OhNut (just recently introduced in May 2018). OhNut allows you to control the comfort ability of penetration depth. “Life’s too short to deal with painful sex, you deserve pleasure too!” Click here to find out more.

Emily Sauer, founder of OhNut, has a mission to help women build sexual-esteem around deep pelvic pain. OhNut, is scheduled to be featured at the Endometriosis Summit, to be held on March, 3, 2019 in Hobokon, NJ.

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Endometriosis Summit -SOLD-OUT!

We are thrilled to report that this event has SOLD OUT with over 320 tickets being sold!! Given it’s success it is likely the conference founders will host another one in the near future. You can still register to be on the wait list by going to the Endo Summit’s website.  Dr. Barron will be presenting on a panel called Endometriosis 101 along with:

  • Dr. John F. Dulemba, OBGYN, The Women’s Center, Denton Texas
  • Dr. Juan L Salgado, OBGYN, San Juan, Puerto Rico
  • Dr. Laurence Orbuch, OBGYN, offices in New York and Los Angeles

A Message from Dr. Sallie Sarrel; PT, ATC, DPT & Dr. Andrea Vidali, MD (Endometriosis Summit Co-Chairs)

We have just under 4 weeks to go before this landmark event that combines patients and practitioners in an all panel-style Town Meeting.

Our event is SOLD OUT and we have a huge wait-list. Yay! Grateful for the support. We are so excited to share this event and our voices with you and the endometriosis community.

Please remember that our aim is to educate, we will encourage conversation and discussions the day of the event but our panelists will not discuss specific case details or how to manage your particular medical issues.”

Useful phone App for Endometriosis patients; benefits research as well

Many of our patients that have pelvic pain already have a diagnosis of endometriosis, while others are concerned they might have it and want to track their symptoms.  Enter Phendo.  Phendo is an app to “track, manage, and understand endometriosis,” and is part of Citizen Endo, a research project to better understand endometriosis through the Department of Biomedical Informatics at Columbia University.  Participants agree to participate in Phendo is an observational research study to establish a catalog of the signs and symptoms of endometriosis as experienced by people with endometriosis and “the opportunities to reflect upon your collected data may help you in managing your disease.”  Kudos to  Mollie McKillop, MPH, MA. and Noémie Elhadad, PhD who are behind the project!

We think this is a great research project and encourage patients to consider participating!  The data submitted is already being used in one collaborative project, the Research Out-Smarts Endometriosis (ROSE) study.

Who’s Eligible to use the app and participate?

Individuals eligible to participate in the study include:

  • Adolescents (those 13 and above) and adults (those 18 and above) who have reached the onset of menarche, that is, who have had at least one menstrual period.
  • Adolescents and adults who have experienced symptoms of endometriosis in the past 3 months.
  • Adolescents and adults who have reached menarche but have not experienced symptoms in the last 3 months are eligible to participate as controls.

Those under the age of 18 will need parental permission to participate, and parents or guardians will be asked to co-sign consent.

Check it out!  

Offering In-Office Hysteroscopy

Why am I bleeding?  Why am I bleeding again!  Evaluation for unexplained bleeding often begins with an ultrasound and lab work to see if hormones or something in the uterus is the cause.  If the ultrasound sees something unusual, the next step is often a biopsy or to look inside the uterus with a camera.

Looking inside with a camera allows us to directly see any possible abnormalities that could cause bleeding.  This can include polyps, fibroids and scar tissue.  Hysteroscopy– looking inside with a telescope/camera- can allow us to not only see what is going on, but often to treat the problem.

 

Hysteroscopy may be done for many different reasons, including:

  • To evaluate abnormal bleeding, fibroid (benign, noncancerous) tumors, polyps, scar tissue (adhesions), and possibly cancer of the uterus.
  • To look for lumps (tumors) and other uterine growths.
  • To get a biopsy or tissue specimen for evaluation.
  • To look for causes of why a woman cannot get pregnant (infertility), causes of recurrent loss of pregnancy (miscarriages), or a lost intrauterine device (IUD).

 

Traditionally this procedure has been done in an operating room with anesthesia.  If recent years, with the development of hysteroscopes smaller than a pencil, this procedure can be done comfortable in the office. 

Here at the Center for Advanced Gynecology we have always offered in-office hysteroscopy with the smallest hysteroscopy available at 3.7 millimeters wide.  Experience (and our small hysteroscope) allow the procedure to almost always be done without a speculum or the need for pain medicine.  Dr. Barron is also able to offer treatment at the same time-polyps and adhesions can be removed in the office in one visit.

What’s the advantage of doing the procedure in the office?  It may not be for everyone, but it is almost always less expensive for our patients because there is no hospital or surgical co-pay.  Also, the overall cost to everyone is less then when the procedure is done in the hospital–good news for those who don’t have insurance, have co-insurance, or a large deductible.  Lastly, it saves the hassle of dealing with the hospital (early arrival, parking, new faces!)

What happens during a hysteroscopy?

  • We may offer you a pre-procedure medicine to relax you.  You may also get a medicine that numbs the area around the cervix (local anesthetic)
  • Sometimes, a medicine is placed in the cervix the day before or morning of the procedure.  This medicine makes the cervix have a larger opening (dilate).  This makes it easier for the instrument to be inserted into the uterus.
  • A small instrument (hysteroscope) is inserted through the vagina into the uterus.  This instrument is like a pencil-sized telescope with a light.
  • During the procedure, saline fluid is trickled into the uterus at low pressure to make it easier to see inside.
  • We document what we see with photographs.
  • Wire-thin instruments can also be placed through the hysteroscope to remove specimens, take biopsies, or cut out scar tissue.

AFTER THE PROCEDURE

  • Recovery tends to be very quick as there are no incisions.
  • There may be some mild cramping for a 1-2 days that can be treated with acetaminophen or ibuprofen.
  • There may be some light bleeding for up to 7 days depending on what was done.
  • You can return to work and normal activities the next day!

If you think you need this procedure or have questions, email us at info@virginiagyn.com or schedule an appointment online with Dr. Barron.

EndoFound Visits Capitol Hill

At the Center for Advanced Gynecology we support and commend those working to spread endometriosis awareness. We are thrilled to see that EndoFound and NY based-endo surgeon Dr. Tamer-Seckin recently visited Capitol Hill to talk to lawmakers.  EndoFound has been a rapidly growing advocacy organization started by Dr. Tamer-Seckin and Padma Lakshmi.  Take a look…click here.

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Just Announced: Patient Centered Endometriosis Conference

On March 3, 2019 our very own Dr. Kenneth Barron will be a guest speaker at The Endometriosis Summit: Patient & Practitioner Town Meeting that will be hosted in Hoboken, New Jersey. This unique conference is primarily for patients! Dr. Barron will be presenting Endometriosis 101; offering a broader perspective of other causes of pain in addition to Endometriosis. You can get your tickets now, available @ www.theendometriosissummit.com

Will Routine Speculum Exams Become a Thing of the Past?

 

Speculum for a routine pap

As we’ve posted here before, pap smears (cervical cancer screening) used to be something your OB/GYN did once a year. Testing strategies have changed to incorporate Human Papilloma Virus (HPV) testing and decreased the recommended frequency of testing to every 3-5 years depending on your age. Evidence has suggested that HPV testing alone is an acceptable screening method in most patients but what’s not needed is evaluating the cells that are collected during a pap. What is even more interesting is that PATIENT collected specimens (with a simple Q-tip like swab) is as accurate as a specimen collected by a doctor. Several studies have shown this and the British Medical Journal just released a meta-analysis (where several research study results are combined together to improve the power ((accuracy)) of the findings) indicating that self collected swabs are equivalent to doctor collected swabs.

Recommended HPV test

 

   “When used with hrHPV [high risk HPV] assays based on polymerase chain reaction, testing on self samples was similarly accurate as on clinician samples. Offering self sampling kits generally is more effective in reaching under-screened women than sending invitations… ”

 

So the question still remains…will routine speculum exams become a thing of the past? Just as patients are sent home to collect samples to screen for colon cancer, there is no reason why patients can’t do the same for cervical cancer screening. Unfortunately, the dreaded speculum exam isn’t going away–there will still be a need to follow up on abnormal HPV screening tests, but we predict that the frequency of these will continue to go down.

Fibroids: Basic Info & What’s New

Normal Uterus
Uterus with Fibroid

 

Uterus with Multiple Fibroids

Fibroid tumors of the uterus are extremely common, but only sometimes cause symptoms in women. When they do, they can cause serious bleeding, pain, frequent urination, and constipation. The article below provides ACCURATE information about Fibroids―what they are, how to diagnose them and the options for treating them.

www.medicalnewstoday.com

The only thing missing from that article is another medication  called ‘ Ulipristal Acetate ‘ that will hopefully be available in the US soon.  Ulipristal is available in the United States in a a high dose form used for emergency contraception under the name ELLA.  However, a much lower dose is sold under the name Esmya by Allergan to the rest of the world for heavy bleeding associated with fibroids with impressive results.  It shrinks fibroids, reduces bleeding and is not a hormone…it has not obtained FDA approval yet because of concerns about elevated liver enzymes found in some patients.  To read more about the medication here.

HPV Tests May Replace Most Pap Smears

Pap smears could be a thing of the past — at least for some patients.

An update to the official recommendations for cervical cancer screening now includes the option to get only a Human Papillomavirus (HPV) test—one that looks for a virus rather than for abnormal cells.  Screening recommendations have already been decreased from every year to every 3-5 years because of better understanding of the virus that leads to 99% of cervical cancers.

Take a look at the newest recommendations, according to the ‘Popular Science’ website.

Click on the image below…

 

10 Facts Every Woman Should Know About Endometriosis

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The Endometriosis Association is a patient advocacy and education organization that has been around since well before the internet was available (1980) as a resource for endometriosis patients.  They have been responsible for publishing several patient-centered books and supported endometriosis research as well. Dr. Barron is a supporter and member as well.  Below is their list of 10 facts every woman should know about endometriosis, which we agree with!

  1. Period pain is NOT normal.

  2. This disease affects women all across the world regardless of race, class or socioeconomic status.

  3. Endometriosis can start very young–many of our members report that they have had symptoms since their very first period.
  4. Endo is primarily an imbalance in the immune and endocrine (hormone) systems — The presence of lesions in the pelvis is the tip of the iceberg.
  5. Endo is not completely cured by surgery alone–the underlying environment throughout the whole body must be addressed in order for the woman’s health to be truly improved and to hopefully avoid other health problems related to Endo.
  6. Endo is not cured by pregnancy–some women do have relief of symptoms during or after pregnancy, but others have worsening– A woman should never be pressured into having a baby as a “treatment” for a medical condition.
  7. Environmental toxicity plays a critical role in the development of Endo.  The Endo Association discovered in its original research that Dioxin can lead to the disease–Dioxins are found in pesticides and contaminated food grown with pesticides.
  8. Many other health conditions are found at higher rates in women with Endo: Irritable Bowel Syndrome (IBS), migraines, allergies, intestinal dysbiosis and hypothyroidism. Plus there’s a higher risk for numerous cancers, auto-immune diseases (such as MS, Lupus, etc.) and heart disease.
  9. Diet and lifestyle changes DO make a difference! While medications and surgeries are important options for women suffering with Endo, it’s important to do what you can–take your health into your own hands with the choices you make every day.
  10. The Endometriosis Association is working hard to make REAL CHANGE in the medical world so that women and girls with Endo can have the very best care and treatment options available to them!

Recommendation Reaffirmed to Screen Women for Intimate Partner Violence

The U.S. Preventive Services Task Force (USPSTF)  has finalized its recommendation that clinicians screen reproductive-aged women for Intimate Partner Violence (IPV) — and refer those who screen positive for support services. In addition, the task force says the evidence is insufficient to recommend for or against routinely screening for abuse or neglect in older adults or those with disabilities. Both recommendations are consistent with the group’s 2013 guidance and with its 2018 draft guidance. To read more about this problem read the CDC summary.

Adenomyosis: a less commonly diagnosed cause for heavy and painful periods

Adenomyosis is essentially endometriosis of the uterus. In fact, about 30-40% of patients with adenomyosis will also have some endometriosis. In this often painful condition the glands that normally line the uterus grow in the muscle layer of the uterus. This can be in one small area, spread throughout the muscular layer of the uterus, or as a solid tumor (adenomyoma). When present, patients can experience painful periods, heavy periods, infertility, painful bowel movements, difficulty urinating, or no symptoms at all. An ultrasound in the office has about 80% accuracy in diagnosing adenomyosis while an MRI has about 90% accuracy. Treatment consists of either medicines like birth control pills or surgery. Here at the Center for Advanced Gynecology we treat each patient individually with symptoms or suspicion for adenomyosis. A suspected diagnosis of adenomyosis does not always mean you need a hysterectomy!

Chronic Kidney Disease More Common After Pre-menopausal Oophorectomy

The following is an excerpt from Journal Watch by the New England Journal of Medicine about a recent publication.

Women who have both ovaries removed before menopause may face increased risk for Chronic Kidney Disease (CKD), according to a study in the Clinical Journal of the American Society of Nephrology.

Nearly 1700 women in Minnesota who underwent bilateral Oophorectomy before menopause were matched to 1700 who did not have the procedure. During roughly 14 years’ follow-up, 211 women in the Oophorectomy group and 131 in the matched group developed CKD.

After adjustment for confounders, Oophorectomy was associated with a 42% increased risk for CKD. The risk was higher among women who had Oophorectomy before age 46 and those who didn’t receive estrogen therapy.

The researchers note that “animal models support the hypothesis that estrogen deprivation may have important direct harmful effects on kidney structure and function.” They add, “Women considering bilateral Oophorectomy for the prevention of ovarian cancer … need to be counseled regarding the potential risks of multi-morbidity, which may include the risk of CKD.”

This article highlights another reason why we avoid removing ovaries during a Hysterectomy in most patientseven for endometriosis. There’s an increased risk of poor functioning kidney.  This adds to the known effects of early menopause, shorter lifespan, greater risk for heart disease, osteoporosis, and cognitive impairment.  National recommendations are already to avoid removing the ovaries in patients under 65 at time of hysterectomy and this population based cohort study adds to our understanding of the effects on the kidneys.

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Common Misconceptions about Endometriosis

Tired of the myths and misconceptions of Endometriosis? To get the facts, click the link below which takes you to a great read!

Myths and misconceptions in endometriosis

Published by: by Ros Wood, Heather Guidone, and Lone HUmmelshoj

Dr. Barron joins Monticello Community Surgical Center!

We are pleased to announce that Dr. Barron will begin operating at the Moneticello Community Surgical Center for outpatient (ambulatory) surgical procedures in September 2018! The advantages of having surgery at Monticello for our patients include lower cost (a major advantage for high deductible health plans), transparent pricing, a comfortable environment, and more personalized care.  Keep in mind that higher risk surgeries and those requiring a hospital stay will be performed at Sentara Martha Jefferson Hospital.

 

We Are Members of Privia Medical Group

As of August 13th, 2018, we are proud members of Privia Medical Group!