In an interview with the San Francisco Medical Society, Dr. Wittenberg answered the following questions:
I am a SFMS member because SFMS is my only avenue outside of work to meet and collaborate with colleagues from different specialties. Being a member also has opened doors to meeting colleagues that expand my professional network (very important), and social network (also, very important).
I think the most helpful SFMS member resource is the SFMS Membership Desktop Reference. It provides the complete membership directory organized by name and specialty. It’s great to put a face to a name since the Desktop Reference has member photos. In this day and age, we don’t tend to get out of the office as much to meet colleagues in hospital hallways or lunchrooms.
My greatest achievement outside of practicing medicine is I was lucky enough to be a match for my husband and donated one of my kidneys to him.
What are some of the biggest opportunities or challenges you see in health care within the next five years?
I grew up in England where socialized medicine exists already as a 2 tiered system: public and private. This is the time to diversify yourself and be in a position to provide private or concierge service if you desire.
I love practicing Urogynecology, female pelvic medicine, and reconstructive surgery. Everyone is a puzzle and I try to help solve that puzzle; whether it’s with medication, physical therapy, neuromodulation or minimally invasive surgery. It’s so great in this day and age with more tools emerging to help with my work.
What is your favorite restaurant in San Francisco?
Wow, there are many choices but my favorite is Blackwood Thai on Chestnut Street. Niki, an awesome hostess/ waitress will guide you through an awesome menu including Millionaire’s Bacon as an appetizer or over ice cream as a dessert.
If I wasn’t a physician, I would like to be a veterinarian. Since I grew up in England and read James Herriot books like All Creatures Great and Small, I had dreamed of being in a little Mini cruising through country roads with stonewalls, helping the local farmers with their foaling during a cold night in a barn.
Dr. Kardos is a speaker for myriad genetics and screening women for the BRCA gene.
My Medical Choice
by Angelina Jolie
MY MOTHER fought cancer for almost a decade and died at 56. She held out long enough to meet the first of her grandchildren and to hold them in her arms. But my other children will never have the chance to know her and experience how loving and gracious she was.
We often speak of “Mommy’s mommy,” and I find myself trying to explain the illness that took her away from us. They have asked if the same could happen to me. I have always told them not to worry, but the truth is I carry a “faulty” gene, BRCA1, which sharply increases my risk of developing breast cancer and ovarian cancer.
My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman.
Only a fraction of breast cancers result from an inherited gene mutation. Those with a defect in BRCA1 have a 65 percent risk of getting it, on average.
Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex.
On April 27, I finished the three months of medical procedures that the mastectomies involved. During that time I have been able to keep this private and to carry on with my work.
But I am writing about it now because I hope that other women can benefit from my experience. Cancer is still a word that strikes fear into people’s hearts, producing a deep sense of powerlessness. But today it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action.
My own process began on Feb. 2 with a procedure known as a “nipple delay,” which rules out disease in the breast ducts behind the nipple and draws extra blood flow to the area. This causes some pain and a lot of bruising, but it increases the chance of saving the nipple.
Two weeks later I had the major surgery, where the breast tissue is removed and temporary fillers are put in place. The operation can take eight hours. You wake up with drain tubes and expanders in your breasts. It does feel like a scene out of a science-fiction film. But days after surgery you can be back to a normal life.
Nine weeks later, the final surgery is completed with the reconstruction of the breasts with an implant. There have been many advances in this procedure in the last few years, and the results can be beautiful.
I wanted to write this to tell other women that the decision to have a mastectomy was not easy. But it is one I am very happy that I made. My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don’t need to fear they will lose me to breast cancer.
It is reassuring that they see nothing that makes them uncomfortable. They can see my small scars and that’s it. Everything else is just Mommy, the same as she always was. And they know that I love them and will do anything to be with them as long as I can. On a personal note, I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.
I am fortunate to have a partner, Brad Pitt, who is so loving and supportive. So to anyone who has a wife or girlfriend going through this, know that you are a very important part of the transition. Brad was at the Pink Lotus Breast Center, where I was treated, for every minute of the surgeries. We managed to find moments to laugh together. We knew this was the right thing to do for our family and that it would bring us closer. And it has.
For any woman reading this, I hope it helps you to know you have options. I want to encourage every woman, especially if you have a family history of breast or ovarian cancer, to seek out the information and medical experts who can help you through this aspect of your life, and to make your own informed choices.
I acknowledge that there are many wonderful holistic doctors working on alternatives to surgery. My own regimen will be posted in due course on the Web site of the Pink Lotus Breast Center. I hope that this will be helpful to other women.
Breast cancer alone kills some 458,000 people each year, according to the World Health Organization, mainly in low- and middle-income countries. It has got to be a priority to ensure that more women can access gene testing and lifesaving preventive treatment, whatever their means and background, wherever they live. The cost of testing for BRCA1 and BRCA2, at more than $3,000 in the United States, remains an obstacle for many women.
I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer. It is my hope that they, too, will be able to get gene tested, and that if they have a high risk they, too, will know that they have strong options.
Life comes with many challenges. The ones that should not scare us are the ones we can take on and take control of.
Angelina Jolie is an actress and director.
There are times when a hysterectomy is a must in order to deal with medical conditions that can be quite serious. A hysterectomy can be performed in different ways, but the main purpose is to remove the uterus, and at times, the ovaries as well.
It is an extremely common procedure that is used to treat such conditions as severe or abnormal vaginal bleeding, pre-cancerous conditions found in the cervix, uterine fibroids, severe endometriosis, uterine prolapsed, pelvic relaxation, and cancer. In all of these situations, the procedure is often a must in order to protect the health of the patient.
When your doctor determines that a hysterectomy is the proper treatment for you, then you will need to discuss the types that are currently available.
Laparoscopic surgery is a non-invasive method performing a hysterectomy. During this procedure, a light and very small instrument will be threaded through small incisions in the belly.
The benefits to this procedure include small incisions for less pain during recovery and the fact that you get to keep your cervix. However, this procedure cannot be used in cases in which cancer has been found, especially cervical cancer.
Robotic hysterectomy is considered the most non-invasive method of any type of surgical procedure. The procedure makes use of small incisions and a robot controlled device. The surgeon can have the most exact control possible throughout the procedure. The advantage is much lower risk to the patient and the most precise removal of tissues.
Robotic hysterectomies can be used for a variety of different conditions, including cancer. This allows the doctor to have precise control over what tissue is removed and what is not.
In a few very specific cases, a vaginal hysterectomy may be performed. This procedure involves removal of the uterus through the vagina. Some women prefer this method since it seems less invasive. However, it can only be used in cases of hyperplasia, cervical dysplasia, and uterine prolapse. Additionally, vaginal hysterectomies come along with the possibility of severe complications.
Total Abdominal Hysterectomy
This procedure is the most invasive. It involves a full surgical incision in which the doctor will remove everything: the uterus and the cervix as well as the ovaries in some cases. Because it is so invasive, the procedure is only used in certain situations, including:
- ovarian cancer
- large fibroids in the uterus
- severe endometriosis
Talk to your doctor
If your doctor determines that you need a hysterectomy, then it is important for you to go over your options and determine which would be best for your own condition. Not all hysterectomy options are right for each case, so make sure you go over the details with your physician.
If you have chronic pelvic pain during your period or at different times of the month, it is vital that you see a doctor as soon as you can. There are many different conditions that could be responsible for the pain. Some of those conditions are more serious than others. No matter what the cause, you should not have to deal with pelvic pain that can make your life miserable for days at a time.
However, if you have never talked to your doctor before about this issue, you may not know where to begin or what to ask. The most important thing to remember is that you should ask your doctor any questions you have. Do not leave the doctor’s office without getting those questions answered. If you need some help in determining what to ask, listed below you will find common questions that women need answered about chronic pelvic pain, their treatment options, and what it means for their life.
Important Questions to Ask Your Doctor
- Why do I have pelvic pain? This will need some testing and a diagnosis before your doctor can determine the cause.
- Can I take pain relievers? Your doctor will most likely suggest you take NSAIDs (over the counter anti-inflammatories) to help manage your pain.
- What can I do at home to ease my pain? Your doctor will be able to give you home care instructions that will make your pain a little more tolerable before it can be diagnosed and treated.
- Will my treatment be permanent or will the pain come back? There are some conditions that could come back and will need to be treated at a later date. Surgery could provide a permanent solution if you wish to avoid the chance of recurrence.
- Are you going to refer me to a specialist? Depending on the type of doctor you see, you may need to see a specialist to have the proper treatment.
- Will treatment for pelvic pain cause infertility? This is an important question to ask especially if you are young and have not yet had children. In some severe cases, the best avenue for treatment could be surgery. For those cases, there could be a fertility issue to keep in mind.
- Do I have other treatment options? In some cases, you may actually have more than one treatment choice. You will want to discuss each of them with your doctor to determine which one is best for you.
- What is my expected outcome? Depending on your cause of pelvic pain, you could have different types of outcomes. You need to discuss this with your doctor before starting any treatment.
Pelvic pain can be very disruptive to your lifestyle. This is a condition that you do not want to live with on a regular basis, especially if there is a more serious underlying cause. Be sure to get all of your questions answered before you start any treatment option for your pain.
Urinary incontinence is not something that any woman wants to deal with. While common, incontinence can be due to a wide variety of factors, like age, having a baby, genetics, and illnesses. If you are dealing with urinary incontinence, then you know it comes along with embarrassment and frustration. The good news is that there are ways to treat your condition. With many different options, you will want to discuss those options with your doctor.
At Home Techniques
You cannot completely cure your incontinence at home, but there are definitely things you can do that will help the issue to some level. Here are some things you can do at home to deal with your condition:
- Training your bladder by teaching yourself to hold your urge to go a little longer each day.
- Scheduling your visits to the bathroom about every two to four hours.
- Avoiding beverages that make you need to go quicker, like alcohol, caffeine, and foods that are high in acid.
- Kegel exercises to build strength in the muscles of the pelvic floor.
- Wearing incontinence pads or underwear
- Using a catheter
These at home methods are often just methods of dealing with the urinary incontinence. However, if you only have the mildest of versions, they may be feasible. If you have more severe cases of urinary incontinence, then you will need to talk to your doctor about your options, such as medications or surgical procedures.
There are a few different medications that your doctor may prescribe. Of course you will still need to use other methods like some of those above, but when taken together, they can be successful for some types of urinary incontinence. Here are some of the medications that your doctor may prescribe.
- Duloxetine. This is an antidepressant that can be used for the types of urinary incontinence called stress incontinence.
- Imipramine. This is also an antidepressant that can be used to treat stress incontinence.
- Topical Estrogen. This low dose estrogen can be found in three different forms: vaginal cream, patch, and ring. The topical estrogen can be used to build the strength of tissues in the urethra and the surrounding areas.
- Anticholinergics. These medications are designed specifically for those who have an overactive bladder. They come in many names, including Detrol, Ditropan, Enablex, Toviaz, Sanctura, and Vesicare.
In many cases, surgery is the best option for urinary incontinence. If you have severe incontinence, then a surgical procedure can be a permanent solution so that you do not have to continue dealing with the embarrassing problem.
- Pelvic Sling. This sling is made from natural body tissue to create a hammock type device that will support the urethra.
- Bladder Suspension. A section of muscle will be used to create a device that will support the bladder neck. This helps to take pressure off the urethra.
You have a number of different options to treat urinary incontinence and you will definitely want to discuss each with your doctor.
Check out February’s edition of Marin Magazine for our new ad.
There are many different complications with heavy menstrual bleeding that you may not have even thought of. For example, many women who have a condition that causes heavy bleeding could suffer from anemia and iron deficiency, which can be dangerous to their health. If you think you have a problem with heavy bleeding, you will need to contact your doctor and discuss your condition as well as your treatment options. Remember that anytime you are dealing with your health, you should have your questions answered before you decide on any treatment option.
To help you get started, here are important questions you should ask your doctor. You may have more questions that you would like ask, but this is a good place to start.
Questions to Ask Your Doctor
- Is my level of bleeding categorized as abnormally heavy? Not all cases of heavier than normal bleeding would be considered clinically heavy. Your doctor can help you decide if you have a condition.
- How do I know if I have low iron because of my bleeding? A blood test will most likely be conducted and then your doctor will give you suggestions for an iron replacement therapy.
- Can you go over my treatment options and tell me the advantages, disadvantages, and risks of each? In some cases, you will have choices and you will want to understand each of those choices before you make a decision.
- How will you go about diagnosing my condition? Your doctor should discuss testing procedures and what you will need to go through in order to determine the cause of your bleeding.
- In severe cases, like endometriosis, is hysterectomy my only option? Surgery could be the best option for you so that you do not have to continue suffering, but you may wish to explore other options before you choose this measure.
- If I should consider endometrial ablation, can you tell me more about the success rates and complications of this treatment? This surgical procedure has numerous uses and it could be the right one for you, but you need to know more about it.
- Will you be able to treat my condition or will I be referred to a specialist? There are some cases when a specialist will be called in and you may need to determine what specialist you will like to see.
- What are the success rates of the treatment we have chosen for my bleeding? Some treatments may not be as successful and you will want to take this into consideration before choosing one particular treatment over another.
Heavy menstrual bleeding is a common condition that affects many women for various reasons. You will need to go to a doctor in order to determine what condition from which you are suffering. Be sure to get all of your questions answered so that you can choose the best treatment option to suit your needs. Do not be afraid to ask any questions you may have no matter how small they may seem.
The conventional approach to uterine fibroid treatment involves an open surgery through a large abdominal incision. After cutting around and removing each uterine fibroid, the surgeon must carefully repair the uterine wall to minimize potential uterine bleeding, infection and scarring. Proper repair is also critical to reducing the risk of uterine rupture during future pregnancies.
da Vinci ® Myomectomy
Da Vinci ® Myomectomy, combines the best of open and laparoscopic surgery. With the assistance of the da Vinci ® Surgical System, surgeons may remove uterine fibroids through small incisions with unmatched precision and control. Among the potential benefits of da VinciMyomectomy as compared to traditional open abdominal surgery are:
- Opportunity for future pregnancy
- Significantly less pain
- A shorter hospital stay
- A faster return to normal daily activities
To learn more, check out our section on [da Vinci Myomectomy].
October is National Breast Cancer Awareness Month, which is an annual campaign to increase the awareness of breast cancer and the need for screening. Many people are aware of the disease but often forget about taking steps for early detection and encouraging others to get tested. Although October is Breast Cancer Awareness Month, it is important to remember to raise awareness and educate women about breast cancer throughout the year. We encourage you to ask the hard questions and contact your doctor to learn about early detection, breast health, and the latest research developments.
Dr. Heidi Wittenberg and Dr. Leslie Kardos support National Breast Cancer Awareness Month by performing tests for breast cancer as two of the most experienced gynecologists in their field.
Learn the facts and join the fight against [Breast Cancer].