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Announcement

To our loyal patients,

At Northern Indiana Center for Pelvic Health and Gynecology we strive to provide compassionate, high quality gynecological and urogynecological (vaginal prolapse, fecal and urinary incontinence) care for women of all ages and in different stages of their lives in the Northern Indiana area. We have been honored and privileged that you have entrusted us with your gynecological and urogynecological needs over the years. The constantly changing healthcare landscape has provided challenges to everyone including doctors, patients, and hospital systems. In order to adapt to the changing landscape, Northern Indiana Center for Pelvic Health and Gynecology is pleased to announce exciting news about our future direction.

Beginning April 1, 2017, Northern Indiana Center for Pelvic Health and Gynecology will join Beacon Medical Group. Our new name will be Beacon Medical Group Center for Pelvic Health and Gynecology. By joining Beacon Medical Group, we will be joining the largest most diverse multi-specialty group in Northern Indiana with 350 providers representing specialties in 60 convenient locations in St. Joseph, Elkhart and LaPorte counties.

Through this merger, we will be able to continue to provide quality care and access to you, our loyal patients and we will also be better prepared for the demands of the ever changing medical landscape in the years to come.

We will remain in our current location at 707 N. Michigan Street, Suite 102, South Bend, Indiana, our phone number will also remain the same (574) 367-3800 and we will continue to provide excellent care to all our patients. Should you have any questions or concerns during this transition, please contact our office and my staff will be happy to assist you.

Sincerely,

Dr. Carlton Lyons

Overactive Bladder (OAB)

Bladder control is dependent on two basic aspects; muscle control and nerve control. Overactive Bladder (OAB) is a problem with the storage function and unexpected nerve impulses that cause a sudden urge to urinate. When the bladder receives these inappropriate signals, it can lead to urinary urgency, spasms, and involuntary loss of urine. Sometimes the loss is small dribbles, and sometimes it is a complete loss of control of the bladder resulting in the patient becoming completely soaked with urine. This can become embarrassing, causing patients to isolate themselves from friends, work, and social engagements. Thankfully, there are many treatment options available.

Treatment is tailored to the individual’s symptoms. Often, lifestyle modifications can improve bladder control. For instance, timed voiding, limited caffeine intake, fluid monitoring, and bladder holding techniques or Kegel exercises are a few treatments. If you are still struggling with symptom control, then a trial of medications that work directly on the spasm of the bladder are often helpful. There are many types of overactive bladder (OAB) medications available. Choosing the right one depends on other medical conditions that you may have or other medications that you may be on.

There are some patients who either cannot tolerate OAB medications or they are not effective enough to improve their symptoms. In those particular instances, there are other treatment options available. These options include Pelvic Floor Physical Therapy to strengthen the muscles that help to control the bladder. Pelvic Floor Therapy also includes a vaginal stimulation to help reset better communication between the bladder and the central nervous system. Another option is Posterior Tibial Nerve Stimulation or PTNS. This involves using a small electrode at the inner ankle to slowly stimulate the tibial nerve. This nerve branches from the sacral nerve which controls the bladder. There is also Sacral Neuromodulation Therapy and Botox bladder injections, all of which are successful in improving bladder control, urgency, and frequency.

At Northern Indiana Center for Pelvic Health & Gynecology, we specialize in treating pelvic floor dysfunction and incontinence. The loss of urine or urinary incontinence is not normal. It is not necessarily just part of getting older. Please talk to your doctor or call to schedule an appointment today to discuss your symptoms with one of our practitioners. There is relief of your symptoms available. Let us help you get back to being you!

American Institute of Ultrasound in Medicine Accreditation

We are very pleased to announce that we have been granted accreditation from the

American Institute of Ultrasound in Medicine.

AIUM ultrasound practice accreditation is a voluntary peer review process that allows practices to demonstrate that they meet or exceed nationally recognized standards in the performance and interpretation of diagnostic ultrasound examinations. The accreditation process encourages providers of diagnostic ultrasound services to assess their strengths and weaknesses and initiate changes to improve their practices.

Practices accredited by the American Institute of Ultrasound in Medicine (AIUM) have demonstrated competency in every aspect of their operation, including:

  • Personnel Education, Training, and Experience
  • Document Storage and Record Keeping
  • Policies and Procedures Safeguarding Patients, Ultrasound Personnel, and Equipment
  • Instrumentation
  • Quality Assurance
  • Case Studies

 

Providing our patient with quality diagnostics and outstanding medical care. That’s our mission!

Improved Treatment Technology for Excessive Bleeding

Heavy bleeding is a common problem that affects about 1 in 5 women. Many women find excessive bleeding can makes it difficult to work, exercise and be socially and sexually active. The signs of heavy bleeding can affect women of all ages, but are most likely to start between the ages of 30 and 40.

Endometrial ablation can be indicated for pre-menopausal women with excessive menstrual bleeding due to benign causes for whom childbearing is complete. For some women considering a hysterectomy due to heavy bleeding, endometrial ablation may prevent the need for hysterectomy.

An improved endometrial ablation treatment technology is now available for women with excessive menstrual bleeding, or menorrhagia. This improved technology produces twice the positive outcomes compared to previous technology for treating heavy menses.

The endometrial ablation procedure uses a heat device to ablate (destroy) the endometrium, or lining of the uterus. This tissue is the source of heavy bleeding in women who have not reached menopause. Procedure time from insertion of the device to removal of the device is approximately 3 to 4 minutes. With any surgery, there are risks related to the treatment and to the anesthesia used during the treatment. At your appointment, we will talk to you about the risks and will give you details about your individual situation.

In an international multi-center clinical trial conducted by the manufacturer of this new and improved ablation instrumentation, 92% of patients treated with endometrial ablation reported reductions of bleeding to a less than normal level and 66% reported zero bleeding, at 12 months post-procedure. Results of this study, One-Year Follow-Up Results of a Multicenter, Single Arm, Objective Performance Criteria-Controlled International Clinical Study of the Safety and Efficacy of the Endometrial Ablation System” were published online in the Journal of Minimally Invasive Gynecology, JMIG, a peer-reviewed medical journal published by the AAGL, previously known as the American Association of Gynecologic Laparoscopist.

If you are needlessly suffering from excessive menstrual bleeding, please schedule a consultation appointment to find out if endometrial ablation is right for you. Contact us at (574) 367-3800.

Endometriosis

Have you ever heard of the medical term Endometriosis? It is a perplexing and complicated medical problem that affects nearly 2-10% of American women of childbearing age (www.hopkinsmedicine.org). It is also a known cause of infertility affecting 24-50% of infertile women (hopkinsmedicine.org). Endometriosis is a medical problem where tiny pieces of tissue similar to the tissue we find within the uterine lining begin to implant over the pelvic and abdominal organs. The implants then become stimulated by a woman’s menstrual cycle which on a cellular level leads to inflammation, adhesions, and creation of further implants (Dechernet et al, 2007). This cascade of events then produces variations 0f pelvic pain.

What causes Endometriosis? Although an excellent question, the cause still remains unknown (Dechernet et al, 2007). One prominent theory is that during a woman’s menses small pieces of tissue travel backwards through the fallopian tubes and out into the pelvic cavity instead of, or in conjunction with, a regular period.

Symptoms of Endometriosis: The main symptom is pelvic pain. Interestingly enough, every woman’s degree of pain is different and it doesn’t necessarily correlate with how many endometrial implants someone has. A woman may have only a few implants and have horrific pain and someone else may have a large number of implants and be pain free. Therein part of the mystery of the disorder. Pain can be diffuse over the whole pelvis, only the week prior to menses, and with deep penetration during intercourse. It may also manifest with symptoms that correlate with where the implants are attached i.e. the bowel (pain with defecation) or bladder (pain with urination, urgency, incontinence). Pain can also be experienced by issues endometriosis creates like adhesions. Adhesions are scar tissue or areas that have stuck together like an adhesive. The pulling at this tissue creates pain.

Diagnosing Endometriosis? Diagnosing endometriosis can be a bit frustrating, as the only way to diagnosis it is to see it during a laparoscopy or open surgical abdominal procedure. Often in a clinical setting, endometriosis is presumed and treated as such until it is confirmed surgically or symptoms are managed with medications.

Treatment of Endometriosis: There are many treatments for endometriosis. The main goal of treatment is alleviation of pain and suppression of new endometrial growth. Contraception is often used as it thins the endometrial lining and suppresses surges in our hormonal cycle. Pain medications are also utilized to treat the intense pelvic pain that accompanies the disorder. Ideally, if a laparoscopy is performed, endometriosis can be destroyed with a laser minimizing ongoing pain. Once the scope is completed, a medication called Depo-Lupron is an excellent medication that suppresses new growth and is typically used for about a year. Unfortunately, it can produce menopausal symptoms which can be stressful to patients. However, add-back therapy can be used to assist with symptoms.

I bring this topic up because I want you to know that pelvic pain is not normal and deserves your attention. If it is something you’re struggling with, it is important to have it evaluated. Although it may not be endometriosis, treatment is available which will help increase you quality of life.

Until next time,

Elizabeth Schalliol RNC WHNP

Breast Cancer Awareness – Not Just for October

Since October was Breast Cancer Awareness month, I thought it would be best to discuss a breast topic. A positive sign that I can report is that Breast Cancer rates have been dropping since the year 2000 (American Cancer Society (ACS), 2014). The rate of decline has been associated with improved screening tools and more informed decisions regarding hormonal therapy for menopausal women (ACS, 2014). However, our fight against Breast cancer continues and I would encourage you to perform periodic breast self-exams and to obtain a yearly screening mammogram.

Other findings such as fibro-glandular densities, fibrocystic changes, breast cysts, fibro-adenomas, and micro-calcifications are also found on mammograms that often result in calling a woman back for further testing. Further testing may include a Diagnostic mammogram where they simply take more pictures of targeted areas within the breast and/or a Breast ultrasound. Either way, that call can be scary and lead to anxiousness until results are known. It is important to know that screening mammograms are just that-screening. It is a basic tool to evaluate the breast tissue in order to rule out any abnormality not just breast cancer. There are many other breast issues or symptoms that women or men may have that may or may not need treatment.

*Fibro-glandular Densities are often seen in younger men and women. Breast tissue is denser in this subset of the population (premenopause) since the breast is primarily made up of fat. After menopause, the breast tissue loses its fatty bulky composition as a result of hormonal change and skin/musculoskeletal changes. Dense breast are harder to evaluate though and require more images to examine.

*Fibrocystic changes are another common finding in premenopausal women and menopausal women who are taking HRT (Hormone Replacement Therapy). Fibrocystic changes often trigger pain throughout the month. Our breasts besides fat are also made up of tiny ducts, lobes, and lobules that assist in milk production following childbirth. These areas are hormonally influenced not only after childbirth but cyclically with our menstrual cycle and as a result of contraception and HRT. Hormonal influence can create changes in the fluid in the breast triggering pain. Caffeine is often an overlooked culprit of breast pain as well. It can influence fluid shifts intensifying fibrocystic pain that already exist.

*Breast Cysts are fluid filled sacs that often feel like lumps. The fluid within the cyst may fluctuate depending on the time of the month. As the cyst increases in size it puts pressure on the surrounding tissue creating more pain. Depending on the size of the cyst, your provider may suggest you have drained.

*Fibro-adenomas are lumps of fibrous/milk gland tissue. These lumps are solid and defined and often create great fear. It is often suggested you have these biopsied to confirm they are benign or not cancerous. If found to be a fibro-adenoma they can be left alone or removed based on your comfort.

*Micro-calcifications are small deposits of calcium that develop over time. We all have calcium circulating in the body as a result of food that we eat and supplements we may take. Calcium we know is good for bone health. Most micro-calcifications are benign. Large groupings or patterns often require further imaging to ensure it is not an underlying cancer (ACS, 2014).

I hope you have found this review helpful. I know since starting to obtain mammograms myself the results and findings can be complicated. If ever in doubt, please ask us or your provider for clarification.

Thank you, Elizabeth

Domestic Abuse and Violence

Every 9 seconds in the U.S. a woman is assaulted or beaten. One in four women will experience domestic violence in her lifetime and an estimated 1.3 million women are victims of physical assault by an intimate partner each year according to the National Coalition Against Domestic Violence or NCADV. Females between 20-24 years of age are at the greatest risk of nonfatal intimate partner violence and according to NCADV, most cases are never reported to the police

Recent sporting events have made domestic abuse and violence a hot topic in the media. It can happen to anyone and it is usually excused, or overlooked, or even denied. Often, it starts as small little blows to your ego or subtle comments that are demeaning. Over time, the words start affecting your psyche and all of a sudden a previously strong willed individual has succumb to the emotional and psychological insults and you have no idea how you got here. The abuse becomes psychological and often turns violent. Love is never violent, and no one should ever fear the person they love.

Domestic abuse occurs when one partner tries to control or dominate the other partner. When this domination becomes violent, it is now called domestic violence. The abuser often uses guilt, fear, shame, and intimidation to wear down the victim and gain control over them, and this can often lead threats to the victim or those around. This behavior is never acceptable. Everyone should feel respected, valued, and safe.

There are many signs of an abusive relationship, most telling if you fear your partner. Feeling the need to tip-toe around on eggshells to avoid a blow-up, or feeling belittled, or controlled is unhealthy. This can lead to your own feelings of helplessness, self-loathing, manipulation, or desperation. Over time, the abuse can become physical when the abuser uses physical force against you in a way that injures or endangers you. This physical assault is a crime and police have the authority to protect you. Any situation in which you are forced to participate in unwanted, unsafe, or degrading sexual activity is sexual abuse.

Emotional abuse is a big problem that is often minimized or overlooked. The aim of the abuse is to slowly chip away at the victims independence and self-worth until he or she feels that there is no way out of the relationship or no way to survive without the abuser. Emotional abuse can leave scars that run so deep, it can often be even more damaging than physical abuse. There are many excuses that people use to stay in this type of relationship.

The abuser apologies and showers the victim with love, making it difficult to want to leave. They may even make you believe you are the only one who can help them stop and that things will be different; however the dangers of staying are very real. Often the abuse escalates, and can sometimes end in tragedy. Studies have found that children who witness any form of abuse have a much greater chance of being abusers themselves. Boys who witness domestic violence are twice as likely to abuse their own partners and children when they become adults (NCADV). Sadly, 30-60% of perpetrators of intimate partner violence also abuse children in the home (NCADV.) Studies suggest that up to 10 million children witness some form of domestic violence annually as reported by Domestic Violence Statistics.

Getting help is often scary for victims of abuse. Remember that the abuse is not your fault and there is never a good reason for the abuse. There are shelters and supports systems in all communities. Prepare for emergencies to try and keep safe. Come up with excuses to leave the house day or night if you sense trouble is brewing. Identify safe areas in the house that have windows/doors and phones, stay away from rooms with weapons or without exits. Establish a code word to signal to your kids, friends, or neighbors that you are in trouble. Be ready to leave at a moment’s notice with the car fueled and always facing the driveway exit with a spare key hidden but easily accessible. Practice escaping quickly and safely, and have your children practice too. Memorize emergency contacts who would be willing to give you a ride to a safe place.

If you decide to stay in the relationship, there are some options that can try and make to situation better or safer for you and your children. Contact the domestic violence program to get emotional support, peer counseling, and safe emergency housing if you ever should need it. Build as strong a support system as your partner will allow by getting involved in the community and activities outside the home. Encourage your children to get involved in activities also. Be kind to yourself and develop positive words of affirmation in your own vocabulary about yourself to counter the negative comments from the abuser. Please always consider your safety and the safety of your children.

Local help:

Hope Ministries – 532 S. Michigan St. South Bend IN (574)-288-4842

The Center for the Homeless – 813 S. Michigan St. South Bend, IN 46601 (574)282-8870

YWCA Women’s Shelter South Bend – 1102 Fellows St. South Bend, IN 46601 (574)233-9558

*New Hope Sexual Assault program at YWCA – (574)233-9491

*24 hr crisis line 1-866-YES-YWCA

National help:

The National Domestic Violence Hotline – 1-800-799-7233

The National Sexual Assault Hotline – 1-800-656-4673

 

References:

National Coalition Against Domestic Violence – http://domesticviolencestatistics.org/domestic-violence-statistic

Domestic Violence and Child Advocacy Center – http://dvcac.org/

Domestic Violence Awareness Project – http://www.nrcdv.org/dvam/home

Bladder Health Week

Ladies, it’s time to start talking and “Break Free from PFDs”! If you are like most women, you have LOTS of questions about personal topics that don’t often get discussed – it’s time to start talking! Join us for education and conversation about all of the things our mothers, sisters and girlfriends never told us about…. Break Free from Pelvic Floor Disorders.

 

November 10th – 14th is Bladder Health Week

Please join Board Certified Urogynecologist Dr. Carlton Lyons and Women’s Health Nurse Practitoner, Elizabeth Schalliol for expert advice about Pelvic Floor Disorder (PFD) signs, symptoms and treatment options.

When?

Monday, Nov. 10th at 6:00p – Dr. Carlton Lyons

Tuesday, Nov. 11th at 6:00p – Elizabeth Schalliol, WHNP

Thursday, Nov. 13th at 12:00n – Elizabeth Schalliol, WHNP

Friday, Nov. 14th at 12:00n – Dr. Carlton Lyons

 

Where?

University Commons Medical Plaza – Conference and Training Room

6301 University Commons

South Bend, IN 46635

 

For directions and to RSVP, please call our office at 574-367-3800.

 

Bladder Health Week Flyer

 

What is a Urogynecologist?

What is a Urogynecologist?

The specialty field of Obstetrics and Gynecology serves women of all ages and stages of life. Female Pelvic Medicine and Reconstructive Surgery (Urogynecology) focuses on disorders stemming from the loss of support of pelvic structure as well as urinary tract and rectal dysfunction. In the past a woman with pelvic issue may have been referred to multiple specialists. A problem with the bladder may be referred to a urologist. A problem with the uterus or ovaries would have been evaluated by a gynecologist and a rectum problem would have been referred to a colorectal surgeon. Today, these issues can be evaluated and treated by one specialist the Urogynecologist.

When should I see a Urogynecologist?

Pelvic disorders can be embarrassing, but may lead to greater medical complications if left untreated. Symptoms like leaking urine or feces, or vaginal bulges are not just a normal part of aging. You should see a Urogynecologist if you are experiencing:

  • Leaking of urine or feces
  • Frequent urination or urgency
  • Difficulty emptying your bladder
  • Vaginal pain or bulging
  • Painful intercourse
  • Frequent urinary tract infections
  • Painful Urination
  • Pelvic Pain

There are a variety of options both surgical and non-surgical for restoring your quality of life.

Why should you choose a Board Certified Urogynecologist?

In 2012 The American Board of Medical Specialties (ABMS) approved board certification for Female Pelvic Medicine and Reconstructive Surgery (Urogynecology). Physicians have to meet strict criteria to be permitted to sit for the board examinations which began in 2013. Once a physician achieves board certification, ongoing education and training are required to maintain certification. By voluntarily committing to this career-long process, board certified doctors play a leadership role in the national movement for health care quality. In fact, the American Board of Medical Specialties cites numerous studies have demonstrated that physicians who are board certified deliver higher quality care and have better patient care outcomes.

At Northern Indiana Center for Pelvic Health & Gynecology, we are very pleased to announce that Dr. Carlton Lyons is one of the first specialists in this region to qualify, pass the exam and receive Board Certification in Female Pelvic Medicine and Reconstructive Surgery (Urogynecology).

If you are experiencing any of the issues mentioned above, please know that you are not alone and we can help.

To schedule an appointment for an evaluation, call 574-367-3800.

Oh That Itch!

This month I would like to discuss a nagging problem that many women have but goes misdiagnosed, Vulvodynia. Often, as women, at the first sign of vaginal itching we assume we have a yeast infection. There are many over the counter products used to treat this issue. But, what happens if symptoms persist???

Vulvodynia is the term used to describe chronic itching of the vulva or outer female genital area. Although termed chronic it can come and go and be repetitive or be consistent. Many times symptoms are related to other diagnoses such as a yeast infection, bacterial infection, or other dermatological issues. However, sometimes there is no clear cut answer yet pain, itching, burning, and stinging persist. Many women struggle with discomfort, treat with OTC regimens, and set themselves up for a repetitive scratch-itch cycle and vulvar pain. Unfortunately, symptoms continue affecting us physically and often emotionally as it can lead to a decreased desire for intimacy. Treatment options are available, so I urge you not to guess and to seek the help of a women’s health provider.

In the meantime, be sure to keep your female genital area clean and dry. Cotton underwear is ideal as it allows air flow to the skin. Avoid long term wear of panty-hose/spandex, or tight fitting clothing. Change pads if worn frequently and avoid use of scented products in this general area. Although it may sound funny, ice packs can be used to soothe the repetitive itching if needed. Hope this was helpful, until next time…

~ Elizabeth Schalliol, MSN
Women’s Health Nurse Practitioner