Is your physician ethical?

Alert to Utah Women!

According to Utah statute, ethical behavior is entirely unnecessary. State Code 78B-3-406, in a nutshell, states physicians do not have to inform you of any controversy or risks surrounding devices they may implant in you, as long as you loosely agree to the procedure. Utah Supreme Court of appeals state “This statute abrogates any claims for failure to disclose risks of treatment.” Consumers are not protected by the Food and Drug Administration either. Device manufacturers can submit similar devices under 510(K) without rigorous studies or animal research.

Faltering FDA oversight combine with this code leaving women in search of treatment for urinary incontinence especially vulnerable. The September 2010, Reader’s Digest list synthetic mesh slings to treat incontinence, as one device you’re better off without. They quote Donald Ostergard, M.D., past president of the American Gynecological Association and previous editor for the International Urogynecology Journal, stating “synthetic mesh slings for stress incontinence are a public health hazard.” At the 2008 International Continence Society meeting in Cairo, Ostergard, the keynote speaker, expressed views of senior colleagues, "they consider mesh use a sign of surgical incompetence."

Complications with mesh slings often appear more than three years postoperatively. A 2006 study published in Neurology and Urodynamics, reports major complications are estimated to occur 20-fold higher than reported. A rat study in the British Journal of International Urology (2004) found polypropylene (a common mesh) to invade the bladder muscularis in all of the implanted rats, stating “The use of polypropylene mesh risks serious postoperative complications, e.g. urethral tissue invasion.” Pharmaceuticals list animal studies in the Physician Desk Reference, information easily accessed on line or through a local pharmacy. It is unlikely a typical consumer would have access to peer reviewed journals discussing polypropylene.

In, How to treat pelvic organ prolapse, published by australiandoctor.com, inflammatory reactions to polypropylene never resolve causing chronic pain in 30%. In sexually active women the mesh behaves like a “cheese grater” when exposed to friction. Erosion occurs in 53% of patients. Exaggerated scarring from mesh shrinkage may result in anatomical distortion of the bladder, rectum and vagina. Other serious, disabling and life threatening injuries also occur. (australiandoctor.com 2010).

In 2009 the International Continence Society, agreed serious risks must be disclosed in the consent process, as many specialists regard polypropylene slings experimental (australiandoctor.com). I believe consent must also include unbiased information regarding other available treatments.

As an idealist, married to a physician, I believe an internal moral compass guides most physicians to honor their Hippocratic Oath. However, Utah code 78B-3-406, leaves women vulnerable to less ethical physicians, (shielded from litigation), as they may inappropriately capitalize on a growing trend in incontinence surgery.

On Being Marginal

For those who don’t know me, I’ve been on some sort of journey or quest for sometime now. For nearly two decades I’ve struggled to feel something other than marginal.

As a college graduate, I do realize what takes most people 4 years, took me about the same time most people graduate from medical school. As a mother my shortcomings are also apparent, as desperate teachers and the principal continually call, some even in tears, informing me of my teen’s outrageous behavior. I can’t find my kids immunization records. I thought they were buried in the bottom of the junk drawer. When my sister learned I had a cleaning lady come twice a month she asked “Really?” Apparently you can’t ever tell because the chaos and disorder that surrounds me, distracts others from noticing my toilets and tub sparkle at the moment.

When I worked I felt I had some way to explain my shortcomings, because I was very, very busy. Now that I have been home since the birth of my 3rd child who is now 4, I believe my home should be spotless and my scrapbooks complete. But nothing could be further from the truth in fact sometimes trash and hardened fries fall out of my car when my kids climb out. My purse is like a hermit crab, when it gets bogged down with old receipts, gum wrappers and crud rather than cleaning it out, I relocate my wallet, keys and phone to a new home and toss the old shell in with the heap of scattered shoes in my closet. My towels never match and at times my feet stick to my floor, which once drove me insane.

Though I strive to be tidy, this is my natural born ability and I will no longer fight it. The search for something I’m good at is over. My first year in my 4th decade is coming to close and I am finally at ease. I have found something I do, not just marginally. There is something I am really, really good at. I am a master in fact, of creating a mess. Today I look forward to embracing the rest of my forties armed with the knowledge that what surrounds me matters very little compared to what lies within.

The Botox Blog

A few months ago a friend of mine, whose husband is a neurologist needed an "office person" to fill in on short notice. I offered to help, not realizing how much this experience would transform my views of beauty and aging. The temporary Tuesday job became a more regular thing for me.

One day, the neurologist who I will call Dr. N was referred a new patient for evaluation of seizures. His patient arrived; I'll call her Nan. I greeted Nan a 40-year-old, pretty, I thought,( at least not as wrinkly as me) with full lips, woman. I gave her the patient paperwork and a pen. I rarely greet people with a smile and not have it reciprocated. She wasn’t rude, but she wasn’t friendly. I thought I was friendly, but maybe I bugged her, maybe she was stressed by her seizures. I tried not to interact or annoy her, as I'm perpetually worried that people don't like me. Dr. N was ready to see her and after a few minutes of evaluation he came out of the exam room perplexed, reporting that Nan is nice but that there is something strange about her.

Later I learned that Nan works at a "laser center" and has been working as an aesthetician for nearly a decade. As a benefit she has received copious and frequent amounts of Botox and various filler injections for free. Dr. N is unable to assess her neurological functions completely as her forehead fails to move; apparently the ability to lift your brows symmetrically indicates something. Her brows were entirely immobilized by years of Botox® injections.

Dr. N completed her exam and I prepared her paperwork for the various tests she needed and signed her out. I felt uncomfortable around her even weird and I had no idea why. Dr. N couldn’t figure out why he felt so strange around her either. We agreed that our interactions with Nan left us feeling "odd". In the days that followed Nan’s visit, I found myself thinking and wondering what was so strange about her.

Later that week while driving, a billboard for Rejuvederm® hits me across the face, it tells me "parenthesis don't belong on my face," and now I know exactly why Nan troubled me and left me feeling so empty. She has no parenthesis or adjectives for that matter. Though she may have smiled her eyes did not reflect that and that thwarted my interactions and responses with her.

Imagine reading a Hemingway novel without any adjectives or parenthesis, it would not be the same. We would not and could not connect with the characters. I couldn't read Nan, nor could her doctor. When we see a smile, that’s just not enough. The eyes with their lines and the wrinkles are the adjectives that tell you just what kind of smile it is. If you smile at someone and your forehead is frozen, how do they know you are sincerely happy to see them?

So today I embrace my furrowing worry lines, age spots and parenthesis, despite how they got there. These are the adjectives of my continuing story. Faces are supposed to have adjectives, parenthesis and all kinds of punctuations just like the pages of a well-written book.