Category Archives: OB/GYN

5 Lessons I Learned From Writing a Book

Jessica and I at our first book signing. Feb 2011

I recently came across a bunch of pictures from our book signing and was reminded of this post which was originally published as a guest post on Jon Acuff’s (non defunct) blog. I pored so much of myself into the Pregnancy Companion manuscript, that thinking back to the excitement of the book signing brings a nostalgic smile to my face and fills my heart with warm fuzzies. So here’s what I learned from writing a book:

 

Three years ago, 5 days after bringing a new baby home from the hospital, I signed my first book deal. I was deliriously excited at two dreams coming true at once. In hindsight, I no idea what craziness lay ahead. Luckily, I learned a lot along the way.

  1. You find the time for what’s important

Writing a book is a staggering amount of work, but I’m used to hard work. See, I went to medical school for a zillion years. But working full time, with a newborn and a deadline felt overwhelming. I’m a morning person so I was up at 4 every morning to write furiously before work. Those months were fueled by caffeine and adrenaline, but amazingly worth it.

  1. The rewrites never end

“Working on my final round of edits today . Almost done!” was my facebook status about 900 times. I knew there would be edits, but by the 6th round, the thought of reading the manuscript one more time made me cringe.

  1. You can’t please everyone

The publishing experience takes this platitude to the extreme. I co-wrote a Christian Pregnancy Book. Mainstream Christian publications felt it wasn’t Christian enough (we actually mentioned *GASP* birth control). Secular media felt it was too religious. Different editors gave us opposite feedback. Eventually, we wrote the book that we believed would be most helpful to pregnant moms, and based on the response we get from them, we are pleasing the right people.

  1. Buy Books.

Previously I was a fan of borrowing books or checking out the library; now I buy books. All the time. I appreciate how extremely challenging it is to sell books. If I am ever at a book store and there is a signing going on, I stop what I’m doing and get in line. If the author has no line, I will stop and talk with him indefinitely, feigning interest in the subject, no matter how lame. “Oh a book about a civilization of bunnies, you say? How interesting!” Having been on the lonely side of a signing table, I know the awkward angst of sitting sadly with a fake smile hoping someone will stop by.

  1. My Definition of Success

I am an OB/GYN with a successful practice. My life has not been tainted with failure. When I got a book deal, I assumed that this venture would be met with the success that I’d grown accustomed to in life. Not because I was cocky, (OK, I’m a surgeon, so by definition I am slightly cocky) but because I felt it was a really great idea, and I was naive.  Despite the fact that everyone related to me thought my book was awesome, it was not the best seller I’d hoped it would be. It hasn’t even sold 10,000 copies. But it has helped people and genuinely made a difference in some women’s lives. That is why I wrote it and truly what is important to me. I had hoped it would impact women and be a best seller, but that is not the case. When I get discouraged, the royalty updates from my publisher go in the shredder. But the thank you notes from the people we’ve touched…those stay in a folder to remind me of my new definition of success.

Writing a book did not change my life or make me a millionaire. It did teach me that time management is key, that you can always find time for what’s important, and that success is best measured one person at a time.

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Why I am Giving my Kids the HPV Vaccine

An immunization that could prevent cancer? It seemed like far fetched science fiction when I first heard the rumors as a medical student, but fast forward 15 years and now I  give it to my patients almost every day.

HPV (Human papilloma virus) infects the skin of the genitals and the throat, potentially transforming normal cells into cancer. It is also the culprit for genital warts. There are 2 vaccines FDA approved to protect against HPV and thus prevent these types of cancer.  Cervarix protects against HPV types 16 and 18, which are responsible for 90% of cervical cancers. Gardsil protects against the cancer causing types 16 and 18, but also prevents types 6 and 11 which cause genital warts.

The current recommendation is for girls and boys to get the vaccine at age 11. The virus is sexually transmitted, so the idea is to give it before the kids even start thinking about sex. If they don’t get it in adolescence, the vaccine can be given up to age 26.

I’m often asked by patients and friends if I plan to give it to my kids. The answer is absolutely yes and here is why:

It’s safe.

With nearly 57 million vaccines already given worldwide, Gardasil is a well studied, safe vaccine. The most common side effects are pain at injection site {duh} and fainting.  After getting the vaccine, it is recommended to sit down for 15 minutes to prevent the fainting side effect. Other common side effects include headache and fever. Allergic reaction to vaccines are rare. The data does not show any severe or unexpected short or long term side effects with the HPV vaccine.

I don’t want them to get cancer.

The HPV virus causes 12,000 cases of cervical cancer; 3,000 cases of vulvar cancer; and 8,000 cases of throat cancer each year. The vaccine has been shown to be 100% effective in preventing HPV 16/18 related disease if given before kids become sexually active.  Throat cancers occur most commonly in men, who get the HPV from performing oral sex on women who have the virus. Anal cancer can also be caused by HPV, but it is rare.

I’m not naïve.

We are raising our kids in church, praying for them, and teaching them not to have sexual relations before marriage. But honestly, this is a fallen world and I know a lot of “good kids” who have made stupid decisions along the way. HPV is spread by vaginal, oral, and anal sex. Actually, any genital to genital contact can spread HPV.

Statistically 80% of women will contract HPV in their lifetime. Even if my kid manages to make it to marriage without HPV, odds are his mate will not.

I don’t want them to get genital warts.

Genital warts are not deadly, but they are painful and embarrassing. I’ve gone through many tissues in my office as I’ve comforted sobbing woman after telling them that what they thought was a mole on their labia was actually a genital wart. Genital warts are also commonly seen in pregnancy, as the lowered immune state can lead to the dormant virus suddenly popping up as “cauliflower like” bumps all over their lady regions as they approach the delivery suite {the one time in their life where their lady parts will literally be in the spotlight}.

I don’t want them to get pre-cancer.

The pap smear has become increasingly effective in preventing actual cancer, but the real gem of HPV immunization is the prevention of cervical dyplasia or “pre-cancer.” There are over 1 million abnormal pap smears in the United States each year. Each one requires a colposcopy, where the doctor looks at the cervix under the microscope and takes biopsies. The biopsy shows pre-cancer up to 35% of the time. A cone or LEEP is then performed which cuts out a portion of the cervix about the size of a thimble. Then the woman needs repeat pap smears 2-3 times a year for several years. If the pre-cancer returns, then another LEEP or even hysterectomy is warranted.  The LEEPs are painful and multiple LEEPs can lead to pregnancy complications like preterm delivery.

Abnormal pap smears would not be eliminated by universal vaccination, but would be reduced by 70%. That would save significant anxiety, pain, and money for a lot of women.

Perhaps it’s the misinformed apprehension that some parents currently have about vaccines in general, or maybe just the fact that HPV is associated with sex that throws them for a loop, but currently only 33% of adolescents have received the full vaccination series despite overwhelming safety and efficacy studies. I bet if you ask the 350,000 women a year who needed cone biopsies or even the many who have genital warts, if they wished they could have had the vaccine, the answer would be an overwhelming yes.

I’m a Christian, a doctor and a mom. I love my boys and yes they are getting the Gardasil/HPV vaccine. HPV is a nasty virus that causes a lot of harm and emotional grief.  I don’t wish for them or their future wives to have any type of unnecessary cancer or disease.

The Great Many Juxtapositions that are My Life as an OB/GYN

It was 9:35 pm and I found myself staring longingly at a trash can, salivating at the beautiful sandwich perched precariously on its rim. My hands were trembling from hunger. If you would have checked my blood sugar at that moment, it would have likely been critically low.

My day had started at 6am with a 5 mile run and I hadn’t stopped moving since. I got paged for a stat delivery while I was in the shower and the day had seemed to go down hill quickly. A full office and multiple laboring patients awaited me. My emergency protein bar served as my lunch and during the cafeteria’s dinner hours, I was in the OR on a hemorrhaging ectopic pregnancy. I was so tired I could feel every muscle in my body, and each one throbbed in their own unique way.

 

The sandwich is CLEARLY above the rim.

The sandwich is CLEARLY above the rim.

That is how I found myself in my real life Seinfeldian dilemma. After realizing the cafeteria was closed I had went back to my office in hopes of grabbing a leftover sandwich out of the refrigerator only to realize in horror that someone had thrown the precious salted meats in the trash. However one specimen had perched itself slightly above the rim, still on its original plastic tray.

Do I eat refuse or trek across campus to the doctors lounge for a poptart? If it is above the rim is it technically garbage?  Not to me in that moment. I wolfed down the cold cuts and said a little prayer against listeria and all other types of food poisoning. It tasted divine.

I thought about how very strange my life was, as I sat back and patted my full belly. A mere two weeks earlier I was dining at leisurely at cafes in Paris, now I was George Constanza, eating  out of the trash.

Beautiful gourmet meal from our trip to Paris.

Beautiful gourmet meal from our trip to Paris.

The next day  I ran into a casual acquaintance who remarked how glamorous my life seemed on social media. I laughed and told her my trash eating story. The incident made me think of the many other strange juxtapositions of my life.

There was the time I found myself in one of the messiest deliveries of my life a couple of hours before the hospital Christmas party. While birth is a beautiful moment of life, sometimes it can also be a giant hot mess. During this rather difficult birth I was initially pooped on quite extensively. Then as the baby delivered, I was hit with a tsunami wave of amniotic fluid that soaked me to the core, making a mockery of my ‘protective gear’. The patient then began hemorrhaging, so I performed an internal uterine massage to help stop the bleeding, which equals me inserting my entire arm into her uterus, making me feel a little bit like a large animal vet. The only bodily fluid missing from the event  was vomit. Hours later after a “Silkwood  shower” and a quick makeup application, I find myself at a country club in a little black dress having small talk about the weather.

Many times I’ve been at the playground with my kids only to sneak away a few steps to answer a call from the hospital about a STD or other topic that is definitely not a ‘playground friendly’. Bedtime stories or games of ‘hide and seek’ have often been interrupted with stat pages to the hospital. I’ve gone from reading Dr. Seuss to performing an emergency C-section in moments.

The worst juxtaposition is dealing with loss in the middle of a regular day. While OB/GYN is often a happy specialty, when it is sad it is heartbreakingly awful. I often have to deliver the worst of news: miscarriage, infidelity, cancer, infertility. There have been days where I have went from placing a lifeless baby in a mothers arms and with barely a moment to catch my breath and dry my eyes, to seeing a patient for a new pregnancy right down the hall. Death and life with only moments in between; the roller coaster of emotions is so strange.

I’m not complaining about my job. I’m well adjusted to the bodily fluids and tumultuous schedule. I simply find it intriguing how my life can go from one extreme to another so very quickly. I’m sure most other doctors would have similar stories (well maybe not the trash). Also this serves as a good reminder that if you see me looking semi-fancy in a picture, the special ingredient that made my hair extra shiny, might just have been amniotic fluid.