Mt. Sinai vs. Cornell for Out-Patient Surgery

I just had my third surgery in about a year. The first two surgeries were with Dr. Gary Goldman at Cornell Hospital here in New York City. The last one was with Dr. Rudy Segna at Mt. Sinai Hospital.

I love Dr. Segna and he performed my surgery to take out my ovary much much more quickly than I think Dr. Goldman would have been able to do. In fact, for the first time after a surgery I did not suffer from overwhelming nausea. Dr. Segna was able to perform the surgery in about 35 minutes. And the medical team, including the anaesthesiologist, actually listened to me when I told them about surgical medicines that had seemed to work for me in the past and things that were not so good for me. My pre-surgical experience at Mt. Sinai was as good if not better then my past experiences at Cornell.

My post-op experience was not as good at Mt. Sinai as it was at Cornell. I believe that Cornell has a higher ratio of nurses to patients in the recovery room. Also, I do not believe that children who have just had surgery recover in the same room as adults at Cornell. Therefore, it is more quiet and less stressful and easier to convalesce at Cornell. At Mt. Sinai, there were several children in the recovery room and they were all crying and screaming. It was very distressing. On one level, I felt terrible for the kids and felt as if I was taking on some of their pain through osmosis. On the other hand, when you are feeling sick and weak yourself, silence is so important to help you recover and to reduce your stress levels. I did not have a silent experience AT ALL at Mt. Sinai post-surgery.

Finally, at Mt. Sinai an old man who had just came out of some sort of plastic surgery did not wake up in the post-op room. They tried to revive him and could not. I got to see all of this, because nobody thought to block my view. It seems he had a stroke on the operating table. I would have thought this is something they might have detected while he was still in the operating room, not in post-op. Because this was an emergency, all the nurses and doctors were attending to the poor old man who was essentially in the coma, so I ended up getting out of recovery many hours later than I wanted to.

All in all, the post-op experience at Mt. Sinai was VERY stressful and not very pleasant. My nurses met well, but they were overworked. I am sure there are much worse post-op units in New York City. But I hope to never experience them!

If I were to do it all over again I would either ask Dr. Segna if he could operate on my at Cornell (somehow I doubt this would be possible) or I would request a private recovery room at Mt. Sinai (also, I somehow doubt this would be possible). Hopefully, I will not face this problem in the future and I will remain HEALTHY!

Yet Another Surgery & Birth Control Pills

Be warned, this is going to be a poorly written post as I just need to vent....

I have now had 3 surgeries on my ovary in 15 months. This last surgery (on October 25, 2007 at Mt. Sinai Hospital) I initiated and I told my doctor (Rudy Segna) that I wanted my ovary OUT. You can read about my history with endometriosis and benign tumor growth in my past posts. This has been an extremely hard year on me.

A lot of my problems started about 1 year after I got off the birth control pill. I had been on the pill off and on for almost 19 years. I think that I had taken breaks from the pill for more than a year at a time in the past, and had no problems, but back in the spring of 2005 I got off the pill, thinking that I'd been on for long enough. My periods had never been fun, but they started getting worse and within about a year I started getting very sharp pains in what turned out to be my right ovary.

I had hormone tests and it turned out that although my hormone levels were not high, I was estrogen dominant during the time of the month that my estrogen was supposed to be lower than my progesterone. I also found out around the same time that I was hypoglycemic. So, I started changing my diet. I have since found out that sugar and simple carbs can contribute to estrogen dominance. I am not sure if my change in diet, which has done wonders for my mood and how I feel, has done anything for my estrogen levels. One reason that I do not know is that after the appearance of the 2nd cyst on my ovary, I my doctors urged me to go onto a low dose pill, YAZ. Because YAZ is a low-estrogen pill, the doctors thought it might prove helpful in postpoining more endometriosis and alleviating my ovary pain. YAZ did do away with my most crippling ovary pain, but I did still experience pain.

During my second surgery the doctor found 2 cysts, 1 an endometrioma (in the same spot I had an endometrioma during my first surgery) and 1 a very scary looking seromucinous cystdenofibroma cyst (there is another post on this). There was little to no endometriosis and since my previous surgery had been 10 months before, I was unsure if the YAZ had helped with anything or not.

I decided to stay on the YAZ and about 3 months later I started feeling pain in my ovary again. This time I got proactive and went to my second-opinion doctor, Rudy Segna, who is an OBGYN oncologist and told him that I wanted the ovary out. He said it wasn't necessary unless he found more suspicious growths on my ovary during the surgery, but I told him I wanted it out regardless, because I did not want to keep facing yearly surgeries to remove more growths and I was also freaked out about how much my previous growth looked like cancer (although it was benign).

During the operation Dr. Segna found about 5 more cysts forming on my right ovary, this time they were fibroids. My left ovary was pristine and seems to have always been so. So, my conclusion is that the YAZ is not really helping me. If 5 more cysts formed 3 months after my previous surgery, which seems to be even quicker than the cysts formed after my first surgery when I was not on the pill, I am thinking I should GET OFF THE YAZ. Also, new reports are coming out on how birth control pills contribute to heart disease and blood clots. And frankly, there have been NO long-term studies on the effects of birth control pills, so frankly, we women who have taken the pill over the long term have essentially been guinea pigs, testing out these things.

My fear is that the high-estrogen birth control pills that I was on for so long contributed to my endometriosis to begin with and all of the subsequent growths on my ovary. Part of me is afraid to get off the YAZ because I'm afraid of more endometriosis. At the same time, it really doesn't seem to have helped me and is potentially VERY dangerous! What a conundrum. I am so sick of dealing with these issues. I HATE surgery. I hate the idea of things growing on my reproductive organs. I SOOOO hope that taking out the right ovary will end my problems, but my fear is that somehow the problem will switch to my left ovary, though I don't really see how it would since the left ovary has been such a champ over the last few years.

Anyway, I just needed to vent. If you have any questions, please feel free to contact me.

No Endometriosis Found During Second Surgery

I just met with Dr. Goldman for my two-week post-op appointment. I was elated that he had found no new endometriosis since my previous surgery in August 2006, but was curious as to why that might be. Since the discovery of another endometrioma (cyst) on my right ovary back in February 2007 and the accompanying pain, I had assumed that more endometriosis was accumulating, as well.

I asked Dr. Goldman if the birth control pill I went on in March could be the reason why I was endometriosis free, or if the healthier eating habits or reduction of stress might have helped.

Dr. Goldman told me that sometimes surgery or other invasive treatments such as biopsy can stimulate a patient's immune system. Essentially, the body detects the presence of the surgical instruments and starts to work to protect itself. The newly-charged immune system starts to do its job better than it did before, cleaning out any future endometriosis that may occur.

Generally, every woman is said to have retrograde bleeding whcih can contribute to endometriosis, but most women's bodies work to rid the endometriosis from the pelvic cavity. Women with endometrosis are said to have compromised immune systems because their bodies do not clean out the retrograde bleeding. It is possible that as a result of the foreign bodies introduced into my pelvic cavity during my first surgery in 2006, that my body's immune system kicked into action to begin to clean away the endometriosis that it used to let accumulate.

Dr. Goldman also added that although the birth control pill works to slow down the spread of endometriosis, it will not make existing endometriosis disappear, so he doubts that the birth control pill had anything to do with it.

Finaly, he agreed that healthier eating and reducing stress can be helpful to strengthen the immune system. Perhaps it was a combination of better nutrition, lower stress and the previous surgery that helped me be endometriosis-free over the past months. I only hope that my immune system continues to be strong and to stop any future endometriosis!

Some of the Best Doctors & Healthcare Providers in New York City

As almost everyone knows, there is nothing worse than being sick or hurt - except, perhaps, being sick or hurt when no body can figure out why. Decidedly worse, is being sick or hurt when no one can figure out why AND they won't admit to not being able to figure it out, AND they are not nice, AND they are impatient, AND they don't take the time to listen to you.

As a result of having visited so many of the "top" doctors in NYC over the years with very mixed results, I have come to the conclusion that what makes a "top" doctor a great doctor is not what school they went to, how many awards they have won or how arrogant they are. Experience has taught me that a great doctor possesses the following qualities:

• INTELLIGENCE
  
• KINDNESS & PATIENCE
  
• LISTENS and VALIDATES


• GIVES more than 10 minutes of their time


• ADMITS when they do not know the answer
  
• THINKS outside of the box

Unfortunately, the great health care providers I've met almost never accept insurance (and of course, they are expensive). In fact, there seems to be an overwhelming negative correlation between greatness and insurance acceptance, which is fodder for another article to be written at another time.

My List of Great Doctors and Health Care Providers in NYC:

• Dr. Leo Galland, MD - http://www.mdheal.org/ - 212-717-6792 - Upper East Side. (Does not accept insurance). Doctor Galland is the godfather of integrated medicine. He takes a nutritional approach to preventing and reversing illnesses and is very thorough in researching and diagnosing his patients' health problems.


• Tonya Juge, PT - http://www.hdphysicaltherapy.com/ - 212-988-2501 - Upper East Side. H&D Physical Therapy is perhaps the best place to go for physical therapy in New York City. Tonya is my physical therapist and I think she's great.


• Jeffrey Morrison, MD, CNS - http://www.themorrisioncenter.com/ - 212-989-9828 - Flat Iron District. (Does not accept insurance). Doctor Morrison also takes a nutritional approach to preventing and reversing illnesses. He also has a very nice staff. Very punctual.


• Gary Goldman, OBGYN - 212-535-6100 - Upper East Side. (Does not accept insurance). Dr. Goldman was referred to me as being one of the best OB-GYNs and endocrinologists in NYC. He listens to his patients, is sensitive and kind. Up until meeting him I had always opted for a female OB-GYN.


• Keith Pyne - Sports Medicine, Chiropractor - 212-989-9828 - Flat Iron District. (Does not accept insurance). Dr. Pyne travels the world every two weeks bringing his healing touch to athletes and laymen alike. He doesn't have a Website or even business cards, but he doesn't need them; word of mouth keeps him booked solid. He practices out of Dr. Morrison's office every other Thursday, so book ahead. First consultation lasts an hour; each visit after that is a half hour. Very punctual.


• Mitchell Gaynor, MD - Oncologist, Internist & Hematologist - http://www.gaynoroncology.com/ - 212- Upper East Side. (Does not accept insurance but his staff will fill out the paperwork for you to submit). I was told that Dr. Gaynor is one of the leading oncologists in NYC. Having met him, this is not hard to believe. He has a very holistic approach to wellness and is a firm believer in utilizing antioxidants, supplements and meditation to achieve physical and psychological well-being. He has written several books and articles and leads a meditation session once a month for his patients.


• Benjamin Asher, MD, PC - Ears, Nose & Throat - http://www.restorativeent.com/ - 212-223-4225 - Upper East Side. (Does not accept insurance but his staff will fill out the paperwork and submit for you). Dr. Asher is very nice and very smart. He takes an integrative approach to solving ear, nose and throat problems, incorporating traditional and alternative medicines into his practice. He prides himself in truly listening to his patients and leaving no stone unturned. Also, Dr. Asher's assistant, Harriet, is probably the nicest medical administrative assistant I have ever had the pleasure of meeting. Punctual.


• Rudy A. Segna, MD, FACOG - http://www.themedicalgroupforwomen.com/ - 212-888-8439 - Upper East Side. (Accepts some insurance). Dr. Segna works with Dr. Peter Dottino at the Group for Women on Fifth Avenue. Dr. Dottino was highly recommended to me for a second opinion on a surgery, but as he was on vacation, I saw Dr. Segna instead. He was great. Very professional, knowledgeable, friendly and punctual. I have since seen him several times for my endometriosis-related issues and like him more and more with each visit.


• Jean Shum - Acupuncture & allergies - 917-836-5035 - Upper West Side. (Does not accept insurance). Jean is not a doctor and yet she has greatly helped me with my shoulder pain and has helped other friends I have sent her way with pain and allergies. She works on people with all types of problems, including cancer, chronic pain and allergies and is well known and respected by many of the doctors on this list. A one hour visit with Jean is a very interesting, enlightening and relaxing experience. She is hard to get in to see as she is very busy. Very punctual.


• Jennifer Green, PT, MS, CFMT - http://www.physioarts.com/ - 212-997-7490 - Times Square. (Does not accept insurance). Jenn is one of the 7 physical therapists who work for PhysioArts, an employee-owned physical therapy office that incorporates traditional and alternative therapies in helping its patients recover. Although I have not used Jenn, I have been told by another physical therapist whom I respect that she is top-notch. In fact, she is so popular, that it's pretty much impossible to become one of her clients. Pickychick tip: PhysioArts only allows 30-minute appointments with its therapists. Although this is common practice in New York City (it allows physical therapy companies to make more money), it generally allow enough therapy time for rapid improvement in a patient's condition. For great physical therapists and one-hour one-on-one time with therapists, I recommend H&D Physical Therapy (see above).

Why Do I Get to Pick My Surgeon But Not My Anesthesiologist?

I am about to have a three-hour laparoscopy and am under a certain amount of stress. I have never had surgery before, the diagnosis of my condition is uncertain AND on top of all this, everyone in my family who has ever had surgery has ended up being stuck in the hospital for days due to uncontrollable vomiting and nausea brought on by anesthesia. Motion sickness is very common in my family and this, I am told, tends to make post-operative nausea and vomiting worse. In truth, I am less frightened by the thought of being cut open then I am of vomiting my guts out for three days after the procedure.

Given my apprehension and my desire to do whatever possible to make my post-operative suffering as minimal as possible, I have asked to meet my anesthesiologist before the actual day of surgery to ask questions and to help put my mind at ease, but I’ve been told by my doctor that the anesthesiologist is not assigned until the day of the surgery, and therefore there is no one I can speak with until that morning.

Why is it that I have the right to choose my surgeon but not my anesthesiologist? I wouldn't buy a car without taking it for a test drive; I wouldn't hire an employee without interviewing him/her first. Somehow it seems grossly wrong that I am not allowed to choose (little to say meet and speak with beforehand) the person who will be such an important part of my surgery.

I guess hospitals believe that they should have the sole say in choosing anesthesiologists for their patients. I'm sure it simplifies things for the adiministration to not have patients involved in selecting the players. But just like everything else in life, some people are better at what they do than others, and some people are grossly incompetent and yet still have their jobs anyway.

Not only do I think that patients should be able to choose their anesthesiologists, I believe that there should be a rating system for all healthcare providers by current and previous patients, the results of which could be viewed by prospective patients. This way, healthcare providers would strive to better please their patients, and patients could make educated decisions about the best healthcare provider for them.

Cynthia Almonte - Physical Therapist in Northern Vermont

Cynthia Almonte is an extraordinary physical therapist who works for Fletcher Allen Health Care in Burlington, Vermont, and also has her own physical therapy and personal training practice in St. Albans. Before moving to Vermont in 2004, she worked for several years at the Beth Israel Spine Institute in New York City, and continues to expand on her physical therapy skills through continuing education classes.

Cindy practices "functional mobilization," which seeks to cure injuries by addressing structural, neuromuscular, and motor control dysfunctions. She is very smart and intuitive, having done more to help the nerve damage in my shoulder in the last few months than any of the doctors, specialists and physical therapists that I have seen over the last three years. Instead of just focusing on my diagnosis, Cindy looked at my injury holistically and carefully examined all of the areas surrounding my shoulder to figure out what other factors were contributing to my problem. It turns out tightness and misalignment in other parts of my body were not allowing my shoulder to heal. By working on those areas, I've been slowly recovering and feeling significantly less pain.

If you live in the Burlington Vermont area and are in need of a physical therapist, I strongly recommend contacting Cindy.

Cynthia Almonte - cynthia.almonte@vtmednet.org - Fletcher Allen Health Care - 1775 Williston Road, South Burlington, Vermont 05403 - 802-847-6185.

Endometriosis Doctors - It's really hard to tell a good one from a not-so-good one

Personally, I really don't know how to tell a good endometriosis doctor from a not-so-good one. There are lots of websites out there that list doctors whom have been recommended by friends and readers. However, not all of the doctors listed are necessarily "experts". In fact, given the uncertainty around what causes endometriosis and how to cure it, I wonder if there are any true experts out there. I've heard that endo doctors in Europe have a leg up on U.S. doctors. Frankly, I have no idea.

I would be most impressed by a doctor who recommended alternative treatments along with (or instead of) the conventional ones and who seemed to have a good grasp and respect for both. So far, my doctor, Dr. Goldman, seems to be aware of alternative treatments, but doesn't seem to have any real faith in them. He, instead, only seems to have true faith in birth control pills, Lupron and other more drastic (less natural) means of dealing with endo. This may be sheer wisdom on his part. He may have seen women trying various alternative techniques throughout the decades with no real results. Part of me feels, however, that he, like most conventional doctors out there, just naturally gravitates toward medical solutions and doesn't put much weight in food, diet, supplements or progesterone cream as being able to accomplish much in terms of curing something like endometriosis. This being said, I did use him for my first surgery and am using him for my second surgery.

I will caution readers against one doctor: Masahide D. Kanayama a practioner in New York City and Greenwich, Connecticutt. This is not because I have proof that he is a good or bad doctor. He may be an excellent endometriosis surgeon. What bothered me so much about Dr. Kanayama, whom I met in person after I saw his name listed on Endo Resolved (a website that I actually think is good in terms of presenting lots of traditional and alternative information on endometriosis) is that he claims to have won several awards as being "the top" or "a top" endometriosis surgeon in the U.S., when in fact many, if not all of the awards are questionable at best. For example:

• He claims to be one of the top-6 endometriosis specialists in the U.S., when, in fact, he is just referring to the fact that he is listed on the Endo Resolved website, which is by no means an authority, and instead, merely lists doctors who have been recommended by readers or pretty much anyone who writes in.



• He claims to have won the awards of "Top 100 Health Professionals in the World in the areas of Endometriosis and Advanced Laparascopy" and also of "Distinguished Service to Humankind Award" by the International Biographical Centre of Cambridge University, England. According to Wilkepedia and other web sources, the International Biographical Centre allows people to nominate themselves for membership. Furthermore, those who pay between $500 and $1495 are offered specially crafted "awards". So essentially, Dr. Kanayama paid the IBC for the the "awards" that he "won" from them and they have nothing to do with merit.

Furthermore, I have met with a few endometriosis surgeons in New York City who have strongly cautioned me against him, telling me that he tells people that they need surgery immediately when there is no need. Also, when I met with him he told me that after his surgeries patients do not need surgery again for five years. There is no guarantee of this - ever - and I believe it was wrong of him to say this to me.

Having met quite a few doctors who treat endometriosis in New York City, I did like Iris Orbuch, who looks very young, but did train under C.Y. Liu and Harry Reich, whom I am told are leaders in the field of endometriosis in the U.S. She has been in private practice for 2.5 years and does surgery at Lenox Hill. I liked when she told me that she would never tell her patients to take Lupron (although almost every other endo doctor I have talked to recommends it). Although I must admit, I do feel that some of her answers regarding birth control etal. were geared toward telling me what I want to hear. I also met with Nabil Husami, whom I liked a lot. He was honest in telling me that I do not need surgery immediately and that surgery should always be the last resort. Not many surgeons say this. Furthermore, he was very current in terms of endometriosis statistics and what seems to work vs. what does not. He is a believer in Lupron, however.

Endometriosis - First Diagnosis

I first got an inkling that I might have endometriosis and would need surgery back in July 2006. I had been waking up in pain the middle of the night a few days before the beginning of my period for about 9 months. At first, I thought I was just having period cramps. As the months progressed, the pain became worse, until I finally ended up on the bathroom floor, writhing, feeling as if I would vomit, have a bowel movement and pass out, all at the same time. At that point, I decided to see a doctor. Rather than go to my regular OB-GYN, whom I thought was great for yearly check ups, but perhaps not as sophisticated as these symptoms might merit, I visited Dr. Gary Goldman, a OB-GYN in New York City, who is also listed on certain endometriosis websites as being an endometriosis expert (not that I knew this, or even suspected that I might have endometriosis at the time, I just heard that he was very qualified and very nice).

Dr. Goldman is very nice and has a calm, soothing manner. He has a well-appointed, private office, on east 66th street off Madison avenue (and does not accept insurance). There were two or three women ahead of me for my first appointment. I probably ended up waiting an hour (something I normally never do - if a doctor is an hour late, I just leave), but given the fact I was told that he is very good, I decided to relax my policies on tardiness...

The first half of our meeting I just talked to Dr. Goldman, explaining the progression of my pain, how it was only at night just a few days before my period started, and didn't even occur every month; how I had gone off the pill about a year and a half before after having been on it on-and-off for almost 20 years, and how I had started spot-bleeding about 5 days before my period the month after I stopped taking the pill.

The second half of my appointment Dr. Goldman did a regular pelvic exam and then, did a sonogram, as he has a basic sonogram machine in his office. This is a nice perk as it allows him to immediately get an idea if a patient has cysts or other growths. During the sonogram, Dr. Goldman found a 3 cm cyst on my right ovary. He explained that this was very likely the cause of my pain and that regardless of what type of cyst it was, that it would have to be removed via surgery. This was very scary for me to hear, never having had surgery before and never even suspecting that I might have a cyst down there. He then referred me to a radiology center to get a more sophisticated sonogram (I would never use that center again, but that's another story).

After that sonogram, everything pointed toward an endometrioma. An endometrioma, also known as a chocolate cyst, is generally a cyst that is related to endometriosis. The spot bleeding I had been experiencing before my period since stopping the pill also pointed toward the possibility of endometriosis.

Unlike many woman who have surgery for endometriosis, other than the pain I was experiencing late at night just before my period for about 20 minutes, I wasn't in any other severe pain. My periods were painful, but I didn't think of them as being unbearably so. I was pretty much accustomed to the first two days of my period as being very unpleasant and then feeling pretty good after that. If it had just been based on period pain alone, I would have never consented to surgery. However, a 3.2 cm cyst is another story, and the pain related to that, although relatively brief and infrequent, was extremely severe and debilitating.

I did go on to have surgery and 6 months later my symptoms and cyst returned, but I'll tell you about all of that in another entry...