BackTable OBGYN BackTable

This episode of BackTable OBGYN features an extensive discussion with Dr. Keith Isaacson, a specialist in Reproductive Endocrinology and Infertility, regarding the complexities of diagnosing and treating adenomyosis, emphasizing surgery, medical treatments, and research in the field.

Dr. Isaacson describes the pivots in the field’s understanding of adenomyosis and endometriosis, including the impact of these conditions on fertility and potential treatment pathways. Adenomyosis has been redefined in the past five years as a disease that affects women of all reproductive ages and causes dysmenorrhea, heavy menstrual bleeding, and infertility. Because the disease is found in the myometrium of the uterus, it has historically been difficult to diagnose unless through pathology following hysterectomy; however, imaging has since improved and there are now criteria seen on ultrasound that are consistent with adenomyosis.

Dr. Isaacson then discusses the differences and misconceptions about adenomyosis compared to endometriosis. Additionally, the episode touches on the evolution of treatment strategies over the years, including medical therapy versus surgery. Furthermore, Dr. Isaacson highlights the crucial role of research in uncovering disease pathophysiology and new therapeutic approaches.

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SHOW NOTES

00:00 - Introduction
04:06 - Definitions, Symptoms, and Insights
11:33 - Exploring Treatment Options for Adenomyosis and Infertility
21:30 - The Intersection of Endometriosis and Adenomyosis
30:09 - Imaging, Surgery, and Pathology
36:31 - The Future of Research and Patient-Centric Care

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RESOURCES

Moawad G, Fruscalzo A, Youssef Y, Kheil M, Tawil T, Nehme J, Pirtea P, Guani B, Afaneh H, Ayoubi JM, Feki A. Adenomyosis: An Updated Review on Diagnosis and Classification. J Clin Med. 2023 Jul 21;12(14):4828. doi: 10.3390/jcm12144828. PMID: 37510943; PMCID: PMC10381628.

This episode features host Dr. Mark Hoffman and guest Dr. Jessica Ritch as they discuss the lack of menopause education and research during medical training, and the necessity for practitioners to learn more about menopausal symptoms and management strategies.

The episode begins with Dr. Ritch, a minimally invasive gynecologic surgeon, describing her path into menopause care, including the development of her podcast, EnRitched Menopause. She touches on the role of laboratory workup in menopause, but emphasizes the patient’s symptoms are more important to address than numerical values on labs. She then delves into treatment options, including the complexities of hormone replacement therapy, and the multifactorial nature of sexual function issues. Most importantly, the physicians emphasize listening to patients, offering comprehensive care beyond hormone therapy, and utilizing resources like podcasts to educate both practitioners and patients. Finally, they explore new treatments and the potential future advancements in menopause care.

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EARN CME

Reflect on how this Podcast applies to your day-to-day and earn free AMA PRA Category 1 CMEs: https://earnc.me/I7Ougz

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SHOW NOTES

00:00 - Introduction
08:52 - The EnRitched Menopause Podcast: A Resource for Patients and Practitioners
15:22 - Common Patient Presentations of Menopause
20:43 - The Role of Laboratory Evaluation of Hormone Levels
24:20 - Testosterone in the Menopausal Patient
27:13 - Navigating Hormone Therapy: Estrogen, Progesterone, and Testosterone
31:03 - Physiologic Hormonal Changes in Menopause
35:00 - Shared Decision-Making
39:00 - Exploring Sexual Function and Libido in Menopause
45:38 - The Power of a Physician’s Support and Trusted Advice
50:09 - Innovative Approaches and Future Directions in Menopause Care

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RESOURCES

EnRitched Menopause Podcast:
https://podtail.com/en/podcast/enritched-menopause/welcome-to-enritched-menopause/

Rosy App:
https://play.google.com/store/apps/details?id=com.rosywellness&pli=1 (Google)
https://apps.apple.com/us/app/rosy-womens-sexual-health/id1444780510 (Apple)

In this episode of BackTable OBGYN, renowned reproductive endocrinologist and minimally invasive gynecologic surgeon Dr. Charles (Chuck) Miller delves into the topic of isthmoceles, a common yet often overlooked complication of C-sections, and shares his best practices for repair.

Dr. Miller shares his extensive experience in diagnosing and treating isthmoceles, discussing various surgical techniques including hysteroscopic, laparoscopic, and robotic-assisted resection. He emphasizes the importance of an aggressive surgical approach for achieving higher success rates in terms of future fertility and resolving symptoms such as abnormal bleeding. Moreover, Dr. Miller highlights the need for standardized treatment protocols and reflects on the mentorship, the ongoing journey of learning and adapting in medicine, and the noble profession of healthcare. The episode offers insightful perspectives on a lesser-known gynecologic issue, underscores the value of experience and mentorship in medicine, and advocates for concerted efforts toward establishing best practices in surgical procedures.

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SHOW NOTES

00:00 - Introduction
07:18 - Defining Isthmocele and the History of Isthmocele
10:00 - The Diagnosis of Isthmocele and Its Impact on Fertility
19:31 - Exploring Surgical Techniques for Isthmocele Repair
27:54 - Understanding Hysteroscopic Resection
30:12 - Addressing C-Section Ectopics and Isthmocele Repairs
36:46 - Adapting the Surgical Approach to Different Patient Scenarios
39:35 - Postoperative Complications and Safety Measures
40:55 - The Future of Isthmocele: Surgical Standardization
50:51 - Closing Thoughts and Acknowledgements

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RESOURCES

Ban Y, Shen J, Wang X, Zhang T, Lu X, Qu W, Hao Y, Mao Z, Li S, Tao G, Wang F, Zhao Y, Zhang X, Zhang Y, Zhang G, Cui B. Cesarean Scar Ectopic Pregnancy Clinical Classification System With Recommended Surgical Strategy. Obstet Gynecol. 2023 May 1;141(5):927-936. doi: 10.1097/AOG.0000000000005113. Epub 2023 Apr 5. PMID: 37023450; PMCID: PMC10108840.

In this episode of the BackTable OBGYN Podcast, hosts Dr. Mark Hoffman and Dr. Amy Park discuss how cultivating an effective team culture in surgery can mitigate complications.

The physicians emphasize that how surgical teams treat each other can significantly affect patient outcomes. They suggest under-promising and over-delivering to patients, their family, and members of the surgical team. The doctors recommend having a care culture, allowing everyone to voice their concerns without fear of reprisals. They also discuss the importance of self-management, leadership, and taking responsibility inside and outside the OR for complications and places where the surgery could have gone smoother. They agree that those who nurture a positive OR culture have higher success rates, noting that complications demand more than technical skills to handle - it takes emotional intelligence, humility, and a good support network.

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SHOW NOTES

00:00 - Introduction
02:07 - Dealing with Surgical Complications
04:24 - The Emotional Impact of Complications on Surgeons
07:24 - The Importance of Patient Communication and Care Post-Complication
08:35 - The Role of Consent and Preoperative Counseling in Managing Complications
11:18 - The Importance of a Supportive and Open Culture in Medicine
15:32 - The Importance of Learning from Mistakes in Medicine
24:28 - The Role of Leadership and Teamwork in the Operating Room
29:56 - The Value of Familiarity in a Medical Team
30:38 - The Importance of Recognizing and Appreciating All Roles in a Medical Team
34:31 - The Role of Care and Empathy in Medical Practice
37:28 - The Role of Preparation in Avoiding Complications
40:53 - The Importance of Scheduling and Time Management in Medical Practice
50:31 - The Impact of Culture on Reporting and Addressing Adverse Events
51:19 - The Importance of Feedback and Self-Reflection in Medical Practice

In this episode of BackTable OBGYN, host Dr. Mark Hoffman engages in a comprehensive discussion with Dr. Jorge Carrillo, a MIGS specialist at the Orlando VA Healthcare System and Site Director for the UCF/HCA Healthcare OB/GYN Residency Program, about the complexities of chronic pelvic pain from the perspective of a biopsychosocial model.

The conversation dwells mostly on the intricate relationship between pain, trauma, and the patient’s psychological state as it relates to chronic pelvic pain. Dr. Carrillo emphasizes the importance of adopting a trauma-informed care approach that creates a safe environment for patients. The discussion also covers the use of surveys for patient information, the importance of organizing thoughts during patient evaluation, and an outline of the four major categories of pelvic pain: gynecologic, urologic, gastrointestinal, and musculoskeletal. Dr. Carrillo shares valuable insights into managing complex conditions such as pelvic pain, providing an education-first approach for patients with emphasis on shared decision-making, and outlines how he and his team operate within a multidisciplinary framework for patient treatment.

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SHOW NOTES

00:00 - Introduction
04:32 - Dr. Carrillo’s Journey in the Medical Field
08:51 - The Importance of Trauma-Informed Care in Chronic Pelvic Pain
14:54 - Understanding the Biopsychosocial Model in Chronic Pelvic Pain
19:49 - The Initial Approach to Evaluating Patients with Chronic Pelvic Pain
25:25 - Understanding Nociplastic Pain and Sensitization
28:00 - Treatment Approaches for Sensitization
29:26 - The Importance of Organized Thinking in Pain Management
30:20 - The Role of Questionnaires in Patient Assessment
35:10 - The Importance of Multimodal Approach in Pain Management
43:00 - The Role of the Provider in Organizing Patient Care
45:37 - The Importance of Education in Pelvic Pain Management

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RESOURCES

International Pelvic Pain Society Handouts for Different Disorders of Chronic Pelvic Pain:
https://www.pelvicpain.org/public/resources/educational-resources/informational-handouts