Wednesday, November 28, 2012

Gifts at Christmas: What's Your Strategy?

I love everything about Christmas except for one thing: the presents. Shopping for gifts is like playing a game that's impossible to win. It's my Words With Friends.

You head into the store with several lists – this person wants an Xbox game, the other wants a gift card, and so on – but it's just too easy. It doesn't feel personal or thoughtful enough.

Do you go with the sure thing, or do you take a risk and buy something you think someone will like, as if to say, "Look how well I know you! You don't even have to tell me what you want because we're this close"?

Both strategies have the potential to backfire.

Shopping with a List

I give my husband a shopping list every year, and I have to admit that even I sometimes get it wrong. For instance, last Christmas, I asked for a set of cloth napkins that I planned to embroider with our initials. One year later, those napkins are not only monogram-free, but they're in a bag destined for Amvets. Embroidering, it turned out, was more time-consuming that I anticipated, and who needs monogrammed napkins anyway?

Going Rogue

For our first Christmas as a married couple, there were no lists, just intuition. I unwrapped a box of cereal (to go with the ceramic bowls he'd given me) and a gold-sparkled journal that would make Lisa Frank proud. Instead of saying "thank you," I escorted my husband to the store to return the journal. Terrible, I know.

Yes, Christmas gifts can bring out the worst in people. Every year, I give my nephews exactly what they ask for, and every year, I'm met with a mumbled, "Oh," as they toss the gift aside and move on to the rest of the pile in their excitement. I want to say, "Hey, hang on a minute. Let's talk about how great this thing is," but the moment passes and I'm left wondering what happened.

How Much to Spend?

Then there's the question of how much to spend. I've shied away from gift cards for this very reason. They have a definite price tag, and how do you know what is too much or too little? Who draws the line?

I usually try to match what the other person spends. If we have a history of gift-giving, I have something to go on. But people can surprise you. My dad is planning to install a remote car starter in my car for Christmas. Yay for the car starter, but suddenly my $50 gift to him seems inadequate.

Do We Even Need Presents?

There's a third approach to Christmas that I've never seen in action, at least not successfully: no presents.

One year, Ben and I tried to skip gift giving altogether, thinking that we'd have a more meaningful Christmas. Not so. It turns out that even if you tell your family and friends that you're skipping the gift exchange, they'll buy you something anyway, at which point you feel like an absolute mooch. After Christmas, we played catch-up and bought the gifts that we had so steadfastly refused to give earlier. So much for convictions.

I don't think that I'm experiencing Christmas as I was meant to. Growing up, my brother and I kept a watchful eye over the tree, making sure that one didn't get more presents than the other. As an adult, I still feel as though I'm counting presents, instead of being thankful for what I already have and being fulfilled by spending time with the people I love.

What are your thoughts about gift-giving at Christmas? Do you struggle, like I do, or have you found a way to not get bogged down by gift-giving?

Monday, November 26, 2012

Ask Us Anything: At Age 65, What Screenings Do I Need?

"At age 65 with a total hysterectomy, widowed and not sexually active, do I need anything more than a mammogram annually and a bone dex?"

Dr. Ali Ghomi Responds:

You bring up a very interesting question, and there seems to be disagreement between certain organizations in the country, including the National Cancer Institute, NIH, and US preventative task forces when it comes to gynecologic cancer screening.

There does not seem to be a need for an annual pap smear after the age of 65 since the incidence of cervical cancer is extremely rare in this age population.

Routine mammography seems to be recommended up to age 80 years of age.

Bone scans or Dexa scans do not need to be repeated on an annual basis to screen for osteoporosis, unless there is evidence of osteoporosis or the patient is undergoing treatment for osteoporosis.

If the ovaries have been removed, you do not need to get screened for ovarian cancer by physical examination or other modalities.

Having said that, there is a condition called peritoneal cancer which develops from the lining inside the abdomen. This cancer behaves similar to ovarian cancer. There is no screening for peritoneal cancer. Warning signs are abdominal bloatedness, nausea vomiting and abdominal pain. In addition, there is always a risk of developing vulvar cancer. The initial symptoms are itching and burning of the external genitalia. A gynecologist may be able to perform biopsy if indicated to exclude vulvar cancer.

— Dr. Ali Ghomi

Dr. Ghomi is the Director of Minimally Invasive Gynecologic Surgery and Chair of The Robotic Surgical Committee at Sisters of Charity Hospital. He is the only physician in Western New York who performs Sacrocolpopexy Prolapse surgery using the da Vinci® robot. Sacrocolpopexy is a proven “gold standard” procedure worldwide to repair severe pelvic prolapse. Click here to learn more about Catholic Health's OB/GYN services.

Dr. Ghomi sees patients at the M. Steven Piver, M.D. Center for Women’s Health & Wellness in Buffalo.

If you have a question about your health, click here to ask our experts.

Monday, November 19, 2012

Ask Us Anything: How is Vaginal Prolapse Treated?

"How is vaginal prolapse treated?"

Dr. Ali Ghomi Responds:

Vaginal prolapse occurs when the supporting tissue of the pelvis weakens and the walls of the vagina collapse.

The treatment of vaginal prolapse is typically divided into surgical and nonsurgical management.

Nonsurgical management would involve the insertion of a vaginal pessary (a plastic device to reduce the prolapse) versus physical therapy of the pelvic floor muscle groups.

Surgical management would involve either a vaginal approach versus a laparoscopic/robotic approach. A surgical approach could be with or without a hysterectomy.

Transvaginal mesh insertion can also be utilized with satisfactory outcome, however, at the expense of potential complications of the mesh.

No approach has been found to be superior to the other approaches.

The chosen surgical approach would depend on a number of factors, including the degree of prolapse, the expertise of the surgeon, and any other confounding factors, such as prior surgical history and medical conditions.

— Dr. Ali Ghomi

Dr. Ghomi is the Director of Minimally Invasive Gynecologic Surgery and Chair of The Robotic Surgical Committee at Sisters of Charity Hospital. He is the only physician in Western New York who performs Sacrocolpopexy Prolapse surgery using the da Vinci® robot. Sacrocolpopexy is a proven “gold standard” procedure worldwide to repair severe pelvic prolapse. Click here to learn more about Catholic Health's OB/GYN services.

Dr. Ghomi sees patients at the M. Steven Piver, M.D. Center for Women’s Health & Wellness in Buffalo.

If you have a question about your health, click here to ask our experts.

Wednesday, November 14, 2012

The Power of Thought on Your Health & Happiness

Your thoughts may seem to come and go, but in reality, they're having an enormous impact on your mental and even physical health.

"Any thought that you produce either strengthens or weakens you," said Liz Diamond, a positive thought leader who spoke at the First Annual WomenCare Day of Health in October. 

"Many of our daily thoughts are negative. And when you think negatively, you stress your organs."

Her prescription for banishing negativity: accept what is. Know that whatever happens is for your greatest good. "Whatever is your experience is meant to allow you to grow in some way. Accept whatever is showing up and find peace."

Liz's message resonated with me because I know it to be true.

During a difficult time in my marriage, I read a book by Byron Katie, who has a similar philosophy: live in reality and don't accept your thoughts as truth. Byron says that when you feel discomfort or stress, it's a signal that you're believing an untrue thought.

That I could and should question my thoughts was news to me. When I felt depressed or afraid, I identified the thought behind my fears and asked myself: "Is that true? Where's my proof?" Of course, I never had any.

The effect was almost immediate. I became more accepting of what was happening my life, knowing that even if it wasn't what I wanted, I'd be a stronger person for it. Because I wasn't reacting out of fear or anger, I made positive changes and looked forward to the future, whatever it held. I focused on making each day the best that I could; the current moment was all that mattered.

My change in attitude, my willingness to accept my reality instead of trying to bring about the outcome that I wanted, saved my marriage.

"When you're living in the flow of your life and not trying to force things to happen in your reality, you're inspired," Liz said.

Questioning your thoughts can turn challenges into opportunities.

You can learn about positive thinking in Liz's book, 7 Mindsets to Master Self Awareness. Visit her website for details.

Monday, November 12, 2012

Ask Us Anything: Your Pregnancy Questions Answered

Do you have a question for our staff? Click here to submit it.

Q. How long does it take for a spinal injection for a C-section?

A. Mary Ann Murphy, Director of Maternal Child Services at Mercy Hospital:

Regional (or spinal) anesthesia takes approximately 5 to 10 minutes to administer by the anesthesiologist. Everyone is just a bit different, and sometimes it takes the anesthesiologist a bit longer to be certain that the regional block is adequate for the Cesarean section.

Generally, a Cesarean section is approximately 30 to 60 minutes in duration. The length of time it takes the surgeon depends on the anatomy of the mother and whether she has had other Cesarean sections or surgeries.

Q. When I give birth, will I have to take out my tongue ring?

A. Mary Ann Murphy:

We do request that patient's remove all tongue jewelry. This is to prevent an accidental dislodgement during an emergency requiring general anesthesia.

Q. Is video / photo recording allowed during birth?

A. Mary Ann Murphy:

We certainly allow digital cameras. We do discourage video until the bonding phase of recovery.

On our tours, we like to give patients and their coaches a little speech about "living in the moment" and experiencing birth by using all of your senses: sight, sound, smell, etc. We encourage someonoe other than the coach act as the photographer. So often in today's world, people are so consumed with capturing the moment that they do not live in the actual moment.

A. Mary D'Angelo, Director of Maternal Child Services at Sisters of Charity Hospital:

At Sisters Hospital, we ask that you check with your physician for his approval and ask permission from any staff members before you photograph them. As long as there is no interference with care delivery, we have no problem with creating memories of that very special event.

Q. My OB/GYN is supportive of my attempting a VBAC. However, I know I will be under the care of the nurses and on staff doctor when I get to the hospital. Does the hospital have any rules specific to VBAC patients that differ from mom's delivering without a prior C-section?

A. Mary Ann Murphy:

At Mercy Hospital, the attending works closely with the in-house physician if the attending will not be in-house on the day that the patient begins labor. Generally speaking, the physician will establish a very conservative plan of care for the patient attempting VBAC: continuous fetal monitoring and conservative means to assist the labor process. We would not use the jacuzzi or aggressive methods to induce labor.

A. Mary D'Angelo:

At Sisters Hospital, we use the same consent and approach to VBAC: continuous monitoring and judicious use of pitocin or other means to stimulate labor.

Q. How long will I have to stay at the hospital after giving birth?

A. Dr. George Danakas, who has privileges at Mercy Hospital:

We usually have the mother stay for at least 24 hours. If she is stable, we can discharge her from hospital. The baby's discharge is determined by the pediatrician.

You can learn more about childbirth at Mercy Hospital and Sisters of Charity Hospital by visiting our website.

If you have a question about your health, click here to ask our experts.

Wednesday, November 7, 2012

Small Changes that Make a Big Impact On Your Waistline

Before the holidays bring you face-to-face with buffets and sweets, minimize the damage to your waistline by cutting calories and making better food choices.

Watch the presentation below to learn strategies you can apply at the grocery store, at home and when you're dining out.

Transform Your Eating Habits from chsbuffalo

You can learn more about healthy eating by reading our Smart Eating series.

Monday, November 5, 2012

Ask Us Anything: Do You Perform Lap Band Surgery on Patients Who Have Had Gastric Bypass?

"Do you perform lap band surgery on patients who have had gastric bypass?"

Dr. Dang Tuan Pham Responds:

Gastric bypass whether done laparoscopically or open is an excellent surgical procedure for the treatment of morbid obesity (defined as Body Mass Index >40 kg/m2 alone or >35 kg/m2 with significant co-morbidities) and constitutes the standard of care in the United States to which all other bariatric procedures are compared.

Unfortunately, a few patients despite their initial success, may regain some, if not all, of their weight. There is much debate in the medical community about why these patients regain weight, and the answer is still not clear, but some reasons such as poor eating habits, grazing, stretching of the stomach pouch, widening of the opening between the stomach pouch and the small intestine (gastrojejunostomy stoma), or adaptation mechanism of the small intestine, have more proponents than others.

The evaluation of a patient for revision is a comprehensive process consisting of a careful review of the patient's weight loss history, a detailed history and physical examination to eliminate an endocrinologic disorder, a multidisciplinary nutrition, behavioral health and gastroenterology specialist evaluation, as well as ancillary testing such as an upper GI radiographic examination to review the anatomy etc.

Then, if indicated, we might propose one of  three options:
  1. A laparoscopic band over bypass
  2. A laparoscopic gastric pouch stapling or suturing to reduce the volume of the gastric pouch
  3. Transposition of the jejunojejunostomy anastomosis more distally along the intestinal tract
A fourth option is the ROSE procedure, a transoral, endoscopic outpatient procedure consisting of suturing the GJ stoma to narrow the opening between the pouch and the small intestine but this is not currently offered at my practice.

In the lapband over bypass procedure, an adjustable gastric band is placed laparoscopically (through small openings) around the stomach pouch, providing the restriction that is currently missing from the patient's gastric bypass due to the dilated pouch and stretched stoma. An appropriately adjusted gastric band will keep food in the pouch producing satiety for the patient.

The band over bypass requires an overnight stay in the hospital and has a low complication rate but necessitates a high level of commitment from the patient.

Repeat weight loss varies from patient to patient but may go as high as 50-70 lbs. after one to two years.

– Dr. Dang Tuan Pham

Dr. Pham practices at Buffalo Minimally Invasive Weight Loss Surgical Solutions, PLLC. His entire practice is dedicated to helping the obese lose weight and start leading a healthier lifestyle. He makes it a priority to establish long-lasting personal relationships with his patients so that they can more easily maintain their new, healthier lifestyle.

If you have a question about your health, click here to ask our experts.
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