Medical Care
Abnormal (and Normal) Pap Evaluation and Treatment
Pap smears are a success story in the world of cervical cancer prevention. We perform pap smears using liquid-based cytology (Thin Prep Paps) according to the very latest guidelines. The discovery of the connection of the Human Papilloma Virus and abnormal pap smear findings revolutionized the approach to treatment of abnormal pap smears. The Thin Prep Pap smear allows us to check for any abnormal cells AND see if the Human Papilloma virus is present. For patients needing a more specific check of their cervix, we use a "high-tech" computerized microscope, called a colposcope, to visualize and photographically record our findings. We also perfom LEEP's (loop electrode excision procedure) and cryosurgery for conditions requiring treatment.
Adolescent Gynecology
We provide comfortable and educational visits for teenagers starting at 13 - 15 years of age, or when they begin menstruating. We want to see an adolescent before she becomes sexually active. As a matter of fact, we are now vaccinating young women (one recomendation would be ages 9 - 26) with a vaccine against the most common cause of cervical cancer: Human Papilloma viruses. The first visit often does not include a pelvic examination. It is an important time in a girl's life to provide accurate information and health guidelines about female anatomy and physiology. We hope to establish an open provider-patient relationship, and give every young woman a ready resource for the challenges of the teenage years.
Contraceptive (Birth Control) Counseling
Contraception has always been a vital service in our practice. The choices facing women these days can be confusing, so we will not only help explain the choices available to you, we will try to customize our recommendations to your individual situation. We offer oral contraceptives, patch contraceptives, vaginal ring contraception, intrauterine devices, instruction in natural family planning, barrier techniques such as diaphram or the sponge or proper use of condoms. For those wishing permanent sterilization we offer tubal ligations done laparoscopically.
Fertility Counseling
For women who wish to be pregnant but have not become pregnant after 12 months of unprotected intercourse -- or even after 6 months for women over the age of 35 -- fertility counseling is warranted.
Laparoscopic Surgery
Advanced laparoscopic surgery is a less invasive approach to major surgery with a faster recovery time.
Menopause Care
The average age for menopause is 51, but menopausal-type symptoms including hot-flashes, mood changes, irregular cycles with irregular bleeding, depression, insomnia and dry vagina can occur even ten years earlier. In addition to menopause care we offer "peri-menopausal" care. During this transition in a woman's life special attention is paid to lifestyle and preventive health issues. A woman faces a number of stressors including children growing up, care of grandchildren, facing the end of her reproductive years, job changes, spousal transitions, physical limitations, care of aging parents, metabolism (yes, we mean gaining weight around the middle!). The list is long.
Add to this the impact from the Women's Health Initiative research that makes us feel guilty about trying to add back dwindling hormones. Our entire gynecology team (doctors, nurse practitioners, and physician's assistants) is here to help you identify and understand your individual situation, and find a good balance of lifestyle and other support measures, which could include hormone therapy. We are especially interested in your long-term health, including your heart health, bone health, gynecological health and mental health. It is a good time to review your personal and family histories for risk factors, and decide which tests or treatments might benefit you most (including updating your vaccinations). We want you to think of these years as some of your best years ... because they are.
Midwifery
Midwifery is probably the most ancient healthcare profession. Today, there are over 7,000 nurse-midwives in the United States. More couples are choosing a midwife for a unique birth experience. Certified Nurse-Midwives (CNMs) are registered nurses who have received advanced education in obstetrics and gynecology. After passing a national certification exam, they are certified by the American College of Nurse-Midwives and licensed by the state as Advanced Registered Nurse Practitioners (ARNPs). CNMs provide safe, effective maternity care in a manner that promotes health, embraces the family and seeks minimal intervention in the birth process. Couples often seek out midwifery care because of their excellent safety record and lower rates of Cesarean birth, forcep and vacuum use, and episiotomy.
Our philosophy focuses on wellness and patient choice. We support your decisions during labor, including natural childbirth or the use of pain relief medications including epidural anesthesia. Usually we stay with you during your entire labor and provide pain relief measures such as massage, relaxation techniques and encouragement. Consequently, medications are needed less often. If conditions develop outside of our training, we work closely with obstetricians to care for your needs. In addition to pregnancy and birth, our scope of practice covers a variety of women’s gynecological and health care services, including providing pre-pregnancy counseling, performing annual exams, prescribing medications and offering contraception. Nurse-midwifery care is covered by most insurances.
Naturopathic Medicine
Our Center is one of the first to offer a combination of traditional and alternative healthcare. You can schedule an annual exam with any of our providers, including our naturopathic physician, Michelle Ramauro. Many chronic illnesses can be nicely managed with her help. If you are not sure what a naturopathic physician is or what types of problems she deals with, just call our regular clinic number and explain your needs to our patient coordinators.
Obstetrics and Prenatal Care
Currently, we have five physicians (Drs. Michele Delorit, Karen Wells, Susan Eagan and Guoli Johnston) and four certified nurse midwives (CNMs Sharon Hammond, Michelle Jackson, Debra Monson and Janice Smith) providing prenatal and obstetrical care. We feel we offer some of the most personalized and state-of-the-art prenatal care in the nation. However, we must give equal credit to the outstanding hospital staff, facilities and perinatal department here at Evergreen Hospital Medical Center. This is a great place to have a baby.
The enthusiasm, teamwork and dedication for mother-child care at this hospital pervades the whole experience from your first visit with us, through your delivery at the hospital to your post-partum visit. The hospital rooms are designed for single room care so you labor, deliver and care for your newborn all the same room. Each room is equipped with a jetted tub, day bed for your support person, DVD player, refrigerator, and much more. Additionally, although most newborns room in with their parents after they are born, those needing closer supervision receive care in the Special Care Nursery, which is also family-centered. The nursery has mostly private room care which allows parents to room in with their newborns (there are a few exceptionally busy times when newborns have to share a room).
The hospital has in-house anesthesiologists, neonatologists (newborn specialist pediatricians) and evening and weekend in-house obstetricians. There are so many educational opportunities here through labor classes, mother-baby groups, exercise groups and various support groups that you become a member of the Evergreen family.
We offer ultrasound and non-stress testing in our office. The lab draw station is just across the hall from our Suite A waiting room. If you require high-risk obstetrical care, we co-manage your care with the perinatology group here at Evergreen, which is called Maternal Fetal Medicine. This group provides a dietician for diabetic care, genetic counselors and even a special RN care coordinator for multiples (twins, triplets and up!). The perinatal group also offers the most advanced testing for prenatal screening, called the Combined Screen, as well as the options of chorionic villus sampling or amniocentesis.
We hope you are beginning to understand how we feel: very fortunate to practice at Evergreen with a wealth of available services.
Pre-pregnancy Counseling
On-site Mammography
A radiology group, Imaging Associates, provides mammograms in our office 4 to 5 days each month on Wednesdays and some Thursdays. In addition to their team of radiologists, they bring a portable machine with the ability to "double-check" images with a computer. If you need a screening mammogram AND your annual exam, you can schedule both for the same visit.
Pelvic Floor Relaxation and Urinary Incontinence Evaluation and Treatment
We are very fortunate to have Dr. Kathryn Arendt on our physician team. Dr. Arendt trained in advanced pelvic surgery and specializes in evaluation and treatment of pelvic floor disorders including incontinence.
We are now able to address any previously unspoken conditions, such as a woman's inability to control gas, feces and urine. Some women have discomfort from relaxing pelvic organs that have lost the support of the pelvic floor and are causing pressure or even prolapsing outside the body. We can help you.
One of the most common conditions is urinary incontinence. There may be one or more causes for this inability to control urine loss. A careful history check and physical, bladder voiding diary and questionnaire will help elucidate the problem. Additionally, Dr. Arendt has equipped a urodynamics procedure room to perform a more in-depth, computerized check of your voiding function using cystometrics equipment. Once you are specifically and accurately diagnosed, Dr. Arendt can offer treatment options specific to your individual condition such as pelvic floor exercises, the use of devices such as pessaries, medical management with tablets or creams, or surgery. The surgeries Dr. Arendt performs include some of the newest mid-urethral slings and mesh support systems.
She has one goal, and that is to improve the quality of a woman's life.
In addition to her position at the Center, Dr. Arendt is also the medical director of the Evergreen Hospital Medical Center's Pelvic Floor Disorder Center. She has a coordinated referral team of physical therapists, radiologists, nurse practitioners, urologists, general surgeons, and colorectal surgeons who work together to evaluate and treat symptomatic conditions of the pelvic floor. If you have more than one system involved (voiding and defecating) or need more than one specialist, this is the place to come and get comprehensive care.
Urogynecology
Our gynecologists with special training and expertise in the care of women with pelvic floor dysfunction work with women who have problems of prolapse and/or troublesome incontinence or when your primary doctor recommends consultations. These conditions happen when the pelvic floor is damaged by childbirth, repeated heavy lifting chronic disease or surgery.
Primary Care
We consider ourselves an Obstetrics/Gynecology specialty office. However, there are three nurse practitioners in our office who provide primary care services:Carol Verga, ARNP, CNM, started as a nurse practitioner midwife and then retired from midwifery, and now she specializes in gynecology and primary care. In particular, she is our resident expert in cervical abnormalities and skin conditions including the genital area.
Candace Degenstein, ARNP, has provided primary care in all of her practice settings.
Patti Quick Showalter, PA-C, has been providing primary as well as gynecological care to women since 1982.
All three care providers will emphasize the latest screening and care for disease prevention, and they pay special attention to skin lesions, heart/breast/lung and colon health, bone density, and cholesterol, thyroid and diabetes screeing. Other areas of focus are maintaining good diet and exercise habits, and staying up-to-date on your vaccinations. The main emphasis is education in all of these areas, and we rely on this team to keep us current on recommendations for primary care.
Surgical Services
Surgical services at the Center include both major and minor surgeries.
Minor surgeries include the procedures we perform in the office or in an outpatient surgery setting. These surgeries do not enter the abdominal cavity. A "D & C" (dilation and curettage), uterine polyp removal, or a simple surgery on exterior genital tissue is considered a minor surgery.
Major surgeries include laparoscopic procedures, vaginal surgeries, and abdominal incision surgeries called "laparotomies."
Hysterectomies may also be started using the laparoscope to disconnect the upper tissues and then completed by bringing the uterus or uterus and ovaries out through the vagina. Whenever possible, we perform a surgery laparoscopically because your recovery is usually quicker, you typically will not require an overnight stay in the hospital, and the procedure is considered "minimally invasive." Depending on the complexity of the procedure, we may invite Dr. Chau-Su Ou to assist with the surgery. Dr. Chau-Su Ou is a well-known gynecological surgeon who specializes in highly technical laparoscopic surgeries.
Vaginal approach surgeries are also major surgeries. A Vaginal hysterectomy is performed without any incision on the abdomen. The incontinence and prolapse surgeries are also usually performed vaginally requiring less recovery time than an abdominal incision.
Sometimes an abdominal incision is needed. All Cesarean sections are, of course, through abdominal incisions (usually a low, horizontal incision). Also, there are uteruses, fibroid tumors, and ovarian tumors that are just too big to remove through the vagina or the scope. The surgical approach is based on the safest route for the patient.
Ultrasound Services
The Center for Women's Health performs its own obstetrical and gynecological ultrasounds. We employ one full-time and two part-time highly-skilled sonographers—Karin, Giselle, and Nancy—who operate two state-of-the-art ultrasounds five days a week.
Ultrasound imaging is one of the safest and most beneficial tools we have to diagnose normal and abnormal pregnancies for obstetrics and to find the cause of abnormal pain and bleeding in the gynecologic patient. Often, ultrasound enables us to rule out a concern. For instance, we can see that an ovarian cyst has resolved or that a uterine lining is too thin to be an endometrial cancer.
We more recently added an extra video screen in each ultrasound room for the patient's viewing comfort. You no longer have to turn your head at a sharp angle to see the screen; the image is displayed right in front of you.
The physician assigned to reading ultrasounds comes in either during or immediately after each gynecologic scan to explain the results and answer any questions you may have. During the obstetrical ultrasound, the sonographer will give you a "tour" of your baby; the physician typically does not come in for a routine obstetrical scan unless there is an abnormal finding or a feature that requires explanation. We always strive to give you immediate feedback on ultrasound findings.
We also perform an enhanced ultrasound procedure called a sonohysterogram in which a vaginal probe ultrasound is performed after painless installation of a small sterile saline solution inside the uterine cavity. This solution allows slight distention of the uterine cavity so we can see if a polyp or fibroid is projecting into the cavity and causing abnormal bleeding.
Our Center is one of only a few private offices that has sought and attained AIUM accreditation. AIUM stands for American Institute of Ultrasound in Medicine. Hospital ultrasound departments and free-standing radiology centers are usually accredited by a formal institution, but private offices are not required to do so. We chose to do this for our office for two reasons. First, it forces us to research and maintain national standards as well as requires each physician to maintain 30 hours of ultrasound education every three years. Secondly, it is proof to our patients that they are receiving the highest standard of care. You can see our accreditation certificate posted outside ultrasound room #1.
Our patients have given us lots of positive feedback over the years about their preference to have their ultrasounds done here. We hear about how much their comfort is addressed and how helpful it is to get the immediate feedback and be shown on the screen what is happening.