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In the News: AAP Recommends LARCs for Sexually Active Adolescents

garOctober 30, 2014 – Earlier this month, the American Academy of Pediatrics (AAP) recommended that the first-line contraceptive choice for sexually active adolescents is a long-acting reversible contraceptive (LARC). This is a new recommendation for the APP, which is an organization of 62,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. Read more…

Discovery to Cure

Discovery to CureOn September 28, we are forming a team of walkers to support Discovery to Cure and New Treatments for Women’s Reproductive Cancers

Hundreds of walkers will be strolling through the Yale University campus for two miles with tour guides along the way to point out the sites on a beautiful fall day. The walk begins with registration at 10:00 A.M. and will end at approximately noon followed by door and raffle prize drawings. All registered walkers will be entered and must be present to win door prizes.

Join our office team at The Yale Commons (enter through Woolsey Hall) at 168 Grove Street (corner of College Street), New Haven. This is a family friendly event (sorry, no pets). Only people who are pre-registered by September 14th will be guaranteed the customized t-shirts. Registration is $20 for adults. Children under 16 are free.

This is a fundraiser for a great cause. Please plan to ask your friends and family to contribute towards your walk and personal fundraising goals!!

Follow This Link to visit my personal web page and help me in my efforts to support Discovery to Cure.

Monday, September 8th, 2014 at 13:17

A primer on emergency contraception pills

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First, the simplest way we describe these pills to our patients is to call them emergency contraception that prevents pregnancy after unprotected sex. They are not traditional birth control. And they do not cause abortion because they work before a pregnancy occurs.

According to the American College of Obstetricians and Gynecologists, fertilization, the union of an egg and a sperm, occurs in the fallopian tube. During the next few days the fused egg and sperm move through the fallopian tube to the lining of the uterus, where it implants as a cluster of cells that will become the fetus and placenta. Emergency contraception pills do not work at this point. Read more…

Tuesday, August 19th, 2014 at 12:00

Your daughter’s all-important first visit to our office

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“When should my daughter first see a gynecologist?” is a question our patients often ask during their visits to us, followed by an almost always immediate second question: “What kinds of things do you do to calm the nerves of the first visit?”

The optimum time for a first visit to our office is between ages 13 and 15. As for the second answer, because it can be scary for your daughter as young girls often feel embarrassed or nervous discussing their bodies, we make the visit as pleasant and comfortable as possible, and consider this a get-to-know-you session, where we begin building relationships and talk about health, education and prevention.
In most cases young girls visit our nurse practitioner Laury Berkwitt, who specializes in women’s health, is a mother of two, and is passionate about caring for young women and adolescents. She knows how to speak to young girls and is able to get them to open up, talk and ask questions. Read more…

Child’s obesity linked to how much – or how little – mom gained during pregnancy

home_pregnancy (2)If you gain too much or too little weight while pregnant, a new study has found that your child has a greater risk of being overweight or obese. The study caught our attention since weight  – “How much or how little should I gain?” – is one of the first questions many of our patients ask us.

The researchers studied 4,145 women and their children, ages 2 to 5, all members of Kaiser Permanente health care plans in Northern California. The women participants were racially diverse and all had a normal body mass index (BMI) before pregnancy, which according to guidelines established by the Institute of Medicine (IOM) means they should gain between 25 and 35 pounds during pregnancy. Read more…

Friday, June 13th, 2014 at 12:32

In the News: The Dangers of Power Morcellation for Uterine Fibroid Removal

The FDA speaks out

Earlier this month, the U.S. Food and Drug Administration issued a memorandum that discouraged surgeons from using a common procedure called power morcellation to remove uterine fibroids. Power morcellation uses a medical device to divide uterine fibroids into smaller pieces that can be removed through a small incision in the abdomen, such as during laparoscopic surgery.

Why was the FDA announcement necessary?

New data from the Center for Devices and Radiological Health show that power morcellation can spread undetected cancers more often than previously realized. According to the data, one in 350 women who undergo a hysterectomy to treat fibroids or who have fibroids removed have undiagnosed uterine sarcoma — a type of cancer that can be aggressive. If power morcellation is performed in women with this kind of uterine cancer, the procedure can spread the cancer around the abdomen and pelvis.

The agency’s review occurred following wide media coverage of Dr. Amy Reed, a 41-year-old Boston anesthesiologist who underwent a power morcellation hysterectomy in October 2013 to treat what she was told were likely benign uterine fibroids. Follow-up tests found that Reed had uterine leiomyosarcoma, a very aggressive tumor. Imaging tests showed that the cancerous tissue had been spread throughout her abdominal cavity, giving her stage 4 cancer.

The FDA stopped short of ordering the devices needed for this procedure off the market because, according to a spokesperson, “there still may be individual patients who benefit from the procedure.”

Uterine fibroids: A bit of background information

Most women will develop uterine fibroids at some point in their lives. Most uterine fibroids do not cause problems. However, uterine fibroids can cause unpleasant or even painful symptoms, such as:

• heavy or prolonged menstrual bleeding,
• pelvic pressure or pain, and
• frequent urination

Between 500,000 and 600,000 women undergo hysterectomies in the United States every year. Up to 40 percent of these procedures are to treat painful fibroids.

What do I think?

I’ve had concerns about power morcellation for some time: I think it’s an expensive and dangerous technique that does not improve surgical outcome. While I’m in full support of the FDA’s safety advisory, I think they should have gone even further and taken the devices off the market until a solution is found. Fortunately, there are some good alternatives to power morcellation, including a small lower abdominal incision, manual extraction though a laparoscopy incision, and manual morcellation via posterior colpotomy (an incision in the back of the vagina). I believe that posterior colpotomy is the best option in many cases because it is safe and associated with minimal postoperative pain and excellent cosmetic outcomes.

If you’re considering treatment for uterine fibroids, be sure to discuss with your physician all the available treatment options, including the benefits and risks. If you’re in the area, give me a call to set up an appointment.

Additional information on uterine fibroids

Extensive information on uterine fibroids can be found at:

FDA Safety Communication: Laparoscopic Uterine Morcellation, April 2014
National Institutes of Health: Uterine Fibroids Fact Sheet, March 2013
John M. Garofalo, M.D.: Uterine Fibroids

About the practice

Dr. John Garofalo, M.D., is a gynecologist located in Fairfield County, Connecticut. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.
Laury Berwitt is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for 10 years, caring for women of all ages.

For more information, go to www.garofaloobyn.com. John Garofalo, MD and Laury Berkwitt, APRN can be reached for personal consultations by calling 203.803.1098.

Mammograms: Making Sense of Conflicting News

In the past few months there’s been a lot of conflicting information about mammograms in the press. Not surprisingly, we get asked a lot of questions by our patients: Are mammograms useful? At what age should I start getting tested? What are the risks? What if I test positive?

Recent News: A Quick Summary

A few months ago, there was a cost analysis of whether women should start regular mammograms starting at age 40 or age 50. Why was this a concern? Because the American Cancer Society recommends that women start mammogram screening every year starting when they turn 40, while the U.S. Preventive Service’s Task Force recommends that women get a mammogram every other year starting at age 50.

A few weeks later, a Canadian study reported that mammograms did not reduce breast cancer deaths. This study was criticized by U.S. radiologists as being flawed and misleading.

The Latest Word

Even more recently, the American Medical Association published the results of studies that attempted to put all the previous research into perspective. For the first study, researchers at Harvard examined all the research done on mammograms since 1960. They concluded that while mammograms have benefits, these benefits have been “oversold,” while the potential harms have been minimized.

Who Should Get Screened, And When?

The researchers also found that annual mammograms can reduce the risk of dying from breast cancer by about 19 percent; but the benefit varies based on a woman’s age and her underlying cancer risk. For example, breast cancer becomes much more common as a woman ages. Here are the statistics:

chart

As for women age 75 and older, the study found that there have been no tests to see whether women of this age benefit from regular mammograms. This means that there’s no way to know how much regular mammograms might extend the life of a woman in this age range.

The Risk of Overdiagnosis

The Harvard study also evaluated overdiagnosis, in which women are treated for a cancer that would never have been life-threatening. The researchers found that about 19 percent of women who are diagnosed with breast cancer as a result of a mammogram undergo unnecessary surgery, chemotherapy or radiation.

So What’s the Bottom Line?

The researchers concluded that mammography is a useful but not perfect screening test. So if you’re trying to make a decision about mammography, be sure to discuss the risks, benefits, uncertainties, alternatives, and your own health history and preferences.

About the practice

Dr. John Garofalo, M.D., is a gynecologist located in Fairfield County, Connecticut. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.

Laury Berwitt is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for 10 years, caring for women of all ages.

Laury and Dr. Garofalo offer mammography and related consultation services as part of well woman care.

For more information, go to www.garofaloobyn.com. John Garofalo, MD and Laury Berkwitt, APRN can be reached for personal consultations by calling 203.803.1098.

Vaccines During Pregnancy: Are They Safe?

There’s been a lot of conflicting information lately about vaccines during pregnancy. And not surprisingly, we hear a lot of questions on this topic at our medical practice. The short answer to the “are vaccines safe” question is that certain vaccines are strongly recommended during pregnancy, and that the known benefits of these vaccines are generally believed to outweigh any potential concerns.

Here are a few of the more common questions we’ve heard, along with our answers.

What is a vaccine and how does it work?

Most vaccines are solutions that contain a weakened, killed or similar version of a virus or organism that causes a particular disease. Vaccines take advantage of the fact that immune systems can “remember” infectious organisms and viruses.

Vaccines are generally injected into the deltoid muscle (the outer part of the upper arm). Vaccines are formulated so that they cannot get you sick, but they can prepare your immune system to fight that particular disease. In other words, vaccination can provide immunity without you having to experience the disease or its symptoms.

Should pregnant women get vaccinated?

Certain vaccinations can protect you from various infections and illnesses during and even after pregnancy. This protection is passed to your unborn child, helping to protect your child during pregnancy and even for the first few months after birth. This is particularly important for infections such as pertussis (whooping cough), which is highly contagious and can be particularly deadly for unborn newborn children and infants.  Vaccinations can also protect you from getting a serious disease that could affect future pregnancies.

However, not all vaccinations are safe during pregnancy. Vaccines that should generally be avoided during pregnancy include:

  • Varicella (chickenpox)
  • Human papillomavirus (HPV)
  • Measles
  • Mumps
  • Rubella

In addition, vaccines that contain weakened but live viruses — such as the nasal spray vaccine — are generally avoided for pregnant women (although they are considered safe for postpartum or breastfeeding women). Instead, pregnant women are usually given vaccines that contain inactivated (killed) or synthetic versions of the virus or infection-causing agent.

Your healthcare provider can help explain the vaccinations you should consider before, during and after your pregnancy.

Should pregnant women get a seasonal flu vaccine?

Inactivated seasonal and H1N1 influenza “flu” vaccines are recommended for most pregnant women. Pregnant women have a higher risk for serious complications from influenza than non-pregnant women of reproductive age. Flu  vaccine can protect pregnant women and their unborn babies, and also protect the baby after birth. In fact, the Centers for Disease Control and Prevention ¬— a federal agency that protects public health and safety through the control and prevention of disease, injury and disability — classifies pregnant women as a group that is more eligible to receive flu vaccines when the vaccine is in short supply.

What vaccines are safe during pregnancy?

Other than flu vaccines, the only vaccines recommended for routine use during pregnancy are primary or booster Tdap (tetanus, diphtheria and acellular pertussis) vaccinations. One dose of Tdap vaccine is recommended during each pregnancy, regardless of when you had your last Tdap or tetanus-diphtheria (Td) vaccination.

If you’re traveling abroad or if you’re at increased risk of certain infections, your healthcare provider may recommend other vaccines during pregnancy, such as hepatitis A, hepatitis B and meningococcal or pneumococcal vaccines.

When during my pregnancy should I be vaccinated?

Ideally, all women who are pregnant or might be pregnant during the influenza season should receive the inactivated influenza vaccine in October or the first half of November (prior to the influenza season), regardless of their stage of pregnancy. Vaccination after this period can still be beneficial because peak influenza activity usually occurs in January or February, but may occur as late as May.

Other immunizations during pregnancy may be delayed until the second or third trimester, to minimize concerns about complications. However, certain routine immunizations such as tetanus vaccines may be given during the first trimester if there are special risks to the unimmunized pregnant woman, fetus, or newborn.

Can a vaccine when I’m pregnant cause my child to become autistic?

Some researchers claim a connection between autism and childhood vaccines —particularly measles vaccine and thimerosal, a mercury preservative used in vaccines. However, the overwhelming majority of evidence does not support an association between immunizations and autism. The Advisory Committee on Immunization Practices (ACIP) does not recommend avoidance of thimerosal-containing vaccines for any group, including pregnant women.

Additional information on vaccines

Extensive information on vaccines and immunization can be found at:
www.immunizationforwomen.org
www.cdc.gov/vaccines
www.cdc.gov/vaccines/pubs/ACIP-list.htm

About the practice

Dr. John Garofalo, M.D., is a gynecologist located in Fairfield County, Connecticut. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.

Laury Berwitt is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for 10 years, caring for women of all ages.

Laury and Dr. Garofalo offer and wholeheartedly recommend influenza and Tdap vaccinations during pregnancy.

For more information, go to www.garofaloobyn.com. John Garofalo, MD and Laury Berkwitt, APRN can be reached for personal consultations by calling 203.803.1098.

 

da Vinci Surgery In The News: How Safe Is It?

A few days ago, I saw a local newspaper article that described a botched robotic surgery from 2009. The article went on to claim that new surgical technologies such as the da Vinci® Surgical System are not always properly evaluated by physicians and hospitals in terms of their potential harm to patients. Perhaps most alarming, the article noted that there are questions about the experience and expertise of many of the surgeons who use the equipment.

I always encourage my patients to be fully informed about the advantages and potential risks of any procedure they’re considering. From my perspective, the recent media coverage provides an excellent opportunity to explain robotic surgery and review what you can do to help prevent the kind of complications mentioned in the article. Finally, at the end of this blog you’ll find a description of my practice and what my patients can expect if they choose robotic surgery.

What is the da Vinci Surgical System?

As I explain on my website, the da Vinci Surgical System uses small incisions to allow surgical access for miniaturized surgical instruments and a high-definition 3D camera. Seated at a da Vinci console, the surgeon views a magnified, high-resolution 3D image of the surgical site. State-of-the-art computer technologies convert the surgeon’s hand movements into precise micro-movements of the da Vinci instruments. Introduced more than five years ago, the da Vinci Surgical System has been used successfully in tens of thousands of procedures.

As a minimally invasive technique, robotic surgery typically offers the benefits of less pain and bleeding, faster recovery and fewer potential complications compared to traditional “open” surgery. It also allows higher levels of precision and complexity than non-robotic laparoscopic procedures. However, as with any kind of surgical treatment, there are risks associated with robotic surgery. These risks include injury to tissues or organs; bleeding; infection, and internal scarring.

Questions for you to ask before you agree to robotic surgery:

COEMIG certification?
If you’re considering any gynecologic surgery, including one that uses robotic technology, be sure to ask if your surgeon and his or her hospital are COEMIG-certified. COEMIG stands for “Center of Excellence in Minimally Invasive Gynecology.” According to the American Association of Gynecologic Laparoscopists (AAGL), which created the COEMIG program, COEMIG certification is only given to surgeons and facilities that uphold an “unparalleled commitment and ability to consistently deliver safe, effective, evidence-based care.” COEMIG standards are frequently upgraded as surgical processes improve. Certification is not merely a one-time achievement; it must be maintained. Designees are regularly monitored by a special medical review agency.

Experience with robotic and laparoscopic surgery?
If you’re considering gyn surgery, be sure that your surgeon is not only COMIEG-certified but highly experienced in laparoscopic and robotic surgery. Remember that a surgeon cannot safely go from “open” hysterectomy to complex robotic surgery overnight. So ask: How much experience does your surgeon and his or her hospital have with robotic surgery? How many years of experience and how many surgeries? Likewise, how much experience does the surgeon have with non-robotic laparoscopic surgery? What is the surgeon’s record of successes and complications from robotic surgeries?

Don’t be afraid to speak up and ask. These questions can help reduce surgical risks while providing reassurance that your provider and healthcare facility are committed to your health and safety.

About Dr. John Garofalo, M.D.

Dr. John Garofalo, M.D., is a gynecologist located in Fairfield County, Connecticut. Dr. Garofalo was the first gynecologist in lower Fairfield County to be certified on the da Vinci Surgical System more than four years ago. He has performed hundreds of procedures with the da Vinci Surgical System, with a complication rate of less than 1%. He also has more than 10 years of experience performing complex non-robotic laparoscopic surgeries.

Dr. Garofalo is certified to use the da Vinci Surgical System for diagnosis and/or treatments associated with the following conditions and procedures:

About Garofalo OB/GYN & Associates

Dr. Garofalo’s practice, Garofalo OB/GYN & Associates, has been designated as a Center of Excellence in Minimally Invasive Gynecology (COEMIG) by the American Association of Gynecologic Laparoscopists (AAGL). According to the Surgical Review Corporation (SRC), which administers the program on behalf of AAGL, more than 650 providers around the world currently participate in the COEMIG program, which was launched in 2010.

For more information on Dr. Garofalo and his medical practice, go to www.garofaloobgyn.com. Dr. Garofalo can be reached for a personal consultation at 203.803.1098.

AAGL Awards Garofalo OB/GYN with COEMIG Designation

AAGL COEMIG Seal_Light2 (2)“I would like to share my news that John M. Garofalo, MD has been designated as an AAGL Center of Excellence in Minimally Invasive Gynecology (COEMIG).”

The COEMIG program is focused on improving the safety and quality of gynecologic patient care and lowering the overall costs associated with successful treatment. The program is designed to expand patient awareness of – and access to – minimally invasive gynecologic procedures performed by surgeons and facilities that have demonstrated excellence in these advanced techniques.

The COEMIG program ensures the safest, highest quality care is delivered to minimally invasive gynecologic surgery patients worldwide, regardless of where they choose to have their procedure performed.

By designating the individual surgeon and facility together, patients are able to distinguish providers who have met the requirements for delivering high-quality perioperative care from those who have not. Insurance companies will also be able to use the designation to identify those committed to excellence.

AAGL only designates this high banner of quality to surgeons and facilities that uphold an unparalleled commitment and ability to consistently deliver safe, effective, evidence- based care. The program is structured to help minimally invasive gynecologic surgery providers continuously improve care quality and patient safety.

For more information about the AAGL, visit www.aagl.org. And for more information on the Surgical Review Corporation, visit www.surgicalreview.org.

Friday, September 13th, 2013 at 10:30