Trends in Women's Healthcare- March Issue
-Steven Beverly, M.D.

One of the new technologies that Dr. Dodson and I are excited about is the HALO breast pap test. Almost on a daily basis, we see women that are worried about breast cancer. Breast cancer is the second leading cause of cancer death in the United States for women.
One in eight women will develop breast cancer at some point in her lifetime. This year alone, over 40,000 women will die of breast cancer. An estimated one million women have breast cancer, but do not know it yet. Over two thirds of women that develop breast cancer have no family history or other risk factors. The majoritiy of all breast cancer begins in the ducts.
The HALO system is used to collect (NAF) nipple aspirate fluid from the breast ducts so that it can be cytologically evaluated. This allows us to detect abnormal cells prior to seeing anything through mammography or for patients younger than those who typically have mammograms. The HALO will identify women at high risk for breast cancer in the future. This will allow women to make lifestyle changes to decrease their cancer risks, have increased monitoring, or have medical interventions to prevent or treat early breast cancer.
The HALO test uses heat, suction, and compression to collect fluid from the breast. It takes about five minutes. The HALO uses adjustable breast cups, similar to a breast pump. The machine is used to suction, heat, and massage to aspirate fluid from the nipple, which is collected and sent off for analysis. This process doesn't typically cause any pain and doesn't require anesthsia.
The HALO system is not designed to replace mammograms or other tests. It is a screening test similar to a pap smear that checks for cervical cancer. The HALO is a great adjunct method to current screening methods, such as yearly breast exams by your physician, montly self breast exams and--for women over forty---mammograms.
When abnormal cells are found, they allow women to make lifestyle changes to lower the risk of breast cancer such as adapting to low-fat diets, getting regular exercise, quitting smoking, and limiting alcohol. Increased screening also can be undertaken, such as frequent mammography, and in some cases MRI. Some women may also be started on medication to prevent cancer.
The HALO breast pap will help indentify women at a higher risk for cancer and allow physicians to get them on appropriate preventative tracks. This test is especially useful for younger women who do not yet receive mammograms.
Trends in Women's Health Care- May
-By Steven Beverly, M.D.
One of the most common and frustrating problems women face is urinary incontinenece. This is becoming more and more of a problem. Dr. Dodsom and I see women that have this problem on a daily basis. Incontinence encompasses multiple problems, including "stress related," "urge", and "overflow."
Urinary incontinence refers to the involuntary loss of urine from the bladder. This can cause social embarrassment and hygiene issues for the person affected. This affects 17 million people in the United States. This disease can cause significant anxiety and can limit social activies.
"Urge" incontinence refers to a patient's urge to go to the restroom but not having the ability to make it there on time. This is a result of muscular spasms of the bladder, causing discomfort.
"Stress" incontinence occurs when increases in abdominal pressure cause urine to leak. This can result from laughing, sneezing, or straining to lift an object.
"Overflow" incontinence happens when you are unable to empty your bladder. Once the bladder becomes too full, some of the urine will leak out, similarly to water flowing over a dam.
One of the new trends is a treatment for stress urinary incontinence (SUI) called Renessa. It is a non-surgical, office-based treatment for women who not only experience SUI but also have hyper-mobile urethras. Traditionally, stress incontinence has been treated with Kegal exercises and pessaries when first diagnosed. Then, physical therapy, involving biofeedback and electrical stimulation, may be added. This can be beneficial to patients with mild symptoms, but the results have been disappointing for women with moderate to severe stress incontinence. There are no medications that are approved to treat stress incontinence. However, imipramine is sometimes used to treat SUI. The next option traditionally involves surgery to correct the problem. Most women that have surgery have a mid-urethral sling placed, commonly referred to as "TVT" or "sling." This has a high success rate (80-90%), but is a vaginal surgical procedure, which will require hospitalization, anesthesia, and recovery time.
Renessa is a non-surgical procedure that treats incontinence better than biofeedback, Kegals, and physical therapy. The Renessa treatment uses a small probe that is placed in the bladder through the urethra. It then uses radio frequency to heat the tissue at the base of the bladder through the urethra. It then uses radio frequencey to heat the tissue at the base of the bladder, and is then immediately removed. This is done in the doctor's office. It takes about thirty minutes to complete, and most women can immediately resume normal activities. The improvement of SUI takes about 60-90 days to see. About 76% of women saw significant improvement in their symptoms, 58% were able to stop using pads, and 35% had no more leakage at all. 
The Renessa system now offers a treatment option for women that have failed conservative treatments and are either not ready for surgery or cannot safely undergo it. It does not have the same cure rate as the sling but does give women another choice in their health care. If the Renessa does not work, the sling procedure can still be performed. 
Trends in Women's healthcare- July issue
- By Steven Beverly, M.D.
Some of the most difficult problems that Dr. Dobson and I encounter are women's symptoms of an overactive bladder that have not been relieved with the use of medications. In May, I discussed Renessa, a new option for wome that suffer from stress incontinence, or leaking urine with cough or sneezes. Today, I will review some of the treatment options for overactive bladder symptoms.
Overactive bladder, or OAB, encompasses urinary urgency, urinary frequency, and urge incontinence. This is characterized by having very little time from feeling the sensation to urinate to the need to actually go, or experience leakage of urine. Women that experience these symptoms have mapped out every bathroom facility from home to their destination. Many require the use of panty liners, or sanitary napkins. This can cause distress, leading to ladies no longer participating in many activities that they once enjoyed.
The traditional treatment for OAB has been the use of behavior therapy and medications. All of the medications are very similiar and work in a similar manner. The main difference is the number of side effects. These medications include Ditropan, Detrol, Toviaz, Sancutra, Vesicare, and Enablex. The most common side effects of these medications are dry mouth, constipation, blurred vision, and dry eyes. These medications improve symptoms 60-70% of the time. 
Until recently, if these medications failed to produce good results, or if the side effects were too severe, there we no other options. In fact, 55% of women cannot tolerate these medications.
Recently, several other options have become available. Some of these options includes electrical stimulation, botox, sacral nerve simulation (interstim), and percutaneous tibial stimulation (urgent P.C.)
Electrical stimulation uses low-frequency vaginal probes to treat incontinence. One third of these patients notice positive long-term results. The treatment is usually administered, and monitored, by a specially trained physical therapist.
Interstim is an implantable device that uses mild electrical impulses to stimulate the sacral nerves. These are the nerves that control the bladder and muscles related to urinary function. Interstim first uses a test stimulator to confirm that it will work. Then a minor procedure is performed to place the device in the sacrum. The device works a little like a pacemaker. It can work for urge incontinence and urinary retention and looks promising for fecal incontinence. It has also shown improvement in interstitial cystitis patients.
Urgent P.C.  works on the sacral nerves as well. It involves placing a small needle into the tibial nerve, just about the ankel. Electrical current passes through the needle to stimulate the nerve. This treamtent is conducted once weekly for twleve weeks and lasts thirty minutes per session. It is effective about 70% of the time. For long-term results, maintenance therapy is required. The stimulation is not painful.
Injections of Botox into the bladder has also been shown to help overactive bladder but have not been approved by the FDA and are not yet being covered by insurance. It can last up to nine months. It can also cause some women to have trouble emptying their bladder until the effects wear off.
In summary, women now have options if medications are not right for them. Now, electrial stimulation with physcial therapy, Botox in the bladder and sacral nerve stimulation (interstim and Urgent P.C) can improve or cure OAB. These new options are exciting because they allow women to be cured of a problem that they previously not only had to live with but also had to adjust their lifestyle to accomodate.