Archive for the 'Medical' Category

Vasectomy

Saturday, October 12th, 2013

“Can vasectomies really make a difference? Mine made a big difference in my life, and to this day, I consider it the single most important contribution I have personally made to the wellbeing of future generations….“ Paul Ehrlich.

 

It was time: I walked across the hall, lowered my pants and lay down on the exam table. Dr. Sam Callaway took good care of me.

We had two great sons and our family was complete. Although my wife volunteered to get her tubes tied, I decided to practice what I preached and went for the vasectomy. That was thirty years ago, and I’ve never regretted that decision.

My largest fear was that Sam’s office nurse would be around still, but Judy had already left. Sam talked to me as he worked and I barely felt any discomfort. He explained that he used a very thin needle for the local anesthesia, made tiny incisions and he was gentle. In a few minutes it was all over and I was on my way.

I’ll admit to some soreness that evening when I spoke at the prepared childbirth class my wife was teaching. And I moved carefully the next day when I needed to perform a cesarean. All in all, I took just a few aspirins (that was before ibuprofen!) and never had any ill effects.

Men have an anatomical advantage when it comes to sterilization. Whereas a woman’s tubes are deep inside her body, a man’s tubes, the vasa deferentia (singular: vas deferens) are much more accessible. When they are interrupted, sperm cannot get released, and the man is unable to cause pregnancy. Fortunately, sperm are only a tiny fraction of the male ejaculate, so sex is unchanged—or better, for lack of fear of pregnancy.

A vasectomy takes only a few minutes, is done with local anesthesia and is amazingly safe and effective.  The main hitch is that it takes several months to wash out all the sperm, and the man should be tested to be sure that he really is shooting blanks before trusting the surgery. Fortunately, the failure rate is less than one in a hundred.

Tubal ligation is more common in the USA than is vasectomy. Among married couples, one in 7 men is sterilized while one in 5 women has had the surgery. Since many sexually active people are not married, the overall statistics show a larger preponderance of women taking control of their fertility—more than a half million women are operated on every year while only half that number of men get snipped.

The popularity of vasectomy varies by country. It is rare in many parts of the world such as in Africa, but a quarter of men in New Zealand have had the surgery.

In Durango perhaps only one physician is left performing this important procedure after Centura took over the family practice group at Mercy. Dr. Mark Forrest has performed hundreds of vasectomies, including on some of my friends—and they have all done well. He says that it usually takes two visits: a consultation, then the actual surgery. He will check semen samples two and three months later, and if both are negative for sperm, the surgery can be considered a success. If this protocol is followed, the failure rate is lower than the rate of pregnancy after tubal ligation.

Furthermore, vasectomy is much less expensive. Nationwide, the price of male sterilization is $350 to 1000. Female sterilizations can now be done without an incision. Essure™ is an office procedure performed through the woman’s cervix, with mild sedation and local anesthesia. Unfortunately, its overall cost is about the same as tubal ligation—$1500 to 6000.

The first World Vasectomy Day will be observed October 18th of this year. This event was decreed by Jonathan Stack, an award-winning documentary filmmaker. The event will be celebrated by Dr. Doug Stein performing his favorite operations—you guessed it!—live from Australia. Dr. Stein has performed over 30,000 vasectomies, perhaps a world record.

Mr. Stack went to Dr. Stein for his own procedure, and thus got the idea for the film. His reasons for favoring vasectomy include: “…it’s time for men to share the burden of family planning” and “…we have to do a fairer job of sharing the planet’s finite resources.”

You can find out more at: www.worldvasectomyday.org, including links to the film’s trailer. They need money to finish this important film. I donated already, and hope that you will also consider supporting this film—because it is time for men to share the burden of family planning!

© Richard Grossman MD, 2013

Update on Abortion

Saturday, April 7th, 2012

Many years ago I worked for three weeks in Swaziland, South Africa. A memory still haunts me.

Most mornings we saw one or two young women through the emergency ward. Almost all of these women were from surrounding communities, were “visiting an auntie” and they hadn’t eaten breakfast. All were carrying early pregnancies and reported bleeding. Indeed, on examination there was blood and the cervix had started to open.

Bleeding and cervical dilatation in pregnancy usually ends up as a miscarriage, and can lead to a serious infection unless a D&C is done to empty the uterus.

Another doctor told me this pattern had been happening for a long time. We surmised that some doctor in this city was using instruments to make it appear that these patients were about to miscarry. It would be easy to instrument the cervix, tell the young woman to go to our hospital in the morning—and to skip breakfast. “I hope all goes well tomorrow at the hospital. And have your boyfriend wear a condom next time,” I can imagine that doctor saying.

In Swaziland abortion is only legal to save a woman’s life. The physician who opened the cervix was taking a big risk, allowing him to charge an outrageous fee.

Don’t laws that prohibit abortion decrease its frequency? No, apparently not. Norway, known for its excellent medical statistics, found that the incidence of abortion did not rise when it was legalized in 1978. This finding was borne out by a recent article in the world’s premier medical journal, Lancet.

The study looked at all the world’s countries. 84 have liberal abortion laws; the remaining nations (like Swaziland) prohibit abortion, with few or no exceptions.

Outlawing abortion does not prevent women from terminating unwanted pregnancies. Where it is illegal, however, women are subjected to unsafe procedures and risk their health and very lives. Surprisingly, this study found the incidence of abortion is higher in places where it is outlawed. This may be because these are also places where women are not esteemed, and where contraception is difficult to obtain.

Wherever laws permit safe abortion, two observations are made. Maternal mortality from unsafe abortions decreases drastically, and women are treated with more respect.

More surprises are to be found in another research paper from England. It is an exacting review of the psychological effects of abortion. Although many studies in this field are of poor quality, the researchers found 44 high quality studies.

To reduce the possibility of bias and to ensure transparency, the reviewers sent out a request for comments. Several anti-abortion (as well as pro-choice) organizations responded, and their comments influenced the final report.

The questions the multi-faceted panel of experts set out to answer are: How prevalent are mental health problems in women who have an induced abortion? What factors cause poor mental health outcomes after an abortion? Are mental health problems more common in women who have an abortion compared with women who deliver an unwanted baby?

The report’s findings are summarized:

•            Unwanted pregnancies are associated with an increased risk of mental health problems, and the rate of problems is the same whether women had an abortion or gave birth.

•            The most reliable predictor of post-abortion mental health problems was having a history of mental health problems before the abortion.

•            There are additional factors associated with an increased risk of mental health problems specifically related to abortion, such as pressure from a partner to have an abortion and negative attitudes towards abortions in general.

The study recommends:

“…it is important to consider the need for support and care for all women who have an unwanted pregnancy because the risk of mental health problems increases whatever the pregnancy outcome. If a woman has a negative attitude towards abortion, shows a negative emotional reaction to the abortion or is experiencing stressful life events, health and social care professionals should consider offering support, and where necessary treatment, because they are more likely than other women who have an abortion to develop mental health problems.”

We are lucky in La Plata County to have wonderful assistance for women carrying unintended pregnancies. The Pregnancy Center supports women who plan to deliver, while Planned Parenthood provides access to safe, compassionate abortions. I am concerned, however, that the people who demonstrate outside Planned Parenthood may not provide accurate information to women who are considering abortion. The demonstrators may have a negative influence on those women who are at risk for mental health problems.

© Richard Grossman MD, 2012

Goodbye Obstetrics

Sunday, March 4th, 2012

I helped with the birth of my last baby here in Durango in November. He is a healthy boy who weighed just under seven pounds.

More than 35 years ago we chose Durango as the best place to raise our two sons. They are now both married and left town long ago. My wife, Gail, and I still enjoy living in La Plata County—it is our home.

Durango was not the most lucrative place to practice back then, and it still isn’t. My starting salary was just $2,000 a month, and often I worked eighty hours or more a week. The work is strenuous, but helping women and families achieve their reproductive goals has been very satisfying.

At age 68 most people are already looking forward to full retirement. I still have goals to achieve, and am happy to be healthy enough to continue working. But I do enjoy sleeping a lot!

Perhaps I should hold my former neighbor, Dick Edwards, responsible for some of my reluctance to retire. Shortly after moving in to our first home on Rio Vista Circle I met Dick on the sidewalk. He said that retirement is dangerous—that a lot of people get sick or die shortly after they quit working. Of course there may be an error in this thinking, since some people retire due to bad health.

About 15 years ago I decided to work less and to be more active in the community and with global issues, and was able to do so. Although my income decreased, our sons had finished college and expenditures also had decreased. Working less allowed me to be active in volunteer organizations. Now I am involved in one local—Durango Nature Studies; one national—a committee of Planned Parenthood; and one international—Quaker Earthcare Witness.

I will continue practicing office gynecology. One of my goals is to take part in a Food and Drug Administration study of Quinacrine Sterilization. This is a means of permanent female sterilization that can be done without anesthesia. It is so simple that midwives have performed thousands of these procedures. QS uses a drug, quinicrine, that was developed in the 1930s as a replacement for quinine to prevent or treat malaria. It was prescribed to millions of GIs during the Second World War. The FDA has approved quinacrine for several uses, but not yet for sterilization. I hope to participate in a study of QS that will start in 2012. Quinacrine sterilization holds the promise of providing inexpensive, safe control of fertility for the millions of the world’s women who want to prevent pregnancy permanently.

Through the years I have been amazed by this community’s support. For instance, the Ballantine family has published this column for over 16 years. They allow me to own the articles’ copyrights so some of the articles have been reprinted, and I distribute them to 75 people in several countries by email. I plan to continue writing Population Matters! which may be the only regularly published newspaper column in the world that focuses on human population issues.

Providing safe, legal and caring abortion services has been controversial, but one of my priorities. I know that many people oppose abortion; I honor their feelings. But I also appreciate that there are many, many who support access to abortion. Twice in the past week strangers have come up to me to thank me for being a doctor who performs abortions.

It has been just 35 years since I started working here—more than a third of a century. The time has come for new people to take the reins. I would like to introduce Dr. Brie Todd, who has just joined Four Corners OB-GYN. She is a perfect fit with the rest of the staff of the organization—compassionate, up-to-date and technically excellent. I will continue working a few days a month in the office. For pregnant women or those who need frequent visits, I am happy to turn their care over to Dr. Todd and the other physicians, nurse practitioners and physician assistant at Four Corners.

            On this day, Christmas, I would like to recall a very important birth that is celebrated by two billion people worldwide. Two thousand years ago childbirth was dangerous, especially in a stable. In many parts of the world it still is perilous. We can be thankful that we live here and now, and that the little boy who was born on this day, and his mother, both did well.

© Richard Grossman MD, 2011

Creative Commons Attribution 3.0 United States
This work is licensed under a Creative Commons Attribution 3.0 United States.