Delivering caring, personalized, quality healthcare to women in an environment that is supportive, education-focused and compassionate.

Women’s Surgery

Osteoporosis: “The most important factor is prevention”

May is Women’s Health Month, a great time to celebrate and promote stronger health and a perfect time to discuss the latest information about preventing and treating health challenges like osteoporosis.

More than 44 million American women experience the debilitating effects of the bone disease, and many women fear aching joints and brittle bones are an inevitable part of aging. It is important to know the risks, and engage opportunities to maintain optimum bone-health.

Dr. Lawrence R. Housman is an orthopaedic surgeon who specializes in musculoskeletal disease at Tucson Orthopaedic Institute. He sat down with us to discuss the best ways to prevent and treat osteoporosis.

osteoporosis, know your risksWhy are women at greater risk for osteoporosis?  

Women start with a lower bone density than men. They also lose bone mass more quickly as they age. Between ages 20-80, women will lose about 1/3 of her bone density compared to men who lose only 1/4 of their bone density in that time frame. Estrogen levels also affect bone density, and women lose bone mass more quickly in the years immediately following menopause than at any other time of their lives.

What can accentuate this risk?

Alcohol in moderation is not a risk factor, however more than four drinks per day results in a twice the risk of hip fracture. Steroids can also increase this risk. Long term use of steroids will double the risk of fracture in women.

It should be noted that proton pump inhibitors (e.g. Nexium/Protonix used for stomach disorders such as acid reflux) decrease the absorption of calcium from the stomach.

While increasing fiber, phylates (beans, wheat bran), oxalates (spinach, beet greens, rhubarb) and phosphorus (colas) can provide other health benefits they can also interfere with calcium metabolism.

What are the most effective means of preventing osteoporosis?

Regular exercise is one of the most effective means of preventing osteoporosis. Thirty minutes per day – walking is excellent, and Tai Chi reportedly decreases falls by 47 percent and hip fracture by 25 percent.

Nutrition is another import part of maintaining healthy bones. Fruits and vegetables are important. Women ages 19-50 should take in 1000 mg of calcium daily and women older than 50 should get 1200 mg per day.

Vitamin D is another vital nutrient the body needs to prevent osteoporosis. An individual can get their vitamin D through measured exposure to sunlight or through supplements. A diet with dairy, protein or calcium fortified foods (e.g. orange juice), fish (salmon/sardines) and yogurt (6 ounces has 300 mg of calcium) will go a long way in getting vitamin d to the bones.

What are the warning signs of the disease – and when is it time to see a doctor?

There are usually no warning signs before a fracture occurs; therefore, the most important factor is prevention.

A primary care provider (PCP) is the best person to monitor bone health. Most physicians recommend a DEXA (bone density test) after the age of 50.

The DEXA scan is the bone density test done most frequently and is predictive of fracture risk. The scan will also show whether you have normal bone density, osteopenia (bone is becoming weaker) or osteoporosis (bone is at high risk for fracture).

If a fracture occurs, then an orthopaedist would enter the picture to advise on treatment concerning the spine or extremity fracture.

If diagnosed with osteopenia or osteoporosis – what’s next?

With treatment patients can live normal, active and happy lives.

There are many types of medications that are now available – which work to reverse and then rebuild the bone loss. With treatment, the risk of a vertebral fracture drops from between 30-70 percent and the risk of a hip fracture drops by up to 40 percent.

Dr. Housman is an orthopaedic surgeon who practices at the Tucson Orthopaedic Institute. He earned a medical degree from the University of Alberta in Edmonton, Canada and completed an orthopaedic surgery residency at the Montreal General Hospital and McGill University. Dr. Housman is fellowship trained in several orthopaedic pursuits and is a past chief of staff at Tucson Medical Center. He has also served as president of the Western Orthopaedic Association and Arizona Orthopaedic Society.


Minimally-invasive, Robotic Procedure Allows Women to Get Back to Their Active Lifestyles

Childbirth is a beautiful thing, but it also can lead to a condition in which muscles supporting the pelvic region weaken, causing organs to slip from their normal position.

Over time, women could develop what’s known as pelvic relaxation syndrome, which can include a range of troublesome and painful symptoms.

Dr. Jeffrey Palen, an obstetrician and gynecologist, said women shouldn’t let embarrassment keep them from exploring options to restore function.

Pelvic relaxation can manifest itself in a number of different ways:

  • The bladder can descend into the vaginal area, which can lead to incontinence, including leakage that coincides with a sneeze, cough or laugh.
  • In some cases, the rectum can bulge up into the vagina, leading to severe constipation.
  • In other cases, the upper part of the vagina itself can sag into the vaginal canal, and in severe cases, can lead to protrusion of tissue mass from the vagina.

Women often don’t know there’s an effective and minimally-invasive surgery that can help put things back where they’re supposed to be, said Dr. Palen.

Traditionally, surgeons used to make a large incision in the abdomen to re-suspend the vagina to sacral tissue. It was an invasive procedure that required multiple days in the hospital.

Using a da Vinci “robot” that is able to translate the hand movements from a surgeon into smaller, more precise movements, surgeons can now correct the problems with just a few tiny incisions, even for women with complex cases.

The surgery takes about two hours. Women often stay overnight and go home the next day. While they’ll still have limitations on heavy lifting and strenuous exercise for six weeks, they’re usually feeling quite well within a matter of days, Dr. Palen said.

Recently, he saw a 68-year-old patient who came to see him who had been treating her symptoms through the use of a pessary, a donut-shaped piece of plastic which can non-surgically manage symptoms. Dr. Palen said it isn’t an ideal choice for many women, because of increased risk of pressure sores in the vagina and because it requires follow-up visits with a doctor every few months. The woman was relieved to find out there was an alternative, he said.

“I don’t think a lot of women know about the treatments that are available now and I don’t think enough physicians know about it either,” he said.

Dr. Palen chalked up the lack of information in part because many women are reluctant to tell their physician about their condition, because they find it embarrassing.

But leaving the conditions unchecked can impact their quality of life, he said. Fear of episodes of incontinence can lead to increased social isolation, he said. And for women with protrusions, it can make standing, walking and exercise difficult. Intercourse also can be painful.

“I hope women out there understand that doctors have heard it all and we’ve seen it all,” Dr. Palen said. “They just need to share what their problems are. These are things that often can be easily fixed, and once they’ve been functionally restored, they don’t have to live with these limitations on their lifestyle.”

Cindy Creed, the manager of patient care services in women’s surgery at TMC, said the new procedure allows women another alternative to one in which a large vaginal mesh is used for pelvic support. Some significant health problems have been reported with the procedure as the mesh eroded, causing pain and infection.

Dr. Palen agreed, noting this mesh is not only more refined and softer, but more importantly, there are no vaginal incisions, which could interrupt the blood supply to the vagina and weaken it.

“The da Vinci has really helped us address the problem in a different way and that’s been a great benefit,” Creed said.

Read more about urinary incontinence in women here

Unique Physician Partnership Demonstrates Benefits of Collaboration

“First and foremost, you have to treat the cancer and it has to be medically safe,” Dr. Roeder said. “But there are a number of ways you can do a good, safe operation. If you think about the aesthetics up front and it doesn’t change the safety of the operation, so much the better.”

Take a lumpectomy, for example. In many cases, radiation will be the preferred treatment following surgery.

It’s far easier to do reconstruction work on tissue that hasn’t been irradiated, given subsequent decreased blood flow and a possible tightening of the skin, the doctors noted.

If the patient would benefit from a breast reduction, the two can work together to simultaneously remove the cancerous tissue while doing the cosmetic work, rather than trying to do the work post-radiation. “For many patients, they end up with prettier breasts than when we started,” Dr. Eades said.

That’s not important to all women, he noted. But there are many who do place importance on aesthetics. “For some women, if a patient feels better about herself, it can really make a difference in her recovery,” Dr. Eades said.

The collaboration between Drs Eades and Roeder is an unusual one, but one that has huge benefits for the patient. Read more in this post from TMCAZNews.

Hello, It’s Nice to Meet You – Catherine Crawford RN

We are celebrating the 25th anniversary of the first women only surgical center in Southern Arizona – The Joel M. Childers Women’s Surgical Center. The center focuses on delivering gentle, specialized care for women undergoing surgery. Take a moment to meet Catherine, part of the dedicated staff caring for our community’s women. 

 Where are you from?
I was born in San Diego and moved to Tucson in 1969.

What do you love about Tucson?
I love the smell of the desert after the summer rains. The people in Tucson are so nice and even though it has grown it still has the feel of a small town.

When you’re not at work, what do you do for fun?
I love to sing. I am involved in my Church choir and I sing on the Praise Team. I also love to go biking with my husband and friends.  I am blessed with  wonderful peeps and enjoy going to dinner with them and our husbands on Friday nights. I love to travel and see my son perform professionally in Musical Theater Productions in New York and throughout the country.

What is the best aspect of your job?
I love working in women’s surgery. We work as a team and support each other in giving our patients safe care.  I feel it is such a priviledge to be a Nurse and to provide our patients with the care and respect they deserve.

What would you like women to know about the center?
When you are scheduled on our unit for surgery  all of the staff makes it a priority to give you safe care and to meet your needs. Our staff prides themselves in making each patient feel like they are the only patient we are caring for. It is the best place in Tucson to have any kind of women’s surgery.

I feel it is so important to educate women on the importance of getting yearly gynecological exams.  There is so much health information we can obtain from our gynecologists at our yearly appointments. I know there is some fear associated with these appointments because of the unknown but if we can educate women at a earlier age regarding what happens at these exams I know there are some diagnosis we can diagnose earlier and even some we can prevent.  Education is the key when it comes to Women’s Health Issues.