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Every year, women go marching off to their gynecologists for their annual pelvic exams... not because anyone wants to have the exam, which is after all a close-up look at the vagina and cervix. As a woman, I can tell you that it’s certainly intrusive as tests go, but for more than a half century, having "a pelvic" every year has been a cornerstone of a woman being responsible for her health. In late 2009, the American College of Obstetricians and Gynecologists (ACOG) announced that for healthy women, there is no reason to have an annual Pap test, and now some prominent gynecologists have posed the idea that this may be a good time to rethink the need for an annual pelvic exam as well. I find myself wondering, Is that really a good idea? It’s an important question that you (or the women in your life) need to give careful thought to.
Purpose of the Pelvic
Frankly, I am more than a little concerned about taking the "annual" out of the pelvic. Cervical screening in the form of the Pap test, began back in the 1940s as an annual test for cancer and abnormal cells that might lead to cancer. Gynecologists gradually began to supplement the Pap with a complete exam of the vaginal area.
Doctors supported the broadened exam because in addition to the cervical cancer screening, it allowed them to check for chlamydia and gonorrhea (common sexually transmitted bacterial diseases)... masses, including uterine fibroids... and possible early indications of ovarian cancer such as bloating and changes in bowel habits.
A Changed Field
The Pap has an impressive record -- cervical cancer rates have been reduced by 50% in the last 30 years. ACOG, however, has come to think that because cervical cancer is very slow-growing, having the test every few years gives sufficient time to detect it. The downside of the Pap -- and one motivating factor for ACOG’s change -- is that the test is associated with a significant number of false-positive results that lead to further examination via cervical excisions... and, in turn, cutting cervical tissue has caused a disturbing increase in premature deliveries among the women who have had these excisions.
I must admit that while all of that makes some sense to me, a 50% reduction in cervical cancer rates strikes me as huge. Mightn’t those false-positives -- currently estimated to be 1% to 10% -- be reduced in some other way, I wondered? I kept reading through the new guidelines, but a small nagging sense of doubt stayed with me.
The case that many gynecologists are making against annual pelvic exams goes beyond the false-positives. While no one disputes the fact that the exams do detect fibroids, a recent evaluation of data on pelvic exams published in the Journal of Women’s Health found that such information is generally not useful because detection before symptoms show up doesn’t affect treatment or outcome. The same article also reported that the pelvic exam does not help in the early detection of ovarian cancer. Again, I’m just not so sure. I know from friends who’ve had this terrible cancer that bloating, bleeding and back pain can each be signs of the disease -- yet women often attribute those symptoms to something else, something as innocent as normal menstrual changes or a strained back. Sometimes, it takes a doctor to add everything up. And in fact, the idea of fewer pelvic exams is unsettling for a fair number of doctors as well as for individuals like me.
My opposition to ACOG’s new guidelines becomes even firmer as they pertain to young women. According to ACOG, even sexually active young women who have no symptoms should wait until they are age 21 to have their first cervical cancer screenings compared to the previous recommendation of three years after first sexual intercourse or age 21, whichever occurs first.
The fact is that not all sexually transmitted diseases have symptoms that are obvious to laypeople -- let alone teenaged girls. I’m worried that by recommending against young women having these exams, medical reimbursement may be made more difficult to obtain and young women who do have problems will not feel comfortable making an important appointment that they need. Embarrassment is not the worst thing in the world. Colonoscopies are considered by many to be embarrassing, as are prostate exams. In my own estimation, embarrassment is something to deemphasize, and catching problems early is the place to make sure that significant emphasis remains.
So, my skepticism over fewer pelvic exams has turned into an opinion. And here it is: I feel quite strongly that fewer pelvic exams and fewer Pap smears would, on the whole, set back the cause of women’s health. To my mind, there are simply too many things that can go unrecognized and therefore untreated when a woman isn’t seen by, and doesn’t talk with, her doctor. If a woman notices symptoms, she will certainly make an appointment on her own. It’s those symptoms that go unnoticed that are the reason for concern.
Arthritis Abolished in Minutes by Doctor's Astonishing Speed Cure
People fly in from all over the world to visit the famed California clinic of Dr. Mark Stengler. His naturopathic speed cures are the stuff of medical legend -- sought after by film actors, sports stars and mega-millionaire CEOs. Legions of patients can attest to the power of this amazing new botanical "nano-cure." An NFL hero was stunned by its speed, as it eased his chronic hip pain in minutes! Better still, the relief "held" for days.
Read on...
Do-It-Yourself Stroke Rehab? Surprising Findings...
While many people survive strokes and manage to keep their own "selves" very much intact, for others the remnant physical or mental damage of the stroke goes on and on. Careers and relationships suffer when a formerly vibrant, independent person is transformed into one who is in need of assistance for everything from driving to dialing the phone to showering and dressing.
Since 1995, survival rates for stroke patients have been boosted by nearly 30% -- but, sadly, many of those patients have remained deeply impaired. They have trouble walking and they are at high risk for falls. Innovative therapies have been developed for physical therapy to aid in recovery. While helpful, much of this technology is expensive to develop, costly to purchase and must be administered by a trained specialist as part of a structured exercise program, putting it out of reach for many patients.
Now a study from Duke University has taken the results of patients doing intensive, center-based rehab with high-tech equipment and compared them with the results of people who work at home with a visiting physical therapist. The researchers also investigated whether rehab started long after a stroke -- as much as six months later -- still can be helpful.
Exciting, Unexpected Results
The study examined the progress of 408 stroke survivors, all of whom had their strokes either two months or six months earlier. Some of the patients who had suffered strokes six months previously were wait-listed to begin therapy at a center and so had not received any rehab. All of the patients were divided into three groups. Those who had strokes two months previously either underwent therapy in a center for high-tech rehab (group one)... or had home-based rehab with a therapist (group two), emphasizing progressive strength, balance and walking exercises. The third group of patients -- those who were wait-listed -- also started the high-tech program. Rehab for all groups took place in three weekly sessions over 12 weeks.
I spoke with the study author, Pamela Woods Duncan, PhD, PT, professor of physical therapy at Duke University School of Medicine. She explained that the goal of the study was to determine how well patients functioned one year after a stroke with different therapy protocols -- and that the research yielded two excellent findings:
First, while the researchers had anticipated that high-tech rehab would be more effective, much to their surprise that was not the case. "Using technology was not superior to working with patients at home in function, balance and walking exercises," Dr. Duncan said.
Furthermore, the study put to rest the belief that only early rehab works. The results were the same in all three groups including the late starters -- 52% of all patients showed significant improvement, walking well in the home and walking more in their communities.
On Your Own?
Stroke patients absolutely need rehabilitation and regular exercise, Dr. Duncan told me, but added that it would be a grave mistake to misinterpret these findings to mean that stroke patients can do well simply by exercising on their own at home. Stroke patients need careful cardiovascular monitoring and a trained therapist to design and conduct a program that is in keeping with their progress. Safety is an issue, especially early on in rehab when the risk of falling is high -- so using professional therapists, at least initially, is critical. That said, in-home therapy uses less expensive equipment (such as elastic bands), requires less training for therapists and needs fewer clinical staff members than in-patient care. And, physical therapy for stroke patients is not just a 12-week endeavor -- it must be a lifelong habit in order to keep the muscles strong and supple. Developing an at-home therapy plan that can be administered by family members can be cost-effective and also very helpful at maintaining and even continuing to improve the physical function of the patient.
Source(s):
Pamela Woods Duncan, PhD, PT, professor of physical therapy, Duke University School of Medicine, Durham, North Carolina.
Be well,
Carole Jackson
Bottom Line's Daily Health News
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