Wednesday, Oct 17, 2018

October Is Breast Cancer Awareness Month

October is
Breast Cancer Awareness Month

“The goal of breast cancer awareness campaigns is to raise the public’s knowledge of breast cancer: it’s detection, it’s treatment, and the need for a reliable, permanent cure.”

From the very first exam, I start discussing breast care awareness with my patients. The way I see it, breast cancer should be considered a curable disease. Much depends on the stage of the cancer (how far has it spread) at the time of diagnosis. Some important facts to know:

• 1 in 8 women will develop breast cancer in their lifetime. The longer we live, the more likely it is to occur. Young women tend to develop more aggressive breast cancers

• Breast Cancer is the most common cancer in women

• Most women (8 out of 10) who get breast cancer DO NOT have a family history of the disease. 5-10% of breast cancers can be traced to a gene mutation, such as BRCA 1&2

• 1% of breast cancers occur in men

• The biggest risk factor for developing breast cancer is being a woman. Women with dense breasts on mammogram have a 1.5-2.0 times higher risk of developing breast cancer than those with average breast density

• Women with more menstrual cycles (early menarche & late menopause) have a slightly higher incidence of breast cancer. Breast-feeding over 12 months slightly reduces the risk of developing breast cancer

• Exercise has been shown to reduce the risk of breast cancer. Obesity increases the risk. Smoking cessation reduces the risk of multiple cancers, including breast. Keep alcohol intake to a moderate level (1 glass/day) and maintain a healthy, plant-based diet low in animal products

I discuss the importance of “self-exam” from an early age. Know your breasts! We have moved away from trying to teach “how to do it, “ but rather emphasize the importance of being familiar with one’s own body, and encourage seeking evaluation if changes are noted. This can include a firm mass, signs of infection (e.g., redness and swelling), dimpling, a newly inverted nipple, etc. Rarely is pain a sign of breast cancer, especially if it is cyclic and occurs in both breasts. However a localized, persistent pain deserves investigation.

Ideally, breast cancer screening should be individualized. A comprehensive breast center (such as Hoag Hospital or Pacific Breast Center) will take a detailed history and update it yearly. From that information, a lifetime risk assessment of developing breast cancer can be obtained. Generally, if that risk is greater than 20%, additional imaging techniques will be recommended. I practice The American Cancer Society and The American College of OB/GYN recommendations and begin screening my patients at age 40 and continuing annually. This may begin earlier based on family history or other individual factors

Mammogram is the most important diagnostic tool for detecting breast cancer at an early stage. Tomosynthesis creates a three-dimensional image that allows for better detection, especially in a woman with dense breasts. Digital mammography allows the images to be manipulated/enhanced on a screen for better detail resolution. Mammograms are x-rays that do provide a small amount of radiation. The amount of radiation is roughly equivalent to flying from Los Angeles to New York, and getting mammograms has not been shown to increase the risk of breast cancer.

Ultrasound uses sound waves to image tissue. It is most helpful to determine whether a breast lump is solid or a fluid filled cyst.

MRI (magnetic resonance imaging) uses magnetic and radio waves to create a picture of the breast, which requires an injection of dye.

A breast Biopsy is the way to sample the tissue, look at it under a microscope, and determine whether cancer cells are present. It is the only way to make a definitive diagnosis.

Thermography is not a proven method to screen for breast cancer

Realistically, we are unlikely to decrease the incidence (occurrence) of breast cancer. Breast cancer is far and away the most common cancer I see in my patients, my neighborhood, and among my friends. The good news is that survival and cure rates are better than ever! Women have many choices with their treatment plans, and the majority will go on to live robust, healthy, wonderful lives.

Monday, Sep 24, 2018

When Should a Girl / Women See a Gynecologist?

As my own daughter turns 16, I am often asked this question by friends, patients, and neighbors, “When should I bring my daughter in to see you?” We have also recently been devastated by the abuses performed by the US women’s gymnastics team physician, Larry Nasser and the USC Student Health Gynecologist, George Tyndall. A visit to the gynecologist should provide relief, comfort and cure. It should never be a time of abuse.

My hope is to provide a basis of understanding of what my profession can help with, and to empower all young women to take ownership of their health and wellness.

When I was growing up, my friends and I all “knew” that we would go to a gynecologist when we were around 18 to start having yearly internal exams and pap smears. Times and knowledge have changed since then, and currently I recommend the first visit under the following circumstances:

• Delayed onset of Puberty

• Difficulty with the Menstrual Cycle: irregular, painful, or heavy flow

• Considering becoming sexually active / Dating/ Has a boyfriend

 • New symptoms of itching, burning, abnormal discharge, frequent & painful urination

• Before graduation from high-school and going off to college

 The first visit no longer necessarily includes a physical exam. Often I will meet the patient, review their history with their family member present, discuss any concerns the patient and mother/family member have and review several important points:

1.) The Doctor/Patient relationship has binding confidentiality. Under no circumstances will our office disclose/discuss private health information with anyone else without the patient’s permission (with the exception of those items that fall under mandatory reporting) The patient should feel comfortable at all times and should feel empowered to express any concerns or decline any aspect of an exam.

2.) The patient should have a sense of trust and has the right to request a chaperone at all times. The patient should feel comfortable at all times and should feel empowered to express any concerns or decline any aspect of an exam. A male provider should always have a chaperone present.

3.) The goal is to treat, educate and improve one’s quality of life.

At this point, I will ask the family member to leave and interview the patient privately. My experience is that I will often learn information that is not readily shared when a family member is present, and it is critical to provide appropriate care.

I usually will have the patient seated in a chair as I show her how the exam table works, what stirrups look like, explain the speculum, the pap smear, culture tubes, etc. I spend the remainder of the visit addressing any individual problems and discussing the many ways I can assist with their future health-care needs.

REPRODUCTIVE CARE

This includes pregnancy prevention: oral contraceptive pills, IUDS (intrauterine devices), implants (Nexplanon), injections (Depot Provera), barrier methods (condoms), and permanent sterilization (vasectomy & tubal) as well as pre-conception counseling and infertility evaluation.

OBSTETRICAL CARE

From conception through pregnancy, delivery and postpartum, we evaluate and manage the well-being of the fetus and mother.

INFECTIOUS DISEASES

This encompasses a variety of disorders including yeast and bacterial vaginitis, urinary tract infections, and sexually transmitted bacteria, parasites, and viruses (the most common being chlamydia, herpes I & II, and HPV). Education on prevention is extremely important, including promotion of the HPV vaccine called Guardisil 9 to prevent cervical and oral cancers.

CANCER SCREENING

Early detection often means cure. The yearly gynecological exam includes screening for breast, ovarian, uterine, cervical and vulvar cancers. We also often detect skin cancers and enlarged lymph nodes or thyroid glands. I streamline my recommendation for mammogram based on the patient’s family and personal history, but in general I order a baseline at age 35, then annually at age 40.

MENSTRUAL CYCLE

From the onset during puberty to the absence after menopause, a gynecologist can help treat painful cramps, heavy bleeding, irregular flow, fibroids, endometriosis, and polyps. This includes education and understanding of a women’s anatomy and physiology to allow the patient to make the best choices to manage her individual cycle.

HORMONE MANAGEMENT

Many disorders fall under this category including polycystic ovarian syndrome (PCOS), low production of estrogen due to eating disorders or excessive exercise, and increased production of prolactin. As hormones vary throughout the cycle, premenstrual syndrome (PMS) or menstrual migraines can affect one’s well-being. As a women heads towards menopause, lack of hormone production can bring on hot-flashes, night sweats, mood disturbances, and painful intercourse.

GENERAL HEALTH

Much of the yearly exam includes discussion of healthy life-style choices including ways to avoid diseases and common causes of morbidity and mortality. This includes regular exercise and activity, healthy eating habits, safe alcohol consumption, smoking cessation, accident prevention (wear seat-belts and helmets), healthy sleep-habits,  and stress-reduction. I emphasize the buddy system, rape prevention, and safe-sex practices. We recommend routine cancer and disease screening through blood tests and other studies. Often we are on the front line of diagnosing anxiety, depression, and other mental health issues. We make many referrals for appropriate treatments.

In Summary

Clearly, this is intended to give a general overview of the items an OB/GYN can assist a woman with throughout her lifetime. It is a privilege and a partnership. A women’s healthcare should be individualized to meet her needs, answer her questions, and provide her with the tools to make the best decisions she can to keep herself strong, vibrant and living her best life.

The current generation of young women I see today are bright, strong and confident. The internet allows access to information and provides accountability. I believe with the right resources, this group of young women will be stronger and healthier than ever!

Tuesday, May 10, 2016

Welcome Christina McEligot, Nurse Practitioner

Christina We are so happy to welcome Christina McEligot, Nurse Practitioner, to our practice! Christina is a native of Orange County, Christina loves working close to home. She joins our practice after a 16 year medical career in the hospital and private practice setting. Christina is married, mother of four young children (11, 8, 4, and 1), and a board certified women’s health Nurse Practitioner. Christina graduated with honors from the top-ranked University of Cincinnati’s women’s health nurse practitioner program. Throughout her career Christina has focused on women’s health issues; with a particular interest in obstetrics and complex gynecological issues. She sees patients across the continuum, and is well versed in the latest trends in women’s healthcare. In her free time Christina enjoys working out, traveling, and doing outdoor activities with her family. Her idea of a perfect day is a relaxing spa day at Pelican Hill, or sitting on the beach in Coronado with her family.

Christina will be in office Monday, Wednesday, and Friday’s.

Tuesday, Dec 01, 2015

Giving Tuesday

It’s Giving Tuesday! This holiday season don’t forget to give from your heart —

Dr.’s Kroll and Vanblaricom with Mother and Daughter Group — Bringing holiday cheer to CHOC Hospital Lobby.

Have a great holiday season!

#CHOC #GivingTuesday #NewportCenterWomensHealth

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Friday, Oct 30, 2015

Breast Cancer Awareness Month

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October has been Breast Cancer Awareness Month- We see football players wearing pink sleeves, soccer players in pink socks, pink ribbons and candy, even pink pumpkins! But I want to take a moment to address this disease, which is the most common cancer to affect my patients.

•1 out of 8 women in Orange County will develop breast cancer in their lifetime

•Cases of breast cancer in younger women is rising

•Family history accounts for LESS than 10% of all breast cancers

•1% of all breast cancer occurs in men

•There are multiple forms of breast cancer

•The earlier the diagnosis is made the earlier the stage and the greater chance of cure

•Breast cancer is a curable disease

With those facts in mind, I would like to give you my perspective. I have been in private practice for 17 years in Newport Beach. I have diagnosed breast cancer during clinical exams, including during a six week post partum visit. I have screened patients for the BRCA gene (same mutation Angelia Jolie has) and have diagnosed half a dozen patients who have then gone on to have life preserving surgery. I have ordered thousands of mammograms, ultrasounds, and MRI’s which have led to the diagnosis of breast cancer in hundreds of patients, many under the age of 45. I have not had a single patient die of breast cancer.

I am a grateful for my colleagues in radiology, oncology, and breast surgery, who continue to strive for best ways to care for these patients. I believe a comprehensive breast center, such as Pacific Breast Care or Hoag Breast Center provides the complement of services and counseling to best serve my patients in a compassionate and timely manner.

I continue to advocate the guidelines supported by the American College of OBGYN: Women should start screening mammograms at age 40 or sooner based on their history. Personal risk assessments should be provided to ensure adequate imaging, including ultrasound or MRI, as in the case of dense breasts.

I am disappointed in the manner in which the Preventative Task Force and the American Cancer Society announced their new guidelines to the press, recommending mammograms at age 50 and 45 respectively. With this, they have added confusion, promoted loss of funding for these services, and most importantly they have failed to emphasize their recommendations based on a cost/benefit analysis.

I am offended that they cite increased anxiety due to unnecessary biopsies as a reason to put off screening mammograms until later. Moreover, as a woman, I would be more anxious knowing that no screening tests were being done.

In sum, Breast Cancer is a common, prevalent, and curable disease. I encourage my patients to advocate for their own healthcare. Each individual in my practice is valuable and maintaining their optimal health is my priority.

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Wednesday, Aug 05, 2015

New Health Rules At 30, 40, 50, 60 – More Magazine

Yes, physicians read the same magazines you do … and often I find myself “double-checking” the medical advice offered.
I must admit, in this day and age of internet searches and easy access to expert information, there are many excellent heath writers. And sometimes the information provided is in such a simple, succinct format… I think it would be helpful to share.

Here is a simple synopsis from MORE Magazine, May 2015 Vol 18 No.4 p.103-107.

New Health Rules at 30, 40, 50, 60

I do still order baseline mammograms at 35, but my take home message:
Eat more almonds and of course reduce stress; whether chatting with a friend, hugging a child, or watching a sunset.

Enjoy!
Dr. Gigi Kroll

Tuesday, Jul 14, 2015

Both Sides of the Bedside: Book Review

I just finished reading “Both Sides of the Bedside” by Christine Magnus Moore, RN, BSN. I am so proud to know this amazing woman and I am motivated by her strength, faith, and compassionate journey with cancer.

We will all face it: individually, with a family member, friend, co-worker, or neighbor. Maybe it hasn’t touched your life yet but it will.
Cancer is the rally-cry in medical circles. We want to prevent it, catch it early, and eradicate it. We “Race for the Cure” and we “Walk for Life,” yet too often we do not know what to say or how to help.

Christine’s honest look at the human journey will speak to you, whether a patient, a survivor, or a support person. Her perspective reminds us of the value a kind word can bring. She has taken one of life’s greatest trials and has triumphed by using her words and wisdom to encourage and connect. Truly, this is the human journey and we are on it together.

I encourage you to read this great book.
Thank you Christine!

Dr. Gigi Kroll, MD

bothsidesofbedsideFRONT

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www.bothsidesofthebedside.com
Purchase Book on Amazon:
http://bit.ly/bothsidesofthebedside
Facebook:
https://www.facebook.com/BothSidesOfTheBedside

Tuesday, May 19, 2015

You Know You Are Pregnant When…

Check out this comical wise new read from Kate Casey. A hands-on mother of three, with a fourth baby on the way.

Having been pregnant three times myself and taking care of thousands of pregnant women – these words of humor and wisdom ring true.

I think this would be a great read for any pregnant mom to-be. It is nice to realize we are not alone!

KateC

You go to Costco for a new refrigerator but leave with two pizzas.
-Danielle D., Ventura, CA
You hug the toliet more than you hug your husband.
-Samantha S., Laguna Niguel, CA
You get to pee, and you already did.
-Erica M., Stow, MA
You start checking out strollers on the street like you used to check out hot guys.
-Braunwyn B., Miami, FL
You are walking down the street and can smell the perfume of people in their cars driving by.
-Megan J., Middlebury, VT
You save your best outfit/undies for OB appointment day.
-Natalie G., New York, NY
You show up for a 6:00am workout with evidence of the powdered donuts you just shoveled in your face.
-Christine B. Palmyra, PA
You need a nap to prep for bedtime.
-Gwen G., Grosse Pointe, MI
You want to physically assault the person that asked if you were having triplets.
-Kelsey W., Newport Coast, CA

BookS

Here is a link to her awesome website!
Love and Knuckles

Friday, May 08, 2015

Charlie’s Story

Dear Patients and Friends,

It is with great humility and awe that we share with you the featured speech and video from the CHOC Glass Slipper Guild Gala held May 2nd, 2015. Jackie Hart touched our lives; during her pregnancy, delivery, and postpartum course with Charlie. Please read on to be inspired by a mothers love, a caring family, a team of medical professionals, and CHOC. As obstetricians, we are so grateful to have a hospital that can help our babies not only survive, but thrive.

Thank you Jackie, “This is our Fight Song.”

Drs Kroll and Vanblaricom

Charlie’s Story- An Overview:

It is such an honor to be standing up here tonight. It is so very humbling to be asked to speak on behalf of the many families that are served every year from our amazing hospital, with stories big and small, knowing ours is just a very small piece of the puzzle.
Our family is forever indebted to CHOC. Our relationship began in 2008 when we were blissfully preparing to welcome our first son into the world.
It was a beautiful Sunday in early June, and for some reason, I had this funny feeling that something just wasn’t right. After a quick call to my doctor, Dr. Kroll, who is here tonight, she advised me to pop in to Labor and Delivery at Hoag, to make sure all was ok.
I was three weeks from my due date, and while the initial exam turned out ok, an ultrasound discovered that I had zero amniotic fluid in my uterus. A small membrane had grown at the bottom of the baby’s bladder and trapped all of the amniotic fluid inside the baby’s belly. I was told that we would be induced and quickly called our family to tell them to head to the hospital; the baby was coming! But I had no idea the severity of this and the affect this condition would have on our baby.
Once the neonatologist walked in the room I quickly understood the gravity of our situation. The pressure of the fluid trapped in the baby’s belly was doing major damage to his bladder, valves, ureters and kidneys. And since my kidneys were doing the work for the baby in utero, he was surviving. But once born, they were unsure if they would be able to function on his own.
In addition, the amniotic fluid was no longer cycling through the baby’s lungs, and without that constant flow, we were to prepare for the very real fact that his lungs may not function properly once born. We needed to get him out immediately and begin medical intervention, and the doctors made it very clear that we were to prepare ourselves for the possibility that, despite all of their efforts, they could not guarantee that our baby would survive.
On June 23, 2008, Charles Ryan Hart was welcomed into the world. He was a beautiful baby, yet his birth was quite a blur. Luckily we were in great hands of OBGYN, Dr VanBlaricom, along with an army of NICU professionals from HOAG hospital. Once little Charlie arrived, there was quite a bit of action. It took some time to get him breathing, and after a quick kiss, he was whisked away for his first round of emergency medical care. It was overwhelming to have just delivered your first child, and to suddenly find yourself in an empty room, wondering whether or not your baby would survive.
After 24 hours, we overcame obstacle number one. His lungs were functioning, though he was very sick. He was diagnosed with Grade V hydronephsrosis and posterior urethral valves. He had a big fight ahead of him. It was time to put him in the care of the Big Leagues. It was time to go to CHOC.
When we arrived, it was other worldly. The NICU was abuzz with doctors, and nurses, machines, beeps, buzzers, and so many babies being cared for so diligently and efficiently. And that’s when we met Dr. Khoury, chief of Pediatric Urology . Up until then, we had heard every worse case scenario situation. Possible dialysis. Valve replacement surgeries. Synthetic Ureters, Transplants by age 2. But when Dr. Khoury sat with us, and looked us in the eye, we suddenly felt like there was a good possibility things could actually turn out to be ok.
Our time there was a complete roller coaster. One minute you are celebrating small victories, the next you are down on your knees praying harder than you’ve ever prayed in your life. We had so many up and down moments in the hospital, including Charlie’s emergency surgery at 4 days old.
The day before he drank from a bottle for the first time. Things were starting to look up. However, that night, there was a problem. The nurse explained that during his middle of the night bottle, Charlie vomited, aspirated, and could not get the fluid down. He wasn’t making the progress they had hoped. The doctors decided they need to intervene and he would be going into emergency surgery that morning because, despite all of the ultrasounds and radiology tests, they needed to go in and see the condition of their insides for themselves.
They gave us several possibly scenarios and outcomes, explained the risks, and then we watched them wheel him away. It was overwhelming to completely surrender and relinquish control, and handover a piece of your heart to these doctors and nurses and hope they would work miracles. Yet somehow, you knew they would do everything they could. I remember praying that morning, “just let him live. Just let him live. I can handle ANYTHING if you just let him live”.
It turns out Charlie’s surgery was the best case scenario. Once they were in they were able to perform the least invasive procedure. A few hours later, out he came to recover. And from that moment things started slowly looking up.
Though his insides were still damaged, two weeks later, Charlie was deemed stable enough to go home. He started as an outpatient a few days a week. Then it became weekly, then monthly.
Charlie has continued to grow strong despite kidneys that functions at ten and seventy percent. At age three, he revisited CHOC for a weeklong stay due to a severe blood infection related to his condition. To present, he continues to visits CHOC regularly for bloodwork, ultrasounds, and the occasional radiology testing. He will be monitored into adulthood, to make sure his kidney function can keep up with his growing body. And when he becomes a full grown, healthy adult, we may able to take our final deep breath and sigh of relief. But until then, we will depend on CHOC to take care of our son.
I am so appreciative to Dr Khoury for his unrelenting, care. He will forever be one of my most favorite people on the planet, and he knows he is our true guardian angel.
Today Charlie is a happy, thriving six year old who loves his family, friends, football and baseball. He is a proud big brother to three year old Will and nine month old Ben. And is the best son we could ever ask for.
CHOC is a teaching hospital. Every time we have ever gone Dr. Khoury is there training and teaching up and coming doctors, and pulls up Charlie’s films. If you could see the difference in what his insides looked like at four days old until now you would be amazed. And he has said numerous times that had it been a couple of decades ago, Charlie would not have lived past age two. That’s unbelievable.
And that is why it is so important to support our hospital so we can continue to improve, research, and keep it cutting edge to maintain the caliber of doctors and facilities that will make it the BEST. If the last twenty years saved my child’s life, imagine what the next twenty can do.
Since Charlie has been born, I have friends in and out of CHOC for small to large reasons. My dear next door neighbor had open heart surgery at just two years old. A coworker’s daughter has been Leukemia free for two years after receiving treatment at just one years old. And a dear friend who is with me tonight will be undergoing surgery for her five year old son this upcoming August.
Whether it be your grandchild, your child, a friend, a baby that has not yet come. These are the children that we love. They are our world. And we are their quarterbacks. I know you would do anything for them. My prayer is that you will all be lucky enough to never step inside of CHOC in your life. But life happens. So let’s give our children health. Let’s give them the care they deserve. The best care possible. This Guild has worked tremendously hard to reach our million dollar pledge. Let’s meet it tonight. And then some. Because where would we be without CHOC? And where would we be without our children?
On behalf of all of the children at CHOC, we wish you all happiness and good health and thank you for supporting our children.

Thursday, Oct 17, 2013

Focus on Breast Health

It’s October, and we’re talking breast health.  So what exactly does that include?  It’s about knowing your breast cancer risk based on family history; having regular screenings; knowing what’s normal for you/seeing your doctor if you notice any changes, and finally, making healthy lifestyle choices.

Below are some smart guidelines from the Susan G Komen Foundation.

1. Know your risk

• Talk to both sides of your family to learn about your family health history

• Talk to your health care provider about your personal risk of breast cancer

2. Get screened

• Talk with your health care provider about which screening tests are right for you if you are at a higher risk

• Have a mammogram every year starting at age 40 if you are at average risk

• Have a clinical breast exam at least every three years starting at age 20 & every year starting at age 40

• Sign up for your screening reminder at komen.org/reminder

3. Know what’s normal for you and see your health care provider if you notice any of these breast changes:

• Lump, hard knot or thickening inside the breast or underarm area

• Swelling, warmth, redness or darkening of the breast

• Change in the size or shape of the breast

• Dimpling or puckering of the skin

• Itchy, scaly sore or rash on the nipple

• Pulling in of your nipple or other parts of the breast

• Nipple discharge that starts suddenly

• New pain in one spot that doesn’t go away

4. Make healthy lifestyle choices

• Maintain a healthy weight

• Add exercise into your routine

• Limit alcohol intake

• Breastfeed, if you can

And one more recommendation that we thoroughly believe in: go for a mammogram with a friend.   Meet for coffee, make it a date and most importantly, get it done.  Pictured above is us doing just that last week, with our breast care team.

Wishing you great health and a happy fall.

Warmest,

Dr. Amy Van Blaricom and Dr. Gigi Kroll