Preview Newsletter
Ethicon 7/19
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Edwards v. Ethicon Set in WV for August
Jul 18, 2016 | Mesh Medical Device News Desk
Ms. Edwards was implanted at Piedmont Healthcare, Atlanta, GA with a TVT-O by Dr. Harold Wittcoff. -
Ramirez v. Ethicon Pelvic Mesh Trial – Justice Delayed, Justice Denied
Jul 19, 2016 | Mesh Medical Device News Desk
Will number five be the charm for Jennifer Ramirez? The case of the San Antonio, Texas woman and her case against Dr. Cesar Reyes and Ethicon (Johnson & Johnson) has been continued four times. -
Millions of Women Are Injured During Childbirth. Why Aren't Doctors Diagnosing Them?
Jul 18, 2016 | Cosmopolitan
By Laura Beil
When Jennifer had her second child in 2005, she knew within days that something worrisome had happened to her body. For the first time in her life, she couldn't make it to the toilet. -
Doctors discuss risks of untreated female pelvic condition
Jul 18, 2016 | Lubbock Avalanche-Journal
By Ellysa Gonzalez
Many women experience pelvic injuries during birth but few ever actually report it.
Client Attorney Privileged/Attorney Work Product/At Request of Counsel
Online Sources
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Edwards v. Ethicon Set in WV for August
Jul 18, 2016 | Mesh Medical Device News Desk
Ms. Edwards was implanted at Piedmont Healthcare, Atlanta, GA with a TVT-O by Dr. Harold Wittcoff.
Court documents show Ethicon attorneys, want to exclude the expert opinion of Dr. John T. Steege, who would testify TVT-O was defective and caused her present day pain.EDWARDS V ETHICON, (Case No.), Friday, August 12 is jury selection. Trial commences Monday, August 15, 2016, 8:30 a.m. Pretrial conference July 21, 2016 to explore any final options such as settlement.
The defendant corporation is Ethicon, a division of Johnson & Johnson, the manufacturer facing the largest number of mesh cases (33,874 as of today) consolidated in this federal court among seven manufacturers. Ms T. Edwards of Georgia, and her husband are the plaintiffs.
This is the fifth delay for this trial. Attorneys are Mark Mueller, John Fabry, Breanne Vandermeer for Ms. Edwards and Christy Jones and Dave Thomas for Ethicon.
The Counts include Negligence, Strict Liability-Manufacturing Defect; Failure to Warn; Defective Product; Design defect; Fraud and fraudulent concealment, Negligence, Breach of express warranty, violation of consumer protection laws, gross negligence, unjust enrichment, loss of consortium and punitive damages.
A defense experts include Dr. Elizabeth Kavaler, previously seen in the Gross trial as well as Dr. Stanley Zaslau.
The case was filed December 31, 2012.
This trial is limited to six days writes Judge Goodwin in a June 12, 2015 order.
Edwards v. Ethicon, see the Complaint here.
BackgroundThe TVT-O has already been found to be defective in this same courtroom before Judge Joseph Goodwin in the Huskey v. Ethicon trial. See the background story here. Also in the Linda Batiste case in Dallas in April 2014, the jury concluded the TVT-O made by Ethicon was defective and awarded Ms. Batiste $1.2 million. See the story here.
Meanwhile, Waves of cases will be heard in groups and are currently on a pre-trial schedule heading for trial in Charleston federal court.
There is no trial date yet set for MULLINS V. JOHNSON & JOHNSON/ ETHICON , (Case No.2:12-CV-02952) in Charleston, WV.Even though the pretrial was supposed to be completed June 30, 2016, the case is continuing with pretrial filings, several every day of July so far.
This is a trial of 37 plaintiffs appearing at one time before Judge Goodwin in Charleston, WV. All of the plaintiffs had been implanted with Johnson & Johnson’s TVT (tension-free vaginal tape) and all are from West Virginia. Even though different implanting doctors are involved, the injuries are similar enough to consolidate them into one case before Judge Goodwin in this multidistrict litigation (MDL).
Pre-Trial is Not Concluded
Also filed on this day, a Notice of Deposition for Dr. Vladimir Iakolvev. He is the Doctor from Toronto, Canada who was present in the Boston Scientific trial of Egnayhem and three other defendants.
Dr. Vladimir Iakovlev, is a Pathologist and the Director of Cytotechnology at St. Michael’s Hospital in Toronto. The anatomic pathologist looks at biomarkers and conducts pathological evaluations of explanted transvaginal mesh, among other materials.
They also filed a notice to cancel the deposition of Ronald L. Rink of Pittsburgh, concerning the destruction of documents by J&J.
Dr. Bruce Rosenzweig
July 20 2016, the deposition of Bruce A. Rosenzweig will take place in Chicago.
The deposition of Dr. Donald Ostergard will take place July 22, 2016 in Denver, Colorado.
Medical Exams
July 20, one of the Mullins Plaintiffs will have to under a medical exam by Dr. Catherine Matthews at Wake Forest Baptist Health in Greensboro, NC.
On that same date another plaintiff must submit to a medical examination conducted by Dr. Joseph Carbone in Danville, VA. Another plaintiff in the group submitted to a medical exam July 13th 2016 conducted byDr. Kimberly Kenton, in Lake Forest, Illinois. These doctors will conduct the exams on behalf of Ethicon/ Johnson & Johnson.
The deposition of Dr. Janet Tomezsko will take place in Evanston, Illinois July 19th 2016 to be conducted by Fidelma Fitzpatrick of Motley Rice.
Dr. Harry Johnson was deposed relating to six plaintiffs in Mullins on July 13, 14 and 15 in Baltimore MD as filed by Aimee Wagstaff.
On July 13th, the defendant filed an objection to taking the deposition of Dr. Catherine Matthews. The Defendant objected to providing work that had been compensated by the defendant or expert fees charged. Dr. Joseph Carbone, MD will be deposed on July 22 in Danville VA pertaining to two plaintiffs in the Mullins case, submitted by Jeffrey Kuntz of Wagstaff & Cartmell.
The deposition of Dr. Stanley Zaslau took place July 14th in Morgantown, WV.
Risk Benefit or Safer Alternative Design
Much of the last minute wrangling has to do with the question- How must a Plaintiff Prove defective Design. Does she need to show a safer design existed?
In the latest filing today, July 18, Ethicon asks Judge Goodwin to reconsider its ruling that Plaintiffs are not required to present evidence that a proposed safer alternative design would have reduced specific injuries or, alternatively, Ethicon asks the Court to certify the issue to theWest Virginia Supreme Court. If granted, the move would further delay setting of a trial date in the Mullins case.
In the plaintiffs’ opposition to the above, Bryan Aylstock and Thomas Cartmell write on July 11th, that the bottom line is that a product constitute a defective design when its risks outweigh its benefits. Design defect can be established by this risk-benefit analysis and does not need to rely on the existence of an alternative design. See Doc #903. It has already been established ad nauseam, says their motion filed July 11, 2016.
You might recall, in other pelvic mesh trials we’ve seen the debate between laser cut versus mechanically cut mesh, the laser presumably being superior to the other because the serrated edges are smoothed in the heating process. If that is what the state requires, that is what Plaintiffs’ attorneys must argue, even though they ultimately may believe the design of pelvic mesh and the material are the problems for which there is no safer design or material.
Mullins complaint, July 11, 2012, U.S. District Court, Southern District WV. Background story on MND here.
This case will combine the efforts of at least a half dozen plaintiffs firms and promises to be a huge case when and if it ever makes it to court. Already deposed are Dr. Dionysios Veronikis, M.D. and Dr. Jerry G. Blaivas, M.D. on July 7th in New York City, related to two plaintiffs.
In a filing June 27, 2016, plaintiffs ask to amend the original complaint and include the spoliation issue to case which is recognized under West Virginia law to be a stand-alone issue.
J&J purportedly destroyed hundreds of thousands of documents that were related to mesh litigation before any trials were heard. Plaintiffs have since determined that more instances of purported spoliation have occurred since it was first revealed. See PTO#100 Doc #1069 Feb. 4, 2014 on spoliation.
See the background story on Mesh News Desk here and here. ##
http://www.meshmedicaldevicenewsdesk.com/edwards-v-ethicon-set-wv-august/
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Ramirez v. Ethicon Pelvic Mesh Trial – Justice Delayed, Justice Denied
Jul 19, 2016 | Mesh Medical Device News Desk
Will number five be the charm for Jennifer Ramirez? The case of the San Antonio, Texas woman and her case against Dr. Cesar Reyes and Ethicon (Johnson & Johnson) has been continued four times.
Now it is on the docket for trial finally August 8, 2016 before Judge Karen H. Pozza in San Antonio Texas.
But MND has been informed it may be continued again. As of this writing it is still on the docket. Stay tuned.
Ramirez v Cesar Reyes/ J&J/ Ethicon Case No. 2012-ci-18690, filed in the 407th Civil District Court in San Antonio, Texas.
Jennifer Ramirez was 28 years-old when she was implanted with a TVT-O Sept 17, 2010 to treat stress urinary incontinence (SUI). The TVT-O (obturator) has already been found to be defectively designed in another Texas court (Batiste v. Ethicon) and in a trial in West Virginia (Huskey v. Ethicon).
She experiences ongoing pain and some mesh remains after she had an explant surgery in December 2010, according to court documents.
Is Five the Charm?
The Ramirez v. Ethicon case was supposed to start November 2014, then January 2015, then reset to July 13, 2015, then again April 27, 2016 when there was some talk of a settlement which disrupted that trial date.
Ramirez is suing her doctor Cesar Reyes MD as well as Johnson & Johnson and Ethicon. He is an obstetrician and gynecologist from San Antonio. See his reviews here.
On August 6, 2015, Judge Joseph Goodwin had to decide whether federal court had jurisdiction over this dispute. He remanded the Ramirez case (WV federal case number 2:15-cv-09131) back to state court denying J&J’s Motion to Stay as moot. Ethicon wanted it to remain in the Southern District of WV. Here is that document.
There’s been a great deal of back and forth between Texas and West Virginia over this case.
Ethicon removed to the District Court for the Western District of Texas June 8, 2015, asserting the state had the original subject matter jurisdiction. On June 9th, the plaintiff moved to remand the case to the state court. On the same day Ethicon moved to stay all proceedings in the Texas federal court. On July 1, 2015, the case was transferred into MDL 2327 to federal court in West Virginia.
The case then was remanded back to San Antonio, to the 437th Judicial District Court of Bexar Co. on August 7, 2015.
Attorneys for Ramirez are Matthews and Associates, Edwards de la Cerda, Freese and Goss.Today it’s on the docket in the 407th Civil District Court before the Honorable Judge Karen H. Pozza. Location 407th Civil District Court, 100 Dolorosa, 4th Floor
San Antonio, TX 78205August 8, 2016, 8:30 amThe court does not file documents electronically but you can see what’s been filed here.
There are currently 33,874 cases filed against Ethicon / J&J in the Southern District of WVand thousands others filed in state courts around the country as well as internationally. This fall there will be numerous trials underway naming J&J /Ethicon as the defendant corporation after a break in any trials naming this defendant. ##
http://www.meshmedicaldevicenewsdesk.com/12163-2/
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Millions of Women Are Injured During Childbirth. Why Aren't Doctors Diagnosing Them?
Jul 18, 2016 | Cosmopolitan
By Laura Beil
When Jennifer had her second child in 2005, she knew within days that something worrisome had happened to her body. For the first time in her life, she couldn't make it to the toilet. She peed without warning. She took her 2-week-old to the grocery store down the block and had to waddle home with poop in her pants. Nonetheless, at her six-week checkup, her doctor told her everything looked great — that she had torn during birth, but the tissue had healed.
She didn't object. "I don't even know, when I look back, why I didn't just say, 'No. Everything's not great,'" she says. "I internalized it."
At 34 years old, she didn't want to give up running, her favorite sport. And she didn't have any pain — in fact, she hardly had any feeling in her vagina at all. So she laced up and started training again around her Marin County, California, home, carrying a plastic bag with baby wipes and a change of clothes to clean herself up after every run. She stopped carpooling to races, embarrassed by how she smelled on the way home, and stopped hanging out with her teammates. Her fear of leaking got so bad that she couldn't leave her house without pads and underwear stashed in her purse. She says her incontinence probably played a role in her decision not to return to her job as a management consultant.
Feeling like she was somehow responsible, like she wouldn't be in this shape if she had only done enough Kegels (a vaginal strengthening exercise) after her son was born, she did not return for her next annual checkup, or the one after that, or the next one. When a close friend's health scare finally pushed Jennifer (who preferred to be identified by her first name only) to go in for an appointment, the doctor concluded that her pelvic floor muscles were so damaged from childbirth that they were practically useless. By then, she'd been suffering for eight postpartum years.
Childbirth is one of nature's most wondrous but biologically brutal feats. For nine months, a woman's muscles and bones bear the increasing weight of a baby that isn't even slightly ergonomically positioned. During a vaginal birth, muscles and other tissues stretch and often tear as something the size of a cantaloupe is forced through an opening that is normally about the size of a carrot. Sometimes, pelvic bones crack under the duress. At the beginning of the last century, as many as 9 in 1,000 American women did not survive the process. And according to a recent spate of studies, a disturbing number of women like Jennifer still quietly endure incontinence, painful sex, back aches, and crippling pelvic pain for years after giving birth because of undiagnosed and untreated childbirth injuries.
One study of more than 1,200 women published January 2015 in the British Journal of Obstetrics and Gynaecologyreported that 24 percent of women were still experiencing pain during sex a year and half after having a baby. Another study published last June in the journal PLoS One found that 77 percent of more than 1,500 mothers studied had persistent back pain a year after having their babies, and 49 percent had urinary incontinence. ("We did not expect it to be that many women," says Angela Vinturache, MD, PhD, one of the study's authors.) These problems aren't just results of vaginal births; a 2014 study of 1,115 mothers — about half who had cesarean sections, half who had vaginal births — found similar degrees of continuing pelvic pain regardless of how their baby was delivered. Last August, researchers from the University of Michigan likened childbirth to running a marathon — only before a marathon, you train — after giving 68 women MRIs seven weeks after birth. The MRIs showed that 29 percent of them had evidence of fractures they never even knew they had in their pubic bones, while 41 percent had undiagnosed tears in their pelvic floor muscles, which wrap around the vagina and anus. Childbirth is a well-studied traumatic experience for women's bodies, yet modern medicine still leaves far too many mothers debilitated, sometimes for the rest of their lives.
Jennifer's cursory six-week checkup illustrates the beginning of the problem. During this single appointment (which is standard doctors' advice and what most insurance covers), muscles and other structures of the pelvis usually get scarce attention. "Contrary to what one may think, ob-gyns are not trained to evaluate pelvic floor muscles or nerves even though they work in this region," says Stephanie Prendergast, MPT, co-founder of the Pelvic Health and Rehabilitation Center in Los Angeles and co-author of ofPelvic Pain Explained. "A speculum pushes right past the very muscles and nerves that cause problems as the OB tries to get to the uterus and cervix." This exam is the extent of most American women's postpartum care.
Beyond that, obstetric training is understandably focused on life-threatening childbirth complications, like hemorrhage or infection. Non-life-threatening (but still painful and incapacitating) problems get less attention, says Sarah Fox, MD, a professor and researcher at Brown University and former president of the International Pelvic Pain Society. "American physicians and American healthcare providers can go through all of their training and never get any instruction on managing women's pain," she says.
Pain is a complex, sometimes indefinable experience, one that can't be easily evaluated on a typical postpartum exam, especially in a medical office that is expected to cycle patients through in 15 minutes. In a survey of 41 ob-gyn residents published in 2014 in the Journal of Graduate Medical Education, Kathryn Witzeman, MD, an ob-gyn at Denver Health and director of the Women's Integrated Pelvic Health Program, found that the doctors-in-training felt "overwhelmed" by patients with chronic pelvic pain because they did not feel prepared to care for them. "If things look normal, there may not be an understanding of what else is going on," Dr. Witzeman says.
And because childbirth injuries relate to taboo topics (like incontinence and sex), women who have them often don't push their rattled doctors. Sarah Prince, now a 29-year-old Utah mom, was cleared by her doctor to have sex six weeks after the birth of her first child. But when she and her husband tried, she got "a sharp, stingy, burny pain" and it remained painful for weeks. When she returned to her doctor several months postpartum, his advice was, "Go slow." He clearly didn't want to give her more detailed sex advice, she says. But fighting through pain was not Sarah's idea of a satisfying sex life. "I could tell that my husband was frustrated," she says. "It frustrated me too, but because I wanted to avoid sex." She had the same experience — months of uncomfortable sex — after her second child was born and again received no useful medical advice, but didn't push through the awkwardness for a diagnosis.
After her six-week checkup, Jennifer's pelvic problems only got worse. She quickly realized that the lack of feeling in her vagina and surrounding area was the reason she was often surprised by her incontinence. But that also had obvious repercussions for her relationship with her husband. "I'd be feeling all sexy and then we'd go to have sex and I'd realize I had a little stain in my underwear. I'd try to hold on to some shred of dignity at first, like, 'Oh, I'm going to go shower,' but he knew," she says. The lack of musculature in her pelvis caused vaginal prolapse, a condition where the pelvic floor sags and the uterus can hang down into the vagina, which gave her a heavy feeling and made her labia hang lower than they ever had before. The couple had bonded over running, but she'd started making up excuses not to run with him. She'd lost time with her running friends, and now she was losing time with her husband. "If you can't exercise and you're home with your baby and you don't see your friends and you're pooping your pants, how are you supposed to feel confident?" She felt isolated, dirty, and depressed.
The postpartum depression that often couples with childbirth injuries adds another layer to the difficulty getting a diagnosis. In a landmark report from the Institute of Medicine in 2011, a team of experts noted that women "have faced not only severe pain, but also misdiagnoses, delays in correct diagnosis, improper and unproven treatments, gender bias, stigma, and 'neglect, dismissal and discrimination' from the health care system." Among the reasons: health care professionals who not only lack education on how to deal with chronic pain but also discount women's pain as "emotional." A 2010 report from the Campaign to End Women's Painnoted that women's pain is treated less aggressively and taken less seriously than men's. Amy Tuteur, MD, who writes on The Skeptical OB, attributes it to a sense that "men are more stoic so if they complain it must be real." But it's hard to be stoic when you're simultaneously embarrassed, in pain, and trying to care for a newborn baby.
Doctors do want to help their female patients, but they also stay in the lane they know, says Leah Millheiser, MD, director of the Female Sexual Medicine Program at Stanford University School of Medicine. The lanes they know, in this case, often come at two extremes: Do Kegels, and if that doesn't work, about 320,000 women each year undergo surgery to strengthen the pelvic floor.
Kegels are commonly prescribed, but, Prendergast says, a 2015 study that showed that about 1 in 4 women are unable to do a Kegel correctly, and for some women, pelvic floor muscles may be too tight, not too weak, and need to be lengthened, not strengthened. Plus, many women's problems can't be solved with Kegels alone.
Surgery can sometimes lift prolapsed pelvic floors, stop incontinence, and remove painful scar tissue, but it's not the magic bullet many ob-gyns treat it as. Krysten (who preferred to be identified by her first name only) had a vaginal birth without complications with her second baby in May 2013, but a tear in her perineum, the skin and muscle below her vagina, that should have healed in a few weeks was still painful 12 weeks later. "It was this awful pulling," she recalls. "If I walked around too much or if I tried to exercise, I felt a burning pain." Her doctor could find nothing wrong other than some excess scar tissue, and as long as she didn't move, she was pain-free. But she had a toddler and a newborn. Lie still?
When her son was 3 months old, Krysten returned to her obstetrician because of her ongoing pain. The doctor recommended an operation to remove the problematic scar tissue. She underwent surgery that autumn — only to be left in more agony when additional scar tissue formed in response to the surgery. "I met so many people who bounced back after four weeks," she says, "and I would say, 'Really? Because I'm crawling around like an old lady.'"
Her pelvic floor muscles shot and unable to do Kegels, Jennifer visited a urogynecologist who recommended surgery to insert transvaginal mesh, an implant that supports the vaginal walls and bladder. The operation has come under fire for frequent complications that include bleeding, pain during sex, organ perforation, and more urinary problems, and was bumped from moderate-risk to high-risk this year by the FDA. Jennifer did not take this decision lightly, but her doctor persisted. "He said, 'You need surgery badly, but here's the thing: I'm going to Africa for four months, so you're going to have to wait,'" she says. She'd been incontinent for eight years, she figured; what was another four months? Still, every time she didn't make it to the bathroom was another humiliation.
The shame of many childbirth injuries — and the expectation that new moms will simply "bounce back" — is another reason women don't get treatment. Jennifer was ashamed that she hadn't healed when other mothers had, ashamed that she'd failed at Kegels, ashamed that she was wetting herself more than her child was. She was ashamed that she didn't have Kim Kardashian's "slim post-baby bod."
The media's obsession with new-mom glamour — whether it's Marissa Mayer's two-week maternity leave, or descriptions of Kate Middleton "looking immaculate just hours after giving birth" — has created the perception that recovery from childbirth is quick and easy. One Daily Beast column, lamenting the lack of postpartum attention for American moms, pointed out that after women bear children, "we beckon them most immediately to rejoin the rest of us. One New York mother summed up her recent postpartum experience this way: 'You're not hemorrhaging? OK, peace, see you later.'"
"We have a new cultural view of childbirth that tremendously minimizes how physically and emotionally difficult it is," says Dr. Tuteur, of The Skeptical OB. "As a result of this view, women are ignoring physical symptoms."
Also keeping women from care is that these problems have afflicted women for generations. "If a woman has a problem like urinary incontinence or prolapse, they'll talk to their mom or their sisters, and their mom and sisters may have experienced a similar thing and that may normalize it," says Dr. Fox, of Brown University. In one Scandinavian study, women didn't seek help, figuring the problems would go away or there was nothing to be done.
But tending to minor problems when they happen can help you avoid major ones down the road. Janis Miller, PhD, the researcher from the University of Michigan who conducted the MRI study of muscle rips and fractures, says the women in the Michigan study didn't even know they were hurt. "One woman explained it to me as, 'It's like I have a mild toothache,'" Dr. Miller says, "so we're not talking excruciating, severe pain there." Still, although hairline fractures are common and usually heal well on their own, they are often caused by the levator ani — the main muscle of the pelvic floor — pulling away from the pubic bone, increasing the chance of incontinence and prolapse later in life. "When we examine women who have had prolapse, more than 50 percent of the women showed the same tear [of the levator ani muscle]" from childbirth, Dr. Miller says.
When her urogynecologist postponed her surgery, Jennifer's frustration was at an all-time high, so she summoned her courage to visit a physical therapist at a friend's recommendation. She hated it. "You know, it's such a treat to get to talk about how you pee and poop your pants, and then you take off all your clothes, and they put fingers in both holes," she says sarcastically. Her desperation led her to a different physical therapist, then another. She bounced around to physical therapists for two years, hoping to put off the surgery she was afraid would only make matters worse, but nothing was working. Because most insurance covers a limited number of doctor-prescribed physical therapy sessions (some cover 60 days, 12-60 sessions, or up to $1000 worth) she paid large out-of-pocket fees for most of her treatments. Just when she was reaching her breaking point, she tried one more therapist.
After long searches, some women have found astoundingly simple solutions to their injuries. Sarah Prince, the Utah mom whose doctor had simply told her to "go slow" with sex, finally found relief after her third child was born. Frustrated that she was still (still, 2.5 years after her first child was born) having painful sex, she reached out to her midwife, who mentioned that estrogen cream might help heal the tissue causing her pain. Even better, she gave her a free sample of the cream, calledEstrace. "The pain was virtually gone after a week," Prince says. "It was amazing."
Krysten, the mom whose surgery had made her pain even worse, eventually found her solution after scouring the Internet. "I was like, 'What is wrong with me? How come I can't find anybody else in the whole entire world that has experienced the same pain?' The ob-gyns always made me feel like I was nuts," including one who told her she just "needed extra time to heal." While Googling one day, she learned that Elizabeth Akincilar-Rummer, one of the founders of the Pelvic Health and Rehabilitation Center, had moved to the Boston area, where Krysten lives. She booked the first appointment she could.
Akincilar-Rummer assured her she was not crazy, that the excessive scar tissue left after her births and surgery was causing all the muscles in her groin and upper legs to tighten. "I remember sitting there and being stunned and thinking, What? Why didn't somebody else catch this?" Krysten says. The physical therapist worked the scar tissue between her thumb and forefinger to make it more mobile. Krysten repeated the massage herself at home every other day for weeks, along with stretches and foam rolling, until one day she realized the pain was gone. "I was like, 'Oh my god. I can get up. I can walk. I can make dinner. I can go outside and play with my kids.' She gave me my life back."
Jennifer finally found a physical therapist she liked last fall. "I walk in, and I lie on the table. I'm like, 'Whatever you need to do, do it,'" she says. It was really awkward at first. Because of Jennifer's nerve damage and lack of muscle tone, her therapist used electrodes shaped like tampons, inserted in her vagina and anus, to give small electric pulses that stimulate the muscles in her vagina and perineum. It was almost unbearably uncomfortable for the first four sessions, but she slowly started to feel better, and "it stimulated muscles I didn't even know I had," Jennifer says. Once she had some muscle control, she learned to strengthen her pelvic floor muscles while in a yoga inversion, using gravity to assist with proper muscle contraction — a technique her previous therapists hadn't suggested. It felt like her body was starting to respond to her brain's commands again. "Yes, it's uncomfortable to have someone with their fingers up your vagina or even your anus, you know, prodding and poking and asking you to squeeze and seeing which muscles are weak," she says of the sessions, which she "wouldn't wish on anyone." But after six weeks, Jennifer's incontinence almost completely disappeared. She never returned to the doctor who recommended surgery.
Recognizing the number of women who need help, some obstetricians are fighting to modernize training programs to get more ob-gyns thinking about everyday pain in addition to the more serious issues. Dr. Fox at Brown University is one of a growing number of doctors who believe that lasting change in postpartum care will require putting more emphasis on pelvic health in the medical curriculum. "As someone who started out as primarily a gynecologic surgeon, over the years, I've really transitioned away from it," she says. While only about 10 percent of patients will have adverse effects from their operations, most women don't even know that worsening pain or nerve injury from surgery is a possibility. "With chronic pain issues, surgery should not be our first stop, and really we should be trying multiple things before hitting that. Surgery is not a substitute for a thorough evaluation with a focus on the pain history and a full physical exam," she says. To make more doctors aware, the International Pelvic Pain Society is "working hard to educate providers, reach out to people in training, people in practice, and to reach out to patients to help get people educated about this issue."
Dr. Millheiser, the sexual health expert from Stanford, says obstetric education is slowly improving, though "we're nowhere near where we need to be." And she says improvement can't happen without cultural shift, starting with less public marveling over the quickest birth comebacks and more frank talk about women's health issues below the navel. When problems are openly discussed, "women are going to become empowered, and they are going to go to their doctors and say, 'I had a baby. I'm breastfeeding. My vagina feels like the Sahara Desert. It is horribly painful to have sex and my relationship is suffering. What can I do about it?'" she says. "Open the conversation so women understand it's OK to talk to their doctors and insist on answers."
This February, her son now 11 years old, Jennifer pulled on her running shoes and went on her favorite mountain runs — one that left her soiled last summer — and came back with her shorts dry and her confidence intact. She still does physical therapy for 10 to 20 minutes every day, but she does it alone, in the privacy of her own home. She talks about pelvic floor rehab with the fervor of an evangelist. "I consider those people saints," she says of the therapists who finally healed her injuries. She can run with her husband again, and he jokes about the magical reversal of her vaginal prolapse ("My labia just got sucked back up. He's like 'Where did they go?!'") On the phone, she sighs, remembering a recent date they went on. "I wore white underwear with no panty liner and they were still white when we got home," she says. It's the little things now. "That's a great way to end a date."
http://www.cosmopolitan.com/lifestyle/a59626/birth-injuries-postpartum-pain-untreated/
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Doctors discuss risks of untreated female pelvic condition
Jul 18, 2016 | Lubbock Avalanche-Journal
By Ellysa Gonzalez
Many women experience pelvic injuries during birth but few ever actually report it.
The most tell-tale symptom of injury is urinary incontinence, said Shelly Hook, an OB-GYN with Grace Health System.
“If they leak urine when they cough, sneeze or laugh, especially when the bladder is full, it’s one of those things that they think ‘yeah, my mother had it, my grandmother had it.’ It’s one of those things that’s put off as being normal when it’s really not.”
Some women choose to ignore their symptoms, but local doctors said alternatives to living uncomfortably are available.
Dr. David Blann, OB-GYN with Covenant Medical Group, said embarrassment is one of the more common reasons women don’t discuss pelvic organ prolapse with their doctors. Rather than treat the discomfort, they ignore it.
“For some, it’s a bigger problem than it is for others,” Blann said. “Some people accept that as part of baring children.”
But ignorance can lead to bigger consequences, Blann said.
“It can progress and be a bigger problem,” Blann said. “It’s typically easier to catch when it’s caught earlier.”
Dr. Roger Yandell, chief of gynecology for the Texas Tech Health Sciences Center and University Medical Center, said untreated symptoms could result in wider tears in the pelvis and pelvic organs slipping down and out of the body.
Pelvic organ prolapse is caused by a weakness in the interior of the pelvis, often as a result of childbirth or trauma, he said.
“The real problem is the ligaments that run between the bladder and the vagina are torn,” Yandell said.
It creates uncomfortable sensations and sometimes embarrassing consequences, he said.
“Babies are large objects,” Blann, with Covenant Medical Group, said. “They have to fit through a fairly small space on the way out. To allow that to happen, there’s relaxation of the muscles that support the pelvis to the degree that they can sometimes sag causing pressure, pain, pain with intercourse.”
Blann said it’s akin to a hernia.
There are various methods to treat pelvic prolapse but each body is different so there’s no one-size-fits-all approach.
Yandell said surgery is an option.
Pelvic surgery is especially tedious, he said.
“When I was in medical school,” Yandell said, “one of the professors of anatomy told us the anatomy of the female pelvis is the second most difficult in the body to learn. The worst is the inside of the brain. That’s really hard. The ligaments and connective tissues and structures in the pelvis are real complicated and most doctors don’t deal with it at all once they get out of anatomy after med school.”
The goal of the surgery is to reattach the pelvic organs to the interior of the body while still allowing enough room to comfortably use the bathroom. Yandell compared the surgery to the story of the three little bears.
“With the surgery, if you don’t do it tight enough, it still leaks,” he said. “If it’s too tight, you can’t pee. It’s got to be just right there in the middle.”
Hook said pelvic organ prolapse is more common in caucasians and Hispanics. It’s unclear why.
“Family history or genetics play a role in it,” she said. “If your mom or grandmother suffer from incontinence, you’re likely going to.”
One way to fight it is by performing kegal exercises, which can help regain pelvic support, she said.
“I tell patients to do it at red lights or stoplights,” she said.
Hook, Blann and Yandell said pelvic organ prolapse is another reason for women to be aware of their bodies. The earlier symptoms are caught, the easier they can be to treat.
“Their gynecologist may not ask about it so they don’t know that it can be addressed,” Hook said.
http://lubbockonline.com/local-news/2016-07-18/doctors-discuss-risks-untreated-female-pelvic-condition#.V43Edfl94qc
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