It's Ovarian Cancer Awareness Month and we heard from SIMEDHealth Gynecologist Dr. Oscar Osorio! 

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Endometriosis affects about 1 in 10 women during their reproductive years. March is Endometriosis Awareness Month, and we discussed endometriosis and possible complications with SIMEDHealth gynecologist Oscar Osorio, MD.

1. What is Endometriosis?

“Endometriosis is a chronic condition seen in women where endometrial tissue, normally found lining the inside of the uterus, is found in places outside of the uterus.  The abnormal tissue growths can occur on the fallopian tubes, ovaries, intestines, or any surface inside the abdomen,” says Dr. Osorio. “Just like the lining inside the uterus, during menstruation, the endometrial tissue growing outside the uterus becomes inflamed and can cause pain.”

Symptoms for endometriosis include painful periods, heavy periods, pain during or after sexual intercourse, lower back pain, abdominal pain, and bad cramping around menstruation. Some women don’t have any symptoms, yet endometriosis can affect fertility, so it is essential to see your gynecologist regularly so they can monitor for any signs or changes.

2. What are the possible causes of endometriosis?

“The actual cause is unknown, but there are several theories. One of the most widely accepted theory is there is retrograde menstruation, which is when the menstrual blood flows back through the fallopian tubes into the pelvic cavity.  This then results in endometrial tissue implants developing outside the uterus,” says Dr. Osorio.

3. Why is endometriosis hard to diagnose?

“Endometriosis may be easily suspected, but it cannot be easily seen on x-ray, ultrasound, or other imaging studies,” said Dr. Osorio.  “It needs to be seen directly to be diagnosed.  This can be done by laparoscopy, which is a minor surgical procedure.”

4. What are some complications people will endometriosis may experience?

Dr. Osorio explains, “Endometriosis may potentially cause infertility, damage to some organs, and debilitating pain if not managed properly.” According to the Mayo Clinic, about 30-40% of women with endometriosis have issues getting pregnant. “Dealing with a chronic condition can also cause depression, anxiety, or other mental health conditions.”

5. What are the treatment options?

“The first line of treatment or initial treatment is usually hormonal regulation with birth control pills or other similar hormonal medications,” Dr. Osorio reports.  These can help regulate the menstrual cycle, which often lessens the pain. There are other types of medications for chronic use that may be used.  These are used in short, repeating courses. Surgical intervention with excision of lesions, removal of cysts, and excision of scar related adhesions may be required. Ultimately in patients with no response to treatment, full hysterectomy with removal of ovaries may be needed.”

Click here to schedule an appointment with Dr. Osorio or one of our other qualified gynecologists.

January is Cervical Health Awareness Month and is a time to shed light on this preventable but still deadly cancer. Cervical cancer is found in the uterine cervix and occurs in almost 13,000 women each year in the United States.

1. Are there causes for cervical cancer?
The majority of the time, cervical cancer is caused by long term infection from the human papillomavirus, also known as HPV. People can be infected with HPV by skin to skin contact or through sexual intercourse. There are lots of different types of HPV, with only a few linked to cancer.

2. What are its symptoms?
In the early stages of cervical cancer, there are usually no symptoms, which is why it is essential to get your Pap smear regularly. If the cancer becomes more advanced, symptoms can include abnormal vaginal bleeding, bleeding after menopause or sex, longer heavier menstrual periods, abnormal vaginal discharge, and pain during sexual intercourse.

3. What can be done to prevent this cancer?
Getting your HPV vaccination is a great way to prevent being infected. The Centers for Disease Control and Prevention recommend all children aged 11-12 receive the two-dose vaccine. The second dose is administered six months to one year after the first. If you are older, you may need a third dose. They do not recommend it for anyone older than 26 as more people have already been exposed to HPV and vaccination after this time is less effective.  

4. How is cervical cancer found?
Gynecologic exams visualize the cervix and perform a Pap smear. The Pap smear screening tests look for cell changes in the cervix that could become signs of cancer or pre-cancer. It is recommended that women start getting Pap smears when they are 21 and, if normal, repeat them every three years.

5. Is the treatment process any different from other cancer types?
Cervical cancer treatment can require combinations of chemotherapy, radiation, or surgery, just like other cancer types. But it can also be treated with targeted therapy, which uses medications and other substances to kill the specific cancer cells but not the healthy cells and immunotherapy, which uses the body’s immune system to fight cancer. What stage your cancer is in and what type of cervical cancer you have will determine the specifics of your treatment process.

Click here to schedule an appointment with one of our Women’s Health physicians.

October, most associated with pumpkins, and changing temperatures, is also commonly associated with the color pink for Breast Cancer Awareness Month. According to breastcancer.org, As of January of this year, 3.1 million women have a history of breast cancer in the United States. We talked to SIMEDHealth Gynecologist Dr. Linda Grover about some common myths that still surround this cancer despite the overwhelming amount of pink showcased this month.

1) Finding a lump in the breast means you have breast cancer.

Dr. Grover explains, "Approximately 90% of the palpable breast lumps found in women between the ages of 20-50 are not malignant.”

Breast cancer odds increase with age but what is critical for all ages is a prompt, professional evaluation. While most lumps are not cancer, it isn’t easy to determine this just by palpitations so it’s always a good idea to have them evaluated by your healthcare provider. Never let fear cheat you out of a good outcome. This is to say that if you feel a lump in your breast, don't make assumptions it’s nothing, get it checked out by your physician.

2) Breast cancer is only a women’s issue.

"Interestingly, some reports indicate breast cancer in men has been steadily increasing in frequency in the last 26 years. Most men with breast cancer do not have identifiable risk factors at diagnosis”, says Dr. Grover, “men with known BRCA2 mutations are a higher risk.” Although less than 1% of men receive a breast cancer diagnosis, any apparent breast lump should be evaluated. The classic presentation of breast cancer in a man is a painless firm mass beneath the nipple.

3) If you have a family history of breast cancer, you will get it too.

Having a family history of breast cancer is not a defining risk for developing breast cancer. According to Dr. Grover, "Only 5-10% of breast cancers in women are hereditary. Without any family history of breast cancer, 1 in 8 U.S. women will develop breast cancer. If a patient has one first degree relative (such as mother or sister) with the disease, her risk will increase about twofold. If two first degree relatives have breast cancer, the patient's risk will increase about threefold."

More distant relatives with breast cancer histories have less impact but are useful in formulating recommendations for genetic testing. Other risk factors exist, and it is wise to not only know your family history but how to protect yourself from breast cancer with a healthy lifestyle.

4) A mammogram can cause breast cancer to spread.

So many myths exist about mammograms. Dr. Grover explains, "Mammography screening decreases the breast cancer mortality rate by about 46%, according to studies done on hundreds of thousands of women and seven different statistical models. As multidisciplinary medical management, adjuvant treatment, and additional screening tests (MRI and ultrasound) emerge, these statistics will change and attribute decreased mortality to a broader combination of factors." However, there is no evidence, and under no circumstance should mammography be blamed for the metastasis of breast cancer. Earlier detection and better treatments save lives.

5) If the BRCA1 or BRC2 gene is in your DNA, you will get breast cancer.

“First, it is vital to explain that there is a difference between having the BRCA1/2 gene and having the BRCA1/2 mutation. Everyone has the BRCA1/2 gene, but only about 1 in 400 people have the mutation. Having the mutation carries the risk of developing cancer, but it does not mean you will definitely get it.”

Dr. Grover explains, "by age 70, these specific mutations carry a breast cancer risk of 55-70% for BRCA1 carriers and 45-70% for BRCA 2 carriers. Younger age patients (age30-40) are at risk of earlier-onset disease. Multiple other cancers are also linked to these mutations.

In light of these alarming rates of cancer, national guidelines recommend the removal of the tubes and ovaries by age 35-40 in BRCA 1 carriers and age 40-45 in BRCA2 carriers. Again, it should be noted that less than 10% of women with a familial history of breast cancer carry these specific gene mutations. Before making any decisions, please talk to your doctor about what option would be best for you if you are a BRCA1/2 mutation carrier.

Breaking down the myths and knowing the facts is essential to staying healthy and conscious of the signs from your body. Dr. Grover is a gynecologist physician in our Women’s Health Gainesville clinic. Click here to schedule an appointment with her!

Ovarian cancer accounts for 2.5% of cancers in women, according to the Ovarian Cancer Research Alliance. September is Ovarian Cancer Awareness Month, and we talked to SIMEDHealth gynecologist, Dr. Austin Chen all about it. 

1. Where is the ovary located in the body, and what does it do?

 Ovaries come in pairs. One on each side of the body. When standing, the ovaries are located below the hip bone and produce eggs at regular intervals after hitting puberty. It contains the chromosome and genetic material of the body. Dr. Chen says, "The ovaries also produce several hormones, estrogen, progesterone, and testosterone. These hormones tell the uterus when to have menstrual cycles, support fertilization, and pregnancy in its early stage. The ovarian functions interact with the environment, lifestyle, aging, and other hormones from other glands such as thyroid." 

2. What are some symptoms of ovarian cancer?

 "There are no unique or specific symptoms ascribed to ovarian cancer, says Dr. Chen. Vague changes in bowel habits, weight, and appetite can happen as ovarian cancer progresses. This vagueness and non-specific quality make recognition of cancer's presence challenging for both doctors and patients. Furthermore, ovarian cancer, at early stages (I & II), tends to be silent.

3. How is ovarian cancer diagnosed?

 Dr. Chen says, "Discovery of cancer occurs during either an unsuspecting surgery as a surprise or is highly presumed before planned surgery." So basically the doctor and patient will have no idea or are highly suspicious. If it is discovered during unsuspecting surgery or after a pathology result returns, there is a good chance it is in its early stage. If the symptoms and an exam are highly suspicious, the patient will go to a gynecologic oncologist. A physical exam, blood test, CT scan, MRI or ultrasound, are all tools used to determine if an ovary is cancerous.

4. What are the treatment options for someone diagnosed with ovarian cancer?

 Surgery and chemotherapy are the most common treatments the majority of the time; it is a combination of both. Gynecologic oncologists and medical oncologists work together to coordinate the chemotherapy and figure out what will work best for the patient and their cancer, says Dr. Chen.

5. Does the use of birth control increase the risk of ovarian cancer?

 Dr. Chen says, "No. On the contrary, women with present or past exposure of birth control pill for five years or more will have a 50% reduction of ovarian cancer risk."

6. What is the difference between ovarian cancer and ovarian cysts?

 A cyst is a fluid-filled sac. Most commonly, cysts are formed during ovulation and are entirely harmless. One type of ovarian cysts is follicular cysts. These follicular cysts can be seen on the ultrasound and occur when an egg grows inside a follicle sac. Eventually, the pouch should break open, but if it does not a cyst form. Another common type of cyst is called corpus luteum cysts. These occur when follicle sacs break free, but the mass of cells does not shrink. The sac reseals itself and forms a cyst. Both of these types of cysts go away on their own, or if they are serious, they can shrink them with medication. 

 We use imaging studies (ultrasound, CT, MRI) to help determine if a cyst requires medical attention or not. Dr. Chen adds, "The doctor may also order blood tests to help to make a decision." 

Dr. Chen sees patients in Gainesville and Lake City. Click here to schedule an appointment with her!

We sat down and talked to our newest physician of SIMEDHealth, Dr. Austin Chen. Dr. Chen is a board-certified OB-GYN specializing in robotic surgery. Dr. Chen is now accepting patients. If the video is not shown, click here.

SIMEDHealth is pleased to welcome our newest physician and surgeon to Women's Health Dr. Austin Chen!

Chen received an undergraduate degree and a medical degree from the State University of New York (SUNY) at Stony Brook. She then went on to complete her residency at Columbia Presbyterian College of Physician & Surgeons at Harlem Hospital. 

After completing her degree, Chen went on to teach at NYU Medical School and the University of Nevada School of Medicine. She created and built her own successful practice in New York, and was the senior Ob-Gyn consultant for St. Mary's Hospital Lacor in Gulu, Uganda. Dr. Chen's time in Uganda was very impactful as she was able to help not only many patients, but also her fellow staff members. Cervical cancer is rampant in places such as Uganda, and Dr. Chen took initiative and implemented a district-wide free cervical cancer screening program for the healthcare workers. About 400 people in total has screenings done and three early cancers were found and treated. Chen also brought the first laparoscopic system to northern Uganda and in the future is working towards building a laparoscopy training program there.

Dr. Chen is available to start taking patients on March 1st, 2019.  

SIMEDHealth Women’s Health has taken a step forward with the acquisition of a device called the EndoSee. This new technology makes the hysteroscopy procedure quicker, easier, and more effective. A hysteroscopy is an assessment of the inside cavity of the uterus, according to Dr. Osorio of SIMEDHealth Women’s Health. The EndoSee is a handheld device that lets doctors see the inside of the uterine cavity quicker and easier than ever before. According to Endosee.com, this device allows doctors to complete a hysteroscopy “in an average of 3 minutes.” Anesthesia was normally necessary for hysteroscopy before but, now with the EndoSee, no anesthesia is needed.

Prior to the EndoSee, patients normally were given a sedative and anesthesia. The procedure could have lasted anywhere between 5 minutes to an hour and required more time after to recover from the sedatives, anesthesia, and procedure itself.  

Other available services at SIMEDHealth Women’s Health include:

• wellness exams
• pap smears
• annual exams
• urinary incontinence
• hematuria
• UTI testing
• urodynamics
• pre and post-menopausal natural hormone therapy
• birth control comprehensive evaluations of pelvic pain
• endometriosis and endometrial biopsy
• pelvic organ prolapse
• colposcopy/abnormal pap smears
• abnormal uterine bleeding
• osteoporosis evaluation and management
• pelvic pain
• mass and inflammatory disease

Click here for more information about our women’s health doctors and locations!

January is Cervical Health Awareness Month. Cervical cancer was once one of the most common causes of cancer death for American women, but now it can be easily prevented with vaccinations and regular screenings.

Learn more about cervical cancer and cervical health with SIMED Ocala Women’s Health Physician, Dr. Oscar Osorio.

1. What exactly is cervical cancer?

Cancer is an abnormal growth of cells on any tissue. The growth is invasive and spreads to adjacent and distant organs, causing damage to tissues. Cervical cancer is cancer of the “tip” or distal area of the uterus.

2. What part of the body is the cervix?

The cervix is the lower, neck-part of the uterus that leads to the vagina. It is where the menstrual flow exits the uterus. The cervix is accessible and seen in the vagina during a gynecologic exam.

3. Who is cervical cancer common in?

Cervical cancer is caused by the HPV virus. The HPV virus is a sexually acquired organism that infects the cervical cells, potentially causing cancer. Although the virus is most common in younger women, teenagers, and women in their early 20s, cervical cancer itself is more common in women older than 30. Women who smoke are at increased risk, as are women with immune deficiencies and those with HIV infection.

4. What is a cervical screening? How does it work?

A cervical screening is a test designed to identify HPV infections on the cervix in early stages, and thus, avoid progression of the disease to cancer. If cervical cancer is identified, the patient will receive treatment and will be put under surveillance as needed.  You can get tested for cervical cancer with a Pap smear.

5. How often should people get a cervical screening?

Screenings with pap smear should start at age 21, and current recommendations state a pap smear should be performed at least every 3 years.

6. How else can people avoid cervical cancer?

Other than getting a pap smear as recommended, because HPV is a sexually acquired disease, using condoms could potentially decrease risk. Additionally, refraining from smoking could also reduce the risk. Because cervical cancer is linked to HPV, you should also get vaccinated against HPV. The Centers for Disease Control and Prevention recommend vaccination at ages 11-12, but women can be vaccinated up to age 26.

7. Aside from a screening, what symptoms might indicate someone has cervical cancer?

Early cervical cancer is mostly free of symptoms. One of the most common symptoms, though, is abnormal vaginal bleeding, especially after or during intercourse.

Have you gotten screened for cervical cancer? You can get a screening at the SIMED Women’s Health clinics in Gainesville, Ocala, Lake City, Chiefland, or Lady Lake.

To schedule an appointment, call:
Gainesville, Lake City, Chiefland: (352) 331-1000
Ocala, Lady Lake: (352) 391-6464
Or you can request an appointment online.

If you would like to schedule an appointment specifically with Dr. Osorio in Lady Lake or Ocala, call (352) 391-6464 or request an appointment online.

Did you know SIMED offers Women's Health Physical Therapy? Reclaim control of your body.

SIMED offers women's health physical therapy at our Gainesville, Ocala, and Lady Lake locations. 

You can get treatment for: 
- Muscle Weakness
  - Bladder and Bowel Dysfunction
  - Frequency and Urgency Issues
  - Incontinence - Bowel and Bladder Leakage
- Pelvic and Perineal Pain
- Low Back Pain
- Post Prostate Procedures
- Cystocele and Rectocele

Gainesville: 352-373-6565
Ocala: 352-351-5019
Lady Lake: 352-259-0842

Meet the SIMED Women's Health Physical Therapist:

Filamae Garnica will be working with patients for the Women's Health Physical Therapy.

She is knowledgable and trained to treat conditions specific to women.

She can recognize and help patients with a variety of problems and help them restore control over their bodies.

Don't wait to change your life! Talk to your doctor or call your SIMED Physical Therapy location today.

Learn about our other physical therapies.