The Specialty of Urogynecology [Interview][Transcript]

dr_sangeeta_mahajan_urogynecologyGuest: Dr. Sangeeta Mahajan
Presenter: Neal Howard
Guest Bio: Division Chief, Female Pelvic Medicine and Reconstructive Surgery, UH Cleveland Medical Center Fellowship Program Director, Female Pelvic Medicine and Reconstructive Surgery, UH Cleveland Medical Center Chair, Gynecology Quality Assurance Committee, UH Cleveland Medical Center Assistant Professor, Urology, CWRU School of Medicine Associate Professor, Obstetrics and Gynecology, CWRU School of Medicine.

Segment overview: Dr. Sangeeta Mahajan, Division Chief of Female Pelvic Medicine and Reconstructive Surgery at University Hospitals in Cleveland, Ohio discusses the field of Urogynecology.

Transcription
Health Professional Radio – Urogynecology

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Neal Howard:   Hello and welcome to Health Professional Radio. Thank you for joining us here today, I’m your host Neal Howard. In studio with me is returning guest, Dr. Tina Mahajan. She is the Division Chief of Female Pelvic Medicine and Reconstructive Surgery at the University Hospitals in Cleveland, Ohio. And she’s here today to talk with us about the field of urogynecology. Welcome to the program Doctor.

Dr. Tina Mahajan:   Thank you for having me Neal.

N:   Well the field of urogynecology, I thought that Gynecology kind of encompass everything down there. Talk about how you became a specialist in the field of urogynecology.

M:   Well it all started actually in college, I decided I wanted to be a Gynecologist in college because I was very interested in women’s issues and I came from a Medical family. So I’ve grown up in that environment and then when I got to Medical School, went to ObGyn I was really more interested in the moms than the babies and … Gynecologic surgery and I loved the operating room. And then when I got to residency, still continued to be interested in Gynecologic surgery but even in the Medical School I really enjoyed Plastic Surgery but didn’t want to be a Plastic Surgeon, didn’t want to do breast augmentations. And I enjoyed Urology and basically decided as Resident, correction not even as resident, the medical student but I wanted to be what we used to call Urogynecologist, but now we call it Female Pelvic Medicine and Reconstructive Surgery and I did four years of residency in ObGyn and three years of training and subspecialty in Urologic Gynecology and did a duo fellowship in Urology and Urogynecology and then started our Division right after out of fellowship. So it was a long path but basically I do Gynecology meets Urology meets Plastic Surgery and I always tell patients that I’ll make everything look like they’re 20 again and they can have as many kids as they want or do whatever they like and we’ll fix it all and they get all look perfect again.

N:   You’re involved in the overall health of the female reproductive system in all aspects. You mentioned Plastic Surgery, is that what you do normally or are there times when you’re called upon to perform a hysterectomy or something else?

M:   So I too often do hysterectomies but most of my work has to do with leaking, leaking with coughing, sneezing, bearing down nobody should have to wear a pad or a diaper or not be able to exercise or go for a walk because they’re worried they’ll leak urine or laugh very hard. We often treat that with exercises sometimes and often surgery. I also do a lot in dealing with non-medical incontinence, meaning the bladder wants to empty even when you’re not at the bathroom yet or feeling an urge to go you can’t control. We treat that with being smarter about our fluid intake choices, conservative treatment, sometimes medications and rarely more invasive things. And then one of the biggest things I do is prolapse, when you feel a bulge down there that shouldn’t be there, people have always talked about a fallen bladder or a fallen rectum or a fallen uterus. We make things as they should be, sometimes that involves the hysterectomy but often it means restoring the supports that over time start to weaken and not hold up against gravity. I always tell my patients that gravity is not our friend and just like we start to droop in our breasts, we start to droop down there and we’ll make everything resist gravity again, make it look good again and feel good – that’s the most important thing.

N:   When you’re talking about prolapse issues, is that something that’s more prevalent in older people or can that happen for a variety of reasons no matter what the age? And when that does happen, does the age play a huge factor in how it’s addressed?

M:   It definitely can happen, it’s more common as we age but I had patients in my 30’s who have uteruses that are almost all the way outside and falling out. But it tends to be related to multiple issues as genetics is the biggest thing. So if your mother had a bulge, you’re more likely to have a bulge or your sister has a bulge down there or leaks when she coughs and sneezes. It also has to do with having children, the more children you have the more risk you are. If you do heavy weight lifting in your daily life, I once had a patient who was a welder and she lifted fifty pound metal sheets and she developed prolapse or bulge just from all that heavy lifting. My youngest patients who are in their 30’s, my oldest patients are in their late 90’s or early 100’s, so everyone now sometimes surgery is the answer but if surgery is not the answer we have other non-surgical options that can help make people more comfortable.    

N:   What would you say to the person who is considering going into the medical field and considering Urology or Gynecology? What would you say to that student who’s looking to find something that combines, like you did their love of surgery and their love of the female reproductive system? What courses or things you should do in prep?

M:   I think commitment to making women’s lives better is very important and to be honest this is my favorite part of my job. I tell people I feel like I give them their lives back. They may be have not been able to do things that they enjoy because they were worried about discomfort or leaking. So I think really just wanting to be a good person and do good things for people are key components, I think it’s important to be good with your hands, it’s important for Medical School to do well with Sciences, in Math and everything but beyond that I think it’s the desire in the patients you touch to make things better for them. And my favorite part of what I do are my patients, I get to take care of mothers and grandmothers and it’s such a joy. And they are with me for years and years and then I have other, I have rule in my office that you can come and cry about anything and everything and we’ve been in an all female office, I’m a female, my practitioners are female and my support staff in my office are all female. And we tell people, people apologize for crying and sometimes its tears of joy, sometimes they’re upset, sometimes they just need some attention and someone to listen to them. So we have a “All crying is totally fine” rule and no apologies for crying, they can cry about anything they want and sometimes you just need a friend. Sometimes their husband passed away, a child passed away but we try to take care of them emotionally as well as physically and medically.   

N:   Do you find in your experience and in your practice that there are a large number of people that come in simply to change themselves cosmetically without any problem whatsoever, without having a prolapse or without gravity taking over or without having had an injury? Do you involve yourself in strictly cosmetic surgery when it comes to Urology or Urogynecology?

M:   No, I don’t think that’s the case. I think everybody I see for 99.9% of them have something that bothers them or hurts them and we can make that better. Or sometimes in a rare occasion it’s for me just to tell them that that’s totally normal. Because we don’t necessarily see other people’s pelvic areas and I tell them “That is a normal thing, you’re not abnormal.’ And that in itself is very reassuring but then most of the cases they do have something that pains them or bothers them, uncomfortable that we can make better.

N:   Well it’s been great having you in with us today Doctor.  

M:   Thank you very much for having me.

N:   Thank you. Where can our listeners go and get information about Urogynecology?

M:   They can go on out national society which is www.augs.org

N:   Thank you. You’ve been listening to Health Professional Radio, I’m your host Neal Howard in studio with Dr. Tina Mahajan. She’s the Division Chief of Female Pelvic Medicine and Reconstructive Surgery at the University Hospital in Cleveland. And she’s been in studio with us talking about the field of Urogynecology. Transcript and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to this podcast on iTunes.

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