Our Practice is Unique

You will find a warm and caring "small office" environment, with a friendly but professional atmosphere. We emphasize education and an understanding of your health issues, preventive strategies, and open communication. We provide the best combination of natural treatment, less invasive approaches and the latest medical-technical advances when appropriate.

We have worked very hard to combine our expert training, long experience, continuing improvements and quality assurance programs to offer you a service unique in Southwest Florida. We have gained the confidence of thousands of loyal patients, and the regional medical community with our exceptional standard of care.

For example, we are the first and only Gyn practice in Sarasota to be accredited in specialty ultrasound services. Dr. Swor incorporates his experience and clinical expertise in combining thorough examination with physician-performed endo-pelvic and breast ultrasound when indicated.

We also share our experience through our participation in the education and training of other healthcare professionals and provide lectures in community and national seminars. Dr. Swor pioneered laparoscopic surgery, Gyn laser surgery and surgical robotics in the Sarasota area. In the early 1990's, he co-founded the Center for Advanced Surgery at Sarasota Memorial Hospital and continues to develop new minimally invasive surgery techniques and alternative treatment options.

We now are working in conjunction with the ObGyn Department at the University of South Florida College of Medicine to offer a local advanced center for fertility care. Located at the Physician Care Clinical Research Center on South Tuttle Avenue, patients can see specialists in infertility and receive advanced reproductive technology such as insemination, follicle assessment and IVF/GIFT related services in Sarasota and Tampa.

Our gynecology department at Sarasota Memorial Hospital is a regional referral center, with many high tech services not available at most community healthcare centers. Dr. Swor is the chairman of the ObGyn department, where gynecology was ranked #1 in all Florida and in the top 50 nationwide by US News and World Report in 2006.

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Our Specialty

Women's health issues are our specialty, and Dr. Swor, Beth Hinkelman, ARNP, Allison Smith,    ARNP, and Karen Collins, ARNP, have practices devoted to improving the health of their patients. They see patients for ongoing preventive care, cancer screening, evaluation of pain, bleeding, pelvic support, hormonal concerns, infertility and surgical opinions and other advanced treatment. From adolescent care through mature women's needs, we provide a private, comfortable and professional gyn service in a warm and caring environment. Dr. Swor has 18 years of Board-certified experience and is one of an elite group of gynecologists accredited in both advanced laparoscopy and hysteroscopy. We are affiliated with the University of South Florida College of Medicine and Physicians Care Clinical Research Center, so we can bring our patients the latest in advanced gynecologic care.

We evaluate and treat patients from all over the world in cooperation with their primary care internists, family doctors, urologists, and current OBGYN providers. We are also open to assisting patients of non-traditional medical practitioners and believe in a practical wholistic approach to patient care.

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Advanced Nurse Practitioners

Allison Smith, Beth Hinkelman, and Karen Collins provide expert advanced gyn nurse practitioner care at Swor Women's Care. They specialize in counselling and general Gyn care of all age groups, especially young women. See our practitioners page to learn more about us.

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Gyn Update for Patients and Staff

Newsflash- We have officially launched our USF-Sarasota ObGyn affiliation. This includes graduate education programs, resident and fellow teaching, and outpatient clinical research. We also have opened the Sarasota-USF Gyn subspecialty clinic at the Physician Care Clinical Research Center on Tuttle Avenue, near our office.. We just opened Physician Care Clinical Research for women’s health studies and body composition lab.

Menopausal Hormone Controversy- The pot is still boiling here. All patients deserve an individualized approach to care regarding menopausal changes. Many women find that hormone replacement of some kind is essential to healthy and satisfactory living. We suggest a careful analysis of a patient’s needs, risks and experience at least annually. Synthesized estrogen carries a potential risk of accelerating breast cancer growth, increasing thromboembolic risks, gall bladder risks and may increase EXISTING cardiovascular disease (synthetic progestins, especially Provera are believed by many to be the culprit in lipid change and CVD risk). Human identical female hormones definitely help bone strength, bladder and vaginal tissues and probably healthy vascular systems. If vasomotor or other symptoms are severe, then low dose progesterone and/or estrogen can be offered safely to most patients. There are several topical formulations that are excellent “power boosts” to atrophic vaginal tissues and help bladder urgency too. We prefer newer formulations that are human-identical (ie estradiol, estriol, progesterone). These are lower dose and theoretically safer that those used in the past. They are prescribed in a transdermal delivery to avoid “first liver pass”. Many women benefit from physiologic replacement of androgens for improved energy and libido.

Breast Cancer- We encourage a watchdog attitude in early breast cancer detection. Monthly self-breast exam, annual (or more) clinical exam and yearly mammogram starting at age 35-40. High risk patients need additional surveillance, which may include MRI, ultrasound or more frequent clinical exam. If the mammogram, the patient or the clinician finds an abnormality, then at the very least a short interval re-examination is done.  If any suspicion, then refer to a qualified breast surgeon.  We do an in-office clinician-performed breast ultrasound at the time of clinical exam if indicated. Breast cancers caught early are very effectively treated with lumpectomy and radiation therapy. In selected patients, Mammosite brachytherapy provides focused radiation treatment to the lumpectomy site. 

Guardasil HPV Vaccine-  We recommend all girls and young women ages 9-26 receive the HPV vaccine against cervical cancer associated subtypes 16 and 18, and wart-related subtypes 6 and 11. This vaccine is safe and effective and if used appropriately, will reduce HPV-related disease dramatically. We would expect a 70% reduction in cervical cancer and high grade dysplasia. At a cost of $400-500, there are reimbursement issues, but the vaccine is available and should be offered.

PAP Testing Recommendations and Evaluation of Abnormal PAPs- recent changes in the recommended frequency of screening and algorithms for workup of abnormals is still confusing. Some patients do in fact qualify for less than yearly screening. These criteria include Medicare patients with a long history of normal PAPs, who can be tested every 2 years, and also “low risk” younger patients. Rather than grill patients on their sexual history, we believe in offering annual screening to all patients less than 65. Even post-hysterectomy patients benefit from PAP screening since cytology helps detect VAIN (vaginal intraepithelial neoplasia), vaginitis and urogenital atrophy. When a PAP reveals ASCUS (squamous atypia), we either do reflex HPV testing to detect “high-risk” HPV or at least repeat a PAP in 3-6 months. If the high-risk HPV is positive, or the 3 month PAP is also positive, then the patient will need colposcopy. PAP results clue us in, colposcopy gives the diagnosis. A significant number of these patients will have precancerous lesions. If any PAP reveals AGUS (glandular atypia), then the patient needs endocervical and endometrial evaluation. These patients need to see a Gyn. Appropriate follow-up for AGUS is vaginal ultrasound and biopsy as many of these patients will have a polyp or endometrial lesion. The other possibility is adenocarcinoma, especially in older patients.

Specialty Gyn Ultrasound- In our office, when indicated, we offer vaginal probe pelvic ultrasound test, done by the gynecologist. We were accredited by the American Institute of Ultrasound in Medicine in 1999 and peer-reviewed by fellow clinical staff at USF.  This specialized testing offers an immediate clinical correlation with exam findings that exceeds the quality of most pelvic ultrasound studies. We also offer a similar breast ultrasound test and fine needle aspiration for evaluating lumps and mammogram abnormalities.

Urinary Incontinence, Interstitial Cystitis and E-stim- A significant number of women, when asked, will complain of problematic bladder leakage or pain/frequency syndrome. There has been a new wave of interest in this area and associated testing, drug therapy and minimally-invasive procedures. We have in-office urodynamics, IC evaluation and related therapies that have provided many patients with successful outcomes for their bladder dysfunction. E-stim is our non-surgical electronic pelvic floor therapy for a variety of bladder and gynecologic problems. We consulted with urogynecology specialists at Mayo and have essentially tried to duplicate their program. Please ask your doctor or our staff about urine leakage, pelvic pain, bladder pain and frequency, and consider the option of thoughtful workup and treatment from a Gyn specialist.

The LASH procedure- laparoscopic removal of part of the uterus, sparing the cervix. This is a minimally-invasive alternative to hysterectomy for many patients. The cervix is used to maintain or improve pelvic support and reduce the occasional problem of post-hysterectomy sexual dysfunction. After 12 years experience, most in the last 5 years, we have seen significant reduction in pain, healing time and functional disruption. Our practice quality data shows an average return to 80% function at one week post-op.  Patient satisfaction has been outstanding, and our 5 year results have been submitted for publication.

Endometrial Ablation- this is a type of hysterectomy alternative used ONLY for bleeding issues in a relatively “normal” uterus, where cautery or heated water is used to heat-treat the endometrium rendering it inactive and results in no period or, at least, decreased flow. It is a minor surgery similar to D&C in recovery time.

Augmented Vaginal Repair and Suburethral Slings- new technology and devices are the popular in Urogynecology and pelvic floor repair.  We have seen great outcomes with the Repliform human tissue graft material to bolster weak fascia tissues in anterior, posterior and paravaginal repairs of rectoceles, cystoceles, etc. Laparoscopic “lift” procedures can be done with fast recovery, and preservation of organs. Newer needle-placement techniques and smaller sizes in suburethral slings, allow for outpatient treatment, excellent outcomes and fast recovery.

Laparoscopic Surgery- As you probably are aware, we do almost all of our major Gyn surgeries via the laparoscope. The exception is the unusual situations such as more advanced Gyn cancers (and we now have our own local gyn oncologist, Jim Fiorica,MD, and nearby Moffitt/USF Cancer Center for those). Patients contemplating an “open” gyn surgery such as hysterectomy, fibroid or endometriosis surgery or pelvic repair, can consider other alternatives and another approach. Recovery from laparoscopic surgery is measured in days, not weeks, and excellent outcomes statistics are well-documented.

DaVinci Robotic Surgery-  We now have the robotic technology to assist with advanced laparoscopic surgery. DaVinci adds 3D visualization, improved instrumentation and other benefits on complex gyn surgical procedures.

Physician Care Clinical Research- Located on Tuttle Avenue, near our office, the PCCR Center offers all patients additional options in treating a variety of conditions, such as abnormal PAP, sexual dysfunction and endometriosis. Patients can be referred to he center with a simple phone call to 941-954-2355. All patent care and treatment are provided at no cost to patients.. See www.PCCRsarasota.com

Michael Swor MD

Chairman, SMH Department of ObGyn

The #1 Gyn department in Florida (as ranked by US News and World Report)

 Fellow AmericanCollege of OBGYN

Fellow American College of Surgeons

Assistant Clinical Professor, Dept of OBGYN, University of South Florida

Affiliate Clinical Professor, Florida State University

Accreditation Council for Gynecologic Endoscopists- 1995 founding member

Accredited GYN Specialty Ultrasound 

Bladder Testing and Treatment

We also offer in-office bladder health and functional assessment for women with a loss of control, urgency and leakage. We can help many women with decreased bladder function using simple exercise instruction, innovative devices, new medications, bladder training, electronic pelvic toning and, if necessary, minimally-invasive outpatient surgery.

Our "E-stim" electronic pelvic therapy was developed with the help of urogynecology colleagues from the Mayo Clinic. Computerized pelvic floor muscle stimulation can effectively help many different types of bladder problems, sexual dysfunction and pelvic tone loss. Click Here to learn more.

We also offer thorough evaluation, testing and treatment of Interstitial Cystitis (IC). This often misdiagnosed cause of bladder frequency, urgency and pelvic pain is caused by a breakdown in the bladder lining that occurs gradually over many years. A simple survey questionnaire, followed by a simple in-office test can help determine those with this chronic disabling disorder. New treatments can help up to 80% of the people who suffer from IC. Take a simple survey to see if you might have IC.

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Pelvic Prolapse, "dropped bladder", etc

We have expertise and a special interest in problems of decreased pelvic support. This includes weakness in seven areas of female pelvic support. Difficulty emptying the bladder, leaking, vaginal looseness and bulging/pressure are common complaints related to these problems and we can help you improve support with instructions, devices, and surgery if necessary. See pelvic prolapse info.

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Personal Care and Sexual Health

We now have personal care products available for discreet purchase in our office. Ask about the Pelvic Toner for resistance Kegel exercises and our recommended high quality personal lubricants. We also help patients and partners with evaluation, counseling, and prescription treatment for sexual dysfunction. Ask about testing for low testosterone, natural hormone boosters and Viagra for men and women.

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Breast Cancer Screening

We are committed to a comprehensive breast cancer screening and treatment program in the Sarasota area. At Swor Women's Care, we do breast cancer risk analysis, take a careful personal and family history, do appropriate clinical examination, refer for mammograms and other imaging and encourage and teach monthly self-breast examination. When advisable, we also offer Firstcyte NFA testing, breast ultrasound and FNA needle aspiration. We also work with local and regional breast cancer experts when a multispecialty approach is helpful. Call today for a complete breast cancer risk analysis, thorough breast examination and mammogram referral if appropriate.

Take this breast cancer risk assessment yourself....Click Here.

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Ovarian Cancer Screening

Click Here to see our recent write up on this site regarding risk assessment and testing related to ovarian cancer.

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Physician Care Clinical Research Center

We are involved with Physician Care Clinical Research Center of Sarasota and have many years of experience in FDA-approved clinical research into new treatments and techniques.

Interested in participating in FDA-Approved Clinical Studies?

Click Here for more info...

Current studies include new treatment for migraine, high blood pressure, hot flashes/ low sex drive, vaginal dryness and Crohn's disease....

More articles on Hormones, Estrogen, Progesterone, New Studies, Testosterone, Etc

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THE WHI: IS HORMONE REPLACEMENT BENEFICIAL OR HARMFUL?

The estrogen deficiency associated with the menopause can have a negative impact on a woman's sense of well being. Menopausal women are at increased risk for osteoporosis and some may also have an increased risk for heart diseases. After years of increasing estrogen use, women's concerns about hormone use have increased following media accounts of the early termination of the estrogen/progestogen arm of The Women's Health Initiative (WHI).
Prior to the report of the WHI in July 2002, it was estimated that 15,000,000 postmenopausal women were taking estrogens because multiple studies and decades of use had demonstrated a balance of benefits and risks. With the wide media coverage and the daily blitz from all sorts of news programs, it was estimated that up to 50 % of the 15 million women using hormones stopped them. Many women stopped therapy without even discussing it with their physician; while, so many doctors were not sure of how to respond, some even advising their patients to discontinue their hormones. read more...

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Surgery Update

See our latest Gyn Surgery Update for patients and doctors...Click Here

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Prescription Information

Click Here to link to our Discount Prescription Information Resources 

We also offer our expertise and advice in choosing vitamins and supplements that are backed by clinical research and expert opinion. See our affiliate products page at www.medeonhealth.com to help you choose high quality supplements for almost all nutritional needs.

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Supplements for Women

Most active women with typical day to day stress, occasional missed meals, etc., can benefit from the following nutritional supplements:

- Fiber and Water: high fiber diet with supplements as needed (like Fibercon) and 8 glasses of pure water
- Calcium Carbonate or Gluconate with magnesium: 1000-1500mg elemental Calcium daily as needed ...This is best obtained through diet, as Calcium and minerals are difficult for the body to dissolve and absorb and use effectively...new data suggests that many of the popular products available for calcium are ineffective and contain traces of lead
- B-Complex: High in B-6 and folate (800 mcg), at least 100% of the recommended daily allowance.
- Vitamin E: 400 to 1000 international units daily (unless BP or bleeding sensitive)
- Vitamin C: 500 to 1000 mg daily in divided doses (careful in kidney stone formers) Omega 3
- Fish Oils: for heart and vascular protection
- Baby aspirin: 81 mg for stroke and heart attack prevention if not contraindicated by your physician

"Natural forces within us are the true healers. Let your food be your medicine and your medicine be your food" --Hippocrates

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Cancer Prevention

Cancer is a group of separate diseases which are all similar in the respect that there is an uncontrolled growth of abnormal cells. The type of cancer is usually defined by the organ in which it started. Many scientists believe that tumors are a result, at least in part, from a poor natural immune response. So, in fact, cancer is the result of a weak body. Keep your immune system strong with good nutrition, rest, exercise, stress reduction and reducing exposure to toxins and chemicals (like smoking).

The symptoms and signs of cancer vary according to the type of cancer, but they all have at least one of the following "warning signals." Listen to your body, seek regular health care and let your clinician know if you exhibit any of these symptoms. Regular check ups and recommended screening tests can help in early detection and improved treatment.
Consider extra Vitamin E and Omega 3 fish Oils for extra cancer protection for the theoretical benefit of reducing free radicals in your bloodstream.

1. Change in bowel or bladder habits.
2. A sore that does not heal.
3. Unusual bleeding or discharge.
4. A thickening or lump in the breast or elsewhere.
5. Indigestion or difficulty swallowing.
6. An obvious change in a wart or mole.
7. Nagging cough or hoarseness.
8. Unexpected weight loss, fatigue, "ill-feeling", etc.

Self Exam Monthly, clinician exam yearly and mammogram yearly after 40 are the cornerstones of early breast cancer detection. We also offer breast ultrasound and information on risk assessment and genetic testing. Breast cancer is a woman's number one cancer risk (other than lung cancer in smokers)...

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PMS Advice and Help

Many women experience Premenstrual Syndrome (PMS) in varying degrees of discomfort. Symptoms range from acne flare ups and breast tenderness to mood swings, depression and insomnia. The following supplements can help relieve symptoms:

1. Calcium - Studies have demonstrated that 1,200 mg of calcium per day can help reduce the severity of PMS symptoms.
2. Magnesium - Supplemental magnesium may help alleviate some of the emotional symptoms, fluid retention and breast tenderness.
3. Vitamin B6 - Take as part of a multivitamin or B-complex.
4. Evening primrose oil - This is a source of gamma-linolenic acid (GLA) which can help normalize hormone levels and influence prostaglandin synthesis.
5. Omega-3's - These essential fatty acids can help with both the inflammatory process and with mood.

 Click Here for a specific Women's Health Basics supplement that is natural, safe and medically recommended

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Calcium: which form is best?

For adults, dairy products supply 72% of the calcium in the U.S. diet, grain products about 11% and fruits and vegetables about 6%.1 Milk drinkers get 80% more calcium in their diet compared to non-milk-drinkers.2 Apart from total calcium content, foods and supplements should be evaluated in terms of the bioavailability of the calcium they contained (i.e., how much of it is actually absorbed and utilized by the body.) Calcium absorption from various dairy products is similar, at about 30%.3 However, many people choose alternatives to milk and dairy products for health reasons, such as the prevention of atherosclerosis or food allergies. A variety of calcium-fortified nondairy beverages are now available. However, the bioavailability of calcium in these beverages may differ from that of milk. A study of calcium-fortified soy milk found that the calcium in it was absorbed at only 75% of the efficiency of the calcium in cow’s milk.4 While cow’s milk and fortified soy milk are therefore not equivalent as calcium sources, the difference can easily be overcome by either consuming more of the fortified soy beverage, or by consuming soy beverages fortified with proportionally higher amounts of calcium.

Dietary supplements may contain one of several different forms of calcium. One difference between the various calcium compounds is the percentage of elemental calcium present. A greater percentage of elemental calcium means that fewer tablets are needed to achieve the desired calcium intake. For instance, in the calcium carbonate form, calcium accounts for 40% of the compound, while the calcium citrate form provides 24% elemental calcium.

Many medical doctors recommend calcium carbonate because it requires the fewest pills to reach a given level of calcium and it is readily available and inexpensive. For people concerned about cost and only willing to swallow two to three calcium pills per day, calcium carbonate is a sensible choice. Even for these people, however, low-quality calcium carbonate supplements are less than ideal. Depending on how the tablet is manufactured, some calcium carbonate pills have been found to disintegrate and dissolve improperly, which could interfere with absorption.5 The disintegration of calcium carbonate pills can be easily evaluated by putting a tablet in a half cup of vinegar and stirring occasionally. After half an hour, no undissolved chunks of tablet should remain at the bottom.6

Calcium carbonate may not always show optimal absorption, but it clearly has positive effects. For example, calcium carbonate appears to be as well absorbed as the calcium found in milk.7 In fact, some studies indicate that calcium carbonate is absorbed as well as most other forms besides calcium citrate/malate (CCM).8 9 For example, a recent study found absorption of calcium from calcium carbonate to be virtually identical to absorption of calcium from calcium citrate.10

For people willing to take more pills to achieve a given amount of calcium (typically 800–1,000 mg), calcium carbonate does not appear to be the optimal choice, because other forms have been reported to be absorbed, absorb better (however, they do require more pills per day because each pill contains less calcium). For this reason, some doctors recommend other forms of calcium, particularly CCM. Research shows that CCM is absorbed better than most other forms.11 12 13 CCM may also be more effective in maintaining bone mass, than some other forms of calcium supplements.14 Because of their similarity in both name and structure, CCM can be confused with calcium citrate, but they are not the same.

CCM is not the only form of calcium that might be absorbed better than carbonate. For example, most,15 16 though not all,17 studies suggest that calcium citrate might have some absorption advantage over calcium carbonate. However, no evidence suggests that calcium citrate is as well absorbed as CCM.

Microcrystalline hydroxyapatite (MCHC), a variation on bonemeal, has attracted attention because of studies reporting increases in bone mass in people with certain conditions18 and better effects on bone than calcium carbonate.19 Similar positive studies exist using CCM.20 However, unlike CCM, MCHC has only occasionally been compared with other forms of calcium. In limited research that does make comparisons, MCHC fared poorly in terms of solubility, absorption, and effect on calcium metabolism.21 22

Remarkably little is known about the relative efficacy of amino acid chelates (pronounced “kee-lates”) of calcium. In the only commonly cited trial, absorption was measured for an amino acid chelate called calcium bisglycinate and compared with absorption from citrate, carbonate, and MCHC.23 In that trial, the amino acid chelate showed the best absorption and MCHC the worst. Although CCM was studied in that trial, it was taken under different circumstances than the chelate (with meals), so drawing definitive conclusions is not possible.

Whatever the form, calcium supplements typically are absorbed better when eaten with meals.24 Moreover, research indicates that taking calcium with meals may reduce the risk of kidney stones and supplementing with calcium between meals might actually increase the risk.25

Besides how to take calcium supplements, scientists have also been studying when to take them. Supplementing calcium in the evening appears better for osteoporosis prevention than taking calcium in the morning, based on the circadian rhythm of bone loss.26 In order to not increase the risk of forming kidney stones, most doctors tell people to take calcium supplements only with food.

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What is the relationship between calcium supplements and stomach acid?

Years ago, researchers reported that people who do not make hydrochloric acid in their stomachs cannot absorb calcium adequately when the calcium is taken alone.27 In that report, adding hydrochloric acid restored normal calcium absorption. Although researchers have subsequently confirmed these findings, they have also discovered that these same people absorb calcium normally if they take it with meals. In addition, researchers have noted that giving these people hydrochloric acid does not further improve absorption during meals.28 Others have confirmed that hydrochloric acid, either from pills or from the stomach, is unnecessary for the absorption of calcium, as long as the calcium supplement is taken with meals.29 30 31 32

Some doctors have expressed a concern that antacids that contain calcium (like Tums®) or calcium supplements that also act as antacids, interfere with the body’s absorption of calcium. However, this is not the case. Calcium carbonate, the principal ingredient in both Tums and many calcium supplements provides significant (though not optimal) absorbable calcium, as discussed above. Other forms of calcium that might be more bio-available, such as calcium citrate, also act as antacids. The form of calcium associated most consistently with best bio-availability, CCM, is itself, an antacid despite the fact it is used almost exclusively as a source of calcium.

Other concerns about the antacid effect of most calcium supplements (particularly when taken by people who do not need and are not seeking an antacid) are voiced by some doctors because stomach acid is needed to protect against bacterial infection and also to help digest protein. In theory, calcium supplements with antacid activity could at least temporarily interfere with these processes. However, to date, these concerns remain hypothetical.

Health Tip........Total Cereal has 1000mg of calcium for a great way to get it without supplements

The best lead-free, dissolvable, absorbable, bioavailable calcium supplement (with Magnesium and D and trace minerals is...Osteoguard by Clinician's Choice. We stock it in our office or you can order online through www.medeonhealth.com

References:

1. U.S. Department of Agriculture, Nationwide Food Consumption Survey 1987–1988, PB-92–500016. Washington, DC; U.S. Government Printing Office, 1989. 2. Fleming KH, Heimbach JT. Consumption of calcium in the U.S.: food sources and intake levels. J Nutr 1994;124(8 Suppl):1426S–30S. 3. Nickel KP, Martin BR, Smith DL, et al. Calcium bioavailability from bovine milk and dairy products in premenopausal women using intrinsic and extrinsic labeling techniques. J Nutr 1996;126:1406–11. 4. Heaney RP, Dowell MS, Rafferty K, Bierman J. Bioavailability of the calcium in fortified soy imitation milk, with some observations on method. Am J Clin Nutr 2000;71:1166–9. 5. Kobrin SM, Goldstine SJ, Shangraw RF, Raja RM. Variable efficacy of calcium carbonate tablets. Am J Kidney Dis 1989;14:461–5. 6. Shangraw R, chair, Dept. Pharm, U. of Maryland, quoted in: “Ask Dr Tastebud,”Nutr Action Healthletter 1990;Sep:13. 7. Mortensen L, Charles P. Bioavailability of calcium supplements and the effect of vitamin D: comparisons between milk, calcium carbonate, and calcium carbonate plus vitamin D. Am J Clin Nutr 1996;63:354–7. 8. Sheikh M, Santa Ana C, Nicar M, et al. Gastrointestinal absorption of calcium from milk and calcium salts. N Engl J Med 1987;317:532–6. 9. Kohls K, Kies C. Calcium bioavailability: A comparison of several different commercially available calcium supplements. J Appl Nutr 1992;44:50–62. 10. Heaney RP, Dowell MS, Barger-Lux MJ. Absorption of calcium as the carbonate and citrate salts, with some observations on method. Osteoporos Int 1999;9:19–23. 11. Miller J, Smith D, Flora L, et al. Calcium absorption from calcium carbonate and a new form of calcium (CCM) in healthy male and female adolescents. Am J Clin Nutr 1988;48:1291–4. 12. Harvey JA, Kenny P, Poindexter J, Pak CY. Superior calcium absorption from calcium citrate than calcium carbonate using external forearm counting. J Am Coll Nutr 1990;9:583–7. 13. Smith KT, Heaney RP, Flora L, Hinders SM. Calcium absorption from a new calcium delivery system (CCM). Calcif Tiss Int 1987;41:351–2. 14. Dawson-Hughes B, Dallal GE, Krall EA, et al. A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. N Engl J Med 1990;323:878–83. 15. Nicar MJ, Pak CY. Calcium bioavailability from calcium carbonate and calcium citrate. J Clin Endocrinol Metab 1985;6(2)1:391–3. 16. Harvey JA, Kenny P, Poindexter J, Pak CYC. Superior calcium absorption from calcium citrate than calcium carbonate using external forearm counting. J Am Coll Nutr 1990;9:583–7. 17. Sheikh MS, Santa Ana CA, Nicar MJ, et al. Gastrointestinal absorption of calcium from milk and calcium salts. N Engl J Med 1987;317:532–6. 18. Epstein O, Kato Y, Dick R, Sherlock S. Vitamin D, hydroxyapatite, and calcium gluconate in treatment of cortical bone thinning in postmenopausal women with primary biliary cirrhosis. Am J Clin Nutr 1982;36:426–30. 19. Rüegsegger P, Keller A, Dambacher MA. Comparison of the treatment effects of ossein-hydroxyapatite compound and calcium carbonate in osteoporotic females. Osteoporos Int 1995;5:30–4. 20. Lloyd T, Andon MB, Rollings N, et al. Calcium supplementation and bone mineral density in adolescent girls. JAMA 1993;270:841–4. 21. Heaney RP, Recker RR, Weaver CM. Absorbability of calcium sources: the limited role of solubility. Calcif Tissue Int 1990;46:300–4. 22. Deroisy R, Zartarian M, Meurmans L, et al. Acute changes in serum calcium and parathyroid hormone circulating levels induced by the oral intake of five currently available calcium salts in healthy male volunteers. Clin Rheumatol 1997;16:249–53. 23. Heaney RP, Recker RR, Weaver CM. Absorbability of calcium sources: the limited role of solubility. Calcif Tissue Int 1990;46:300–4. 24. Heaney RP, Smith KT, Recker RR, Hinders SM. Meal effects on calcium absorption. Am J Clin Nutr 1989;49:372–6. 25. Curhan GC, Willett WC, Rimm EB, Stampfer MJ. A prospective study of dietary calcium and other nutrients and the risk of symptomatic kidney stones. N Engl J Med 1993;328:833–8. 26. Blumsohn A, Herrington K, Hannon RA, et al. The effect of calcium supplementation on the circadian rhythm of bone reabsorption. J Clin Endocrinol Metab 1994;79:730–5. 27. Ivanovich P, Fellows H, Rich C. The absorption of calcium carbonate. Ann Intern Med 1967;9:271–85. 28. Recker RR. Calcium absorption and achlorhydria. N Engl J Med 1985;313:70–3. 29. Bo-Linn GW, Davis GR, Buddrus DH, et al. An evaluation of the importance of gastric acid secretion in the absorption of dietary calcium. J Clin Invest 1984;73:640–7. 30. Serfaty-Lacrosniere C, Woods RJ, Voytko D, et al. Hypochlorhydria from short-term omeprazole treatment does not inhibit intestinal absorption of calcium, phosphorus, magnesium or zinc from food in humans. J Am Coll Nutr 1995;14:364–8. 31. Knox TA, Kassarhian Z, Dawson-Hughes B, et al. Calcium absorption in elderly subjects on high- and low-fiber diets: effect of gastric acidity. Am J Clin Nutr 1991;53:1480–6. 32. Eastell R, Vieira NE, Yergey AL, et al. Pernicious anaemia as a risk factor for osteoporosis. Clin Sci 1992;82:681–5.

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Deciding on Gyn Surgery

8-30-03

Millions of American women suffer needlessly from pelvic pain, bleeding problems and other gynecologic problems. Medical breakthroughs provide many options for treatment depending on the cause and extent of the problem and the individual situation of the patient. Unfortunately there is a continuous stream of misinformation that creates controversy and confusion. The internet provides a fantastic resource of excellent reference information, but users have to weed through an obstacle course of self-serving, inaccurate or purposely one-sided “expert” opinion on any particular issue. There is no better example of this than in the topic of women’s health. A recent segment on ABC’s 20-20 program about hysterectomy accomplished its purpose in getting a reaction from viewers, but couldn’t have been more slanted. Still, it’s an important subject that needs thoughtful discussion, especially if it is a serious medical treatment option and you are the one considering it.

Hysterectomy is the surgical removal of the uterus. This is the organ with the primary function of receiving the fertilized egg from an ovary and carrying the developing fetus to birth. If it’s not doing that, the uterus is preparing monthly to do the same task. In some women, significant problems such as pain, excessive bleeding, or cancer risks bring up the option of hysterectomy. In most cases there are many options or variations to consider. These might include removal of one or both ovaries, vaginal repair work, bladder repair, or other procedures accomplished at the same time for specific purposes. Almost all hysterectomies can now be done through small incisions or a vaginal technique, avoiding large incisions, higher risks and extended recovery. In many cases, there are better and less invasive surgical options where hysterectomy can be avoided or postponed. These include laparoscopic surgery, laser, endometrial ablation, myomectomy, hysteroscopy and even removal of a part of the uterus…the supracervical alternative to hysterectomy. Of course, for most conditions, there are many considerations that are non-surgical. Non-traditional medical techniques may also be advised.

One of the biggest breakthroughs in recent years is the refinement of the LASH (laparoscopic supracervical hysterectomy), which involves removing only a portion of the uterus with no vaginal incision and only small incisions in the navel and lower abdomen. The biggest benefit of this minimally-invasive approach is the fast recovery and less “down time”. The additional suggested advantages, although not yet proven, are the possibility of even less chance for any negative sexual effects or future bladder/ pelvic support problems. If Gyn surgery is recommended, and future child-bearing is not desired, this technique should at least be considered. Most patients undergoing a LASH procedure are 80% back to normal after just one week. These patients don’t have periods anymore, but have an undisturbed vagina and cervix. If the ovaries are left in place, then hormonal function should be the same as well.

There continues to be controversy regarding sexual function and gyn surgery. Most research, practical experience and common sense suggest that with current techniques and well-informed patients, the potential for negative effects is very unlikely. Actually many procedures are done with the goal of improving pelvic pain and/or sexual function. If pain, extreme menstrual periods, fear of unwanted pregnancy or pelvic support problems contribute to sexual problems, then an improved sex life is anticipated. Exceptional situations, such as major cancer surgery, radical life-saving procedures and sudden surgical menopause from the removal of both ovaries in younger, premenopausal women might be expected to impact sexuality in a negative way. Unfortunately, these much less common scenarios are the ones that receive most of the attention when the “negatives” of gyn surgery are debated. In some of these cases, or any individual situation where sexual issues result or develop, a full effort at correcting problems is warranted. What is known about female sexuality suggests that contributing factors are complex, and much of the human sexual response is perception. The brain is the most important sex organ as evidenced by the “non-pelvic” causes of the majority of sexual problems, the existence of “wet dreams” and surprisingly satisfactory function seen in many people with spinal cord injuries, major pelvic trauma or sensory-motor loss from disease.

The bottom line is this…when significant gynecologic problems warrant corrective action, find a reputable specialist that is trained, certified, highly-experienced and fosters a sense of trust. Review all available options, including surgical and non-surgical methods. Allow for a thorough workup and evaluation. Consider a second or even third opinion. If possible, try the simplest and least invasive approach first. In the care of a qualified, board-certified gynecologist, one can anticipate successful outcomes in the vast majority of cases. As with any important decision, your own knowledge and confidence helps tremendously in making the right choice.

Michael Swor MD
Assistant Clinical Professor
Department of OBGYN
University of South Florida College of Medicine

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Detecting Cancer of the Cervix - New technology

9-4-03

Michael Swor MD

New technology is now available to women in the fight against cancer. Regular Pap smears have appropriately become an important part of preventive health care, and have helped to dramatically reduce the number of American women diagnosed with invasive cancer of the cervix. In the rest of the world, cervical cancer is the second most common cause of cancer death.

Now a new test can be requested in some clinics, that improves the ability of detecting precancerous lesions on the cervix. PapSure® is the only in-office, direct visual screening test cleared by the U.S. Food and Drug Administration for all women having a pelvic exam and standard Pap smear. PapSure® combines the results of a traditional Pap smear and speculoscopy (a magnified view of the cervix) using a special light for vaginal illumination, which helps trained clinicians to visually identify abnormalities that have the potential to become cancerous.

Cervical cancer is a serious disease, but unlike breast cancer, is almost 100 percent preventable with accurate screening and early detection of dysplasia, a common condition that, left untreated, can lead to cancer. Risk factors for developing cervical cancer include poor health screening, smoking, and unprotected sexual activity. Certain sexually transmitted diseases dramatically increase the risks, namely specific strains of HPV (human papilloma virus).

There are typically no symptoms of precancerous change in the cervix. Women who undergo regular checkups and Pap smears will usually have any abnormality detected at a precancerous early stage. If checkups are infrequent, or the Pap smear is not done, improperly obtained or misread, the early stage problems could be missed, and the abnormality might progress to cervical cancer. If that is the case, then a fully curable issue becomes a potentially life-threatening one.
Some clinical studies show that traditional Pap smears can have a high false negative rate. This means that Pap samples that actually have cervical cancer cells present may be reported as negative. There are a number of reasons why a traditional Pap smear may appear normal even though abnormal cells exist on the cervix. Errors in detecting cervical abnormalities may occur due to lesions that don’t “shed” cells from the surface of the cervix, inadequate cell sampling, omissions or mistakes in transferring cells to a slide, and human error in reading the Pap smear slide provided to the lab.

Attention was first focused on the potential for misreading the Pap smear itself, with instances of incorrectly read slides making newspaper headlines across the United States.

Accordingly, the first efforts at improving screening were directed at improving the quality of Pap smear slide reading. With an expert gyn examination and experienced Pap smear collection technique, combined with quality lab cytology services, the likelihood of missing an abnormality is relatively small. Any improvement in the process would be helpful, however.
The Clinical Laboratory Improvement Act (CLIA) mandated that a limit be placed on the number of Pap smear slides that an individual technician can read daily, and further mandated that a minimum of 10% of the slides must be over-read. Simultaneously, a number of companies began developing new Pap smear slide preparation techniques. These liquid-based tests (Autocyte and ThinPrep) are now available and are also proven to increase the successful early detection of cervical cancer.
At the same time these lab-based technologies were being introduced, another type of technology was being investigated. This even newer type of test was an answer to research data showing that some women with cervical pre-cancer, and even some with cancer, might not "shed" the abnormal cells. If this is the case, then even when the liquid-based Pap smears are done, and done correctly, an abnormal lesion on the cervix might not be detected. Rather than depend on the collection of cells, this new PapSure® test, assesses the cervix directly, with a closer magnified look, and could truly add to the accuracy of the Pap smear. Instead of a better Pap, speculoscopy is an extra test done in addition to the Pap. When combined with the routine Pap smear, it is known as PapSure®.

While the Pap smear provides a sample of surface cells, the visual portion of a PapSure® exam may reveal cervical abnormalities that the Pap smear alone may not detect.
Research studies have shown that PapSure® more than doubles the detection rate of cervical abnormalities as compared to the Pap smear alone.
This testing is simple and generally painless. Although is takes a few minutes longer, there is no additional discomfort associated with the visual portion of the PapSure® exam.
PapSure® is indicated in all women undergoing a pelvic exam and Pap smear. Current guidelines recommend that women who are or have been sexually active, or have reached age 18, should have Pap tests and pelvic exams regularly. There is no known age at which Pap tests cease to be effective. Women should discuss how often to have the gyn pelvic exams and Paps with their physician.

Since the test is relatively new, not all gyn practitioners are trained and offer PapSure®. Another consideration is that insurance companies may not pay for this extra test. The good news is that for what it offers in improved care, the cost is relatively low (approximately $50). And, of course, if extra non-invasive testing can reduce cancer risks, then cost-benefit is measured in lives saved.

As far as waiting time, the two part PapSure® gives immediate results on the visual portion of the exam, and the same 1-3 weeks results on the typical lab portion of the exam.
Although PapSure® detects a higher percentage of abnormalities in the cervix than Pap smear alone, not all of the abnormalities detected by PapSure® are cancerous cells. If either the visual part OR the lab part is abnormal, then additional cancer screening tests will be advised.
If the PapSure® test is abnormal, then the options that may be discussed include the following:

Watch and wait: Many times the most medically sound decision is to wait carefully and boost the body’s own ability to self-correct minor problems. It is not uncommon to recheck testing in a 2-6 month interval, if the abnormality seems minor to the trained clinician.

Colposcopy exam: This is a more detailed visual exam where the physician will examine the cervix using high-power magnification, light sources and applied liquid solutions. If anything looks suspicious, a small sample of the tissue may be biopsied for laboratory testing.

The most significant benefit of PapSure® is confidence. With PapSure®, patients can be confident that if any cervical abnormalities exist, even early disease, an experienced healthcare provider may be able to see it, even if the Pap smear does not detect it.

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New Ideas in Pelvic Pain and Bladder Problems

Michael Swor MD

9-4-03

One of the problems of current specialized medical care for women involves the separation of bladder and gynecologic conditions. Women with frequent urination, urgency and recurrent bladder infections are often referred to Urologists. When pelvic pain is the main complaint, it is usually the Gynecologist that does the evaluation. Two common disorders can cause symptoms that affect both bladder function and the reproductive tract. One of these conditions is endometriosis, and the testing and treatment for this condition is well-understood. The other condition has been poorly understood until recently, yet may affect as many as 8 million American women. This condition is known as Interstitial Cystitis (IC). Recent research has opened a new chapter in the diagnosis and treatment of IC.

Endometriosis

One of the most commonly diagnosed causes of pelvic pain in women is endometriosis. In this chronic condition, tissue that acts like the lining inside the uterus grows outside the uterus and is responsible for painful periods, painful intercourse, infertility and a number of other symptoms. Endometriosis can occur early in the female life cycle and can be suggested by the pattern of symptoms. Pelvic examination and ultrasound can reveal clues about the presence of endometriosis, but the actual diagnosis typically requires a procedure known as diagnostic laparoscopy. The gynecologist uses a narrow telescope-like device to carefully look inside the abdominal and pelvic body cavities through an incision in the navel to actually see the endometriosis implants. This procedure is done under anesthesia and gives the specialist an opportunity to treat the disease at the same time with surgical tools including lasers. Special drug treatment is also available and even birth control pills, Depoprovera and other therapy is potentially helpful in the treatment. Some doctors specialize in gynecologic problems such as endometriosis and careful, aggressive management usually results in successful outcomes and preservation of the uterus and ovaries. Untreated, the condition gradually progresses, and can result in disabling pain, scarring and occasionally the need for more extensive surgery. Although many natural remedies have been tried, none have proven to be of significant benefit. Since pregnancy temporarily stalls the progression of endometriosis, we see more women with this condition in our current society than we did in the days of early and frequent childbearing.

Interstitial Cystitis

IC used to be a rare diagnosis, but a new understanding of the condition has provided an improved ability to identify women (and men) who suffer from this progressive and often disabling disease process. The typical IC patient complains of bladder urgency, frequency and symptoms of bladder infection (UTI or cystitis). Many patients have some kind of pain associated. The pain of IC can be in any location in the lower abdomen, pelvis, vagina or external genital areas. The pain syndrome often flares with cycles, and tends to gradually worsen over the course of one’s life. Symptoms can also include vaginal irritation, burning and painful intercourse.

IC develops when the natural mucus barrier protection in the bladder lining starts to break down. This allows the normal high levels of potassium in urine to diffuse into the nerves and muscle fibers in the bladder wall and surrounding tissues. The potassium damages the nerve and muscle cells, causing pain and poor function. The bladder begins to feel more urgency and decreased capacity. Treatment is aimed at improving the mucus barrier and decreasing the concentration of potassium. The nerve and muscle tissues can then regain strength and function.

Since there is a relationship with the body’s allergic response, flare-ups can also occur during the allergy seasons. Traditional testing such as cystoscopy and even laparoscopy is not effective in finding the problem. Researchers have discovered a new test that is very accurate in determining when IC is present. The test is offered to patients who have a high score on a bladder symptom/ pelvic pain questionnaire that was developed by experts on the condition. Because much of what is known about IC is new information, the disorder is frequently misdiagnosed as endometriosis, chronic UTI/Cystitis, vulvodynia, chronic yeast infection and a number of other diseases. Many other patients with IC are left without any specific diagnosis or treatment. Without proper care, the process worsens, and symptoms increase. Later stages of the disorder are more difficult to reverse and damage can become permanent. With a careful evaluation, simple testing and brand-new treatment programs, up to 80% of people that suffer from IC can get significant improvement and lead normal lives.

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More Ideas for Better Health
Busting Fitness Myths
By S. Kirk Walsh for WeightWatchers.com

"Flat abs now!" "Miracle abdominal crunches!" Daily, we are bombarded with get-fit-quick messages on television, in magazines, and even via friends. With this inundation of information, how do you sift through the fiction for the fact? Below, we've enumerated some of the most common fitness myths -- and set the record straight -- so you won't fall prey to these common fitness fallacies.

More is better - Often when you're kick-starting a new fitness routine, the tendency is to go into overdrive. "People start working out eight days a week, 370 days a year, thinking it will get them quicker results," explains William Sukala, MS, CSCS, a clinical exercise physiologist at Sharp Memorial Hospital in San Diego. "They usually burn themselves out and eventually fall off the exercise wagon." The key to fitness success is consistency and moderation. Establishing a regular routine should be your top priority.

Doing sit-ups will give you a flat stomach - People are always looking to target specific areas of their bodies with exercises, believing that zillions of sit-ups will lead to a picture-perfect, washboard stomach. "There is no such thing as spot reduction," says Sukala. Sit-ups and crunches can strengthen your abs, but they can't get rid of fat. "Only regular exercise training -- aerobic and strength -- and a sensible diet can eliminate excess body fat," says Cedric Bryant, Ph.D., chief exercise physiologist at the American Council on Exercise.

Women who lift weights bulk up - It takes numerous hours -- and years -- of heavy weight lifting for professional bodybuilders to bulk up like the Incredible Hulk (often with the help of steroids). Also, most women are not genetically predisposed to develop large muscles because they don't have the stores of testosterone needed for this kind of muscle development. "In fact, many women lift weights that are far too light," says Sukala. "If you can lift a weight for 45 repetitions without stopping then it's too light. After ten or fifteen repetitions, you should feel the weight becoming heavier." The goal of lifting weights is to tone and strengthen.

I must join -- and live at -- the gym to establish a regular fitness routine - Some people are intimidated by all of those mirrors and high-tech machines. Find a workout buddy and walk around the neighborhood. Or try another favorite activity, such as tennis or biking. "All you need to do is commit to moving -- and it can be cumulative, like walking to a co-worker rather than sending an email or taking the stairs instead of the elevator," says Bryant. "Exercise is like loose change in your pocket -- it can add up."

The best time to work out is early in the morning - "There is no rhyme or reason to the best time to work out," explains Sukala. "People should work out when they're comfortable: This could mean 4:00 in the morning for some people and 10:30 in the evening for others." One thing to keep in mind is that blood pressure is more elevated in early morning for most people. So, if you exercise n the early morning, particularly with resistance training exercises, your blood pressure response is probably going to be higher. If you have normal blood pressure, this should not pose a problem. However, if your resting blood pressure tends to be elevated, discuss early morning exercise with your physician. And for most people, the best thing to do is to try different times of day and see what works for you.

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Skin Health.........What is MD Forté and what can it do for me?

The MD Forté dermatologic products contain high levels of Alpha Hydroxy Acid (AHA) to normalize the exfoliation process and increase the moisturization of your skin. These processes generally slow down with age and exposure to the sun. AHA dissolves the cellular "cement" that binds dead cells together and slows living cells from reaching the skin surface. As the dry outer layer is exfoliated by AHA, younger, healthier, smoother-looking skin is revealed. Click Here for more information. These products are available only through physicians.

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Helpful Herbs and Supplements for Hormone Problems

There are many supplements available to help with hormonal problems. In addition to the individual vitamins and supplements below, some new formulations and combinations have been developed. These herbal and vitamin combinations were designed and clinically tested to help women with a variety of hormone issues. Call the office or Click Here for more information on Women's Isoguard, and other reliable products.

Basic Hormone Support
Vitamin E: 800 to 1000 units daily
Soy-based foods & products: tofu, soy nuts, soy milk
Natural Progesterone Cream 20-80 mg daily (we provide this at Swor Women's Care in prescription and non-prescription strengths)

Hot Flashes/Night Sweats
Women's Iso-Guard & Remifemin
Evening Primrose Oil
Black Cohosh
Dong Quai & Licorice Root

Natural Progesterone Cream

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Reducing Your Risk of Migraines

People who experience migraines know how potentially debilitating they can be. However, there are steps you can take to avoid migraines. First and foremost, be aware of activities or circumstances related to your migraines by keeping a diary to help you identify triggers. Common triggers include:

1) Fluctuations in female hormones. Changes in estrogen and progesterone levels with menses may be associated with migraine headaches.
2) Sensitivity to tyramine. This amino acid, found in foods such as aged cheese, wine, certain liquors, processed meats, pickles and olives, may trigger migraines in some people.
3) Sensitivity to tannins. Tannins are found in coffee, tea, red wine and apple juice.
4) Sensitivity to MSG (monosodium glutamate).
5) Extreme sensitivity to weather or altitude changes.
6) Sensitivity to glaring or fluorescent lights.
7) Change in sleeping patterns.
8) Stress

If you suffer from migraines and don't like the thought of taking strong prescription medications, consider trying butterbur (Petasites hybridus). This herb is native to Europe, northern Africa and southwestern Asia, and has been used for centuries as an effective remedy for headaches, back pain, and asthma. More recent evidence suggests migraine sufferers may benefit from butterbur's actions - reducing inflammation and spasms in blood-vessel walls - without experiencing the side effects associated with prescription medications (except some burping). A study published in Neurology, Dec. 28, 2004, reported that after four months, people taking 75 mg of butterbur for migraines had 48 percent fewer migraine attacks per month - similar to the effects of prescription migraine drugs. Be very careful about the butterbur you purchase - use only butterbur extracts that are guaranteed to be free of pyrrolizidine alkaloids. The adult dosage ranges from 50-100 mg twice daily, and should be taken with meals.

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