Frequently Asked Questions


Are you taking new patients?

Yes.

Why do you have your office in a house rather than a medical office building?

When I finished graduate training I worked in the Health Department in Adams-Morgan in Washington D.C. This was interesting and good in many ways. After I had my son, I moved back to Charlottesville and worked for 10 years in a traditional physician owned practice. This was very perfect for me at that time. That practice closed in 2000 when the physician left the area. At that point in time, much had changed in the medical world in terms of payments from the insurance companies compared to when I began practice in 1987. The result of this change was a significant push for productivity. What productivity means in healthcare is seeing more patients in less time. This is not something I wanted to do. In order to have the freedom to schedule the time I wanted to spend with my patients, having my own practice seemed the best way to go. Having a home based office (yes it is my home above my office) results in the lowest possible overhead giving me the economic latitude to practice the way I prefer—hour long appointments for new, annual and problem visits. It is possible to practice quality healthcare in a 20 minute appointment, and many practitioners do this. But I like to take the time and look at all the issues a woman has in her life—physical, social, emotional, spiritual and her lifestyle choices that may be contributing to her overall experience of health and life. In one hour this is possible.

Additionally, my home based office is quiet, warm and well—homelike, and professional. Many of my patients have commented on how comfortable they feel in my office setting. Gynecology care by nature is a bit discomforting. By making it as warm, friendly and private as possible, I find the women I care for appreciate the difference a home based office makes.

Why didn’t you become a doctor?

I find this a very interesting question and one that has been asked me directly quite a few times over the years. What it presumes is that at some point I wanted to be a doctor. Obstetrics and Gynecology is a surgical specialty and as a medical specialty is focused on identification and treatment of disease. When I decided I wanted to be involved in healthcare, what drove me was an interest in childbirth and specifically creating a safe place where women could birth in their strength and in their individual way. Over the years my gynecology care has evolved in a similar way, helping women identify their issues and find the best way they can to achieve optimal health in the way that best suits their beliefs. To this end I have focused not only on western medical modalities but also on lifestyle, mind/ body, herbal, homeopathic and nutritional approaches. I use routine medical diagnostic and laboratory testing and prescription medications, when they are desired and indicated, but my focus is on the whole person, not the part that is their reproductive system. While I could well have ended up in this same place as a physician, as some do, I never had the interest to devote myself to either surgery or the study of disease as perceived by western medicine. But I do know wonderful doctors who I refer to when their expertise is needed.

Why do you no longer attend births?

After 19 years it was just the right time. Will I ever return to birth? It’s hard to say. At the last birth I attended, Elizabeth, the lovely nurse I was working with, turned to me and said “So this is your last birth!”. At that time it was not a conceivable concept. So then, and now, I say—I just don’t know, life makes many turns.

Can you write prescriptions?

Yes. It is one option of care and/or treatment, sometimes the best. I approach each situation individually and discuss it with the woman I am caring for.

What do you think of Birth Control Pills?

Hormonal contraception—pills, vaginal rings, shots, implantable devices, intrauterine devices (Mirena has progesterone, Paragard has copper) all have their place in the world of contraception. As do diaphragms, cervical caps and condoms. The good news is that in the 21st century we have many options. It is useful to remember that prior to the 1960’s a scant 50 years ago, there were condoms and diaphragms only. I welcome every method of contraception, as for each method, there is a woman best served by it.

We know that 5 years of hormonal contraception halves a woman’s risk of ovarian cancer. Now this is a fairly rare cancer in this country with a rate of 12.8 per 100,000 women but it has a high mortality rate of 8.4 per 100,000 (http://seer.cancer.gov/statfacts/html/ovary.html#incidence-mortality) . The reason for the high mortality is that it is very hard to find in it’s early stages.

Also if a woman contracts chlamydia or gonorrhea while on hormonal birth control the infection is less likely to ascend into the uterus/ovaries. And it is when these infections ascend that they can cause fertility problems. The protective effect is due to the hormonal contraceptive’s thickening the cervical mucus. The thickened mucus keeps the bacteria out of the uterus.

But estrogen increases the risks of harmful and potentially deadly blood clots. This is more true if the the woman is significantly overweight, smokes cigarettes, and/or is inactive. Or has a family history of excessive clotting.
Is there a link between hormonal contraception and breast cancer? If so it is not very strong, most studies say no and a few studies say yes. But given this, I think mixing up your contraceptive choices over your reproductive years is probably the safest bet.

So it is great for some, OK for others and seriously dangerous for a few.

Can you refer me for a mammogram?

Yes.

Do you prescribe bio-identical hormones? And what are these anyway? And are they safer than synthetic hormones?

Yes I do prescribe them.

They are hormones that are chemically identical to what a women’s body produces. Synthetic hormones such as premarin and provera are biologically similar to estrogen and progesterone, but chemically they are different forms of what our bodies produce.

Are they safer? There is not any evidence to show that estradiol is safer than synthetic estrogens. There is some and growing evidence to support progesterone as a safer choice over synthetic progestins. And in my experience, the bio-identical forms of both work better and have less negative side effects than the synthetic forms.

Estrogen exposure in the post menopausal woman does increase occurrence of breast cancer and blood clots which can lead to stokes and/or heart attacks. The incidences are not huge, but they are there. They are dose and duration related. We know that women who have earlier menarche and late menopause have higher incidence of breast cancer—and you can not get more bio-identical then your own estrogen. Similarly overweight women have higher estrogen levels due to the storage of estrogen in fat cells (adipose tissue). They also tend to higher rates of breast cancer. So is it reasonable to take hormone replacement? That depends on how you are being affected by this time of life. Again this I discuss individually with every patient.