Author: Greenville Womans Care

My name is LaDena Renwick Tilley.

I fought breast cancer twice and I won!! I was first diagnosed with breast cancer in 1999 and had a lumpectomy with chemotherapy and radiation. I was 30 years old. Then, in 2013, I was diagnosed again and had a bilateral mastectomy. I never thought in a million years that I’d be going through it again.

This last battle was the hardest due to the fact that both of my breasts were being removed, my body was being transformed. As a woman having breasts is part of our womanhood. If it wasn’t for my FAITH IN GOD and the support of my loving, incredible husband, family, friends and my Greenville Women’s Clinic family I couldn’t have gotten through it.  

Having breast cancer did affect me, mentally and emotionally. I allowed myself to grieve because I was experiencing a loss, but then I thought if my FAITH is going to be authentic then it must be tried. Always remember that doubt sees obstacles, but FAITH sees the way. I had to learn that my breasts don’t define me as a woman, for a phenomenal woman isn’t defined by her physical appearance, but by the content of her spirit and she doesn’t allow her flesh to overrule the righteousness of GOD that is destined in her life. Her beauty lies within.

Whenever we hear the word cancer it brings fear upon us but allow courage to take center stage so that fear has no place in your life. My experience with breast cancer has been one of self-growth and assurance.

Assurance that I am more than a conqueror, a warrior, a victor and not a victim. I’ve grown in love, patience, peace and strength and learned how to thrive in the midst of troubled times. Every survivor of breast cancer is a CEO, which is a CHOSEN EMPOWERED OVERCOMER, therefore we must be prayerful daily, humble in our living and a service to others.

I salute all those who have lost the fight, are fighting or will be fighting this disease. 

May I say to you, be determined to fight with LOVE, DIGNITY, and DILIGENCE!! When I look in the mirror I am reminded of the battle that I fought, but more importantly the VICTORY that I’ve WON!!! The road to recovery has been a long one, but as Maya Angelo said “I wouldn’t take nothing for my journey,” I am so Blessed to be a two-time survivor.

During the month of October when you make a donation to Greenville Women’s Clinic to provide financial assistance to local breast cancer survivors in need of post-mastectomy care with Avila Physical Therapy -OR- share a story or image related to breast cancer month or a survivor and tag Greenville Women’s Clinic in the post on Facebook you’ll be entered into a drawing to win one of the following items donated by The Spa at Merle Norman:

• 25-minute Swedish Massage
• A Signature Hydrating Manicure
• You and up to 3 Guests receive a Hydrating Body Treatment in the Grotto and use of all spa amenities
• Additional prizes will also be available!

Depending on your Facebook privacy settings, you will need to be sure to share the post using the setting “public”, you may also share the picture directly on our page.

Have you heard about the current debate over breast cancer screening? It is a hot and heated topic. We are all at risk for breast cancer, even our male counterparts. Our risks increase with our age. Well, ladies, age is the current debate. What age is best to start breast cancer screening if you have no family history or risk factors?

Let’s look closely at this debate. This has come about due to the new recommendations by the U.S. Preventive Services Task Force (USPSTF). This task force is now recommending that a woman starts her routine breast cancer screening NOT at age 40, but ten years later, meaning at age 50. To be clear, this is if you have no family history of breast cancer or risk factors like dense breast, history of chest radiation or other medical concerns. The recommendation also states that mammogram screenings not be done annually but every 2 years unless medically indicated otherwise. The reason behind this is that the benefit of a mammogram increases with age and the evidence supporting mammograms truly finding cancer starts at age 50. You may be feeling mixed emotions at this thought, especially if breast cancer has hit close to home.

The USPSTF was created in 1984 as an independent panel of national medical experts who volunteer to review current healthcare practices and then compare this to our evolving knowledge of evidence-based medicine. Based on this review, this panel then makes recommendations that aim to improve the health of all Americans through screening, counseling or primary care medical services offered. Our U.S. Congress has authorized this panel to convene annually to present any needed recommendations to affect change to improve our healthcare practices. The topic at present for them is now breast cancer screening. The Panel believes that the evidence supporting the practice of performing mammograms prior to age 50 in the general population may not warrant the risks to women of a younger age. They now recommend that mammograms done between the ages of 40 to 49 be done after a discussion between Patient and Health Care Provider any then only perform every 2 years. This is a direct contrast to the recommendations by the American College of Obstetrician Gynecologists (ACOG). ACOG recommends that a mammogram be done starting at 40-years old and continue annually. USPSTF has also found that the evidence supporting mammograms after age 75 is “insufficient to assess the balance of benefit and harm.” According to ACOG, it is again a decision between Patient and Provider, as we know the risk of breast cancer does increase with age.

In Medicine, we work hard to keep Patients safe no matter the task at hand. We are constantly assessing the balance of risk and harm, hoping the odds favor true benefit rather than harm. The most common harm that a mammogram could impose on a woman prior to age 50 is an inaccurate result. You may have received that dreaded call, “Ma’am we need you to return for additional imaging.” If an initial mammogram is not conclusive, then additional tests and procedures must follow. For example, if a 40-year old woman is told her mammogram is concerning for breast cancer, she then goes on to have more imaging and ultimately a breast biopsy. The biopsy shows normal breast tissue. The initial mammogram was therefore wrong. Could this biopsy have been avoided? Did this biopsy cause harm? Does this cause unnecessary anxiety or added discomfort to a woman? What are the overall costs to society? Bottom line, is it all worth it? This is the argument. The battery of tests and procedures following this initial inaccurate screening result leads to major costs to our healthcare system.

I can tell you, there is a great divide in medical opinion about how and when breast cancer screening should be done in the United States. As an Obstetrician Gynecologist, our national organization, The American College of Obstetrician Gynecologists, has held firm, that at present, we believe it is best to start breast cancer screening at age 40 for ALL women. We also feel it is a personal decision and discussion between you and your healthcare provider, and the decision to start annual mammograms even sooner is based on your family and medical history. I feel strongly that the present debate might also place our personal choices, access to screening and medical insurance coverage in jeopardy. Many commercial insurance carriers do alter their coverage based on recommendations like that of the USPSTF It is therefore so important that we remain knowledgeable and an active voice in this debate.

Let me show you some of the evidence for breast cancer that we know at present. Unless you have a family history of breast cancer, we all have a 1 in 8 risk of developing breast cancer in our lifetime. Meaning, think of you and 7 other of your girlfriends. One of you will develop breast cancer in your lifetime. If you have a family history, the chances are even higher. To make this even more real to you, let’s look at the evidence.

The lifetime risk of breast cancer by age is as follows:

• In our 20s, 1 woman in 1,760 has a chance of breast cancer.
• In our 30s, 1 woman in 220 has a chance of breast cancer.
• In our 40s, 1 woman in 69 has a chance of breast cancer.
• In our 50s, 1 woman in 42 has a chance of breast cancer.
• In our 60s, 1 woman in 29 has a chance of breast cancer.

Do you see how age and our risk of breast cancer relate? If we delay breast cancer screening until age 50 and then only perform a mammogram every other year, how many women would be affected by a missed or delay in diagnosis of their breast cancer? It is important to discuss and consider this debate, not just from a personal perspective, but to help educate and advocate for all women and our health. Breast cancer screening is proven to play an important role in diagnosing breast cancer early, and therefore improving a woman’s chances for survival through early treatment and ultimately a cure. The pain to lose a loved one from a completely detectable and survivable cancer cannot be described.

You have the power to be a part of this ongoing debate and the time is now. One would think it is only logical to find breast cancer fast and find it early, right? Well, unfortunately with this and really any cancer screening, it is not so simple. It is a matter of evidence-based medicine, meaning we track hard evidence about current medical practices and patient outcomes. This information is then used to apply a recommendation or practice, which is best for the entire population. It is not just a matter of medicine sadly, but of access, effectiveness, cost and certainly insurance coverage. The guidelines for insurance coverage follow recommendations created by our national organizations and governmental guidelines. It is therefore important to be a part of the conversation as decisions are made.

For our current debate over breast cancer screening, you may become involved by contacting your local government representative, discussing with your healthcare provider and the U.S. U.S. Preventive Services Task Force has invited you to participate and voice your opinion by going to their website: www.screeningforbreastcancer.org

Abnormal uterine bleeding is a common problem in women’s health. It may present as bleeding that is excess in volume or that occurs at an unexpected time. When a woman sees her physician to evaluate the cause of the abnormal bleeding, the explanation will fall into one of two categories. The first category is an imbalance of hormones (dysfunctional bleeding) that may be treated with hormones such as oral contraceptives or progesterone. The second category is an anatomic change involving a new growth of tissue in the uterus, such as polyps or fibroids (benign muscle tumors), or less commonly, cancer that can develop in the uterine lining. The evaluation may include a pelvic exam (with a pap smear if one has not been done recently), lab work including a pregnancy test, complete blood count, and occasionally hormone tests that check the function of the thyroid and pituitary glands. Pelvic ultrasound is a very useful test, showing the anatomy of the uterus and ovaries. A sonohysterogram is a procedure in which sterile saline is advanced through the cervix into the uterine cavity during the ultrasound. This allows a detailed image of the uterine cavity and may reveal small changes in the lining. An endometrial biopsy may be performed to assess for pre-cancers, cancers, or infection within the lining of the uterus. This specimen is then sent to the pathologist for evaluation. If the pathologist sees evidence of cancer, the treatment plan will include urgent consultation with a cancer specialist and surgery that includes a hysterectomy and cancer staging procedure.

Most often, the abnormal bleeding is found to be due to a benign cause. If cancer has been ruled out, benign growths in the uterine cavity can be removed through an out-patient surgical procedure called hysteroscopy, where a fiber-optic device inserted through the cervix can be used to remove abnormal tissue and restore the uterus to a healthy condition. In cases of dysfunctional bleeding where hormonal treatment does not resolve the problem, a good surgical option is endometrial ablation, a minor procedure where the uterine lining is destroyed. For many women, endometrial ablation is a good alternative to hysterectomy due to the rapid recovery and conservation of normal anatomy.

In summary, abnormal uterine bleeding is a common problem that can be evaluated and managed by hormonal or surgical treatment, depending on the findings. Women who develop abnormal bleeding should promptly see advice from their health care providers for timely diagnosis and appropriate treatment.

Having a hysterectomy can be a serious decision and one that should be made carefully. Your physician may have recommended a hysterectomy, but, in many cases it’s optional. You need to be fully informed of your options and the risks and benefits in order to make an informed decision.

Hysterectomy is the surgical removal of the uterus. This procedure ends menstruation and the ability to become pregnant. Therefore, women who want to have children should consider alternatives.

A hysterectomy is only one way to treat problems affecting the uterus. For some conditions, hysterectomy may be the best choice. With uterine or cervical cancer and in cases where a uterine growth causes a blockage of the bladder or intestines, you may have no other option.

The following conditions affect the uterus and require treatment. The treatments may include medication, hysterectomy, or other surgeries:

Uterine fibroids, benign tumors which have increased in size, are painful, or cause bleeding. Hormone medications can be prescribed to shrink uterine fibroids, but they can return when medication is stopped. Medications mimic menopause, so they may also cause symptoms of early menopause. Uterine artery embolization is a non-surgical option performed by a radiologist. During the procedure the uterine artery is blocked and since this artery supplies blood to the fibroid, blocking the flow helps shrink the fibroid. Depending on the severity and positioning of the fibroids, a myomectomy can be performed to remove the fibroids while keeping the uterus intact.

Severe endometriosis, uterine tissue that grows outside the uterus. Since preventing ovulation can reduce the discomfort associated with this endometriosis, oral contraceptives can be used to treat this condition. Hormone medications may also be used to shrink the endometrial tissue. If medications do not effectively treat the endometriosis, laparoscopic surgery may be helpful.

Uterine prolapse, a uterus that has “dropped” into the vaginal canal due to weakened muscles, which can lead to urinary incontinence or difficulty with bowel movements. In some cases, this condition may be improved with Kegel exercises. Since obesity can cause the muscles to stretch, losing weight and quitting smoking can also help relieve pressure on the muscles. Another treatment for uterine prolapse is a pessary, a device inserted in the vagina which holds the uterus and bladder in place. For women past menopause, taking hormones may help keep the pelvic muscles stronger.

Cervical or uterine cancer. Precancerous changes of the cervix which are detected early by a Pap test can be treated with a loop electrosurgical excision procedure (LEEP). LEEP removes the abnormal cells. If the cervical disease moves into deeper layer of tissue or other organs, hysterectomy is usually necessary.

Abnormal bleeding. Treatment for irregular, heavy or severe bleeding depends on the cause. Fibroids, endometrial polyps, hormone level changes, infection, and cancer can all cause abnormal bleeding. Treatments for abnormal bleeding include dilatation and curettage (D&C), hormone medications and nonsteroidal anti-inflammatory medications (NSAIDs.) Hysteroscopic assessment and management may also be effective.

How will you know which treatment is right for you? Based on your condition, you and your doctor should discuss the risks and benefits of each treatment. The treatment used should depend on the nature of your problem and the severity of your symptoms. But, whatever method or option you choose, it’s in your best interest to explore all the treatment options available for your particular condition before choosing hysterectomy.

I get a lot of questions from friends and family about my job. The most frequent question I get when I tell people my chosen profession is “Why would you choose that?” The second is “Did you deliver your own babies?”

My answer to the first usually depends on where I am, who I am with, and (most importantly) what kind of a mood I’m in. If I’m well rested, and I think you are actually interested in my response, I’ll tell you about the first baby I delivered; how it was one of the most awe-inspiring moments of my life, and what a privilege it is to help women welcome a new life into the world. If I’m tired (or at a dinner party), I’ll tell you “I thought it would be a good way to meet chicks” or “the proctologists weren’t hiring.”

My answer to the second, however, is always the same. “No. I just wanted to be the dad.”

I’d probably delivered close to six or seven hundred babies by the time my wife brought our first child and only son Jack into the world. While I will tell you assisting in the birth of a child is never routine, and I am always amazed every time I get to do it today, most of the time there is a anticipated routine that is going to play out. I coach pushing the same way, deliver the baby the same way, and make the same bad jokes about the not charging you if you cut your own baby’s umbilical cord. So as the due date approached and the overnight bag for the hospital sat patiently by the backdoor, I waited, with much overconfidence and arrogance I might add, for her water to break, or for contractions to start, so we could get on doing the same thing I had done hundreds of times before.

Then it started. Somewhere between the screams of pain (peppered with some of the most colorful profanity I have ever heard coming from my sweet Southern Bell of a wife) and the not-so-great fetal heart rate tracing, it became abundantly clear I was in way over my head. I had a head full of knowledge. I knew where L&D was, I knew how to diagnose labor, and I even knew when a C-Section would be indicated. I was technically proficient, but lacked true experience. I was prepared for the what, the when, the where and the how. What I wasn’t ready for was the who. What I wasn’t ready for was to see what labor looked like for MY WIFE.

I knew the definition of labor and how frequent someone needs to contract, but I didn’t know the look of pain on my wife’s face during a really bad set of contractions. I knew sometimes the baby’s heart rate dropped as the cervix was changing, but I didn’t know how it would feel to hear MY baby’s heart rate go to the 60s and sit there (it was really scary, by the way). I certainly have counted to 10 hundreds of times, but I was completely unprepared for how momentous it was to see the woman I love bring another human being into this world with a startling combination of determination, courage and love. I knew how to help deliver a baby, but I never really understood what it meant until I watched my wife make me a dad.

Dad’s, if you feel unprepared for your wife’s upcoming labor, you are. If you are nervous about what’s going to happen, you should be. If you’re scared about all the stuff that could go wrong, that’s OK. And if you think there is anything I can tell you that can get you ready, there isn’t. My wife has given me so much over the years (except my fair share of the comforter… she takes way more of that than she is entitled). But the gift of fatherhood is second to none. I thought I married a strong woman before she gave me Jack and Katherine. Turns out I didn’t know what strong was.

So fellas, be prepared for the unexpected. Trust the amazing staff at Greenville Women’s Clinic and Vidant to take excellent care of your wife and to bring your healthy child into this world. And enjoy every second of being “just dad.”

David Ryan

P.S. Tell the proctologists I’m all set.