I’m calling this the “Test” Pap Smear because since I’ve had Vaginismus I’ve kind of never have had a sucessful pap smear. Seeing how I’m wearing tampons and having intercourse (while not completely pain free and not with out some control) I’m still seeing sucess. I think there is a chance I could have sucess. So my appointment is not until after the New Years, but at least I got one.

I don’t know if the GYN is knowledgable about Vaginismus or the needs of someone with Vaginismus. When I called the place, they basically said there are several doctors. I said is there any that know about Vaginismus. I figured saying something and not waiting until I was at the appointment and sitting awkwardly on the table would be better.

The lady on the phone was like Vaga-what. That was promising and she was like can you explain more. Hmm.. I always love this question. How do you give an answer without telling the whole world whom doesn’t need to know, but will get you to the end point. I’m like pelvic floor contractions (although if they know anything about vaginismus or pelvic floor muscles, I’m sure they know what I have. She’s like well that is the part of the body they are trained in.

I think it would be nice if Gynecologists office would have staff that set up appointments be nurses that have focuses in that area. That way they could maybe do a few hours on telephones and then trade it up with seeing patients in office. Or maybe that is how it works someplaces. So I got to hope that I have someone whom knows about Vaginismus and will work with me the whole way to pregnancy.

I will say finding the right person or someone trained is difficult in an area where people don’t know problems like this exists.

Today I should be getting my period but I haven’t yet. I hate this monthly dance I take with my period but I know it has to be.  I will wait for two weeks after today to take a pregnancy test. I refuse to take one early than that.  I don’t think I have a period problem keeping me from getting pregnant but then again I’m not a doctor.   Some period problems are;

• Amenorrhea which is having no period.
• Oligomenorrhea which is irregular period, skipping of one or more periods.
• PMS which we women know exactly what this is.
• Dysmenorrhea which is the menstrual cramping from mild to debilitating.
• Periods that are too long or too heavy.

I know I keep procrastinating but I gave myself a deadline, by December I have to make any appointment with a GYN.

    Since the flu has left me to the couch with access to a phone, computer, and television. I’ve had time to search the area for GYN’s.  I’ve made phone calls because I  want to find someone whom knows something about vaginismus and my problems.  I have been unsucessful. I guess it shouldn’t suprise me. I have to travel to another area to get physical therapy services.  It really is sad that more GYNs are not specialized or knowledgable about these kinds of problem.

I’m not doing what I did in college.  I’ve learned more about the problem. I’ve learned to develop more respect for myself and knowing my needs.  I’ve learned I’m not a freak, but just someone whom has special needs. I’ve learned that my body has a self defense system, but if respected will allow for things.  I’ve learned that I am strong.  So I’m not going to a doctor to treat me less than I deserve to be treated. So for that reason, I’ve spent a lot of time searching for the right person.

If your brand new to vaginismus, be respectful to yourself. Don’t allow a professional to treat you like your not worth their time. That your a baby or anything.   A professional wouldn’t behave that.  A truely skilled and wonderful GYN will support you in your adventure to sucess and will be willing to sit and talk with you first.   A good site to check out is vaginismusawareness network.

I admitted my daughter for delivery in a Premier, first corporate Hospital in India, now at Bangalore(Branch Office?)
The ChieF Doctor for Gyn,is looked upon with awe by the other Doctors and support staff of the Hospital,not to speak of the patients.
This gentleman,who is around 50, exudes arrogance to the point of irritating patitents;never allows patients to express their complaints/symptoms;in fact he does not allow patients to sit even;he dismisses them in a few minutes, with routine instructions;if you interrupt for clarification, God save you;in every breath, he shall say’ let Natutre take care’, but prescribe ‘n’ scans;if you ask him whether it is safe to avoid lying on the back in advanced stages of pregnancy(as elders say it may be harmful for the mother, the answer is’shut up,you better listen to these old women’I wonder how his mother deliverd him,definitely not in a speciality Hotel, sorry, Hospital.Derisive to the core of Indian thoughts on Delivery, some of which are accepted by medical science, he dismisses other supporting Doctors/staff’s view, as in when an elderly, experienced Scan Department Head suggested not to scan the baby after birth often, he ridicules him.
He demanded the scan to be done immediately, for he wanted close the file!(We did not do the scan.)

Support staff are afraid to air their views on any subject, including the weather, if you are his patient.
What A Doctor!
As comic relief, one should see the Plaque in the Hospital, which after listing major advancements in Gyn.in the History of Medicine, states,after Caesarian Section, the achievement in the world is”…..Hospital offers world class Prenatal and post natal care in India”
Can you beat it for sheer effrontery?

PATIENT FERTILITY EDUCATION CONFERENCE

Workshop Topics Include:

• Diagnosis and Treatment of Infertility
• IVF
• PGD
• Egg Donation
• Pre-Conception Screening
• Acupuncture and Infertility
• Financing Your Care

DATE/TIME: Sunday, October 11, 2009    12:30pm – 5:00pm

Location:  The Crown Plaza Hotel, White Plains, NY

Registration:  Columbiafertility.org or (646) 756-3866
Columbia University College of Physicians & Surgeons
The Center for Women’s Reproductive Care

NO CHARGE FOR REGISTERED PARTICIPANTS

Som en blixt från klar himmel så dök jag ner i PMS-landet idag. Jag tror att det är PMS i alla fall, annars är det en helt vanlig dipp i livet. Jag kan konstatera att det enda stället som jag kan släppa allt som har med barnlöshetens sorg och min förtvivlan över att släpa på en infertil kropp är på mitt träningsställe. Jag går INTE runt dagarna i ända och ältar det, men där släpper jag det helt. Där är jag som alla andra, åtminstone kan jag låtsas och känna det. Där mäts man inte i hur många barn man har eller hur stor familj man har elle rhur många sociala åtaganden man har till helgen. Inte undra på att jag trivs så bra där!

På hemvägen ringde jag mamma och berättade att jag ska få komma till grannstadens IVF-klinik för att få recept utskrivet på nedregleringen. Så fort jag berättat detta och att besöket kommer att kosta 700 spänn så började mamma prata om annat. Och mitt humör dök….djupt. Är det så jävla svårt att komma med lite följdfrågor eller säga något medkännande eller vad som helst? Jag är TRÖTT på att vara kvinnan med en elefantsnabel i ansiktet! Alla ser den, men inte någon har modet att kommentera….

Och grannstadens IVF-klinik då.  Det är 2,2 mil dit och man är där innan man ens hinner tänka infertilitetsutredning. De har t.o.m pengarna tillbaka garanti om man inte blir gravid där. Hade jag levt i ett parförhållande så har jag varit berättigad till 3 gratis försök där. För det har jag ju betalat skattepengar för. Eller har jag inte det? Jag har jobbat sedan jag var 16 år och de sista åren har jag dessutom jobbat som en galning och alltså betalat ännu mera skatt. Och vad får jag för det? Jo, jag får betala 700 spänn för att få ett recept utskrivet. Men tack så jävla mycket moder Svea! Det är ju skönt att leva i ett land där det inte är tillåtet att diskriminera.

Brainstorm criativo com uma equipe diferenciada.

Quem estava lá recebeu conceitos de web, focado principalmente nas ferramentas e estratégia de comunicação.

Foi criado um espaço aberto de discussão que pode facilmente se adaptar para um podcast.

Esta história ainda vai dar muito o que falar.

Fui à feira do empreendedor com o amigo Rodolpho Santos (rodolphosantos.com) para conhecer as novidades de uma feira repleta da mais pura e suada força de vontade.

Conheci projetos legais como o silk em caneta (simples e barato, solução que faz a festa em épica de campanha política), o re-aproveitamento de peças de caminhão que se tornam obras de arte e também o pessoal da agência bamboo digital (torço por vcs!).

Aprendi que a palavra oportunidade significa “o vento que leva ao porto”. Não deixe a vida te levar, busque a sua oportunidade e mire um porto seguro!

  At my fourth Physical Therapy session, I mentioned feeling pain similar to pain I experience with dilating when peeing.  The PT looked at me and asked if I “push” when I pee.  (Doesn’t everyone??-nope!)  My pelvic muscles are soo tight I’ve taught myself to push without thinking.  S0-yes- pain is the result of pushing.  I’ve got to get the muscles to relax so that when I sit, I’m just sitting and letting the pee come out with no muscle movement. 

The Physical Therapist used two fingers and got them in a little more, but I swear I had to bite my tongue due to the pain.  The physical therapist went through the areas that still needed stretching and the parts that were relaxed.  While the fingers were inside, the PT placed the other hand on my butt and had me picture drawing a thread from finger to where the pain was inside and trying to relax the muscles around it.  The PT mentioned noticing a difference and there was a constant reminder and focus on breathing. 

Once I managed to relax the area where the PT’s fingers and hand was, I was told to do my Pelvic Clocks. This is my new homework assignment. I don’t need to have anything inside, I’m just suppose to picture the pain and put my hand to a spot on the butt where I feel tension (which is pretty much any spot you can find back there) and relax and do clocks. 

There was no tennis balls and clocks so my butt muscles got relaxation from that pain.  It has been almost a week since the fourth session.  My muscles have been spasming and I noticed the outside labia of my vagina is really not happy at all.  My husband and I tried to be intimate (without sex) because on top of my own vaginismus issues, I have issues with intimacy and body memories.  I actually started feeling wet down below, but due to the muscles spasming . It really hurt and was annoying and frustrating as ever. 

My husband because he loves me, told me to cancel this Thursday appointment, but I know that most likely I have to fight past some of the soreness to get to the point where I’m healthy and normal.  Its not like ignoring the problem and not doing physical therapy has helped me to avoid pain. 

If its true about a tight pelvic floor and if left untreated or ignored, then the pain isn’t going to go away and could create more problems.  In the beginning, I wasn’t ignoring it. It took me 2-3 years before I found someone whom knew what I had or that I was not abnormal.  When I first told someone that I couldn’t insert a tampon, have sex, and had severe pain at GYNs, I was told that was humanly impossible, and laughed at by a counselor. The GYN’s would say they couldn’t do the exam, get mental help, and that was that.  No mention of dilators, no mention as to why they couldn’t do the complete exam, and a rebuttal that my body had no structural signs.  So for me this has been a long road.  If I chose to give up, I could be in for more problems, and then it would be my fault for ignoring the problem.

Oxford Medical Centre
Dr. Keith Tang
Address: 22H Old Hope Road
Corner of Oxford and Old Hope Rd.
Kingston 5
Phone: 929-8201 / 926-0647 / 926-4373

Ripon Surgerical Centre
Dr. Kemel Gajraj
Address: 10 Ripon Road
Kingston 5
Phone: 926-2177 / 960-8112 / 960-8113 (office) / 927-4112 (home)

For a long list of doctors in Jamaica, visit:
http://kingston.usembassy.gov/medical_information.html

ABC Hospital
Website: http://www.abchospital.com/
Dr. Roberto Almanza
Address: ABC Hospital Office 117
Observatorio y Sur 136
01120 Mexico, D. F.
Phone: + 52 (55) 5272 2607 / + 52 (55) 5272 3393

Clinica Lomas Altas
Website: http://www.clinicalomas.com.mx/
Dr. Eduardo Ibarrola
Address: Paseo de la Reforma 2608-8
Lomas Altas
Near corner of Constituyentes
Phone: 50818100 / 50818208
Email: eibarrola@clinicalomas.com.mx / eibarrola@prodigy.net.mx

To find more English-speaking gynecologists in Mexico, visit:
http://mexico.usembassy.gov/eng/eacs_doctors.html#Gynecologists

8681 – Dra. Battista, Claudia María
Av. Santa Fe 1675 2° “A”
Recoleta
Phone: 4815-4802 y 15-4448-4733
Email: claudiabattista@fibertel.com.ar

14482 – Dra. Beraud de Ahuad, Gisela
Av. R. Scalabrini Ortiz 2433 P.B. “A”
Palermo
Phone: 4831-1318 y 4804-4720
Email: ahuad@tibo.com.ar

10257 – Dra. Brein, Pamela
Av. Pueyrredón 1364 2° “D”
Recoleta
Phone: 4822-5807 y 4829-9301
Email: pbrein@fibertel.com.ar

14883 – Dra. Calloni, María Mónica
Arcos 2289 4° “B”
Belgrano – Colegiales
Phone: 4781-4612 y 4786-9115
Email: mcalloni@arnet.com.ar

8197 – Dra. Campos, Liliana Beatriz
Marcelo T. de Alvear 2345 4° “B”
Recoleta
Phone: 4826-0209 y 4823-9058

Dra Liliana B. Rossi
Address: Rosario 188 1B, Caballito
Phone: 4901-2475

Dra. Adriana Vilariño
Address: Av. Santa Fe 3069 2° “B” – Recoleta
Phone: 4822-8484, 4822-2424, 4826-7090

Clinica Albertini
Dr. German Albetini
Address: Ave. Santa Fe 3040, Fl 2
Phone: 4826-0200

Dr. Sergio P. Ramos
Website: http://latina.obgyn.net/pr/assessores/ramos.htm
Email: Sergio.Ramos@obgyn.net

Dr. Flavio Menteiro de Sounza
Website: http://www.obgyn.net/awards/awards.asp?page=souza
Email: flavio.monteiro.desouza@obgyn.net

Dr. Elisabeth Trouve-Blanchi
Website: www.aventinomedicalgroup.com/Trouve.htm
Address: Via della Fonte di Fauno 22
00153 Rome, Italy
Phone: +39 06 5728-8349
Email: info@aventinomedicalgroup.com
-A French national, Dr Touve was born in France and spent most of her adult life in Egypt, Italy, and Philippines.

Dr. Nico Naumann
Website: www.doctornaumann.info
Address:Viale Regina Margherita, 157
00198 Rome, Italy
Phone: +39/0685300397
Email: niconaumann@hotmail.com
-Fellowships in Fertility Surgery at Columbia University, New York, and Stanford University, Stanford, California

International Medical Center
Address: Via Giovanni Amendola, 7,
00184 Rome, Italy
Phone: 064882371
Phone (during night or weekends): 064884051
They have a 24-hour duty (English spoken). They can send a qualified and dedicated GP to visit you in your apartment or hotel anywhere in Rome. They charge a fee (for a GP 140 Euros, with 50 Euros night and holiday supplement, specialist 160 Euros, same night and holiday supplement). In necessary, they can send a specialist to your apartment or hotel.

Temos o prazer de apresentar mais esse grande DJ e parceiro da DigitalTopSound. DJ oficial da equipe Gyn Bass de Goiânia, o Zuza tem se destacado principalmente com suas produções junto aos artistas da localidade. Falou em ElectroFunk, falou no DJ Zuza.
Para acessar o site do DJ Zuza, basta clicar na figura acima.

C’est l’avant-dernier arc dans le recrutement du nouvel équipage de Luffy avant de s’engager sur la route de tous les périls. Durant cet arc, Luffy montrera sa détermination à devenir le seigneur des pirates. Cet arc voit aussi l’apparition d’un certain “Oeil de faucon“, le meilleur escrimeur au monde. On apprendra par la suite qui est ce mystérieux homme. Tout ce qu’on sait c’est que Zorro veut le dépasser car il en a fait la promesse à Kuina, une amie d’enfance décédée. Enfin c’est dans cet arc que sera recruté l’avant-dernier membre de l’équipage de Luffy, le second maître coq du Baratie, Sandy (alias Sanjji). On en apprendra plus sur son histoire, ses rêves et son caractère.

Et c’est parti pour notre petite fiche d’identité :

Tomes : 5 – 6 – 7  8

Synopsis :

Après avoir libéré le village natal de Pipo, ce dernier intègre l’équipage de Luffy. En chemin, ils rencontrent deux anciens compagnons de Zorro, Johnny et Yosaku. Ces derniers leurs parlent d’un navire-restaurant où ils pourront sûrement recruter un coq pour leur équipage. Ce navire-restaurant se nomme le baratie et il se trouve être tenu par le grand Zeff au pied rouge, ancien pirate avec une jambe de bois. Arrivé sur place, Luffy s’attire déjà des problèmes et écope d’une corvée d’un an sur le Baratie. Luffy semble avoir trouvé le coq idéal mais ce dernier ne sera pas facile à convaincre. C’est sur ces entrefaites que surgit le terrible Capitaine Creek, redoutable pirate à la tête d’une armada de 5 000 hommes. Il ne semble être que l’ombre de lui-même et implore qu’on le nourrisse. Cependant, une fois remis d’aplomb, il décide de s’emparer du navire-restaurant. C’est alors que surgit Mihawk aka “Oeil de faucon”. Il est celui qui a mis en déroute le terrible Capitaine Creek et vient terminer son travail. Il semble que Zorro ait enfin une chance inespérée de montrer sa valeur. De l’autre côté, le combat entre Luffy et le terrible Capitaine Creek reprend de plus belle. Qui en sortira vainqueur ?

Personnages :

Sandy : Second maître-coq à bord du Baratie, le navire-restaurant, il est sur ce bateau depuis sa création. On ne sait pas très bien quelle est la relation entre Zeff au pied rouge et lui, mais Sandy semble avoir une dette envers ce dernier. Toujours est-il qu’il ne perd pas une minute pour draguer les jolies demoiselles de passage sur le navire-restaurant. C’est aussi un excellent cuisinier. Son rêve est de découvrir All-Blue.

Zeff au pied rouge : Ancien pirate qui a navigué sur la route de tous les périls, Zeff au pied rouge est ainsi appelé à cause du sang que ses victimes laissaient sur ses chaussures. En effet, Zeff est un pirate qui ne se battait qu’avec ses pieds car, étant cuisinier, il préférait préserver ses mains. Malgré le fait qu’il ait une jambe en bois, Zeff reste quand même un solide gaillard et même Luffy n’y résiste pas.

Carne et Patty : Ces deux joyeux lurons font partie de l’équipage du baratie. Ce sont deux cuisiniers qui sont dévoués corps et âmes à Zeff. Ils ne supportent pas la façon dont Sandy traite les clients et se sont jurés qu’un jour ils arriveraient à le battre.

Johnny et Yosaku : Ces deux chasseurs de primes sont des anciens compagnons de Zorro lorsqu’il était chasseur de pirates. Ils n’interviennent pas beaucoup dans l’arc du Baratie, mais on les voit dans l’histoire suivante. Pour eux, Zorro est comme un frère.

Capitaine Creek : C’est le pirate le plus puissant militairement d’East Blue. A son nom, les gens tremblent de peur. Il possède une flotte de 50 navires et près de 5 000 hommes sous ses ordres. Les mots “honneur” et “loyauté” n’existent pas pour lui. Tout ce qui compte c’est d’arriver à ses fins, peu importe les moyens. Il ne se bat qu’en employant tout une batterie d’armes (lance-flammes, piques, gaz, cape à piques) et fait tout pour rouler son adversaire.

Gyn : Second de la flotte du Capitaine Creek, Gyn est surnommé “le démon enragé” car dès qu’il commence un combat, c’est un combat à mort.

Cet arc va donc nous raconter l’histoire du coq Sandy mais aussi nous permettre d’en apprendre un peu plus sur chacun des personnages. En effet, on apprend que Zorro rêve de surpasser le fameux Mihawk alias “Oeil de faucon”, que le rêve de Sandy est de trouver All-Blue, que Luffy, jeune pirate débutant, est en fait capable de terrasser la plus grande armée qui existe et enfin que Nami semblait jouer un double-jeu… Ce qui nous laisse présager un final, pour les aventures du côté d’East-Blue, passionnant.

No último sabado a banda esteve ministrando na Ass. de Deus de Aparecida de Goiânia.

Foram momentos de intensa adoração, onde a DP teve a alegria de conhecer uma igreja com sede de adoração.

Todos foram muito amáveis. Ouvimos testemunhos lindos de curas e libertação, desta igreja que está plantada num local estratégico e que necessita muito da luz do Senhor.

Esperamos voltar outras vezes a esta igreja que já mora em nossos corações.

Fiquem na Paz

Post by Jason A. Konner, MD:

Thinning crowds today betrayed increasing ASCO-weariness as the meeting draws near its close. The faithful came out this AM to the clinical science symposium to hear Dr. Audeh present results from the ICEBERG trial of a PARP(poly(ADP-ribose) polymerase-1) inhibitor, or PARPi*, called Olaparib in BRCA-deficient recurrent EOC. Yesterday at the breast plenary, another PARPi known as BSI-201, made a splash with data demonstrating improved clinical outcomes in triple-negative breast cancer when added to Gem/Carbo.
*The science, in brief: PARPi’s block Base Excision Repair of DNA. BRCA-deficient cancer cells already have impaired Homologous Repair of double stranded (DS) DNA breaks and the second hit by a PARPi leads to “synthetic lethality” from an abundance of DS breaks, preferentially in cancer cells, which are more prone to replication errors.
Response rates for Olaparib in EOC were high (33%) at 400 mg PO BID (less for 100 mg) in both plt-sens and resistant pts. Responses appeared better for BRCA2 mutated tumors and in resistant tumors, tho the numbers were small. Tox was mild (Gr ½ N/V/D, fatigue, abd pain). The 2nd talk presented a randomized phase 2 study of BIBF 1120, which targets VEGF, FGF, & PDGF, given to pts following a PR or CR to chemo for relapsed (<12 mo) dz. 5/43 (vs 0/40 placebo) pts appeared to have prolonged PFS and ph3 trials are warranted. Still, no standard mtnce therapy exists for EOC.
The afternoon brought a marathon poster discussion session, where abstracts were grouped as in the following summary (special thanks to Dr. William Tew for his help with these!):
1. Neoadjuvant chemo (NAC) in EOC:
a. To make a pre-op diagnosis, biopsy is best. Cytology of ascites is wrong 20% of time. Relying on CT and CA125 is also inferior
b. Best predictor for optimal debulking following NAC. . .drum-roll. . . it is not decline in CA-125, but rather: AGE!! (old=bad)
c. Do we need to do 6 (vs 3) cycles of NAC?? Answer: Stick with 3 for now.
d. Does length of interval between primary surgery and initiation of chemo matter? Answer: not in suboptimally debulked pts BUT delays may adversely affect outcomes of optimal patients.
2. MMMT (aka malignant mixed mullerian tumors, aka carcinosarcoma)
a. GOG study of tax/carbo in uterine MMMT: ORR 59% 1st line with 7 mo PFS and 14 mo OS. This lends strong support to using this regimen instead of cis or ifos-based regimens, which can be quite toxic for these poor-prognosis pts
b. 2 abstracts supported the use of adjuvant chemo, even for early stages, which I agree is appropriate. RT does not seem to improve survival
c. 1 study added 2 days of ifos to tax/carbo with good response rates at the cost of hi myelotox. Probably not worth it, since t/c alone achieves similar results.
3. Cervix
a. EGFR expression did not correlate with clinical outcomes
b. Oral TKI’s (pazopanib, lapatinib) may have some activity but more study is needed
c. Cetuximab can safely be added to cis/RT but no clear benefit
4. More EOC tales
a. German patients think that for follow-up: 1. CA-125 2. Vag Sono and 3. Pap are most important. Probably not too relevant here.
b. Dr. Chi made a 7-component nomogram for survival that needs to be validated
c. Salvage heated IP chemo can be done but is pretty toxic
5. There were a couple of interesting BRCA abstracts presented
6. BEV in EMC: RR is 13% in GOG study – not terrible! But more data are needed. . .. no perfs were seen 
My take on the day’s results : 1. The PARPi story is exciting and is bound to have a significant influence on the future treatment of EOC. There are several PARPi’s out there. Hopefully more trials will lead to approval soon. 2. I will tend to treat my new optimal EOC patients a bit earlier. 3. I will continue giving platinum-based adjuvant chemo for most MMMT’s, and, though ifos/Taxol remains the data-driven standard rx for patients with advanced MMMT, I will feel more comfortable substituting Taxol/Carbo when appropriate.