PATIENT HANDBOOK
GYNAECOLOGY
Table of Contents Welcome to ILAP Meet Dr. Ryan Halsall Well Woman Visit Annual Checkups Cervical Cancer Screenings & Prevention Menopausal Treatment/Management About Minimally-Invasive Gynaecological Surgery Laparoscopic Surgery Types of Laparascopic Surgery Ovarian Cyst Treatments Treating Endometriosis Treating Ectopic Pregnancy Tubal Ligation/Sterilization Types of Gynaecological Conditions Fibroids Pelvic Pain Abnormal Bleeding PCOS Endometriosis: Get the Facts Other Treatments Colposcopy Vaginoplasty/Labiaplasty Your Hospital Stay What to Bring Where and When to Check-In Post-Operative Care Wound Care Pain Management Bleeding Physical Activity Dietary Needs Follow-Up Visits Contact Us
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Edited by Dr. Ryan Halsall | Contributors: Dr. Ryan Halsall | Fern Elise Foster | William Greenwood | Produced by: STUSH Marketing
Welcome to ILAP
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Island Laparoscopy & Medical Care is a premier provider of minimally invasive bariatric and gynaecological procedures in the English-speaking Caribbean. At the center of our practice is a whole patient approach, which allows us to develop personalized treatment plans for each patient and provide care accordingly. Our staff consists of a team of extensively trained medical practitioners from varying disciplines, all collaborating to provide the delivery of exceptional medical care which will yield optimal results for our patients. In addition to educating our patients on their individual medical conditions and how to obtain the most effective treatments, we also support our patients in developing lifelong skills which will help them live a life in alignment with their long-term health goals.
Get ready to Discover Your New Life!
Meet Dr. Ryan Halsall Dr. Ryan Halsall is a Gynaecologist and Obstetrician who has always had a passion for helping people solve their issues. This passion led him to study medicine and then specialize in Gynaecology and Obstetrics where he has received tremendous fulfilment helping women through pregnancies and helping women overcome conditions like Endometriosis to live pain-free lives. He received his Medical Degree from the University of the West Indies, Mona in 2004 and then went on to do specialized training in Gynaecology and Obstetrics from 2006-2012. This training was done at both The University of the West Indies Hospital and Victoria Jubilee Hospital. During this period, Dr. Halsall worked with thousands of patients, further honing his expertise in gynaecology and obstetrics. Dr. Halsall is a frequent contributor to the Jamaica Observer Newspaper where his articles on Endometriosis and other gynaecological issues have helped countless women find help for issues that they have sometimes struggled with for years. He is also a fellow of the American Congress of Obstetricians and gynaecologists, and an executive member of the Jamaica Medical Doctors Association. As co- founder of Island Laparoscopy and Medical Care (ILAP), Dr. Ryan Halsall works with Dr. Alfred Dawes to provide first class laparoscopic and medical care in Surgical Weight Loss, General Surgery & Gynaecology.
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I've often been asked why I wanted to do medicine and gynaecology and I've often struggled to answer. I've come to the point where I’ve realized that gynaecology chose me and not the other way around. There's no other specialty that encompasses both my interests and the traits that I excel in, my wanting to help people and my love for science... Obstetrics and gynaecology helps me fulfill all of those.
RYAN HALSALL, MMBS BM
Well Woman Visit
Annual Checkups A Well Woman exam is the starting point for all gynaecological care and should be done on an annual basis starting around the age of 13-15. During this visit, Dr. Halsall will review your overall medical history and perform checks on your general reproductive health. Examinations & vaccinations are recommended, as well as general tests such as Pap smears and STD testing. In the event that the doctor is monitoring a condition such as an abnormal Pap test, you may be asked to come in more frequently to re-test.
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Cervical Cancer Screenings & Prevention OVERVIEW Early cancer detection is key in your care at ILAP. As part of your Well Woman visit, a Pap test will be done to help test your cervical cells for cancer. Most women can be screen every three years with the use of liquid based cytology, and some can have screening done every 5 years with the inclusion of HPV testing. TREATMENT The in-office Pap test is quick and ranges from painless to mildly uncomfortable, with results returning to the office within 1-2 weeks. The HPV vaccine is also available and is a shot that is administered in three doses spread out over the course of 6 months or more.
Menopausal Treatment/Management OVERVIEW All women experience menopause later in life. Due to a natural decline in reproductive hormones, women experience varied bodily changes such as vaginal dryness, hot flashes,changes in mood, fatigue, bone density and an increased risk of breast cancer. TREATMENT After the screening process these issues can be treated in various ways such as with hormone therapy, lubricants, medications etc. As every woman is different, a treatment plan will be tailored to her individual needs to make "the change" as comfortable as possible.
I take a holistic approach to what's going on. A patient may come in because she's having pains, but I need to take a full assessment of what her gynaecological history and her health is all about. You're going to talk about cervical cancer screening, breast cancer screening, family history, lifestyles, smoking, drinking... By the time I'm finished, not only have I understood why she came in, but we bring to life other things that may need to be addressed as well. -DR. RYAN HALSALL
Minimally Invasive Gynaecologic Surgery ILAP maintains an atmosphere of first-class healthcare, providing women with leading-technological and surgical options when gynecological surgery is absolutely necessary. Laparoscopy is a minimally-invasive procedure which uses tiny incisions (approximately 0.5–1.5 cm) instead of larger “bikini� or vertical incisions. These leave either a small scar or no scar at all. Laparoscopic surgery is available for the majority of gynecological surgical interventions.
Benefits
Shorter hospital stays, if hospitalisation is required.
Faster recovery and return to normal activities
Less likelihood of developing adhesions (internal scar tissue)
Less likelihood of bowel obstruction (or other complications)
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Less pain
More cosmetically appealing due to smaller scars
Less bleeding
Laparoscope with a video camera
Manipulator Tool Uterus
Ovary
Oviduct
Abdominal Cavity
One of the biggest misconceptions about laparoscopy is that everyone thinks it's super expensive.You have a cyst, you want to remove it, you hear about regular surgery options and then you have laparoscopy. Because you Google everything, you think there is a special price for laparoscopy vs. the price for regular surgery. The truth is that they're pretty much the same cost. -DR. RYAN HALSALL
Types of Laparoscopic Surgery Most if not all gynae laparoscopic surgery patients can be sent home the same day or spend one night in hospital.
For those that are afraid to undergo surgery, firstly, this feeling is not uncommon. I think most of these aversions are based on incorrect third party information. For those who are serious about trying to get help and have their fears, it's always best to come in. Sit down and talk. There are no obligations. For the vast majority of women who come into the office, their fears are completely removed.
- DR. RYAN HALSALL
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HYSTERECTOMY Probably the most common major gynaecological surgery, hysterectomies are performed for a number of reasons. Fibroids, uncontrollable menstrual bleeding, intractable period pains and cancer are the more common indications. The preferred route of removal is either vaginally or laparoscopically (or a combination of the two). Open hysterectomies are usually reserved for very large tumors or with complicated diseases. The down time from this procedure can range from 2-6 weeks depending on whether it’s done laparoscopically or open.
OVARIAN CYST TREATMENTS Ovarian cysts can be simple fluid filled sacs or more complex tumors with solid components. Though mostly benign, there are some that are cancerous. Even the non cancerous ones can cause problems like rupture or torsion. Depending on the size or nature of the cyst, they can be treated laparoscopically by removing the cyst from the ovary(cystectomy), or removing the entire ovary itself. The utmost care is taken to prevent spillage of cyst contents into the abdomen during surgery. If cancer is suspected at laparoscopy, the procedure might be converted to an open one. Recovery period is usually 2-6 weeks.
TREATING ENDOMETRIOSIS Laparoscopy is used to both diagnose and treat endometriosis. During this surgery the lesions are removed or destroyed, thus improving pelvic pain and fertility. Most patients are back to their usual routine within 2 weeks.
TREATING ECTOPIC PREGNANCY An ectopic pregnancy is a potentially life threatening condition where the pregnancy is located outside of the womb (most commonly the fallopian tubes). To treat this we can remove the pregnancy from the tube or remove the tube entirely. Most patients are back to their usual routine within 2- 4 weeks.
TUBAL LIGATION/STERILIZATION This procedure is performed when you are satisfied with the number of children you have or if it’s medically unsafe to get pregnant. Dr. Halsall will utilize small 5mm ports to eithe seal the fallopian tubes with electrocautery or clips, or remove the tube entirely. For all intents and purposes, this is regarded as a PERMANENT method of contraception. You can expect to be back to work in 1-2 weeks.
Types of Gynaecological Conditions
Abnormal Bleeding OVERVIEW Abnormal bleeding is common to experience at some point in life and includes both spotting, as well as your period being lighter or heavier than usual. These occurrences can happen when you're not expecting your flow, are pregnant, or even after menopause. TREATMENT There are various treatment options such as using birth control to regulate flow, or procedures to remove fibroids or polyps. Upon examination, the doctor will determine the best plan of care. Diagnostic tests such as endometrial biopsies can be done in office if needed.
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Fibroids OVERVIEW Fibroids occur in 50% of women. These benign tumors grow inside the walls of the uterus. The size of fibroids can vary from as tiny as a seed to as large as a breadfruit and a patient can have one or many. Most fibroids do not cause any symptoms, but in some more severe cases a patient can experience very heavy periods, frequent urination, enlargement of the lower abdomen, pain during intercourse, pregnancy complications and in some cases even infertility. TREATMENT Fibroids are normally removed surgically, by using open surgery, laparoscopy or hysteroscopy. Before surgery, the doctor may put a patient on hormone therapy to help shrink the fibroids. Depending on the type of surgery, recovery time can range anywhere from 2-6 weeks at home with a 1-2 night stay in the hospital. The doctor will determine the best type of fibroid procedure for you during your consultation.
Pelvic Pain OVERVIEW Pelvic pain is pressure or discomfort felt anywhere in the abdomen below the navel with symptoms occurring continuously or sporadically. The symptoms can range from a dull ache to severe as sharp pains. For some women, the pain can be paired with other symptoms such as abnormal vaginal bleeding, lower back pain and/or vaginal discharge. TREATMENT Dr. Halsall may recommend medication and/or warm compresses to help manage basic pain. Also, the doctor may recommend additional testing to determine what may be causing more severe bouts of pelvic pain.
Endometriosis OVERVIEW Endometriosis occurs when the tissue which lines the uterus is found on other organs, usually within the pelvic area. Symptoms may include pain during intercouse, periods, urination, excessive bleeding and in some cases even infertility. TREATMENT Laparoscopy is used to both diagnose and treat endometriosis. During this surgery the lesions are removed or destroyed, thus improving pelvic pain and fertility. Most patients are back to their usual routine within 2 weeks.
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ENDOMETRIOSIS:
GET THE FACTS WHAT IS IT?
Endometriosis is a disorder in which tissue that normally lines the uterus grows outside the uterus instead.
• It affects approximately 10% of females in the reproductive age group • Over 100,00 women in Jamaica are affected by the disease. • It is among the top three causes of infertility. • As many as 30-50% of infertile women worldwide may have endometriosis. • Many people who have the disease are not aware of it. • The condition can only be diagnosed definitively following surgery. • Due to lack of awareness, many women don’t get diagnosed until 8-10 years after having symptoms
CAUSES
SYMPTOMS
Intense pelvic pain
Infertility
Long menstrual cycles
Nausea or vomiting
- The cause is unknown - It canot be passed from person to person - There may be a genetic component to endometriosis - Research has shown that it can be present during fetal development but may remain inactive until puberty
ALL RIGHTS RESERVED TO U.S. NEWS & WORLD REPORT HEALTH
www.health.usnews.com/wellness/articles/2016-07-21/infographic-what-you-should-know-about-pcos
PCOS OVERVIEW Polycystic Ovary Syndrome is a hormonal balance problem in women. The imbalance can cause various difficulties for women such as conception issues, irregular periods, insulin resistance, extra facial and body hair and acne. PCOS can be genetic, so be sure to inquire about your family’s medical history. TREATMENT Dr. Halsall can check for PCOS with ultrasound, blood tests and physical examinations in office. Lifestyle changes can aid in treating PCOS such as weight loss, exercise, change in diet and quitting smoking. For select cases, laparoscopic ovarian drilling can be used to help improve fertility and can improve other symptoms.
Other Treatments
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Colposcopy Patients with an irregular reading from their Pap test may be recommended to receive a Colposcopy, which is a more in-depth cervical cancer test. During this 10 minute test, Dr. Halsall is able to take a biopsy of the cervix to test the irregular cells. During and after the test, the patient may experience some cramping and some bleeding. It is recommended to wear a pad until the spotting stops and refrain from using tampons or engaging in intercourse. The lab results should be back in the office within 1-2 weeks.
Vaginoplasty/Labiaplasty Vaginoplasty and Labiaplasty are both outpatient procedures which take about 6-8 weeks to heal. Vaginoplasty is a procedure that is meant to tighten up a vagina that has become loose due to age or childbirth.Labiaplasty is a cosmetic outpatient procedure of the labia majora and minora. The procedure reduces the length of the folds of skin surrounding the vulva. These procedures can be performed together.
Labiaplasty - Before & After
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Your Hospital Stay
What to Bring You will be wondering how to prepare for the ‘big day’. Leave non-essentials like nice clothes and jewellery at home. Ensure you carry personal hygiene items such as soap, toothbrush & toothpaste, shampoo, hairbrush, etc. It’s also essential that you bring loose-fitting clothes and comfortable, non-slip slippers. Also bring your prescribed medications, as well as things to keep you occupied and entertained (a fully-charged phone and charger is preferable!)
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Where and When to Check-In The ILAP team will be in touch with you to confirm your surgery date, as well as details of check-in time and the hospital at which your procedure will be performed. As always, feel free to contact our office with any questions you may have prior to your surgery date.
Hospital Checklist Hygiene and Toiletry items, including soap, washcloth, toothbrush, toothpaste, mouthwash and deodorant
Gas-X strips or chewables are a tremendous help to ease the gas pains that are common after surgery.
Eyemask and Earplugs can be a lifesaver,particularly if you have trouble sleeping in new environments.
A Cough Pillow. When you cough, laugh or hiccup, you'll be grateful to have this pressed against your sore abdomen post-surgery. Compression undergarments are also very helpful in this regard.
Comfortable Clothing and Non-Slip Slippers. Loose fitting clothing that is easy to take on and off is best.
Feminine Care items.
Baby wipes keep you feeling fresh.
Prescribed Medications. Be sure to make Dr. Halsall aware of any current medications you are taking.
Lip Balm prevents against dry chapped lips.
Entertainment. Fully charged cell phone or tablet. Don’t forget your chargers!
The facilities that we operate out of provide excellent care in terms of the equipment that's available, the nursing staff, after care... you can be assured that when you come in to have surgery you're not going to be shortchanged in any way. - DR. RYAN HALSALL
Post-Operative Care
Wound Care Patients who have minimally invasive abdominal surgery (laparoscopic) have small incisions and are usually sent home with stitches (sutures) or tape strips (Steri-strips).Tape strips may be removed gently at home (if they have not fallen off) approximately one week after surgery. Soaking the strips with a warm, wet cloth or taking a shower may make the strips easier to remove. Bleeding Some light vaginal spotting or bleeding is expected and may continue for several weeks after gynecologic surgery. Occasionally (especially in the first week after surgery), you may have an episode of heavy bleeding when you stand up or after urinating.
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Pain Management Many gynecologic procedures are followed by some pain or discomfort. Pain or discomfort should improve over time and can be managed with pain medications, if needed. The location and severity of pain depends on the type of procedure. For example, women who have procedures that involve a skin incision (eg, abdominal hysterectomy, laparoscopy) will have pain in the area of the incision, while other procedures that are performed inside the uterus (eg, hysteroscopy, endometrial ablation) may be followed by a crampy sensation (similar to menstrual cramps). Pain medication is available over-the-counter or by prescription. We will give you a prescription for pain medicine if he thinks you will need it. Possible pain medications include acetaminophen (Panadol), ibuprofen (eg, Advil), narcotics (eg, codeine, tramadol), or combinations of acetaminophen and a narcotic (eg, Panadeine, Tramacet). If you are taking other medications, ask your healthcare provider whether it is safe to take these and pain medications at the same time. Do not drink alcoholic beverages, drive, or perform other activities that require concentration while taking narcotic pain medications. If pain becomes severe and is not relieved by the recommended dose of pain medications, call us.
Physical Activity It is normal to feel tired for up to a week after surgery, especially if general anesthesia was used. If you have a major surgery, you may feel tired for longer. Taking a few short naps during the day or resting when you are tired may help. While rest is important, it is also important to walk around several times per day, starting on the day of surgery. This helps to prevent complications, such as blood clots, pneumonia, and gas pains. You can resume your normal daily activities as soon as you are comfortable doing them. Walking and stair climbing are fine. Gradually increase your activity level as you are able.
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Dietary Needs You may eat and drink normally after gynaecologic surgery. You may have a decreased appetite for the first few days after surgery; eating small, frequent meals or bland, soft foods may help. However, if you are not able to eat or drink anything or if vomiting develops, call us.
Follow Up Visits Most women are asked to make a follow up appointment with Dr. Halsall at one week and again at six weeks after surgery. At this visit, we will usually examine your abdomen and pelvic area to be sure that the tissues are healing properly. You will hear about results if you had a biopsy or tissue removed, and you can ask questions about the procedure or your healing process.
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This appointment is a good opportunity to ask questions about the procedure you had, for example:
Were there any abnormal findings?
Were my ovaries removed? Which ovary was operated on or removed?
Was my cervix removed?
Was mesh or any other permanent surgical material used?
My drive to help people is probably something I grew up with, it's innate. We're here to help change lives and make lives better. When I hear the positive feedback from a patient... it’s a great feeling. There’s not much else that can beat someone telling you that what you did for them has changed them for the better.
- DR. RYAN HALSALL
Contact Us
VISIT Island Laparoscopy & Medical Care Shop 69, Winchester Business Centre 15 Hope Road Kingston 10 Jamaica
CALL EMAIL Office - 876.906.8694 info@ilapmedical.com Mobile - 876.455.ILAP(4527) US - (954) 915-4034 WEB ilapmedical.com FOLLOW US @ilapmedical on