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October 23, 2017  
UTERUS1 HERO

Uterus Hero Dr. David Gandell

Dr. David Gandell: Treating a Woman's Cycle Doesn't End at Delivery


February 01, 2005

Dr. Gandell completed his undergraduate education at Northwestern University and received his medical degree from Rush Medical College. His residency in Obstetrics and Gynecology was served at Strong Memorial Hospital and the University of Rochester’s associated hospitals. Dr. Gandell is a Board Certified Obstetrician/Gynecologist, and is a Fellow in the American College of Obstetricians and Gynecologists. He is currently in practice in Rochester, N.Y., with Rochester Gynecologic and Obstetric Associates, P.C. He also holds the position of Clinical Associate Professor of Obstetrics and Gynecology at the University of Rochester and is a medical consultant to the Rape Crisis Service. He is a member of the Board of Directors of Children Awaiting Parents, an adoption agency for difficult to place children. Dr. Gandell, a co-founder of the Parallel support group for pregnancy loss, includes among his professional affiliations membership in the American Society of Colposcopy and Cervical Pathology and the American Society of Gynecologic Laparoscopists. He has been an innovator in bringing new gynecologic techniques to the upstate New York area, and pioneered the use of hydrothermal ablation of the endometrium (HTA) in Western New York. He also introduced the use of local anesthesia for circumcision in the Rochester community, disseminating the technique to his colleagues. Dr. Gandell has special interests in family planning, high risk pregnancies and pregnancy loss, infertility treatment, sexually transmitted diseases, menopause, menstrual problems, sexuality issues, and pre-menstrual syndrome (PMS).

Uterus1: Once you knew you wanted to be a doctor, what was it about OB/GYN that attracted you to it above all other practice areas?

Dr. Gandell: My very earliest memory of wanting to be a doctor was in first grade. I was told to draw a picture of my future self, and I drew a picture of myself wearing a surgical mask, so even as a little boy I was fascinated by medicine. While I was in grade school, I saw a televised open-heart bypass surgery, and for many years I thought I wanted to be a cardiovascular surgeon based on the power of that image.

But once I was in medical school and on my OB/GYN rotation, I delivered my first baby, and was hooked. What was most striking about that first delivery was that the mother was a frightened teenager who had no support; I became her labor support, helping her through her contractions, teaching her how to breathe with them. Though the birth went well, unfortunately the baby had an unexpected severe cardiac defect. My next rotation was pediatrics, where I was involved with treating that baby, who sadly ended up dying. I then began my psychiatric rotation, where I again was involved with the care of the baby’s mother, who had developed a post-partum depression and became psychotic. There was something about the continuity of taking care of that woman during her pregnancy, the delivery, dealing with the after-effects and emotional trauma (and the healing as well) that made me realize that OB/GYN was a very unique field; you get to care for women through their life cycles; you have the privilege of being part of a woman’s life throughout her lifetime. It’s this aspect that is the most valuable for me.

Uterus1: One of the things that distinguishes your career is that in addition to your innovative surgical work, you have so many involvements in more social or relationship-oriented fields. Is this initial experience in labor and delivery how you started down this path?

Dr. Gandell: Yes. First, I had some superb professors in medical school who got me interested in what we call the biopsychosocial or psychosomatic aspects of medical care. At the time, the birth process was very medicalized and had lost its humanistic aspect, though nowadays, thankfully, we’ve reached more of a middle ground. My medical school hospital was open to exploring a less interventional approach to birth. I then came to the University of Rochester to do my residency. U of R is known as the birthplace of psychosomatic medicine, which is why I came here. I didn’t want to just learn standard, routine OB/GYN skills and be a technician; I really wanted to add the psychological and humanistic component to patient care. I wanted to treat the entire patient, not just an organ system.

Uterus1: And what are some examples of this biopsychosocial approach in your life?

Dr. Gandell: Over the last 20 years, I have consulted for our Rape Crisis Service and have helped put together protocols for treatment of sexual assault victims in the ER. I also advocated for post-coital contraception for assault victims when it was not the norm to do so. Early on, my wife and I went through a miscarriage and found that support was lacking for couples dealing with this loss, so we formed an organization to provide support for couples experiencing losses in any stage of pregnancy – miscarriages, stillbirths, tubal pregnancies, etc – and we called it Parallel, since these are all parallel experiences, even if the loss comes extremely early in the pregnancy. We believed this loss needed to be acknowledged to move on with healing

Uterus1: What are other causes that as an OB/GYN, you feel are important to support?

Dr. Gandell: I am a pro-choice physician, believing that in an ideal world every baby should be planned, wanted, desired, and healthy, but recognizing that accidents occur, any contraceptive method can fail, and not all fetuses are normal. I thus also advocate for adoption. It is easy to place newborn, healthy white babies, but it’s much harder to place older or biracial children or sibling groups, or children with emotional problems or physical handicaps; there are many thousands of children languishing in institutions and foster homes who want nothing more than a family. I work with a group, Children Awaiting Parents that tries to match these children with families. Their Web site is www.capbook.org. It’s a tremendous organization whose philosophy is that no child is unadoptable.

Uterus1: You mentioned that medicine has reached more of a middle ground, but outside the University of Rochester, do you see this more patient-centered approach in the rest of the field?

Dr. Gandell: I think it’s still somewhat rare because there are so many demands on physicians’ time – they need to maintain an office practice busy enough to cover overhead and malpractice costs, there are demands from hospitals and committees to maintain privileges, there are demands from personal life to be the best spouse and parent possible. I think those demands can pull a physician away from those few minutes necessary to nurture the humanity of a patient. It’s amazing, all I have to say at the end of a visit, at least what I perceive to be the end, is “Is there anything else?” and then so much other information comes out, whether it’s about an abusive relationship, depression, etc. I’m not saying that I am unique, but I am not your typical physician either; those extra minutes make such a difference and it makes the job fulfilling, even if it makes me run late.

Uterus1: So is it accurate to say that it’s a question of treating the patient as a person, not a list of symptoms?

Dr. Gandell: Absolutely. Very often, the physical symptom – pelvic pain, heart palpitations, etc. – isn’t because there is pathology in the pelvis or the heart, it’s a physical manifestation of an emotional problem. You have to find that out or you spend a lot of dollars and energy pursuing a diagnosis that isn’t real.

Uterus1: So with all these competing demands, how do you balance them?

Dr. Gandell: I try to partition my time to avoid being over-extended, which is a constant struggle. I have a very supportive wife, Dahn, who helps me maintain some balance and perspective. Part of that is because she is an Episcopal priest, so she helps me find that spiritual side. I don’t need to be religious with patients and I’m not, but I also am able to try and give a balance of spirituality for my life and their lives. But it’s also a question of making this balance a priority, similar to trying to fit exercise into a busy schedule – not something that is easy to do but what we need to do.

Uterus1: Given all that you see in your line of work – so much joy alongside so much pain – how do you manage these conflicting emotions?

Dr. Gandell: That’s an insightful question. It’s part of what is special about this job, and I do at times find myself going from one room where there is miscarriage and loss to another room where there is joy and anticipation. How do I deal with this? It’s the empathy … I allow myself to share their feelings. When I tear up and feel their pain, they respond to that. On the same note, if I need to compose myself to go into the next room and see the twin pregnancy that is going well and share that joy, that is what I do. In my mind, I have faith in the life cycle and what I see as the big picture. Life and death and trauma and joy are all part of the life cycle and what make this job so interesting.

Uterus1: How important a role does spirituality play in the lives of your patients and in your life as a physician?

Dr. Gandell: Until I became more spiritual myself, it was something I tended to ignore and I think I missed out on acknowledging that for those people who valued it. I think when bad things happen with no explanation, like the recent tsunami, just acknowledging that there is a higher power can make us feel there is something better ahead, and this is a life-saver for people. But, I certainly don’t believe in imposing any particular religious beliefs on anyone, and I see patients of all different religions. Just acknowledging their beliefs can make a difference in their care, as well as giving them the resources to help make difficult decisions.

Uterus1: You have a lot going on in terms of innovative surgical procedures as well; what differences do these procedures make in terms of quality of life for your patients?

Dr. Gandell: I think that going along with caring about a patient as a total person is treating the patient with as little disruption into their everyday life as possible. For example, I am extremely excited about hydrothermal ablation of the endometrium (HTA) for heavy menstrual periods as an alternative to hysterectomy. I learned about it fairly early after its introduction and have done over 200 of them, most of them under local anesthesia where we can chat and listen to music and the woman does not have to deal with going under general anesthesia. The recovery is wonderfully smooth and quick, one to two days, as opposed to four to six weeks for a traditional abdominal hysterectomy. What’s so unique about HTA is that it is done hysteroscopically and with little pressure. It is not done “blindly” like other techniques, which cuts down on pain and increases effectiveness and safety. Women with abnormal uterine cavity shapes can also undergo this procedure.

Uterus1: What other innovations most closely align with your philosophy towards patient care?

Dr. Gandell: I think we need to be defenders of our most helpless patients, and in this case I am talking about newborn baby boys undergoing circumcisions without anesthesia. This is barbaric and wrong. The use of local anesthesia is simple to do and very safe. It is something I feel passionate about, and I hope it will become a national standard. I perform a dorsal penile nerve block and it makes a huge difference, as there is no crying, screaming or pain on behalf of the babies. There has been a prevailing attitude that newborns don’t feel pain from the circumcision, and even if they do they’ll forget. After about 10 years of showing and teaching it to my colleagues, it’s almost become a local standard, and I’m proud to have been at the forefront of this change in my community. However, there are still doctors performing circumcisions without an anesthetic, and the push to change this practice needs to come from the parents. If enough parents ask for the local block, physicians will start doing it.

Last updated: 01-Feb-05

   
 
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