Hear more from one of Dr. McNamara's patients
Dr. John McNamara completed residency in OB/GYN in what is presently called Carolinas Medical Center, in Charlotte, North Carolina in 1980 and then did a preceptorship in Urogynecology in Long Beach California. He started and was Director of the Urogynecolgy Clinic and Urodynamics lab at the present Carolinas Medical Center from 1980-1992 teaching the residents in OB/GYN. Presently he is in private practice in both Obstetrics and Gynecology, concentrating on pelvic surgery and Urogynecology.
Uterus1: What is your specialty and what techniques do you commonly use?
Dr. McNamara: I do a lot of urogynecology and pelvic surgery. I treat pelvic programs, bleeding disorders, endometriosis, and other gynecologic problems. I do practice some obstetrics, but my main interest in medicine is the pelvic and urology field.
Initially in 1980 when my career began, I both taught and practiced. Over the past 12 years, though, I’ve maintained a full time private practice.
Hydrothermablation (HTA) has opened up new avenues of treatment for patients with bleeding disorders. Prior to this advancement, hysterectomies were the only choice patients had when hormonal therapy to control bleeding disorders didn’t work.
In appropriately-chosen patients the results of HTA have been very good for problems associated with heavy bleeding. Recuperation time is considerably less than with major surgery and risks are minimized as well. HTA is able to treat patients with fibroids up to a certain size.
There are also some innovative surgical treatments in pelvic surgery for the treatment of urinary incontinence and prolapse of pelvic organs. The use of meshes has substantially decreased the recuperation time for patients. Now these procedures are done as outpatients and recuperation is about two weeks instead of the traditional six to eight week recuperation with a three to four day hospital stay. The success rate is good as well and runs 90 percent and above in appropriately-selected patients.
Uterus1: What questions do patients most often ask you and what are your answers?
Dr. McNamara: The most frequently asked question has to do with the use of hormones. My response is very individualized because each patient has to look at the risks and benefits that apply to her situation. Unfortunately, at the moment our science is a little bit uncertain as to the exact risks and for whom, so we have to use a lot of judgment, and the patient needs to be involved in the decision process. I provide my best opinion, but they ultimately have to decide what seems best for them.
Another question many patients have is why they’re gaining weight. It’s a tough topic because as we age we tend to gain weight. The problem is that there’s no magic pill. We just have to eat less and exercise more. Unfortunately that’s the bottom line and it’s not the answer patients tend to want – and I include myself in that group.
Clearly baby boomers have been more active in their lifetimes and are more health conscious. That’s not to imply other generations are not, but the baby boomers did initiate a trend that hopefully they will continue. Not only do they seem more interested in doing research on Internet, they also are more willing to change their lifestyles and join a YMCA or health club or take up a sport they can become passionate about.
|Hear more from one of Dr. McNamara's patients:|
Gina Hudson, R.N., B.S.N. of Charlotte, North Carolina is a wife and mother of two children. In addition to a career as an operating room nurse, Hudson maintains a very active lifestyle that includes boating, water and snow skiing, and aerobics and Pilates workouts at her local gym three to five times a week. She was a very healthy, physically fit 39 year old when heavy uterine bleeding associated with perimenopause threw a monkey wrench in her lifestyle. Ultimately she consulted with John McNamara M.D. and underwent a uterine hydrothermablation (HTA) procedure.
Uterus1: Can you tell us what symptoms led up to you having HTA?
Gina Hudson: It was in 2001 when I was 39 that I started having uterine bleeding that was lasting for a couple weeks at a time on and off again. It was related to perimenopause and didn’t go away for two years – this on and off again bleeding.
I’ve been with Dr. McNamara since 1984, and he tried various medications designed to change my hormones. They would work for a while and then the symptoms would return. It was a very hard situation, bleeding so heavily that you can’t wear tampons and have to resort to heavy pads.
I couldn’t comfortably go to the gym for fear of an accident, and at my 40th birthday party I had to completely change my clothes an hour before the dinner party we had with friends. I’m used to seeing large amounts of blood as a surgical nurse, but it was really out of hand. Also, even though changes were gradual, and my body accommodated the best it could, I did not feel good. My hemoglobin was up and down. At one point it had dropped to 8, and I was very weak.
Uterus1: Why did you eventually decide to have the procedure?
Hudson: I had been with Dr. McNamara since 1984 and trusted him, so when we finally ended up planning for a D&C in the fall of 2003, he asked me if I’d be interested in trying the ablation. At that time it was a relatively new procedure, but he explained the side effects which include not being able to have children. You can still get pregnant, but you don’t want to since after ablation, the uterine wall will not support a pregnancy. So women whose husbands have not had vasectomies have to take birth control pills. That wasn’t a problem for me, and I trusted Dr. McNamara, so I decided to try it. I’m so glad I did. The recovery was easy, and I’ve had no problems since then.
The anesthesiologist thought he might need to put me under general, but I said that since I wasn’t anxious that we should try it with just a local. It worked great, and I didn’t feel anything. The only bad part was in recovery when I got severe back pack from cramping. First they tried morphine and that didn’t work at all. But then Dr. McNamara prescribed Toradol and that took care of it.
Uterus1: How was your recovery?
Hudson: That night I was sitting at the table having dinner with everyone else, and two days later I was at the gym at 8 in the morning doing a double step class.
I had some discharge for about a month, but no more bleeding at all. To anybody thinking about getting this done, I say just try it. It will improve your life. You’ll feel better and you will not have the embarrassment of heavy bleeding.
Uterus1: Do you have any cautionary comments?
Hudson: Choose your physician carefully, though. Dr. McNamara is wonderful at what he does, and has very high success rates. My neighbor, on the other hand, had it done and now has periods again. Also the girl that does my hair had a failed ablation as well. Not me, though. For me it’s been wonderful all the way around, and I encourage women who suffer to give a try.
Uterus1: What changes have you seen the medical profession and patient attitudes during your career?
Dr. McNamara: A huge change we’ve seen in patients is their involvement in their own medical care, and that has been a good change overall. At the same time, I don’t think it’s fair to patients to have all the burden of making choices by themselves. My job as a physician is to give an opinion based on my knowledge and experience. Patients need this kind of information so they can understand the risks and benefits of their options.
Uterus1: What are the strengths of medicine today? The weaknesses?
Dr. McNamara: My concern is where medicine is headed within the present American health care system. I think significant changes have to occur if we want to continue enjoying the quality of medicine we have today.
Tort reform or some type of change to ease the burden on the cost and availability of medical malpractice has got to happen. Right now malpractice insurance for specialties like neurosurgery and obstetrics is so costly that many doctors are being forced out of the fields.
It’s a very complex topic with advocates on every side. I don’t claim to be an expert, but I do see the current situation having an effect on the medical care patients receive.
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