By: Allison Stevens for Uterus1
Joseph Talvacchia, D.O. is a gynecologist in the Philadelphia area. Dr. Talvacchia received his Doctor of Osteopathy from the New Jersey College of Osteopathic Medicine. He then completed a four-year residency training at Hahnemann University Hospital in Philadelphia, PA and has now been in practice for 18 years. In addition to his practice, Dr. Talvacchia has always been involved in teaching at various hospitals in the Philadelphia area, including Thomas Jefferson University Hospital. Dr. Talvacchia resides in Moorestown, NJ with his wife and three kids. His hobbies include wine, travel, and golf.
Uterus1: Why did you decide to go into medicine and particularly women’s health?
Dr. Talvacchia: I’ve always had an interest in science and that drew me to medical school. In medical school, from the time I did my first rotation in ob/gyn I was immediately drawn to it. I liked the idea of primary care for women and I liked the idea of also being in the surgical sub-specialty. I guess I got the best of both worlds
Uterus1: What is the focus of your practice?
Dr. Talvacchia: Right now, my practice is gynecology only. I don’t do obstetrics anymore. So, right now I’d say the big thing is a lot of minimally invasive surgery, and a lot of focus on osteoporosis, prevention and treatment.
Uterus1: Who are your patients?
Dr. Talvacchia: It is a pretty broad spectrum. My practice is in the city of Philadelphia so we see a good cross section of patient population, from the young age of 14 years old, all the way up to patients in their 80s. I also see a fairly wide cross-section in terms of socioeconomic status.
Uterus1: What are some common questions you get from patients?
Dr. Talvacchia: I’d say right now, with younger patients, the most frequent questions are questions about the new HPV vaccine that has come out recently.
From older, menopausal patients, I’ll get a lot of questions about hormone use and whether they should or shouldn’t [use hormones]. That’s a real big topic of conversation for menopausal patients.
Uterus1: You mention that you are getting a lot of questions on the HPV vaccine. How do you respond to those questions? Do you believe it should be mandatory?
Dr. Talvacchia: I don’t think it should be mandatory. But when patients ask me a question on my opinion as to whether I recommend it and think they should get it, for the appropriate patients, I am telling them, yes I do recommend it. There doesn’t seem to be any real downside to it besides the cost. The appropriate patient is age nine to 26, ideally having not yet been exposed to HPV.
Uterus1: I know you mentioned earlier that you deal a lot with osteoporosis, both prevention and treatment, what do you recommend for both prevention and treatment?
Dr. Talvacchia: I think the big thing with osteoporosis is identifying it and making patients aware that osteoporosis really has no symptoms. Unless you screen patients for it, they aren’t going to know they have it. Especially with the aging population, a far larger number of patients nowadays are living long enough to get osteoporosis than they did 30 to 50 years ago. Once you have identified the patients who are at risk or do have it, I go through the whole gamut of appropriate diet, calcium supplementation, and weight bearing exercise, and then when appropriate, medication.
Uterus1: How do you see the practice of gynecology having changed over the years?
Dr. Talvacchia: Well, I think from a surgical standpoint, certainly much more surgery is now done on an outpatient basis. A lot more patients are in and out. Fewer hysterectomies are being done than when I started in practice 18 years ago. A couple of years ago patients would have had hysterectomies because of abnormal bleeding, and now we are able to avoid that.
In older patients, again, you have patients living longer, and an increase in osteoporosis. And there has also been a swinging of the pendulum in hormone use.
Uterus1: You’ve mentioned the controversy surrounding hormone use, can you discuss your recommendations on hormone use?
Dr. Talvacchia: I think you have to individualize recommendations for each patient. There is no one answer that you should give to everyone. Unfortunately there is a lot of misinformation out there. A lot of misinformation made it to the media a couple of years ago when this WHI study was first published and patients heard tidbits, and a lot of them don’t know all the facts of it. So I try and give patients the real facts in terms of what the true risks and benefits are of hormone replacement. Then the patient has to make her own decision in terms of whether she wants to go on hormone therapy for a period of time, knowing what the risk is in her particular situation.
Uterus1: What would you say is the most rewarding part of your work?
Dr. Talvacchia: The rewarding part is being able to help patients improve their quality of life, and fix problems that affect their well being.
Uterus1: If you had to do it all over again, would you still go into gynecology?
Dr. Talvacchia: Yes, absolutely.