:: Primary Care Medical Center is a group practice of primary care physicians specializing in Family Practice, Internal Medicine, Pediatrics, Neurology, Ob/Gyn and Cardiology. ::

PCMC Ob/Gyn Provides Newest Hysterectomy Procedures :: Read More!

Primary Care Medical Center is providing the comprehensive care you need and the personal care you deserve with Dr. Matthew Price and Dr. Corey Forester's obstetric and gynecological services.

Drs. Price and Forester offer annual examinations, pap smears and treatment for abnormal results, in-office ultrasound, hysterectomy, minimally-invasive/laparoscopic surgery, endometrial ablations, outpatient treatment for heavy menstrual bleeding, in-office urodynamics testing, urinary incontinence treatment, contraception, tubal surgery, family planning, pelvic prolapse, surgical and non-surgical treatment, infertility , menopause and DEXA scan (osteoperosis screening).

Obstetrics: Comprehensive and consistent prenatal care is essential to you and your baby’s health. Drs. Price and Forester will always be available to you for your prenatal appointments, accessible for questions, and will be there to deliver your baby! All pregnancies are not routine. Both doctors are eager to care for all of your concerns including your high-risk needs. His office offers the latest in diagnostic ultrasound, fetal monitoring and laboratory testing.

                Our Services Include:
                - 4D Ultrasound
                - 1st and 2nd Trimester Screening
                - Nuchal Translucency

Gynecology: Throughout life, women have a variety of healthcare needs. We encourage women to take an active role in their health care. The office of Dr. Matthew Price and Dr. Corey Forester work hard to offer the latest education, diagnosis, and treatment to promote healthy living. Both doctors have extensive training with world-class surgeons in laparoscopic and minimally invasive gynecologic surgery.

Annual Screening

We should all make appointments to see our primary care physicians each year. Every physician will agree, the best prognosis is found when prevention and early detection of disease are implemented. Depending on your age, your physician can advise which of these screening tests are right for you. For instance, women age 21 and older should receive a yearly pap smear. This is also a great opportunity to discuss self breast examination, contraception, family planning, and safe behavior choices. Women in their 40’s should talk to their physicians concerning mammography, pap testing, leakage of urine, and perimenopausal symptoms. Also, yearly pelvic exams may aid in the detection of ovarian cancer. Women 50 years and older should discuss all of the above, plus colonoscopy to screen for colorectal cancer. In this age group, bone loss becomes a greater risk. A DEXA scan can be performed to evaluate your bone density and calculate your chance of developing osteoporosis.

Bladder Control Solutions

For many women, lack of bladder control negatively impacts their daily routine. Loss of bladder control, or urinary incontinence, can restrict activity as women are afraid to lift bend, or exercise for fear of an accident. Many women are forced to wear urinary liners, pads, or even diapers due to bladder leakage and this daily expense can quickly become a financial burden as well. For years women have been forced to tolerate this embarrassing problem, but there are easy solutions for women to improve their bladder control.

Dr. Matt Price and Dr. Corey Forester, specialists in gynecology and women’s health are trained in modern diagnosis and treatment for urinary incontinence, providing medical and surgical solutions to women with difficulty controlling their bladder. In office testing can be performed to diagnose the reason for leaking and to determine if the problem would be better treated with medications or a simple outpatient procedure. Urinary incontinence remains an undetected and undertreated problem for women.

To find out if you may benefit from treatment, consider these simple questions:
-Do you ever leak urine when you do not want to?
-Do you leak urine when you cough, laugh, exercise, or sneeze?
-Do you leak urine on your way to the bathroom?
-Do you use pads, liners, tissue, or cloth in your undergarments to stop leakage?

If you answered yes to any of these questions, you may benefit from a personal bladder control solution offered by Dr. Price or Dr. Forester.

DEXA

DEXA is an x-ray test and is the most widely used method for measuring bone mineral density (BMD). This measurement calculates your bone health compared to a young healthy population and gives a score based on these results. The BMD is given as a T-score. Osteopenia is diagnosed when the T-score is 1-2.5 SD below the mean. Osteoporosis is diagnosed when the T-score is > 2.5 SD below the mean. Osteoporosis and osteopenia occur in about 44 million American men and women, accounting for about 55% of the population age 50 and older. These conditions increase your risk of developing a bone fracture that can occur without trauma. Screening for these conditions allows physicians to identify patients at risk and help them decrease their chances of developing a fracture.

Recommendations for screening by expert opinion include DEXA screening in all postmenopausal women age 65 and older. The National Osteoporosis Foundation recommends screening in women age 50 and older with known risk factors such as the following: advanced age, previous fracture, long term glucocorticoid treatment, low body weight, family history of fracture, cigarette smoking, excess alcohol intake.

Endometrial Ablation

Endometrial ablation is an alternative to hysterectomy for the treatment of abnormal uterine bleeding. This procedure can be performed in the office or as an outpatient surgery. Candidates for this procedure should meet the following criteria: abnormal uterine bleeding due to benign disease, non-pregnant and no future plans for childbearing, a desire to retain their uterus, and no evidence of infection. The most common postoperative side effects are cramping, vaginal discharge and nausea. A pinkish to dark discharge may be present for two to three days following the procedure and usually resolves by the tenth day. Success rates have been reported at 80-90% three to five years out.

Essure

Essure is an alternative to traditional permanent sterilization. Hysteroscopic sterilization can be performed in the office or as an outpatient procedure by placing a tiny coil through the cervix and into the fallopian tubes. Once the coils are placed, scar tissue develops, causing the tubes to seal shut. The advantages over traditional sterilization procedures are no incisions, possibly no anesthesia, and less postoperative pain. After the procedure has been performed, women may leave the office. Most women experience mild cramping which can be treated with over the counter medications such as Tylenol or ibuprofen. See videos detailing the Essure Process.

Hysterectomy

Hysterectomy is the surgical removal of a woman’s uterus either with or without the removal of ovaries. The most common reasons women choose to have this procedure performed are the following: Uterine fibroids, Prolapse, Pelvic pain or infection, Abnormal (heavy or often) uterine bleeding, and Malignant or premalignant disease. This procedure can be performed abdominally, vaginally, or laparoscopically. One of the newest approaches to removing the uterus is through a single incision through the belly button called a SILS (single incision laparoscopic surgery). The postoperative course and duration of soreness depends on the approach used.

Total abdominal hysterectomy (TAH) is performed in the operating theatre through either a vertical or horizontal abdominal incision. Most patients remain in the hospital for 2 days postoperatively. Patients are then allowed to return home with restrictions including no lifting > 20lb, no bathing, and pelvic rest for six weeks. The typical recovery time is eight weeks.

Total vaginal hysterectomy (TVH) is performed in the operating theatre through an incision in the vagina. Most patients remain in the hospital overnight. Patients are then allowed to return home with restrictions including no lifting >20lb, no bathing, and pelvic rest for six weeks. With this approach there is less pain, complications, and recovery is shorter.

Laparoscopic assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) are alternative routes to perform the procedure. Women with a history of previous abdominal surgery or intraabdominal infection may require one of these procedures. Most patients remain in the hospital overnight. Patients are then allowed to return home with restrictions including no lifting > 20lb, no bathing, and pelvic rest for six weeks. As with TVH, with this approach there is less pain, complications, and recovery is shorter.

Hysteroscopy

Hysteroscopy is an in office procure in which a telescope (hysteroscope) is inserted into the vagina and through the cervix to evaluate the inside of the uterine cavity. Hysteroscopy can be performed to evaluate women experiencing abnormal uterine bleeding, infertility, or those found to have abnormal endometrial linings per imaging. Hysteroscopy can also be used to treat such conditions, sterilization procedures, endometrial ablations, and removal of foreign bodies such as intrauterine devices. Prior to arrival for the procedure, patients are given pain mediction and an anxiolytic. In the office a cervical block is used for pain control. Patients are awake during the procedure and may leave immediately after completion. Some women experience cramping afterward that is well controlled with OTC medications such as Tylenol and ibuprofen.

Implanon

Implanon is a single rod progestin implant used for contraception. The rod is a semi-rigid, 40mm in length, 2mm in diameter, and made of plastic. The device is placed in the upper arm, just below the skin. Implanon is placed in the office with only a local anesthetic and no sedation is required. The implant is an effective form of contraception and works for 3 years. After 3 years, the device should be removed in the office in a similar fashion. Complications are rare, occurring in 0.3-1% of insertions and 0.2-1.7% of removals.

Infertility

Infertility is defined as a couple unable to become pregnant within 1 year of unprotected intercourse. However, 80-90% of these pregnancies occur within 6 months of trying. Fecundity is the chance of becoming pregnant with each cycle. Only 20-30% of young healthy women are able to become pregnant each month. Causes of infertility include Male factor (20%), Ovulatory (20%), Tubal (20%), Peritoneal (10-20%), and unexplained. The proper evaluation of infertility is taken in a step wise manner.

Evaluation: 1. Male factor- semen analysis 2. Ovulatory- regular periods = ovulation (most of the time). Ultrasound gives us a look at the uterine lining as well as the ovarian follicles to predict ovarian reserve. The LH indicator kits are good to tell us when you should ovulate, but the day 21 progesterone level (>2) tells us if you did in fact ovulate 3. Tubal- HSG (hysterosalpingogram) verses Diagnostic laparoscopy with chromotubation 4. Peritoneal- (ie Endometriosis) Diagnostic laparoscopy 5. Labs: Prolactin, TSH, PCO evaluation (not always indicated)

Physiology of the menstrual cycle: The growing dominant follicle produces increased levels of estradiol. Approx 3 days of elevated estradiol triggers an LH surge. Ovulation happens 36-48 hrs following the LH surge (usually around day 14). The cyst (corpus luteum) remains and produces progesterone until implantation occurs. If no implantation takes place, the lack of progesterone induces menses and the cycle begins again (day 1). Initial Treatment: Clomid- a mild fertility drug. Approximately 8% chance of twins and 1/1000 triplets. Take on days 5-9, then start having intercourse every other day (ie day 11, 13, 15…).

Recommendations for screening by expert opinion include DEXA screening in all postmenopausal women age 65 and older. The National Osteoporosis Foundation recommends screening in women age 50 and older with known risk factors such as the following: advanced age, previous fracture, long term glucocorticoid treatment, low body weight, family history of fracture, cigarette smoking, excess alcohol intake.

Menopause

Like it or not, menopause is a part of every woman’s life. The average age of menopause is 50-51; however, symptoms may develop during the perimenopausal years in a woman’s 40’s.

Signs and symptoms of menopause can include hot flashes, night sweats, vaginal dryness, and urinary symptoms. Estrogen is an important hormone that affects many organs of the body including the brain, skin, blood vessels, heart, bone, and breasts. As estrogen levels fall throughout a woman’s life, these symptoms may start to develop.

Recently, there has been much debate concerning the risks and benefits of hormone replacement therapy (HRT). Here, I will cover these risks, benefits, who is a candidate for HRT, and who should absolutely avoid this therapy.

First, what is HRT? HRT can come in the form of estrogen alone or with another hormone called progesterone. Postmenopausal women who still have their uterus need the addition of progesterone to protect against uterine cancer, as estrogen alone can stimulate the growth of the uterine lining which can lead to cancer. Women who have had a hysterectomy do not need this additional hormone. Estrogen can be given in the form of a pill, patch, or vaginal preparation. It should be used in the lowest effective dose, for a short period of time, usually for a duration of five years or less. Second, what are the benefits? HRT can help with the unwanted side effects of menopause including a decrease in hot flashes, night sweats, vaginal dryness, and urinary problems. It also has a positive effect on bone health, decreasing the risk of fractures due to osteoporosis. It has also been shown to decrease the risk of colon cancer. One of the most important benefits is improvement in quality of life due to the positive effects on mood and decreased symptoms brought on by menopause.

Third, what are the risks? As I stated earlier, estrogen has an influence on many parts of the body. This has been shown to increase a woman’s risk of developing breast cancer, uterine cancer, blood clots, gall bladder disease, and coronary heart disease. That is why it is important to discuss these risks with your physician to see if you are a candidate or if other non-hormonal therapies should be considered.

Lastly, who should receive HRT? Any woman experiencing problems irregular bleeding, hot flashes, night sweats, depression, vaginal dryness, or urinary problems should schedule an appointment with their physician to discuss their particular risks. Women with a history of heart disease, blood clots, stroke, or breast cancer should avoid hormonal replacement.

Latisse

Latisse solution is a prescription treatment for hypotrichosis used to grow lashes, making them longer, thicker, and darker. Eyelash hypotrichosis is another name for having inadequate or not enough eye lashes.

SILS (Single Incision Laparoscopic Surgery

Single incision laparoscopic surgery (SILS) is a new approach to laparoscopy. In contrast to the multiple entry points, usually involving up to four ½-inch or smaller incisions, required by traditional laparoscopic techniques, the SILS™ procedure is achieved with one access point through the patient’s umbilicus, or belly button. Because the incision is obscured, the potential for visible scarring may be reduced, a clear advantage over traditional laparoscopic surgery that can leave visible scars at sites of entry. The single incision unique to the SILS™ surgery can result in other potential procedural benefits as well. One 20mm incision through the belly button reduces the potential for wound pain that may accompany additional sites of entry. This procedure can be used to remove the uterus, ovaries, cysts, and for diagnosis and treatment of endometriosis.

TVT/TOT

Tension free vaginal taping (TVT) or Transobturator taping (TOT) are minimally invasive midurethral sling procedures used for the treatment of urinary stress incontinence. Urinary stress incontinence is a condition in which women leak urine when they laugh, cough, sneeze, or exercise. This condition can be diagnosed in the office with the use of history and urodynamics testing. TVT or TOT are easy, safe and effective treatments for this condition. The procedure is performed as an outpatient, last approximately 30 minutes, and patients can return home after the surgery. The recovery period is quick since only a small vaginal incision is made. The procedure itself consists of placing a mesh underneath the vaginal tissue below the urethral, providing a “hammock” support. As the body heals into the mesh, a patients symptoms will continue to improve.

In an office setting tailored to fit the needs of women, Dr. Price and Dr. Forester provide The Comprehensive Care You Need...The Personal Care You Deserve.