Gilbert Obgyn

COVID-19 Update

March 31, 2020 by Dr. Tamar K. Gottfried Leave a Comment

As we all change our habits to slow the spread of the Covid-19 virus, we are exploring new, safer options to take care of our ob/gyn patients. Current recommendations are to avoid any routine office visit that can wait a month without harm. We have not yet been cancelling existing appointments, but that may be required at some point. In an effort to be available for our patients, we will now offer some Telehealth visit options.

We can currently use Facetime, Facebook messaging and will be adding an app called doxy.me to use as well. We will need your email to invite you to the visit.

For our pregnant patients: If you are low risk and feeling well and prefer not to come in for routine visits that don’t need bloodwork or ultrasound, please ask to reschedule to a Telehealth visit. We will ask you to get a home blood pressure cuff / a thermometer/ and a scale at your pharmacy and take your blood pressure, weight and temperature prior to the visit. We will email you a link and a time to log in for the visit like a regular appointment. You will have a 10-15 minute with Dr. Gottfried or Terri. For patients who need monitoring once or twice a week or have other issues needing in person evaluation, we will see you in the office like usual.

For our non- pregnant patients, if you would like to use Telehealth for a counselling or results visit, please schedule a time by calling in , texting , or using zocdoc. We will schedule a visit for you and this will be billed to your insurance using the Telehealth codes.

For all patients who need to come in to the office for a visit, we are doing our best to protect you and to protect our staff . If you have a fever, cough, or are otherwise feeling ill, please call us first to receive specific instructions. For all patients, please come to the visit by yourself if possible to have as few people in the office at a time as possible. Please leave children at home as they may be carriers of the virus without symptoms. If you are coming in for an ob ultrasound, you can have one other person accompany you. We can include other family members in the ultrasound visit via your phone and a conferencing app.

For all of us, please observe social distancing- only leave your house when you have to. Walks outside are okay if away from other people who don’t live in your household. Store visits and food pick ups should only be made by one , low risk member of your household. If everyone goes out to the store or restaurant, it defeats the purpose of social distancing.
Please do what you can to keep you and your family healthy. We are here for you to help you through this difficult time. Please call if we can help in any way.

How to address feminine health questions during the Covid-19 pandemic

March 31, 2020 by Dr. Tamar K. Gottfried Leave a Comment

As we are trying to limit patient traffic through our office during this difficult time, I am thrilled to announce new telemedicine options for ob and gynecology consults.

What is telemedicine? Telemedicine means that you can have confidential access to YOUR doctor or nurse practitioner from the comfort and safety of your home. A lot of what we do in medicine is listening and talking and counselling and coming up with a diagnosis and treatment plan, and that can be done just as easily in a remote setting. We can even look at incisions or bumps or rashes in this format since it is private and secure

How does telemedicine work? First, we schedule an appointment time for your visit and update your insurance information and any demographic information that may have changed since your last visit here. Then, one of the medical assistants Eli or Pattie will call you to update your medical information, and finally, at the time of your visit (it can be a a few minutes delayed since we are still seeing urgent and pregnant patients in the office and are still delivering babies ) you will get an email with the link to your visit. Click on the link and Terri or Dr. Gottfried will be there to speak with you.

What kinds of visits can be done with telemedicine? Any visit that doesn’t require immediate physical exam, ultrasound or lab test can start this way. Birth control consults, birth control pill refill visits, Abnormal bleeding, rash or new skin lesion checks, wound checks, questions about pregnancy symptoms or problems, menopausal symptoms, even consults for our new Viveve procedure, which treats bladder leakage (which can be very helpful if you are coughing or sneezing a lot or exercising more at home). Also, this kind of visit is ideal for consults about lab results or ultrasound or biopsy results.

What are the costs of telemedicine visits? If you are pregnant, these visits are part of the ob package. For gyn visits, these are billed to your insurance just like an office visit, but using different codes Even AHCCCS and Medicare are encouraging patients and doctors to do visits using this technology.

In summary, we are here for you both in person and remotely. While we are asking routine visits to wait until the recommendation for staying at home has been lifted, we are available for pregnancy and gynecology problem visits and your other female health needs. We still are offering in house ultrasound and laboratory services for your convenience . Please call with any questions or book online through the website.

Can I find a doula- friendly obstetrician?

May 2, 2013 by Dr. Tamar K. Gottfried Leave a Comment

Historically, the birth of a baby has been a family event. Throughout much of human history, a woman has given birth surrounded not only by her birth attendant, but by female family and friends who bring their combined experiences to help make her labor and delivery as easy as possible. Nowadays, this is no longer a given. Many women live far from family members or find that their close friends and family may not have any prior birth experience to share with them. This lack of support and knowledge can often complicate the birth experience, especially for a woman who is planning an unmedicated labor and delivery.

In the modern, mobile society, many couples need an extra person to help them navigate the birth process, someone to replace the knowledgeable family members of the past. This is where a doula comes in. A doula is an experienced birth attendant that can be hired by a couple to help them during labor and delivery and even after the baby comes home. Sounds like a great idea- why wouldn’t most obstetricians be thrilled to have a doula in the labor and delivery room? Unfortunately, many OBs have a misconception of the role of the doula or have had an isolated bad experience and feel that their role in the process will be threatened if a couple has a doula there.

Ideally, a doula is an asset to both the laboring woman and to the medical staff. She can help a woman find different ways to transcend the pain of labor, she can help translate medical terminology and what is going on, she can support a couple in the decisions they make during the birth process. A doula, an expectant couple and their medical team all have the same goals- a healthy mom and baby, achieved by as natural a process as can safely happen.

Tamar Gottfried is a Board Certified Obstetrician/ gynecologist practicing general Ob/gyn in Mesa Arizona and affiliated with Banner Desert and Banner Gateway Medical Centers. She can be contacted at 480-545-0059. This is a general interest article only and is not intended to be medical advice. See a medical professional before making medical decisions

I feel a vaginal bulge- Are my insides falling out?

July 27, 2012 by Dr. Tamar K. Gottfried Leave a Comment

Pelvic prolapse is a common complaint in women, especially those who have ever been pregnant. Sometimes, it is something noted by a gynecologist on a yearly exam. Other times, women notice a bulging while in the shower or wiping. Although many women are initially alarmed by this, pelvic prolapse comes in varying degrees and often has little to no impact on a woman’s daily life.

Prolapse is when there is a decrease in strength or a tear in the supportive tissue of the vagina, allowing the nearby organs to bulge into the vagina, especially during bearing down (exercise, coughing, straining for a bowel movement). A bulge in the vagina can be the rectum (rectocele), the bladder (cystocele), the intestines (enterocele), or the uterus. If a woman has had a hysterectomy, the vagina itself can prolapse, bulging into itself. The organs don’t actually come into the vagina, they just push onto the vaginal wall, creating a bulge or ball.

In severe cases, prolapse can cause an uncomfortable pressure sensation, can irritate the vaginal tissues, and can cause bladder or bowel dysfunction. A woman with symptomatic prolapse can try physical therapy or can use a device called a pessary to relieve her symptoms. Pessaries are made of rubber or silicone and come in different sizes and shapes. They are worn in the vagina to hold things in place. Some women use these only during waking hours- others wear them all the time and, if they are not capable of taking them in and out, see a gynecologist for regular removal and cleaning every few months. When conservative measures fail, there are a number of surgeries that can be done for prolapse. However, it is important to refrain from repetitive coughing or heavy lifting after prolapse surgery to minimize the chance of recurrence.

Fortunately, many cases of pelvic prolapse are mild. For these women, who have mild prolapse and minimal to no symptoms, there is no treatment necessary. This is a condition that can be monitored yearly at the Annual Gyn Exam and may never impact a woman’s life.

What is it like to have robotic assisted gynecologic surgery- a physician’s perspective

July 26, 2012 by Dr. Tamar K. Gottfried Leave a Comment

As an ob/gyn physician, the last thing I wanted to do was have gynecologic surgery on myself. Much to my dismay, I discovered that my uterus was hosting several large fibroid tumors. Since I didn’t have any of the typical symptoms of heavy or painful periods, my first instinct was to ignore them. However, given that my uterus was the size of a 4-5 month pregnancy, it became apparent that the fibroids were going to have to be removed before they got larger or grew enough tumor friends that a minimally invasive surgery was not an option.

Although many women in their 40s would jump at the opportunity to have a hysterectomy and be done with periods forever, I was relatively fond of my uterus. It had carried three lovely kids, and I was hoping to go through life with as many of my parts intact as possible. For this reason, and the distant dream of having a little girl to add to my brood of boys, I chose to have a myomectomy, a surgery to remove just the fibroids and preserve my uterus. Additionally, because I am self employed and do not like to spend more than a few days away from my patients, I chose to have the surgery done laparoscopically. My surgeon would use the da Vinci robot to remove my fibroids through 4 tiny incisions and I would return to work in a week.

There is a joke among medical personnel that our medical issues always turn out to be more complicated than anticipated and I was no exception. My surgery- supposedly to remove 5 fibroids in 4 hours- turned out to be a 6 hour procedure to remove 14 tumors. Even so, my gifted surgeon did this through the promised 4 tiny incisions and I was walking unassisted to the restroom within a few hours postop. I was off the IV, drinking fluids and on just a few pain pills that first night and home the next day. My second day home, I went for a 25 minute walk outside and was taking over the counter Advil for pain.

In earlier times, a surgery like the one I had would have meant 6 weeks out of commission and a difficult recovery. I am fortunate that the latest technology has allowed me to return to activity within days. At this rate, I plan to be running and lifting weights by next week. This may not be a “typical” recovery, but it is possible. In conclusion, minimally invasive surgery, like the one I had, is possible and available to appropriate candidates. Although I am not currently performing the robotic procedures, my office partner, Dr. Lori Carrillo and my own surgeon, infertility specialist, Dr. Millie Behera, are available for consulation.

My uterus has been invaded by fibroid tumors! What am I to do?

January 22, 2012 by Dr. Tamar K. Gottfried Leave a Comment

Uterine fibroid tumors are a very common finding on pelvic ultrasound or pelvic exam and tend to cause women to worry unnecessarily. As many as one in 5 women have fibroids, and most will never cause any disruption in a woman’s health. Most commonly, a woman will have an annual exam and an ultrasound will be ordered because her uterus is felt to be enlarged or for another reason such as abnormal bleeding or pelvic pain, and fibroids will be one of the findings on the ultrasound. Fibroids can range in size from very small (grape sized) to very large (grapefruit sized) and can be solitary or numerous. Whether or not something needs to be done about them depends on factors such as size, number, location and symptoms.

What are the symptoms of fibroids? They can vary immensely. Most women with small or few fibroids may have no symptoms at all. These fibroids can be monitored periodically with ultrasound to check for growth. Fibroids that are asymptomatic and not growing rapidly can be left alone because they will shrink after menopause. Other fibroids can cause symptoms such as heavy bleeding, pain, pressure on the bladder or rectum, increased abdominal size, and difficulty becoming pregnant or carrying a pregnancy.

Treatments for fibroids vary based on symptoms. Some menstrual bleeding abnormalities can be managed with medications, even when fibroids are involved. There are nonsurgical solutions for fibroids such as uterine artery embolization or MRI guided ultrasound treatment- these procedures block the blood supply to the uterus or fibroids and shrink the tumors. They should not be used if future childbearing is desired.

Fibroids in the uterine lining can be removed with outpatient hysteroscopic surgery or can be treated during a uterine ablation procedure. Larger fibroids in the muscle of the uterus can be removed with a surgery called a myomectomy, if a woman desires future childbearing. Alternatively, a hysterectomy can be done if a woman is done having children. Either of these surgeries can be done open or laparoscopically. While there is no medicine available that can eliminate fibroids, a drug called Lupron is often used prior to fibroid surgeries to shrink the tumors.

In conclusion, a diagnosis of fibroid tumors usually does not mean disruption to a woman’s life or health. Many fibroids live quietly in the uterus and never cause symptoms. Luckily, if and when fibroids become symptomatic, there are a number of nonsurgical and surgical treatments to treat them. Further information about fibroid tumors can be found at my Mesa Ob/gyn office.