What's up Doc?

I am beyond excited to introduce Dr. Sonia Rebeles to our patients.  I had been searching for a doctor that would complement my practice philosophy for a long time.  I received many great applicants but none that captured my heart and soul until now.  Dr. Rebeles responded to my very quirky and unusual job posting.  Those of you who know me well, wouldn’t be surprised to know that the job listing was a little like this:  Do not apply if your staff will be having tequila shots and celebrating 4th of July early when you announce your departure.  Do apply if there will be mass chaos and mourning if you leave your current job.  She called me laughing and we immediately connected.  I felt like I was talking to my long lost sister and I knew she was the right pick.

Hailing from the Lone Star State and with humble beginnings, she was determined to succeed.  She is Board Certified in Obstetrics and Gynecology.  She had her own practice in Texas but decided to move to California to be close to her sisters.  She  worked for two years in Beverly Hills before deciding to join our practice.  Her area of expertise is in minimally invasive benign gynecologic surgery including robot-assisted (daVinci) surgery and single site surgery.


Dr. Rebeles received her Bachelor of Arts degree from Stanford University in Human Biology and her medical degree from the University of Texas Health Science Center at San Antonio. She completed residency training at Texas Tech University Health Sciences Center at El Paso where she subsequently served as an Assistant Professor in Obstetrics and Gynecology and Director of the Minimally Invasive Surgical Skills Laboratory.

In Seattle, WA, she obtained additional post-residency fellowship training in minimally invasive surgery, where she refined both traditional laparoscopic and robot-assisted (daVinci) surgical techniques using some of the earliest models of robot-assisted surgery. She is one of few female surgical proctors of robotic surgery and has taught many physicians the fundamentals of minimally invasive gynecologic surgery throughout her career.

Dr. Rebeles is a Fellow of the American Congress of Obstetricians and Gynecologists (FACOG), and is an active member of the Alpha Omega Alpha Honor Medical Society, and the American Association of Gynecologic Laparoscopists. Her interests include irregular, heavy or painful menstrual bleeding, fibroids, endometriosis, pelvic pain, and urinary incontinence. Using a combination of compassionate and empathetic care, evidence-based medicine, sound knowledge of pelvic anatomy, and the incorporation of state-of-the art surgical technology, Dr. Rebeles is committed to offering women innovative treatment options for multiple gynecologic problems.

The new 21st Century Mona Lisa and Lasers

Da Vinci's Mona Lisa
Da Vinci’s Mona Lisa

Perhaps the most visited, talked about and parodied work of art in the world is Leonardo da Vinci’s, Mona Lisa.  Medicine is fascinated with Leo.  First, we named a surgical Robot after him and now, an amazing laser called the Mona Lisa Touch.

It is the new talk of the town in the US but has been in Europe for almost 10 years.  It only recently gained FDA approval in December 2014. The FDA is like the bouncer with a chip on his shoulder at the most coveted night club, giving you the stare-down because you are wearing your Skechers, “Shape-ups” and you should be wearing your  “Louboutins”.  The fact that Mona Lisa got in the club despite her 16th century wardrobe was a big deal and her dance moves have been revolutionary.

The Mona Lisa laser is the only non-hormonal option for women suffering from vaginal dryness, painful intercourse and mild stress incontinence (leaking of urine while jumping, running, coughing, sneezing, laughing too hard).  This is revolutionary because in the past, women who did not or could not take hormones really had no other option but to suffer in silence.

austin powersThe Mona Lisa Touch is not the type of laser beam that Austin Powers wanted to use on his shark’s heads.  It is very gentle, relatively benign and it will not attack you. It can be done in the office with no anesthesia and completed in just 3 sessions, 6 weeks apart.  Those of you who are fascinated with Madonna’s fountain of youth and wonder how a 57 yr old can look like this:

Madonna

should know that her secret is the fractional CO2 laser. Without getting too technical discussing reflectors, couplers, kilowatts and power; the laser is special becauses it causes small columns of injury to the skin which then trigger a healing response in our bodies. New collagen, elastin and fibrin are deposited at the site of injury to plump up our skin and make us look more youthful.

The applications for the C02 laser in Gynecology are many.  We use the C02 laser to treat endometriosis, cut through tissue, vaporize warts and other HPV lesions. We also use it to “rejuvenate” the vaginal wall and external genital labia.

I am the biggest skeptic when it comes to gimmicks. I have to admit that when the Mona Lisa Touch received FDA approval, my interests peaked because I knew that there were clinical trials proving its efficacy.  I have yet to regret purchasing this laser for my patients.

I have many breast cancer survivors who are not candidates for hormone replacement therapy.  Their only option is the laser.  Despite a cancer diagnosis, patients want to lead normal lives which includes being able to have sex without pain. There is no shame in wanting this…it is a primal need for many and in my humble opinion, an essential part of every relationship.

We are lucky that we can now talk about these things.  Women in the 16th Century probably had to “grin and bear it”.  It doesn’t have to be the Sahara Desert or sand paper, ladies, your vagina will thank you for the rejuvenation. Who needs People Magazine or the Louvre to be glorified.  With the Mona Lisa Touch your partner will certainly be in awe of you and your new-found laser. Welcome to the 21st Century!

A Rare Form of Ectopic Pregnancy… Cornual Pregnancy

Location for ectopic pregnancies
Locations for Ectopic Pregnancies

An ectopic pregnancy is a pregnancy that occurs outside of the uterine cavity 98% of ectopic pregnancies occur within the fallopian tube. There is a rare type of  ectopic pregnancy  that occurs at the junction between the fallopian tube and the uterus. These are called interstitial or cornual pregnancies  and can be extremely dangerous, often times leading to  rupture at the site of implantation and internal hemorrhage.   Recently, I had a patient who unfortunately developed a cornual ectopic pregnancy one year after having a myomectomy (removal of fibroids).  In her situation,  the site where the fibroid was removed was at the  junction between the fallopian tube and the uterus.  The pregnancy implanted at this site and unfortunately the patient ended up needing a hysterectomy to protect her life.   There was no way we could salvage the pregnancy  or her uterus without causing severe bleeding.  The pathology specimen showed  that the pregnancy had not only developed at the cornua but it had also started to invade the muscle which would have led to an accreta (placenta gets imbedded in the muscle and at the time of delivery does not detach and causes severe  hemorrhaging.

Uterus with Cornual Pregnancy
Uterus with Cornual Pregnancy
Uterus Removed with Ectopic Pregnancy seen on the Right Corner.  Fibroids also visible.
Uterus removed with fetus seen on the left corner. Fibroids also visible.