Specialties

GYNECOLOGY

Gynecology services provided:

• Preventive health care
• Annual breast and pelvic examinations
• Pap smears
• Treatment of pelvic and vaginal infections
• Contraception and Sterilization
• Family planning and counseling
• Screening for and treating sexually transmitted diseases
• Evaluation and treatment of premenstrual syndrome (PMS)
• Infertility evaluation
• Adolescent gynecology
• Urogynecology - evaluation of uncontrolled bladder leakage
• Menopause and post reproductive treatment
• Osteoporosis testing
• Cancer testing
  - Cervix
  - Ovary
  - Breast
  - Uterus
• Gynecology procedures
  - Laparoscopy
  - Hysteroscopy
  - Hysterectomy
  - Endometrial Ablation
  - FirstCyte Ductal Lavage
  - Dilation and Curettage (D&C)

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OBSTETRICS

• Pre-natal testing
• Non-stress testing
• Abdominal and transvaginal ultrasounds
• Fetal heart monitoring
• References for prenatal classes
• References for breastfeeding classes
• Any special conditions or complications
• Delivery of your baby
• Follow-up care after delivery
• High risk pregnancies
  - Management of pre-term labor
  - High blood pressure
  - Multiple pregnancies
  - Diabetes

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LAPAROSCOPY

Small-incision Surgery for the Female Reproductive Organs. Laparoscopy is used to detect and treat many reproductive organ problems such as unexplained vaginal bleeding or pelvic pain. This type of surgery gives Dr. Cardenas a clear view of your internal organs.

How does it work?

Laparoscopy uses a long, slender tool called a laparoscope. Dr. Cardenas will insert this scope and other surgical tools through a small incision. The incision is made in the abdomen (lower belly). A tiny camera is attached to the laparoscope, which sends light into the body. Dr. Cardenas then sees the reproductive organs on a monitor, much like a TV screen. He can turn the laparoscope to look at these organs from all angles.

Your reproductive anatomy:

By learning how your reproductive organs function, you can better understand what Dr. Cardenas sees during Laparoscopy. During each menstrual cycle, changes take place in these organs to prepare your body for a possible pregnancy. After menopause, these cyclic changes no longer occur.

Why laparoscopy is done:

It gives Dr. Cardenas a direct view of your reproductive organs.

This can help him diagnose a problem or find what’s causing your symptoms. Treatment is sometimes part of the same surgery. Laparoscopy is sometimes used for certain other reproductive surgeries. Listed below are some common procedures:

Common laparoscopic procedures:

• Endometriosis — used to help relieve pain or stop heavy menstrual bleeding, also it can help restore fertility. Dr. Cardenas destroys or removes some or all of the abnormal tissue. Special instruments such as lasers, ultrasonic tools, or electrosurgical tools may be used.
• Adhesions — Finding and removing adhesions can help to relieve your pain. Dr. Cardenas cuts the adhesions and frees structures that had been bound by the scar tissue; also it can help restore fertility. Special instruments such as surgical scissors, lasers, ultrasonic tools, or electrosurgical tools may be used.
• Infertility — A means to find out why you are infertile (having a hard time becoming pregnant). Some common causes are blocked fallopian tubes, endometriosis, and adhesions. This procedure may restore your fertility. Sometimes a blocked fallopian tube can be repaired through the laparoscope. Dr. Cardenas may do this with microsurgery (where tiny surgical tools are used to gently handle tissue).
• Ectopic Pregnancy — used to remove the fetal tissue lodged in the fallopian tube. Dr. Cardenas can clear the tube and control any bleeding, and sometimes all or part of the affected fallopian tube can be removed. Special instruments are used such as lasers or electrosurgical tools.
• Ovarian Cysts or Tumors — used to remove cysts or tumors depending on the size of growth found, your age, and whether you still plan to have children. If you have a cyst, Dr. Cardenas may drain it with a small needle. The cyst or tumor and, in some cases, the ovary may have to be removed. This is done with surgical scissors, lasers, ultrasonic tools, or electrosurgical tools.
• Fibroids — used to remove growth from inside the uterine space or within the uterine walls. The can also be found attached to the outside of the uterus. Removing fibroids can help relieve severe cramping or heavy menstrual bleeding. Special surgical tools are used and the method used depends on the size, number and location of the fibroids.
• Tubal Ligation — used to prevent pregnancy. Dr. Cardenas can seal off each fallopian tube by using a ring, an elastic band, or a clip. Also the tubes can be burned closed with electrical energy. This technique can keep the sperm from fertilizing the egg.

Before your laparoscopy:

If you are having a Laparoscopy, it helps to know what to expect. Understand the procedure; ask Dr. Cardenas all of your questions. Know what your insurance carrier covers and what your financial responsibility is. Follow any instructions given by your surgery coordinator and hand carry any written orders from Dr. Cardenas to the healthcare facility. This will help make sure your procedure goes smoothly.

Preparing for surgery:

Prepare for surgery as instructed by your surgery coordinator. Be sure to:

• Have any laboratory or diagnostic test ordered by Dr. Cardenas.
• Avoid taking aspirin or ibuprofen 1 to 2 weeks prior to the surgery. Ask Dr. Cardenas whether you can take routine medications.
• Stop smoking. This will help prevent risks during and after surgery.
• Arrange for a ride home after surgery.
• Stop eating or drinking after midnight before surgery. This includes water, coffee, candy, and chewing gum.

Arriving for surgery:

On the day of surgery, arrive at the healthcare facility as directed by your surgery coordinator. Arriving on time will help prevent delays. You will need to sign a consent form stating that the procedure has been explained to you. If you don’t understand certain parts of the form, ask for help.

Learning about the anesthesia:

Before surgery, you will meet the anesthesiologist to discuss the type of anesthesia you will be given prior to surgery. This medication helps you sleep during the surgery.

How laparoscopy is done:

After you are given the anesthesia, small incisions are made in your abdomen. This way, the laparoscope and other surgical tools can be inserted to perform the procedure.

A closer look:

Dr. Cardenas needs to be able to see your reproductive organs clearly during surgery. Therefore, your abdomen is inflated with carbon dioxide gas or another type of gas. Sometimes, a device is inserted in the vagina to lift the uterus. This helps Dr. Cardenas see your organs better on the monitor (TV screen).

During surgery:

In the operating room, you will lie down on a special table, which may be tilted to help Dr. Cardenas reach your reproductive organs. An IV (intravenous) line will be started by the nursing staff or assistants to give you the medications and fluids necessary during and after your surgery. Once the anesthesia is given, your abdomen is inflated with gas and incisions are made. Dr. Cardenas then inserts the laparoscope and other surgical tools. At the end of surgery, the gas is released and the incisions are closed.

Your incisions:

Dr. Cardenas may make your incisions near the navel (belly button), the waistline or the pubic hairline. Most often, each incision is about a half-inch long. It is sometimes necessary for extra incisions. If a procedure can’t be done through the laparoscope, Dr. Cardenas may need to make a larger incision.

Recovering in the hospital:

It is normal to be drowsy or have some nausea when you wake from your surgery and you may spend a few hours in the recovery room. Your family will be able to visit.

You may have a catheter (small tube) to drain your bladder. The catheter will be removed before your go home.

Risks and complications of surgery:

Dr. Cardenas will explain the possible risks and complications of laparoscopy surgery during your office visits. Some of the complications include the following:

• Infection
• Bleeding
• Risks of anesthesia
• Damage to blood vessels, nerves, muscles, or nearby pelvic structures (the bladder, ureters, or bowel)
• Blood clots
• The need for a larger incision

Your recovery:

You may go home the same day of your surgery, or you may have to stay in the healthcare facility over night. Dr. Cardenas will determine your length of stay after your surgery and give you advice to help your body heal. Please follow all instructions to ensure you heal properly.

Returning home:

When Dr. Cardenas releases you from the healthcare facility, please have a family member drive you home and call Dr. Cardenas if you have any of the following:

• Chills, or a fever of 101F or higher
• Heavy, bright-red vaginal bleeding or smelly discharge
• Difficulty urinating
• Severe abdominal pain or swelling
• Leg pain, redness, or swelling
• Nausea or vomiting

Let Dr. Cardenas know if something about your health does not seem normal, or if you have any questions or concerns.

Becoming active again:

You will get back to a normal routine after your surgery, however you may need to rest for a few days or longer. Little by little, build up to your normal activities. Check with Dr. Cardenas prior to any vigorous exercise or driving. Please do not drive while taking pain medication.

Follow-up visits:

Dr. Cardenas will inform you when to follow-up with an office visit. This could be a few days to a few weeks after your surgery. Be sure to schedule any follow-up visits requested in order to monitor your recovery. When following the advice given, you will find yourself feeling better and enjoying life more.

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HYSTEROSCOPY

If Dr. Cardenas has recommended that you have hysteroscopy, a procedure that allows a view directly inside your uterus. Hysteroscopy is done without incisions and causes little discomfort. It can help him identify the causes of uterine problems. It can also be used to treat some of the following problems.

Hysteroscopy is commonly done to determine the cause of unusually heavy or long periods, bleeding between periods, or postmenopausal bleeding. In certain situations, it may be done to evaluate the cause of severe menstrual cramps. Also, hysteroscopy may sometimes be used to check for causes of infertility or the inability to carry pregnancies to term.

Two uses of hysteroscopy

Hysteroscopy can be used in two ways. To look inside the uterus for problems such as abnormal growths, Dr. Cardenas may perform diagnostic hysteroscopy. If growths or other problems are found, he may remove them during operative hysteroscopy.

Performing hysteroscopy

The tools that Dr. Cardenas uses to perform hysteroscopy include:

• A hysteroscopy (a long, thin telescope) that lets him see inside your uterus, by looking directly through the hysteroscope or at images of your uterus on a video monitor.
• A speculum (the same instrument used during a Pap smear) that gently widens your vagina. The cervix (opening to the uterus) is sometimes widened as well.
• Specially designed surgical instruments that can be inserted through the hysteroscope to take tiny samples of the uterine lining or remove growths.

Diagnostic hysteroscopy

During diagnostic hysteroscopy, Dr. Cardenas examines the inside of your uterus. If growths, scar tissue, or other problems are found, he can use the information gathered during the procedure to develop a plan for treatment, Diagnostic hysteroscopy may be done in your Dr. Cardenas office, an outpatient clinic or a hospital.

Before the procedure

Ask Dr. Cardenas whether you can take a medication like ibuprofen an hour before your procedure. This medication can help lessen the uterine cramps that sometimes occur during hysteroscopy. Before the procedure, you may be asked to fill out some forms. Then you’ll change into a gown and lie on an examination table with you feet in stirrups.

During the procedure

To lessen discomfort, Dr. Cardenas may numb your cervix (local anesthesia). If the procedure is done in a hospital, your body may be numbed below the waist (regional anesthesia), or you may be completely asleep (general anesthesia). Your cervix may be gently widened. The hysteroscopy is then inserted. If a video camera is used, you may be able to watch the procedure on the video monitor.

After the procedure

Menstrual-type cramps and bleeding are common for about 24 hours after the procedure, so wear an absorbent pad. You’ll need to avoid tampons and sexual intercourse for a brief time. Please check with Dr. Cardenas on how long to avoid both.

What your physician looks for

During diagnostic hysteroscopy, Dr. Cardenas looks inside your uterus for anything abnormal. Fibroids, polyps, and adhesions are common problems that may be seen during hysteroscopy. Uterine cancer and hyperplasis (an overgrowth of the uterine lining) are not common, but may be found with hysteroscopy if either is present. During the procedure, a small sample (biopsy) of the uterine lining may be taken for later laboratory evaluation. If you have a "lost" intrauterine device (IUD), it can found and removed.

Procedures that may be performed

• Dilation and Curettage (D&C) — Excess blood and tissue are carefully scraped off the uterine wall.
• Fibroid — Removing fibroids can help solve problems with abnormal bleeding or discomfort.
• Polyp — Removing a polyp can help stop or lessen abnormal bleeding.
• Ablating the Endometrium — Removing or destroying the entire lining of the uterus. After this procedure is performed, pregnancy is rare and carrying a pregnancy to term is no longer possible.
• Adhesions or a Septum — Removing these growths can help restore fertility and the ability to carry a pregnancy to term.

Getting on with your life

To get the best results from your hysteroscopy, follow Dr. Cardenas instructions and keep all of your follow-up appointments. By helping with the diagnosis and treatment of uterine problems, hysteroscopy can provide the peace of mind you may need to get on with life and back to activities you enjoy.

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HYSTERECTOMY

Are you dealing with severe menstrual bleeding, a pelvic infection, or pain? Or, have you been diagnosed with a type of cancer. For these or other reasons, Dr. Cardenas may have suggested that you have a hysterectomy (surgery to remove the uterus). A hysterectomy can relieve symptoms and stop infection. And if you have cancer, it may save your life. Still, making a decision about surgery can be hard. Reading the following information can help.

Hysterectomy today

For years, hysterectomy was the only treatment for women with serious reproductive health problems. Today there are often other options. Discuss your treatment plan with Dr. Cardenas as well as any other health problems such as heart disease or diabetes. He will suggest hysterectomy only if it is the best treatment for your problem.

Problems that hysterectomy can treat

Problems with any of the reproductive organs can disrupt your cycle, cause symptoms, or threaten your health. Some of the most common problems are:

• Endometriosis — when tissue that should line the uterus grows outside of the uterus. Scar tissue (adhesions), sever pain, and excess bleeding can result.
• Fibroids — Benign (noncancerous) tumors. They grow in the uterus. Fibroids can cause heavy periods, pain and pressure in the pelvic area, and urinary problems.
• Pelvic relaxation — when certain ligaments weaken. This can cause the bladder, rectum, or uterus to drop (prolapse). Urinary leakage and pelvic pressure or discomfort may result.
• Cancer — presence of malignant (cancerous) tumors. It can occur in the uterus, cervix, ovaries, or tubes. Some tumors cause abnormal bleeding. Others cause no early symptoms at all.

A hysterectomy may also be done for other reasons as well.

Diagnostic tests

You may be asked to have one or more tests. Their results may help find the cause or extent of your problem. Here are some of the most common tests:

• A Pap test — tissue samples from your cervix and vagina. The samples are checked for abnormal cells.
• Ultrasound — Sound waves are used to produce pictures of your organs. These pictures can show abnormal growths. During the test, a probe may be placed on your abdomen. Or, a probe may be gently inserted into your vagina.
• Endometrial biopsy — a sample of the tissue lining your uterus. The sample is checked for abnormal cells.
• Hysteroscopy — A long, lighted tube is inserted through your vagina. This allows Dr. Cardenas to see inside your uterus. He will check for fibroids and other problems.
• D&C (dilatation and curettage) — The lining is removed from your uterus. It is checked for any abnormal cells.
• Laparoscopy — A thin, lighted tube is inserted through a tiny incision in your abdomen. This allows Dr. Cardenas to check your pelvic organs for endometriosis and other problems.

Planning your treatment

After going over the results of your exam and any tests, you and Dr. Cardenas will make a treatment plan. Options may include hysterectomy by itself or along with other treatments. As you create the plan, Dr. Cardenas may discuss the following questions with you:

• How severe is your problem? — Is your health problem getting in the way of your daily life? Is the problem getting worse? If your answers are "no" treatment other than hysterectomy may be suggested.
• Do you want to have children? — If you do, Dr. Cardenas may discuss other types of treatment.
• Should the ovaries be removed too? — This may be discussed if you have cancer or are at an increased risk for cancer. In such cases, Dr. Cardenas may suggest removing the ovaries and fallopian tubes along with the uterus. If the ovaries are to be removed, talk to Dr. Cardenas before the surgery about hormone replacement therapy (HRT).

The surgical procedure

Before the surgery, you and Dr. Cardenas will discuss how the uterus will be reached. You will also talk about the type of hysterectomy you will have. You may have only your uterus removed. Or, your ovaries and fallopian tubes may be removed as well.

Reaching the uterus

The uterus can be reached and removed in three ways. In many cases, the approach depends on your health problem.

• Abdominal Hysterectomy — a 4 to 6 inch incision is made in the abdomen. The incision can be horizontal (side-to-side) or vertical (up and down). The uterus is removed through the incision. This procedure is done as an inpatient (in the hospital) only. A abdominal incision will leave a scar on the abdomen depending on the location of your problem.
• Vaginal Hysterectomy — An incision is made inside the vagina. The uterus is then removed through the vagina. This can be done if the uterus is not too large, or if it has dropped down into the vagina. This procedure may be done as outpatient in a surgery center or 23 hour stay facility. A vaginal incision leaves no scar on the outside.
• LAVH (laparoscopically assisted vaginal hysterectomy) uses small incisions in the abdomen. A tiny camera and instruments are inserted to view and move the organs. The uterus is removed through the vagina. Laparoscopic incisions leave small scars on the abdomen that is hard to see.

Preparing for surgery

In most cases, a hysterectomy takes 1 to 3 hours. Knowing what to expect before and after surgery can help reduce fears you may have. It also helps you prepare. Be sure to follow any instructions Dr. Cardenas gives you.

Before the day of surgery

A few weeks before surgery you may be asked to:

• Stop smoking.
• Donate your own blood. This is in case you need to receive blood (a transfusion) during surgery.

As the day of surgery grows closer, you may be asked to:

• Have blood, urine, and other tests.
• Stop taking certain medications.
• Sign a consent form for the surgery.
• Stop eating and drinking after the midnight before surgery.

At the hospital

An intravenous (IV) line may be used to provide fluids and medications, such as antibiotics. During the hysterectomy, you will receive anesthesia to keep you pain-free.

Risks and complications

The risks and complications of a hysterectomy include:

• Side effects from the anesthesia
• Infection
• Bleeding, with a possible need for a transfusion
• Damage to nearby organs
• Blood clots in the legs or lungs

What to expect after surgery

You may spend up to a few days in the hospital, if in-patient procedure. While there, ask Dr. Cardenas or the nurse any questions you may have. For the first days after surgery, here is what you can expect:

• The abdominal incision may be closed with stitches or staples. It is covered with gauze. Any staples may be removed during your hospital stay or at a follow-up visit.
• Pain can be relieved with medication prescribed by Dr. Cardenas.
• Urination may be aided by a tube (catheter). It is put in yur bladder during surgery. In most cases, it is taken out a day or two after surgery.
• Vaginal bleeding is likely. You will need to use sanitary pads. Tampons should be avoided.
• Meals may be limited to liquids until your bowels are back to normal.
• Your lungs need to be kept clear of excess fluid. This prevents problems such as pneumonia. You will be shown how to clear your lungs.

Recovery at home

Healing takes time. How much time depends on your health and the type of surgery you had. Expect it to take weeks before you feel really well. Call Dr. Cardenas if you have any of the following:

• Fever or chills
• Heavy vaginal bleeding or smelly discharge
• Redness, bleeding, or discharge at the incision site.
• Pain or swelling in your legs.
• Shortness of breath or chest pain.

To help your body heal, follow these tips:

• Take showers instead of baths.
• Use pads to absorb bleeding or discharge. Light bleeding is likely at first, Brownish discharge may appear for weeks.
• Do not use tampons or douches. They can cause the vagina to become infected.
• Do not have sexual intercourse for as long as Dr. Cardenas suggests, (most likely 6 to 8 weeks).
• To avoid constipation, eat fruits, vegetables, and whole-grain foods. Drink at least 8 glasses of fluid each day.
• Avoid tasks or movements that can strain your incision, such as lifting or bending.
• Ask Dr. Cardenas when you can drive.
• The type of work or exercise you do can affect your healing process, please discuss with Dr. Cardenas.
• Ask you family and friends how they can help.

Take care of yourself emotionally

Having a hysterectomy may affect your emotions. You may be relieved to no longer have symptoms. But you may feel "down" about the changes in your body. You may also have moods swings if your ovaries were removed and you had not yet reached menopause. To feel better, take any medications prescribed by Dr. Cardenas.

Looking forward to the future

Once you have healed from surgery, you can focus on enjoying life. You may have more energy, now that symptoms of severe pain and bleeding are gone. To feel your best, follow Dr. Cardenas instructions, eat right and exercise. And remember, even after a hysterectomy, regular checkups are still needed.

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ENDOMETRIAL ABLATION

What Is Endometrial Ablation

It is the burning, or ablation, of the endometrial lining of the uterus with a resectoscope to control excessive or prolonged menstrual bleeding.

Who is a candidate for the procedure

Women with prolonged and excessive menstrual flow are often incapacitated or severely restricted in their activities each month. Those suffering from this problem are seen in the physician’s office frequently. Many will undergo multiple D&C (Dilatation & Curettage)

procedures, and try various hormonal regimens to control the bleeding. When their condition does not respond to this treatment, their physician often recommends hysterectomy. In fact, 40% of all hysterectomies are performed for this reason.

Endometrial ablation is designed as an alternative to hysterectomy for women with this condition. The goal is to induce total cessation of menstrual flow and eliminate the need for major surgery. Other women who might benefit are those with uterine fibroids and those patients in need of surgery but classified as high risk because of severe medical problems (cardiac, bleeding tendencies, obesity, etc.).

What are the advantages of Endometrial Ablation

As opposed to hysterectomy, endometrial ablation requires no surgical incision or organ removal, and is a safe, cost-efficient procedure done as an out-patient. The patient’s hormonal status remains unaffected. Hysterectomy requires 5 —7 days of hospitalization and a 4 week recuperation period. Endometrial ablation patients return home the same day of their procedure and can resume most normal activities usually within 5 days. This makes endometrial ablation ideal for working women unable to take extended disability leaves.

What happens during the procedure

You will be sedated under general anesthesia. Your uterus is filled with a saline-like fluid. Without making an incision, Dr. Cardenas inserts a telescopic instrument called a hysteroscope through the vagina, past the cervix, and into the uterus. The hysteroscope has a camera and light source, which allows him to view the inside of your uterus on a TV screen. Using a gyneresectoscope, he methodically ablates or burns away the lining of the uterus. This is the layer which is responsible for a woman’s monthly period. Once the procedure is completed, you are taken to the recovery area and allowed to rest. Most patients return that same day to the comfort and convenience of their own home.

How long is the recuperation period?

Most patients rest with only light activity for a day or two and can usually resume their normal schedule in 5 days. Mild uterine cramping for several days is usually all the discomfort you will experience. An occasional aspirin or advil should relieve this.

Where will I have the procedure

Almost all endometrial ablations can be performed in an out-patient setting. The surgery center has all the latest equipment necessary to perform this procedure. Their nurses are specially trained to provide you with a highly personalized and professional level of service.

What are the effects of the procedures

By burning away the menstrual lining of the uterus, endometrial ablation successfully eliminates or greatly reduces monthly menstrual flow. In addition, women have noted improvement in menstrual cramps and PMS symptoms, which have often accompanied their heavy periods.

What if I am not a candidate for endometrial ablation

Certain complicating factors, such as the condition and size of your uterus, may preclude endometrial ablation as possible therapy. The doctor will then discuss other options of treatment for your condition.

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