Anyone with a cervix should get their first Pap smear at age 21 and another every three years before turning 30. Those ages 30 to 65 should have a Pap test every three to five years.

“If you are younger than 21, the American College of Obstetricians and Gynecologists (ACOG) says you do not need this type of screening,” said Amy E. Farrell, M.D., OB/GYN with Norton Women’s Care.

What is a Pap smear test?

A Pap smear (also referred to as cervical cytology or Pap test and named for its developer George Papanicolaou, M.D.) can detect abnormal, precancerous cervical cells. 

Precancerous changes to cervical tissue, or cervical dysplasia, won’t cause any symptoms, but can be identified through lab testing. A Pap test is a very effective cervical screening test. Early detection allows for early treatment, which can be the most successful. A regular Pap smear can identify abnormal cervical cells before they develop into cancer. Even if cervical cancer has started to develop, a Pap test can detect it and lead to early treatment that can preserve fertility. 

READ MORE: What’s the right age to start getting Pap smear tests?

The test is very brief, and while it may be a bit uncomfortable, it doesn’t hurt. You’ll lie on your back with your feet in stirrups and a drape over your legs. Your gynecologist or other health care provider will insert a speculum in your vagina to hold it open to provide access to your cervix. A small brush collects cervical cells and is placed in a tube for testing.

For two days prior to your Pap smear test, refrain from vaginal sex, stop using tampons, vaginal creams, medicines, lubricants or douches. Schedule your appointment for after your period ends. If you have your period on the day of the exam, contact your provider, as menstruation could alter the results.

A pelvic exam is not the same thing as a Pap smear. Although they commonly occur during the same visit, both tests are not a requirement for every appointment. They serve as important ways to keep you healthy, including prevention of certain medical conditions and screening for cancer.

According to ACOG, a pelvic exam is not necessary — unless certain symptoms are present or there is a risk of specific conditions — but a patient and provider should make this decision together.

Is a Pap smear also an HPV test?

Cervical cells collected during a Pap smear are also tested for HPV, a very common virus that often has no symptoms and clears up in a year or two without causing cancer. An HPV infection that persists for many years can lead to precancerous changes that can develop into cervical cancer. 

HPV testing and vaccination can significantly reduce the risk of cervical cancer.

After an abnormal Pap test result

If you get an abnormal Pap test or HPV result, you and your provider will discuss next steps, which could include:

• A review of your medical history with an emphasis on relatives who may have had cervical or another gynecologic cancer
• A physical exam that includes feeling your lymph nodes for any abnormalities
• Follow-up test called a colposcopy: This test gives your health care provider a magnified view of the surface of your cervix. As with a Pap smear, you’ll lie on your back, and your provider will insert a speculum in your vagina to provide access for the colposcopy. The exam causes no more discomfort than a Pap smear. A weak solution of acetic acid (the same acid in vinegar) will be applied to your cervix to highlight abnormal areas. A small piece of cervical tissue may be removed for a biopsy to determine whether there are signs of cervical precancer, cancer or neither. 
• A cone biopsy retrieves a bit of tissue for testing and can serve as treatment by removing all the abnormal cervical tissue. The small piece of tissue is cut in the shape of a cone and may leave you with some discomfort for about a week.

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Monica H. Vetter, M.D., gynecologic oncologist at Norton Cancer Institute in Louisville, is on a mission to help prevent cervical cancer across Kentucky.As a Louisville native and graduate of the University of Louisville School of Medicine, she is passionate about caring for other women in her hometown.“I want all women to be protected,” she said. “I want to make sure we’re giving patients the opportunity to be aware and have a good relationship with a physician so they feel like they can advocate for themselves.”Dr. Vetter has experience treating all gynecologic malignancies, including cervical, uterine, ovarian and vulvovaginal cancers. She also specializes in integrating robotic-assisted surgery for gynecologic oncology and helps patients gain access to national and international clinical trials. As a subspecialized provider who focuses solely on patients with gynecologic cancers, Dr. Vetter’s has expertise in treating those conditions to give patients better health outcomes.

“They live longer. There’s a higher chance that they’re cured. There’s a higher chance they’re going to be offered an opportunity to get into a clinical trial if they need to,” she said. “That’s why our subspecialty is so important within the Norton Healthcare system — it improves the outcomes of our patients diagnosed with gynecologic cancers.”

Kentucky’s high rate of cervical cancer

Cervical cancer is almost entirely preventable, thanks to the screening techniques used by Norton Healthcare providers and facilities. Pap smears can detect abnormal or precancerous cells or HPV infections that can increase a person’s risk of developing cancer.

“If you can identify these cells early, you can intervene so that a person never goes on to develop cervical cancer,” Dr. Vetter said.
However, Kentucky has one of the worst rates of the disease in the U.S. According to the Centers for Disease Control and Prevention, there are 9.9 cases of cervical cancer per 100,000 women in Kentucky, compared with the national average of just 7 cases per 100,0000.

Kentucky’s higher rate of cervical cancer — fourth worst in the country — is often driven by low adherence to cervical cancer screening guidelines, whether it’s due to a lack of access of gynecologic care in rural areas, or simply a busy mom who hasn’t gotten around to making an appointment. Sometimes, people put off the screening because they feel too embarrassed. Dr. Vetter wants to reassure patients that there is no reason to be hesitant. 

“I think there’s a lot of reluctance to talk about cervical cancer and Pap smears, because getting a Pap smear is very intimate with your physician. It can be something people think is embarrassing, because, as a society, we don’t talk about the female reproductive system a lot,” Dr. Vetter said.
Early-stage cervical cancer often has few or no symptoms. When there are symptoms, they’re usually mild, like bleeding during sex or bleeding in between periods, which can be easy to write off as “normal” or not worth bringing up with a health care provider.

“Women may chalk it up to, ‘Oh, I just had an irregular period this month,’ or “My cycles are just a little bit off.’ And if you’re a busy, working woman, you may not even really notice it,” Dr. Vetter said.

Preventing cervical cancer today

Women should be screened for cervical cancer starting at age 21. Patients between the ages of 21 and 29 should receive a Pap smear every three years, while ages 30 to 64 should get a Pap smear with an HPV screening every five years, or a Pap smear every three years.
 
If abnormal cells are detected early, there are surgical interventions that can prevent the development of cervical cancer. Norton Cancer Institute offers cancer patients the most modern treatments and access to hundreds of clinical trials. Dr. Vetter estimates she is one of a relatively small number of gynecologic oncologists in Kentucky. She knows how important it is to establish a comfortable rapport with patients and strives to make every person comfortable discussing sensitive issues about their reproductive health.

“When our relationship is based on transparency and trust, it’s better for everyone,” she said. “Being approachable, straightforward and thoughtful goes a long way when caring for someone.”

Monica H. Vetter, M.D., is a board-certified gynecologic oncologist with Norton Cancer Institute. Dr. Vetter earned her medical degree from the University of Louisville School of Medicine in Kentucky. She completed her residency in obstetrics and gynecology, and a fellowship in gynecologic oncology at The Ohio State University College of Medicine in Columbus. Dr. Vetter is a member of the Society of Gynecologic Oncology, American Society of Clinical Oncology, and the American Medical Association, and is a fellow of the American College of Obstetricians and Gynecologists.

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Pericarditis is inflammation of the sac-like structure around the heart. The fluid in the sac keeps the heart muscle lubricated and serves as a protective lining. Pericarditis is when an infection settles into that fluid in the sac.

“Pericarditis is relatively rare,” said Li Zhou, M.D., Ph.D., medical director of the Norton Heart & Vascular Institute Women’s Heart Program. “For the most part it is short term, meaning if treated properly, it goes away; however, in some cases it can become recurring, which impacts about 28 people out of every 100,000.”

The most common symptoms of pericarditis is sharp chest pain that gets worse with breathing deeply, lying flat or coughing. Some patients also may experience a dull ache that spreads to the left shoulder or into their neck, mimicking the signs of a heart attack and sending them to the emergency room.

“Pericarditis accounts for about 5% of nonischemic ER visits for chest pain meaning they are having pain in their chest but when diagnosed it is not a heart attack,” Dr. Zhou said. “And in these cases, the patient did the right thing. It is always better to be safe than sorry, and going to the emergency department for unexplained chest pain is always the best thing to do.”

“Pericarditis typically doesn’t just develop on its own,” said Lauren R. Albers, M.D., women’s cardiovascular disease specialist with the Norton Heart & Vascular Institute Women’s Heart Program. “Pericarditis can arise as a result of an acute illness, such as virus like the flu; after a flare-up of an autoimmune disease, such as lupus; or can come about as a result of taking certain medications, for example anti-seizure medications, some anticoagulants/blood thinners or hydralazine, a well-known blood pressure medication.”

Treatment plans can vary

The most common treatment includes high doses of anti-inflammatory medications, which are tapered over several weeks, along with colchicine, a heart medication that supports recovery.

“Abstaining from sports or robust exercise in the early stages of recovery is recommended,” Dr. Albers said. “Elevating the heart rate may exacerbate the inflammation and cause discomfort in the chest, as well as dangerous arrhythmias.”

Treatment can take several weeks, up to three  months, because if not treated fully there is a 30% risk of recurrence in the first 18 months after diagnosis. Once treatment begins and the pain subsides, most patients can return to normal activity, including moderate exercise, while monitoring how they feel.

The post Country music crooner Carly Pearce is battling pericarditis — a women’s cardiology specialist explains the condition appeared first on Norton Healthcare.

8 common causes of pelvic pain

1) Endometriosis
Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus, which can cause pelvic pain. This tissue can be found on the ovaries, fallopian tubes or other pelvic structures. Endometriosis can lead to inflammation, scarring and the formation of adhesions within the pelvic area, resulting in chronic pelvic pain. Endometriosis can cause pain that feels like severe menstrual cramps, lower back pain, painful urination and discomfort during sexual intercourse.

Endometriosis also can contribute to pelvic pain through the development of endometriomas, a type of ovarian cyst that forms when endometrial tissue grows within the ovaries and becomes filled with old blood, leading to sharp pelvic pain and discomfort. Scar tissue caused by pelvic adhesions can form from endometriosis, which can cause some pelvic organs to stick together. This can cause pelvic organ prolapse or pelvic floor dysfunction, both of which can make pelvic pain worse. Advanced endometriosis may be treated through minimally invasive gynecologic surgery.

2) Ovarian cysts

Ovarian cysts are fluid-filled sacs that can develop on the surface of the ovaries. These cysts can vary in size and may form as a result of the normal monthly ovulation process, when they are known as functional cysts, or due to other underlying conditions. Ovarian cysts can cause pelvic discomfort when they grow large, rupture, bleed or twist the ovary, leading to sudden and sharp pain in the lower abdomen. The sudden onset of severe pelvic pain sometimes may be an indication of a ruptured ovarian cyst, which requires immediate medical attention to prevent further complications.

3) PCOS
Polycystic ovary syndrome (PCOS) is a complex hormonal disorder that often leads to the formation of multiple small cysts on the ovaries, along with other symptoms such as irregular menstrual periods, excessive hair growth and hormonal imbalances. The hormonal imbalances characteristic of PCOS can disrupt the normal menstrual cycle and result in irregular or missed periods. Additionally, the hormonal fluctuations in PCOS can trigger inflammation in the pelvic region, increasing symptoms of pain or discomfort.

4) Pelvic floor myalgia

Pelvic floor myalgia refers to the chronic contraction and spasm of the muscles in the pelvic floor, which can lead to ongoing pain and discomfort in the pelvic region. These persistent muscle contractions can result from various factors such as stress, trauma or repetitive strain, causing the muscles to become tense and inflamed over time.

Chronic tightness or spasms in the pelvic floor muscles can irritate nearby nerves and cause pain. This condition can cause chronic pelvic pain by impairing the normal function of the pelvic floor muscles, which support proper function of the pelvic organs, including bladder and bowel control, and sexual intercourse.

Physical therapy can help treat pelvic floor conditions by focusing on strengthening and relaxing the muscles in the pelvic area. Through tailored exercises and techniques, a pelvic floor physical therapist can help you improve your pelvic floor muscle function and relieve pain. Additionally, physical therapists can provide education on proper body mechanics and lifestyle modifications to help you manage symptoms effectively.

5) Uterine fibroids

Uterine fibroids are noncancerous growths that develop in the uterus. When these fibroids enlarge or press on surrounding organs, they can cause pelvic pain. Fibroids that grow large can press on nearby pelvic muscles or structures that resulting in chronic pelvic pain, extreme menstrual cramps or pain during intercourse. In some cases, the location and size of the fibroids also can contribute to lower back pain or abdominal pain.

6) Pelvic inflammatory disease

Pelvic inflammatory disease is an infection of the female reproductive organs, often caused by sexually transmitted infections, such as chlamydia or gonorrhea. When left untreated, it can lead to inflammation and infection of the uterus, fallopian tubes and ovaries, resulting in chronic pelvic pain. 
 

7) Urinary tract infection

A urinary tract infection (UTI) or interstitial cystitis are common causes of pelvic pain in women. UTIs occur when bacteria enter the urinary tract and cause infection, leading to symptoms such as pelvic pain, frequent urination and a painful or burning sensation during urination. Treatment for UTIs typically involves antibiotics to clear the bacterial infection, which in turn alleviates the pelvic pain. Drinking plenty of water and maintaining good hygiene practices can help prevent UTIs. 

8) Interstitial cystitis

Interstitial cystitis is a chronic condition characterized by bladder pain and urinary urgency. The inflammation of the bladder wall in interstitial cystitis can result in pelvic pain that is often described as a constant, dull ache in the lower abdomen and pelvic region. Managing interstitial cystitis may involve a combination of dietary changes, bladder training, physical therapy and medications to help reduce inflammation and alleviate symptoms of pelvic pain.

Other causes of pelvic pain 

Not all causes of pelvic pain are due to an underlying gynecologic health condition. For example, some women may experience normal cramping during their period or ovulation. More causes of pelvic pain involve other organs, muscles, diseases or conditions.

Treating pelvic pain

It is important to work with your health care provider to discuss any symptoms of pelvic pain that you are experiencing. They can help detect or rule out any underlying causes of your pelvic pain, diagnose conditions and help treat your symptoms effectively. 

Treatment options can vary, depending on a patient’s unique condition, including age, a desire to get pregnant, preexisting conditions or health concerns. Treatments also can vary based on a patients’ diagnosis, and may include medications (including hormonal medications, such as birth control, for some conditions), physical therapy or minimally invasive gynecologic surgery (MIGS).

A MIGS procedure may be considered for patients with certain complex conditions. Patients should speak to their provider about a referral for a MIGS evaluation for the following conditions: 

• Advanced endometriosis (affecting bladder, gastrointestinal tract, diaphragm, etc.)
• Chronic pelvic pain without apparent cause
• Frozen pelvis
• Severe scar tissue
• Large leiomyomas (fibroids)
• Large ovarian cysts
• Conditions that may make surgery more complicated, such as obesity, diabetes, chronic anticoagulation, circulatory issues, etc.

Norton Women’s Care Pelvic Health Program specializes in caring for patients with pelvic health conditions.

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Fast forward years later ,and she continued to experience worsening issues with pain.

“I was feeling so bad, and it felt like my stomach was full of rocks,” Stephanie said.

She had never been told that fibroids could change over time and was unaware that several of her family members had also experienced fibroids in their lives.

In spring 2023 and now living in Louisville, she was feeling awful and sought help from her primary care physician, who ordered an ultrasound. To Stephanie’s surprise, the fibroids had grown to be so large that her uterus was the size of someone five months pregnant.

The first step was a visit to Steve W. Kang, M.D., OB/GYN with Norton Women’s Care.

“Fibroids can cause different kinds of symptoms, but the most common is heavy or abnormal bleeding,” Dr. Kang said. “When they are large, they can cause abdominal pressure.

“They also can cause issues from pressing on the bladder or colon, resulting in issues with urination or constipation.”

Hitting the high notes: Finding care to fit Stephanie’s goals

“He [Dr. Kang] listened carefully to my issues, and our first treatment option was medication to shrink the fibroids,” Stephanie said. “Unfortunately, that didn’t work. I am a classically trained soprano, so singing is very important to me. I was worried that if I had to have a major, invasive surgery I would be out of performances for more than six weeks — and that wasn’t something I could afford to do.”

Stephanie was immediately referred to Steven J. Radtke, M.D., minimally invasive gynecologic surgeon at Norton Urogynecology Center. Dr. Radke is part of the advanced pelvic health team at Norton Women’s Care. He and Jonathan H. Reinstine, M.D., another minimally invasive gynecologic surgery specialist also with Norton Women’s Care, work with more complex patient issues, such as Stephanie’s large fibroids.

“There are several excellent treatment options available for patients seeking relief from fibroids, which can be tailored specifically to a patient’s needs and wishes,” Dr. Radtke said. “Surgery is sometimes recommended when the fibroids become excessively large or symptomatic. In Stephanie’s case, it was extremely important to minimize disruption to the abdominal wall muscles since she is a singer.

“Fortunately, using advanced minimally invasive surgery techniques we are now able to perform these operations without the need for a large incision, regardless of the size of the uterus or fibroids.”

With a laparoscopic procedure, a thin camera and instruments are inserted into the abdomen through small incisions (about the width of a pencil) and used to complete the surgery. This has been shown to decrease the risk of complications such as infections, scar tissue, deep vein thrombosis (blood clots), etc., and leads to a significantly faster recovery.

“Dr. Radtke was so kind,” Stephanie said. “The first thing he said was it looks like you’ve been through a lot. I almost cried then and there, because he was so supportive. It gave me such confidence.

“I wasn’t even nervous going into surgery. I had a little nausea but the rest was a breeze and I was back to normal activities in two weeks and singing in three.”

Both Stephanie and Dr. Radtke stress that it’s important to talk to your medical provider if you feel like something isn’t right. Your instincts often will be correct.

“Because fibroids can grow slowly over long periods of time, the symptoms may not be immediately apparent to patients,” Dr. Radtke said. “This sometimes can lead to a delay in receiving care.

“Stephanie continued to seek for answers, and while her particular journey took a while, we are very pleased that she is now back out there sharing her voice with the Louisville community.”

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Irregular periods are characterized by variations in the length of the menstrual cycle or the amount of bleeding. There are multiple conditions that can contribute to irregularities in the menstrual cycle.

Abnormal bleeding

• An abnormal period may involve:
• Irregular bleeding
• Heavy menstrual bleeding
• Severe period pain
• Pelvic pain
• Menstrual irregularity
• Abnormal uterine bleeding

“There are multiple causes of abnormal uterine bleeding. Some of the ones we see most often include fibroids, adenomyosis, endometrial polyps, clotting disorders and hormonal issues. Rarely, abnormal bleeding can be a sign of a more serious health condition, so it’s important to talk to your doctor and get it checked. Pinpointing the exact cause is usually possible after an exam in the office, an ultrasound and lab work” said Steven J. Radtke, M.D., FACOG, FMIGS, minimally invasive gynecologic surgeon at Norton Urogynecology Center, part of Norton Women’s Care.

Symptoms of abnormal bleeding may include:

• Bleeding between periods
• Bleeding after sex
• Irregular, unpredictable periods
• Menstrual flow that is much heavier than usual
• Bleeding after menopause
• Bleeding that is accompanied by severe pain or cramping
• Bleeding that lasts for more than seven days

New or sudden changes to your menstrual cycle, including amount of flow or more painful cramps, potentially can indicate other health conditions. Worsening pain is another red flag.

It is important to address any concerns regarding painful or irregular periods with your provider to determine the underlying cause and develop an appropriate management plan tailored to your individual needs and health goals, such as family planning.

“Nowadays there’s a wide range of treatment options available, surgical and nonsurgical, that can help address these symptoms and improve a patient’s quality of life — tailored to their particular circumstances and goals. It’s always a good first step to talk to your primary care doctor or OB/GYN about your concerns,” Dr. Radtke said.

Period pain

Dysmenorrhea, commonly known as period pain, is a condition that affects many people during their menstrual cycle. The primary symptom of dysmenorrhea is cramping in the lower abdomen, which can range from mild to severe, and often can radiate to the lower back and thighs. Other symptoms that are associated with dysmenorrhea may include nausea, vomiting, diarrhea, headaches and fatigue.

Treatment options for dysmenorrhea aim to alleviate pain and discomfort. Over-the-counter pain medications, such as ibuprofen or acetaminophen, often are recommended to help manage cramps and reduce inflammation, in addition to the use of a heating pad. For more severe cases, a health care provider may prescribe birth control or higher-strength nonsteroidal anti-inflammatory drugs for pain relief. Additionally, lifestyle changes such as regular exercise and dietary modifications can help alleviate symptoms of dysmenorrhea.

Primary dysmenorrhea and secondary dysmenorrhea are two distinct conditions that involve painful menstrual periods. Primary dysmenorrhea is typically related to normal menstrual processes, while secondary dysmenorrhea is caused by an underlying medical condition and requires specific treatment to address the root cause of the pain.

Primary dysmenorrhea refers to common menstrual cramps that occur in the absence of any underlying gynecological issues. These cramps typically are caused by the contractions of the uterus as it sheds its lining during menstruation. The pain usually is felt in the lower abdomen and can be managed with over-the-counter pain medication and lifestyle changes.

Secondary dysmenorrhea involves period pain that is a symptom of an underlying medical condition, such as endometriosis, fibroids or pelvic inflammatory disease. The pain with secondary dysmenorrhea is often more severe and may worsen over time. Treatment for secondary dysmenorrhea targets the underlying cause and may involve medications or surgery.

If you are experiencing dysmenorrhea, especially severe or new pain, you should consult with your health care provider.

Uterine fibroids and endometriosis

Uterine fibroids and endometriosis are two common gynecological concerns. Period pain from uterine fibroids or endometriosis is considered secondary dysmenorrhea. Both conditions also may cause painful periods and chronic pelvic pain.

Fibroids are noncancerous growths or tumors that develop in the uterus, often causing symptoms like heavy menstrual bleeding and pelvic pain. Endometriosis is a condition where tissue similar to the inside lining of the uterus starts growing in places where it doesn’t belong, such as the pelvic sidewall, bladder, rectum, etc.  This produces an inflammatory response that worsens during menstrual cycles. Common symptoms include severe pain, bloating, painful vaginal intercourse, painful urination and painful bowel movements. Some patients also may experience infertility.

“A patient is considered to have advanced endometriosis when: No. 1, there is a high burden of disease, for instance, if lesions are covering a large percentage of the pelvis. And No. 2, if endometriosis implants are located on critical structures, such as the bladder, ureters, intestines, diaphragm, etc.,” Dr. Radtke said.

Symptoms of endometriosis often are controlled with hormonal medications such as birth control pills, or medications that temporarily decrease estrogen levels in the body. However, surgery may be recommended in cases where symptoms are severe, are not improving with conservative measures, if advanced disease is suspected, or if a patient does not want to take hormonal medications. Surgery involves removing the tissues affected by endometriosis, allowing the body to regenerate new healthy tissue in its place (excisional surgery).

“Chronic pelvic pain in reproductive-age females is caused by endometriosis 70% of the time, but there can be other issues that cause it as well, such as ovarian cysts, scar tissue, issues with the bladder, intestines or pelvic floor muscles,” Dr. Radtke said. “It is important to talk to your doctor in order to start investigating possible causes.”

Minimally invasive surgical treatments

There are numerous minimally invasive gynecologic surgery (MIGS) options for patients, including those who desire to get pregnant.

“For patients with endometriosis who desire to preserve fertility and want to avoid hormonal medications, the surgical treatment involves making small incisions — less than 1 centimeter — in the abdomen and ‘stripping’ the endometriosis off the affected structures,” Dr. Radtke said. “During this process, scar tissue is also removed in order to restore normal anatomy. We also test the fallopian tubes to make sure they are not blocked.

“When patients are done with childbearing, performing a hysterectomy at the time of endometriosis surgery significantly decreases the chances of it coming back in the future. We usually recommend not removing the ovaries, unless they are very abnormal.”
A MIGS procedure may be considered for some patients with complex conditions.

Patients should speak to their provider about a referral for a MIGS evaluation for the following complex conditions: 

• Advanced endometriosis (affecting bladder, gastrointestinal tract, diaphragm, etc.)
• Chronic pelvic pain without apparent cause
• Frozen pelvis
• Severe scar tissue
• Large leiomyomas (fibroids)
• Large ovarian cysts
• Conditions that may make surgery more complicated, such as obesity, diabetes, chronic anticoagulation or circulatory issues

Addressing the root cause of painful or irregular periods is crucial for maintaining reproductive health and overall well-being. Consulting with your provider for proper diagnosis and treatment options is essential when it comes to managing your reproductive and overall health.

“If you feel like your life revolves around pelvic pain, or worrying about your next menstrual cycle, we’re here to help you get your life back,” Dr. Radtke said.

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Rewind to spring 2022, Rachel felt a lump in her breast. She talked to her health care provider, and they recommended to take a wait-and-see approach, primarily because she was so young and did not have a family history of breast cancer. As the months went by, the lump remained, so it was time to take action. By September, Rachel started the process of having a mammogram, ultrasound, biopsy and even an MRI — making sure her health care team had a good understanding of the tumor and could develop a treatment plan specifically tailored to her. The diagnosis was official: She had triple-positive breast cancer, and treatment would start right away.

Fortunately for Rachel, her care team was close to home. She consulted with Matthew Golden, M.D., general surgeon at Norton King’s Daughters’ Health, about the lumpectomy. Together with Ajay K. Kandra, M.D., medical oncologist with Norton Cancer Institute – Madison, the team established a treatment plan for Rachel. She would start with chemotherapy in an effort to shrink the tumor and it did.

“My scans showed the tumor shrinking after the first dose of chemo,” Rachel said. “And by the sixth and final dose there had been such a radical response, the tumor was reduced to scar tissue.”

“This type of response is called complete pathological response, and can be seen in patients with HER2-positive breast cancers with the right combination of chemotherapy and targeted therapy” Dr. Kandra said. “Patients with this type of response typically have the highest cure rates.”

HER2 is a protein that makes cancer fast-growing but also more responsive to treatments that attack the protein.

The successful response to chemotherapy made the lumpectomy, the next step in Rachel’s treatment plan, somewhat easier. Dr. Golden was able to remove the scar tissue along with a sampling of lymph nodes that would be tested to see if the cancer had spread. It had not, and Rachel was ready for the next step in her care plan. She started radiation, which would be followed by hormone therapy. The extended plan is to continue with a total of five years of hormone-blocker, a pill she takes, while continuing to undergo scans looking for any traces of the cancer returning. Coupled with the other therapies for Rachel, Dr. Kandra feels this will give her the best chances of remaining cancer-free.

A celebration like no other

Rachel has a tribe of support all around her. Her large family includes three brothers and three sisters who stepped in to help her with chores, treatment and moral support. She also had the support of a best friend who “never stopped showing up,” according to Rachel. Taylor Cruz and Rachel have been friends for nine years. Taylor, a registered nurse, was with Rachel at many doctors’ appointments and chemo treatments.

“She helped me celebrate every step and every little victory,” Rachel said. “I asked her to walk with me in the parade. So I can’t wait to celebrate the Oaks Survivors Parade with Taylor.”

The two are looking forward to the Oaks Day festivities. They have selected outfits —including hats —and are looking forward to meeting other survivors and hearing their journey too.

But for all of Rachel’s tribe and support system, the celebration truly began in November 2023 when she completed her final round of active treatment. After 17 infusions, she was finally done and got to ring the bell, a rite of passage for patients completing their active cancer treatment journey.

“It was a scary journey, but I got to meet so many amazing people and do so many wonder things along the way,” Rachel said.

A journey that kept her close to home

For many people, comprehensive cancer care could mean having to drive hours to receive treatment. For Rachel, everything was right in her hometown.

“Rachel received the best level of care at Norton King’s Daughter’s Health, including cutting-edge radiation therapy, chemotherapy and targeted therapy,” Dr. Kandra said. “Having those resources close by is important to the overall health and wellness of the patient. It improves tolerance for the treatment and ability to complete all the recommended treatments.”

Rachel felt a strong connection to so many of the people on her care team and remembers small gestures that really made an impact on her. For example, one time Parag R. Sevak, M.D., radiation oncologist with Norton Cancer Institute, stayed late at the clinic in Madison to make sure all of her questions were answered and she was comfortable after enduring a radiation treatment.

“It was that kind of attentiveness and compassion that helped carry me through this journey,” Rachel said.

Oaks Survivors Parade

This is the 16^th year for the Kentucky Oaks Survivors Parade featuring survivors of breast and ovarian cancer. Survivors, including men, submit their names and are chosen at random to participate. The Norton Healthcare Foundation, along with Horses and Hope of the Kentucky Cancer Program, is a charitable sponsor of the Kentucky Oaks Survivors Parade. Churchill Downs Foundation donates funds to support Norton Cancer Institute through the Norton Healthcare Foundation.

The post Breast cancer survivor recalls journey to celebrate appeared first on Norton Healthcare.

The two rooms offer a more home-like setting and will be ideal for a natural or midwife-assisted delivery, as well as for those who may be expecting the loss of their infant.

The $266,000 project was funded through the Norton Healthcare Foundation with support from donors including the Merrilee Kullman Living Trust.

“We know that many patients would like a more holistic experience for childbirth — but with the safety net of a hospital,” said Gigi L. Girard, M.D.,  OB/GYN and executive medical director of women’s services for Norton Medical Group. “Helping make childbirth more of an experience as opposed to a hospital stay is very important to us.”

These new rooms offer additional space for a family as well as more natural light, enhancing that experience. They are available to anyone coming to deliver at the hospital on a first-come, first-served basis.

All 19 labor and delivery rooms offer natural childbirth options and other services that patients have requested over the years. These include availability of a labor tub, birthing balls, birthing stools, nitrous oxide for pain management, showers and wireless monitors that allow a patient to move around more freely during labor. The hospital has board-certified lactation consultants, including one dedicated to labor and delivery to help patients begin breastfeeding within one hour after birth. This practice has been shown to increase breastfeeding success.

“We’re excited to bring this new option to patients and are grateful to the donors who have made it possible,” said Lynnie Meyer, R.N., Ed.D., FAHP, CFRE, senior vice president and chief development officer, Norton Healthcare. “Just imagine the number of new families who will be touched by these spaces and how it will help them welcome their new little ones into the world.”

Norton Women’s Care, which has locations at Norton Women’s & Children’s Hospital and Norton Hospital, has been recognized as High Performing in Adult Maternity Care (Uncomplicated Pregnancy) by U.S. News & World Report for three consecutive years. It is the only provider in Kentucky to receive the award all three years, and the only in Louisville to receive it for 2023-2024. The designation is the highest award a hospital system can earn in the U.S. News list of Best Hospitals for Maternity Care.

In 2023, Norton Women’s & Children’s Hospital set a new record of delivering 6,446 babies, beating 2022’s count of 6,325. More babies are born at Norton Women’s & Children’s Hospital than any other hospital in Kentucky.

Caregivers at Norton Healthcare’s two Norton Women’s Care birthing locations deliver more than 8,600 babies a year. While many of those deliveries are uncomplicated, Norton Women’s Care also specializes in high-risk pregnancies and deliveries, with a specialty maternal-fetal medicine program and connection to specialists in two neonatal intensive care units. A Level IV NICU at Norton Children’s Hospital offers the highest level of care to critically ill and premature infants. A Level III NICU is at Norton Women’s & Children’s Hospital.

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“I was devastated by the news and thought this can’t be happening,” Sara said. “To be 40 years old and told you have breast cancer.”

While early testing indicated Stage 0 pre-cancerous cells for Virginia, her family was rallying support  from Kentucky to New York and several points in between. They were sending love, support and prayers to Virginia every step of the way.

One of those steps was the recommendation by Virginia’s doctor for her to have BRCA gene mutation testing. This is a blood or saliva test that looks for DNA changes that increase the risk of breast and ovarian cancers.  Virginia’s test was positive for the BRCA gene mutation. When she shared the news with her family — mom, aunts and cousins — she encouraged them to get tested for the BRCA gene mutation too.

Sara also tested positive for BRCA-1 so she decided to move her routine mammogram up two months.   Following this imaging, Sara was diagnosed with Stage 2 triple-negative invasive ductal carcinoma. It was  an aggressive form of cancer. Tiffany S. Berry, M.D., breast surgeon with Norton Surgical Specialists – Breast Health, encouraged Sara to start chemotherapy  immediately to shrink the tumor as much as possible and A the mastectomy could wait.

“Starting treatment quickly, especially for more aggressive forms of breast cancer, is vital for having the best possible outcomes,” said Laila S. Agrawal, M.D., medical oncologist with Norton Cancer Institute. “Sometimes that means starting with chemotherapy first, before surgery.”

Paths running parallel

Virginia and Sara were both undergoing their treatments while their cousin, Katie Kannapell Ryser, was making a hard choice of her own. Katie, 42 years old, tested positive for the BRCA gene mutation as well. She was faced with the decision of having multiple surgery to remove the risk or taking a wait-and-see approach. Katie chose to have a hysterectomy and oophorectomy (removal of both ovaries),bilateral mastectomy and breast reconstruction.

Having lived in New York for several years, Katie looked at all her options for surgery, including major cancer centers nationwide. In the end, Katie chose Norton Healthcare, feeling that after her research and consultations with medical teams, in her words, “Norton was where I felt most comfortable.  As soon as I met Dr. Matt Brown, I knew. ”

“The surgical nurses I met during my surgery were  wonderful,” Katie said. “They were the most intelligent and compassionate nurses I have met. Everyone I encountered was top-notch.”

A week following her double mastectomy  C. Matt Brown, M.D., with Norton Surgical Specialists – Louisville General Surgery. Tissue samples reviewed by pathology afterward revealed that there were precancerous cells in Katie’s breast tissue. She learned from her surgeon that she ”dodged a bullet” by having the surgery before the cancer had a chance to grow.

One year later

Within the span of 12 months, Sara started chemotherapy, underwent a double mastectomy, continued chemotherapy, had breast reconstruction surgery and had her access port for treatments removed.

“The entire year was a roller coaster, and I couldn’t have done it without the love and support of my husband, Bruce,” Sara said. “He was my rock! And my son Alex is a gifted home chef and prepared many healthy and delicious meals for our family.”

She is also very thankful to her medical team and the caregivers she encountered along the way. She kept notes and remembers most of their names.

Katie, who was several months into her recovery when her cousin Sara underwent her double mastectomy, supported Sara in a unique way.

“I passed along my pillows, robe that holds drains, and other things that helped me through my surgery and recovery to Sara, who in return passed them on to her sister, Katherine ‘Kak’ Doll Crawford, who also chose to have a radical mastectomy after testing positive for the BRCA gene mutation,” Katie said. “Our bond is much deeper than first cousins — we are like a sisters now.”

Branches of the family tree

Sara went through Norton Healthcare’s genetic counseling services for the blood test for the BRCA gene mutation.

Sara’s other sister, Rebecca Graves, a gifted artist in New York City, also tested positive for the BRCA gene mutation.

When Elizabeth S. Doll, M.D., tested positive for the BRCA gene mutation, that meant that two of Katherine’s daughters carried the genetic high risk of breast cancer (the other being Virginia, the New Yorker diagnosed with Stage 0 breast cancer at age 40.)

“And when we shared the news with more family members, they sought testing and more came back positive,” Sara said.

Their uncle on their mother’s side, N. Allen Kannapell, along with two of his children, Katie (who chose to have a radical mastectomy and hysterectomy) and her brother, Clay Kannapell, as well as an at least one adult grandchild all have tested positive for the BRCA gene mutation.

“In total, nine of us have tested positive for the gene mutation. Luckily, no one else except Virginia and I have developed cancer,” Sara said. “Virginia truly saved my life. I am religious about getting my mammograms, but it wasn’t time for my yearly mammogram yet. Because of the gene mutation test coming back positive I was able to go early; it was detected and I was in treatment very quickly.”

According to Dr. Agrawal, genetic testing provides information that can help a person weigh their options when it comes to their health.

“Individuals who learn they carry a genetic mutation, but have not been diagnosed with cancer themselves can then make personalized choices regarding screening and steps to reduce the risk of cancer, which may include surgeries to remove breasts or ovaries, called prophylactic surgery.”

Bringing awareness through celebration

Sara and eight other members of her extended family will be recognized as part of the 18^th annual Derby Divas event, an evening of fashion and fun with a mission to help fund mammograms for underserved women in the community through the Norton Healthcare Foundation. Over the past 17 years, the Derby Divas event has raised more than $2.05 million for Norton Cancer Institute in support of breast health initiatives. This includes funding for the Norton Prevention & Wellness Mobile Prevention Center, and providing mammograms and health screenings for underserved areas of the community.

Derby Divas is supported by Myriad Genetics with additional support by Churchill Downs, Brown-Forman, the Diaz Family Foundation and Northern Trust.  Derby Divas will be held Thursday, April 18, 6:30 to 9 p.m., at Rodes For Him and For Her, 4938 Brownsboro Road.

Derby Divas features Derby fashion, food and refreshments. Tickets are $70 in advance, $80 at the door or $40 for young professionals (ages 30 and under). The first 50 people to pay a special $140 admission fee will receive an exclusive gift bag full of beauty products and other goodies. Proceeds benefit breast health at Norton Cancer Institute through the Norton Healthcare Foundation.

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Euwonna is a mastectomy fitter at Norton Cancer Institute Pat Harrison Resource Center in Southern Indiana. Here’s how surviving her own harrowing health experiences led her to a career caring for cancer patients as they heal.

In Nov. 2009, while living in her hometown of Detroit, Michigan, then-36-year-old Euwonna was told by her doctors that they suspected she had colon cancer (which she would later learn was an incorrect diagnosis). A surgery to remove parts of her colon led to severe complications that left her in a coma for three months. During that time, she developed sepsis three times and was resuscitated five times.

Her journey back to health was long and arduous, but her spirit remained strong.

“God has always blessed me with resilience to bounce back,” Euwonna said.

Euwonna was working for a medical equipment company in Michigan when she went into the hospital. When she went back to work, she had a newfound appreciation for her role in helping people get well by ensuring they had the supplies and equipment they needed to heal.

“As a result, life changed for me. I had more empathy for people than I thought I ever would,” Euwonna said.

This is where she first learned about mastectomy fitting. It’s a specialized allied health profession: Mastectomy fitters work with patients to properly fit breast prostheses and provide other post-mastectomy services. Euwonna was encouraged to get her certification for this specialty and began offering these services at her medical equipment store.

In 2014, she followed her gut and took a job in Atlanta, Georgia, at a large health care system as a mastectomy fitter. She grew in that role and stayed until 2020 when she returned to Michigan to care for her ailing mother. She landed back at the medical equipment company where she worked previously. But not long after settling back into her home state, she had another near-fatal health experience that left her needing a feeding tube and using a wheelchair for three months.

Again, this experience taught Euwonna that she was stronger than she ever thought possible. Her strength carried her through this illness, but the experience left her questioning her purpose.

That’s when fate came calling!

Not too long after she had recovered, she received a call from one of Norton Healthcare’s recruiters informing her about the position as a mastectomy fitter for Norton Cancer Institute. According to Euwonna, that call came at the right time for her. While it would require a move, it was a welcome change of pace.

“I was in a place where I knew it was time for change,” she said. “Through it all, God has shown me that I have value, and I can help so many people. I never knew what my calling was, but [after this] I know my calling is people, in no matter what capacity that is. I’ll always be a person of encouragement to others, because we all struggle, and I can relate to the many struggles people may be facing. This is ministry to me.

“I want to make people feel good.”

In her old job, she didn’t have the meaningful interactions with patients that she now enjoys as a mastectomy fitter.

“I’ve gone through a lot, and I’m looking for peace of mind,” Euwonna said. “I want to be in a position to help people again.”

According to her leader, Euwonna’s personal health experiences and warm nature make her the perfect fit for this role.

“The mastectomy fitter role is extremely important for our breast cancer patients,” said Darla York, R.N., nurse manager, cancer resource centers and navigation services. “Euwonna works with [these patients] to help them feel more like themselves after surgery. The fitter is trained to measure patients for mastectomy bras and prosthetics, but she does so much more.  She consoles them, listens to their concerns and prays with and for them. 

“Euwonna is an awesome person. She brings joy, compassion, empathy and genuine concern to our patients.”

Having listened to a calling to help others following her own health struggles, Euwonna said that she has found her purpose.

“Being a servant is important to me,” she said. “I’ve helped so many people feel normal again.”

Mastectomy fitting is made possible by a grant from the Norton Healthcare Foundation.

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