As everyone knows, the Delta Covid variant has led to tremendous strain on Healthcare systems worldwide. In Alberta, we are in the middle of a 'fourth wave' of the pandemic, with hospitals full, ICUs almost overwhelmed, and staff overworked, burned out, demoralized and on the verge of quitting. Things are not good.
Many of you have either had scheduled surgery cancelled, or postponed. Those who had not yet been scheduled, are looking at much, much longer wait times for surgery when the decision is made. There is currently no timeline for the cancellations, or specifically the start up of elective surgery again. One thing is however certain - it will take time to get back to full efficiency when things do start up again. (UPDATE: Oct.21; just received word that elective surgery is unlikely before the new year. In the meantime waitlists are exploding)
Given this 'brave new world' and yes, one has to be brave to thrive and to be honest, even survive, in this world; why not consider an alternative?
It is my distinct pleasure to announce that Dr. Shunaha Kim-Fine will be joining me in practice, starting June, 2021. Dr. Kim-Fine will be a valued new partner and we are very excited to welcome her to our clinic.
Shunaha Kim-Fine, MD, MSc, FRCSC
Dr. Kim-Fine hails from Southwestern Ontario. After completing Medical School at Queen’s University and OBGYN residency at Western Ontario University, she trained at Mayo Clinic, Rochester in the Female Pelvic Medicine and Reconstructive Surgery Fellowship program. She also received a Masters of Science and a Certificate in Clinical and Translational Sciences.
Dr. Kim-Fine started clinical practice in 2014, and joined the faculty of the Cumming School of Medicine at the University of Calgary as a Clinical Assistant Professor. She is the current Head of the Section of Pelvic Medicine and Reconstructive Surgery at the School.
She strives to achieve excellence in patient care, mentor trainees in urogynecology and contribute to academic research both locally and internationally. Above all, she is most committed to working with women towards the goal of improving pelvic floor health and quality of life. She is excited to expand our clinic’s ability to offer women the full range of comprehensive treatment options available today.
Drs. Murphy and Kim-Fine plan to eventually integrate their practices to better serve our patients and referral colleagues.
She will be starting to see patients at the clinic in June 2021.
Please fax referral letters to our usual office number: 403-692 0442
I will be the first clinician to introduce dual mode laser treatment for vaginal tightening, urinary incontinence and prolapse. Standard laser or radiofrequency treatment use a single mode of energy, mostly affecting very superficial tissue. This treatment has the potential to solve a lot of problems, like incontinence, vaginal dryness, pain, painful sex, as well as a feeling of looseness or bulging. I have been offering single mode laser treatment at my clinic now for seven years and have treated hundreds of patients with fantastic outcomes and not a single significant complication. Introducing a second laser wavelength is a unique and safe way to target deeper tissue and get faster, more effective results and outcomes.
Here are two letters I sent to the president of the Alberta Medical Association recently. I strongly believe that our healtcare system is floundering. Doing the same thing going forward, is unlikely to yield better results, so a complete rethink is required.
Dear Dr Warren
You might remember me as the outspoken president of the section of OBGYN a few years ago. I was responsible for putting the issue of the need for private capital in Alberta's healthcare system on the AMA agenda, leading to a session of discussion on this. Not surprisingly, the motion was defeated.
I believe that the current situation in Alberta has proven me right. I want to point out a recent article, ironically sent out today by the AMA:
The reality is that our system has been tested, and found wanting. It has proven to be an embarrassment of epic proportions.
It is my strong belief that the main reason for this is our absolute fixation on the monopoly of state control and denying the reality of the need for private capital.
I also believe that given that the AMA is supposed to stand up for the ability of the system to serve our patients and the public, and physicians' role in it, it has failed miserably in that role.
I hate to say: "I told you so", and that I predicted the current situation, and of course I didn't foresee a pandemic being the trigger; but I indeed did predict exactly this outcome: a collapsing system which cannot possibly satisfy the healthcare demands of our population.
It is a disgrace, a shame and a travesty, and the AMA is culpable of standing idly by, while the system collapses.
I urge you and the current leadership to look again at the AMA's position on this issue, since I believe there has never been a better time for systemic change. That change has to come by first admitting that there is a problem, and that the problem is of our own making.
Magnus Murphy FRCSC
Past President: ASOG and AMA Section of Obstetrics and Gynecology
Dear Dr Warren
First I would like to thank you for replying to my email. I know you are extremely busy and didn't really expect a reply, given the controversial nature of it.
I will try to keep my rebuttal to your reply brief:
I think this is the key point from your reply:
"The commercialization of medicare is challenging for the AMA, as clearly the Minister would be diverting limited Physician Services Budget dollars to another company (presumably the lowest bidder) for the purposes of providing insured services."
I think it is factual for me to state that the reply missed the point of my argument. I am not arguing for any diversion of public funds to private contractors. FAR from it and absolutely not. I strongly believe in public healthcare using public funds and for that to be equitably used to service the needs of the population.
I believe one of the problems is that our vision is simply too small. We are blinded by the limited public funds available, and completely missing the huge opportunities in private capital markets. There are trillions of dollars in capital markets looking for investment homes. What I am envisioning is let's call it a "Mayo Clinic North" or a 'Cleveland Clinic North'. Built by, operated by, and entirely sustained by PRIVATE capital. It will run completely separate from any public investment, funding or control. They will sink or swim by offering quicker, better and timelier services to the population, who will be allowed to spend their own hard-earned dollars directly, or through private insurance, to pay for this.
Yes - the Canada Health Act prohibits this currently, at least if a Province wants to access Federal dollars. But this is the albatros - the Canada Health Act is outdated and a stone on our shoulders sinking the entire system.
My suggestion is for the AMA to again debate a complete overhaul of our mindset and look for innovative solutions to lobby for. This will bring industry (perhaps a multi-billion dollar industry), jobs, capital, innovation and wealth to our Province and help diversifying the economy in a green and sustainable way through a whole new industry. If Alberta is the first, it might even become a National champion for drawing talent and capital to our Province. It will take pressure off the public system and improve access to services for everyone, even those who cannot, or will not, go to such a facility. It will then be up to the public, and especially us as the medical community, to keep the government from reducing spend on the public system. If there is no reduction in public funds, and a major inflow of private capital, how could the system possibly be worse off? The oft used boogie man of the private system drawing scarce human resources is also an argument of the small minded. We currently have such a scarcity because of goverment imposed rationing: too few ORs, too few nursing jobs, with physicians, nurses and others going elsewhere (to a large extent the US), because they cannot find jobs. Private facilities will create jobs, compete with the public sector for salaries and therefore be good for healthcare workers' incomes, including physicians.
Our problem is our small vision, or lack thereof. We need to think big, and out of the box. Continuing to tinker on the margin with what we have, and within our 'small' allowed and available public budget is a recipe for similar or worse outcomes. Everyone knows the saying: "The height of insanity is doing the same thing and expecting a different result.”
Unfortunately, that is exactly what we are doing.
Many patients research their caregivers, be that physicians, physiotherapists or other regulated and unregulated professionals, online. Professional services has to some extent been 'commoditized' by the internet, and especially, social media.
People do not only want to do an internet 'deep dive' on reviews for general commodities they are interested in (a new car perhaps, or a new fridge), but now also personal services, and especially medical services.
A recently published article in JAMA (Journal of the American Medical Association) cast doubt on the efficacy of laser treatment for genital syndrome of menopause (GSM), and specifically the symptoms of atrophy.
This well designed study was done in Australia, and involved a comparison between patients treated with CO2 laser, sham (fake) laser treatment, and estrogen. Although this would naturally raise concern amongst women who have chosen this treatment, I would like to put the matter in some context. On the other hand, two recent studies show that the Fotona Erb Yag laser is highly effective for the treatment of urinary incontinence.
VSculpt Pro. Only obtainable through medical offices, this extra powerful, Health Canada approved and certified medical device might be what you waited for. Many women will benefit from vaginal dilation, especially after surgery for prolapse, or after menopause, if sexual intercourse becomes painful as a result of increasing vaginal dryness and inelasticity. Unfortunately, many women are not comfortable going to an adult store to purchase devices, and besides, it is not easy to know what to browse for, and very difficult to ask for something like this. Many women don't even feel confident enough to discuss such issues with their doctors. The result is that I see women in my practice who had given up on sex years, even decades ago, because it simply wasn't fun. In fact, for many of these women it was decidedly NOT fun. Who can enjoy sex if you have pain every time - if it is dry, and it feels if you are being cut with a knife every time you are penetrated? Well, this is most often the result of atrophy - loss of structural elastic qualities and thinning of the vaginal walls, and this develops insidiously in most women as they approach the menopause and go through it. Less severe cases can also occur in any state where estrogen levels decrease, like with breastfeeding. I've seen too many cases through the years of failed marriages or intimacy free relationships because of this, to consider this anything other than ONE of the most significant quality of life challenges most women will go through in their lives. The good news however is that these problems are treatable. Local estrogen is one way. Erbium vaginal laser is another and is becoming more and more popular world-wide because of the multiple extra benefits laser treatment provides. Now there is VSculpt Pro.
For many women with severe prolapse or incontinence, surgery will be the only effective option. There is however a difference between 'effective' and 'curative'. Incontinence can often (not always) be cured. I contend that prolapse can not. Not so far as the underlying defects and injuries are concerned. The analogy I often use is that of a bad back. Surgery can make it better, but it will never be a normal back...ever again. As a result, it is often better to try safer, less invasive treatments before going to surgery directly. These treatment include physiotherapy, pessaries, and laser. Physiotherapy, laser and PRP (Platelet Rich Plasma) treatment in combination is probably the best all around combined conservative treatment combination available. We offer all of these individually or in combination and our results are as good or better than anywhere in the world.
As anyone who has not lived under a rock lately knows, life as we knew it has changed. One of these changes involves the cancellation of all non-urgent surgery; almost world-wide, and definitely all across Canada and yes, also in Alberta.
No-one yet knows how long these closures will last, but even when elective surgeries open up again, (and my sources tell me this is not going to be anytime soon), there will be delays, disruptions and probably very, very long wait times. If we thought wait times were bad before all this started, well watch out. This is not ideal, but a reality. That is the bad news. The good news is that not all treatments have been cancelled. Yes most Alberta Health Services clinics have been reduced to essential services, but that doesn't necessarily mean all private practices and facilities are closed, at least not yet. Now that scheduling surgery is simply not an option and since we don't have any idea when surgery will be available, maybe now is a good time to really consider a more conservative treatment. Who knows - maybe you'll never want surgery afterwards! In that case at least some personal good might have come from this situation.
Suffering from Genital Syndrome of Menopause, incontinence, vaginal laxity, prolapse, hemorrhoids or sexual dysfunction like discomfort or pain? You'll want to read this.
This latest essay (written Oct. 20, 2019), is not so much an 'exciting announcement, as a 'getting it off my chest' piece. For real 'exciting announcements', please look under the drop-down menus above, especially the 'news' tab. There is a LOT of information on this website, but you might have to work for it just a little bit.
Fotona lasers and Fotona laser treatments are now endorsed by Health Canada for genital syndrome of menopause (a costellation of symptoms including incontinence, vaginal dryness and dyscomfort, prolapse, painful intercourse etc.). This is something NO other device manufacturer can claim; and for good reason. Fotona lasers and the respective treatments have been proven by exhaustive research to be effective, safe, and in many cases superior to traditional treatment options, including surgery. And that without any of the usual complications.
There are many devices on the market claiming efficacy. In many cases these claims are unencombered by any actual research or proof regarding both efficacy, as well as risks. Fotona lasers have been proven to be safe, effective and well tolerated in the treatment setting. Fotona is one of the oldest laser manufacturers in the world and have decades of research experience in almost every possible field of laser application one can think of (industrial, military, medical, cosmetic etc.). With Fotona there are no unanswered questions and nobody is subjected to inadvertent 'experimentation'.
This is a question I get regularly. Sometimes it is framed as a rhetorical question, but othertimes it is real; surprising as that may seem. People often need help with difficult decisions. The problem is of course that no one can really make such a decision, other than yourself. Only you know the impact of the problem on your quality of life, your relationships, and what your risk tolerance and tolerance for pain, recovery, and downtime is. Only you know what your financial position is; will it for instance be better to pay out of pocket for a treatment that has no downtime so that you can immediately return to work for instance, or will the recovery time away from work not affect your finances, future standing in your work or whatever project you might be busy with. Are you aware of, and do you accept that even if you choose surgery, that it might not be a complete solution nor the last surgery you might need for this problem?
Nobody can make these decisions except yourself, maybe with the help of your family.
I'm about to tell you a very important secret. It will shock you and disturb you. It will make you angry, and possibly miserable. But it will also make you free. Free from unreasonable expectations. Free from unneccessary but inevitable disappointment. Free from chasing after unattainable perfection and free from blaming others, including your surgeon.
You see - for too long physicians, gynecologists and pelvic floor surgeons have misled their patients into thinking they can do, and accomplish, that which they cannot.
A recently published scientific article confirmed the effectiveness of Erbium Yag laser treatment for urinary incontinence. This is just ONE example of over forty peer reviewed articles now proving the effectiveness of Erbium Yag laser for a variety of urogynecological indications, with indications increasing and expanding, as experience shows successful outcomes with treatment.
Here is a link to the abstract on Pubmed, which is the biggest medical scientific database in the world.
Laser vs TVT and TOT mesh sling
The FDA recently published a warning about the proliferation of unproven and dangerous laser and other energy devices for vaginal treatments. I completely agree with the warning. We are back to a situation when mesh first became popular, with rapid industry mobilization into a market where they perceive easy profit to be made. In 2008 I wrote an article about the situation with mesh, and predicted a class action lawsuit and problems. That article can be read, unaltered from my 2008 writing, below, under the heading: 'New Devices'. Now it is about energy devices. The important thing is that the problem is with unproven, unregulated machines and uneducated users and providers. Not all lasers are the same and not all mesh is the same. It can be used safely, with effectiveness, but it can also be abused by unscrupulous companies and naive providers.
Technological advances in medicine has gained momentum in all fields, with regenerative medicine and anti-aging medicine in the lead. Tremendous advances have been made already and some of the predictions for the future are almost mindboggling. Increased expected lifespans don't even seem to be a debating point anymore - it is generally accepted that it is coming.
I am one of the first practitioners in Canada to introduce and offer direct, intra-urethral but office based laser treatment for certain types of difficult to treat stress urinary incontinence and overactive bladder (OAB). Currently certain types of these conditions are very difficult to treat, and in some cases almost untreatable because of associated medical problems that rule out surgery. Our current treatment options for some such situations are highly unsatisfactory, and often don’t work very well.
The International Urogynecological Association's 41st annual meeting was held in Cape Town, South Africa in early August, 2016. Dr. Murphy was honoured by being asked to be on faculty for the conference, and was one of a select few people who taught during the two full day courses held for international delegates. He gave four lectures in total, during the workshop and course titled: Current controversies in pelvic floor surgery. The invitation re-confirms Dr. Murphy's standing in the international community as an recognized international expert.
The 2017 International Urogynecological Association meeting was held in Vancouver in June. During the meeting two internationally recognized expert surgeons were asked to do demonstration surgery, and Dr. Murphy was one of them. The other was Dr. John Gebhart from the Mayo Clinic in the US. The surgery was performed on stage, on cadaver patients, in front of a live audience. The procedures were broadcast in real time on large screens and were interactive, with both surgeons wearing microphones. On stage was an internationally recognized expert panel for moderation and keeping the surgeons' feet to the fire.
Letter written by Dr. Murphy in 2008 predicting mesh related class action lawsuits:
Pelvic Health & Childbirth was published already in 2003. During the years since then there have been significant developments in the recognition and treatment of pelvic floor disorders, especially incontinence and pelvic organ prolapse.
I've been following the development of the vaginal mesh class action lawsuits with interest. Please read my essay dated August 2008 on this website, under the title 'New Devices'. You'll see that I predicted a major class action lawsuit coming soon, at that time! Here were my exact words quoted from my 2008 whitepaper: