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• "Routine" Gynecologic Exams for Women of Short Stature

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Routine Gynecologic Exams for Women of Short Stature

Judith Pratt Rossiter, M.D.

When getting up on an examining table is a chore at best and perhaps close to impossible, a routine GYN exam is anything but routine. While I have met some little women for whom annual exams are truly not a problem, many more have at least some degree of difficulty related to their stature and/or limited joint mobility. This takes an event which is already dreaded by most women and makes it even more uncomfortable, even humiliating. Here are a few ideas that might be helpful to consider for your next gynecologic visit.

1) The health care provider: Be sure your health care provider is willing to be creative. An open-minded care provider is more likely to help find ways to accommodate the exam to your body habitus, rather than insisting on the traditional positioning and approach.

2) The examination table: The table is usually rather high too high to hop up, as patients are often asked to do. A provider caring for little women might consider purchasing a step stool for the office, if this is suggested to him/her. Don't wait for them to think of it on their own, they probably won't. If no step stool is available, take advantage of what is there. Most GYN examination tables have steps that pull out at the foot of the table. That at least gets you a little closer to the goal. You might be able to get on the table from there. If not, a chair might be the next step, or help from the office staff.

An alternative to the examination table is a regular bed or a gurney at its lowest elevation. By raising the hips with a firm object (e.g. a bedpan turned upside down), the exam can be completed without having to use and examining table at all (this is one place that the care provider's willingness to be flexible becomes essential).

3) The stirrups: The metal attachments at the end of the examination table designed to support women's feet during a GYN exam are called stirrups. For some little women, these can be used if pushed in close to the table. For others, more flexion at the hips and knees is required than is physically possible.  Here are some alternatives.

a. Slightly raising the head of the table may provide a better angle to allow use of the stirrups.

b. Most examining tables have a covered tray at the end of the bed that can pull out. By resting the feet there and dropping the knees to the sides, an exam can often be accomplished without stirrups. The bedpantrick (raising the hips with an upside down bedpan) may improve positioning for this approach in some women.

c. For some little women, particularly those with limited movement of the hips or knees, human stirrups are helpful. A nurse or assistant can support each leg for the few minutes required to complete the exam.

4) The speculum: The (often dreaded) instrument used to inspect the vagina and cervix and allow for obtaining a Pap smear is called a speculum. They come in many different sizes, ranging from very small (pediatric) to very large. Many little women require the use of a pediatric speculum. A care provider should have one available at the time of the exam BEFORE the beginning, so they don't need to wait for someone to get one while you lie there waiting. Some little women have no trouble with the size of an average speculum, but having a smaller one available, just in case, is important (you will probably have to inform/remind the health care provider of the need for a small speculum, unless they routinely care for other little women).

5) The exam: If the positioning is adequate and the speculum is the right one, the exam can go as smoothly as they ever do. Keep in mind, almost NO women actually LIKE having a GYN exam, so if it's tolerable, it's pretty good.

Closing thought: There are some women who simply cannot tolerate GYN exams for one reason or another. Though not preferable, information can be obtained about the size and shape of the uterus and ovaries by ultrasonography (i.e. sonogram / ultrasound). This does not allow for screening of cervical cancer, which is the reason for the Pap smear, but is better than no evaluation at all, when necessary.

My Experience with Sleep Apnea:  Night and Day 

 Anthony Connor

Do you ever wake up in the morning and feel more tired than when you went to bed or feel like you just can't get yourself going? Have you ever awoken with a headache in the morning and couldn't get rid of it unless you downed 2 cups of coffee or soda? Do you also feel the need to take a nap in the afternoon or feel like dosing off while sitting in a meeting, watching a movie, or even driving a car?

For the past couple of years, I have experienced all of these feelings at various times but nothing ever seemed consistent. Most of the time, I dismissed it as caffeine addiction and the fact that I had not been exercising regularly. And it wasn't until I attended an LPA district regional conference in Minneapolis this past April that I figured out what was causing the headaches and fatigue in the morning.

My friend, Abdi, who is also a dwarf, had come with me to the regional and we decided to room together. Abdi had immigrated to the US from Somalia about a year and half ago, and this was his first LPA event, so I was pretty excited about attending this district regional in particular.

During the night while we were sleeping, he awoke to my snoring (this came as no surprise to my friends who go camping with me). Moreover, he witnessed me stop breathing several times and gasping for air between snoring episodes.

Abdi speaks little English. What English he did speak the morning we left the regional was worth volumes. With sparse sentences and body language, he communicated to me what he witnessed during the night when he woke up to my snoring during the night.

Like most dwarfs, I have been through my share of surgeries and doctor visits. As such, I have become reluctant in my young adult years to visit a physician unless it is absolutely necessary. But this time was different. This time, I thought to myself, If this guy barely speaks English, and if he was able to communicate my sleeping patterns to me, I better get to a doctor and have this checked out.

The Monday after the regional conference, I contacted Dr. Jay Ellison, a geneticist here in Rochester that I have come to know. I told him what my friend Abdi had witnessed, and he immediately referred me to Dr. Bruce Staats, a sleep specialist at the Mayo Clinic in Rochester, Minnesota.

I visited Dr. Staats, and he scheduled me for a sleep study the evening after I saw him. What is a sleep study you ask? To put it simply, I slept at the hospital with a bunch of wires hooked up to me so they could monitor my heart and breathing patterns while I slept. I slept the first 4 hours as I usually do, I was woken up in the middle of the night, and I spent the remaining 4 hours sleeping with the assistance of a CPAP machine.

Fast forward to the following morning, I met with Dr. Staats to discuss the results of the sleep study. The results of the study were shocking. During the first 4 hour sleeping period, I quit breathing 96 times in one hour. An EKG of the first four hours showed that I exhibited an irregular heart beat at times. My blood oxygen saturation level also fell to very low levels several times (meaning my blood was not getting the oxygen that it needed). And to top it off, my snoring on a scale of 0 to 4, was a 3! The latter 4 hours of sleep during the study was a different story. During the second half of the sleep study (with the CPAP machine), I had no instances of apnea (i.e., I breathed continuously), my heart beat was normal, by blood oxygen level stayed normal and I did not snore at all!

What do you ask is a CPAP machine? CPAP stands for Continuous Positive Air Pressure. A CPAP machine is a small air blower device connected via a hose to a nose or face mask you wear while you sleep - much like a regular oxygen mask, with straps to keep it in place. Essentially, this device blows air into your nose (and mouth if you have a full face mask) to keep your airway from collapsing and creating an obstruction by increasing the air pressure in your airways.

Dr. Staats sent me home with a CPAP machine that day, and I have to tell you, I took to the machine like a fish in water. Sleeping with the CPAP machine has made a huge difference in my life. I have been using the machine since this past May, and it's like night and day. I go to bed at 11PM, wake up at 5AM (without an alarm), and I feel like a million bucks. I have more energy now than I have in the past 5 years. I no longer need coffee to get going in the morning nor do I have headaches when I wake up. I have seen my performance increase at work. I have the stamina to exercise when I get home from work in the evenings. And to top it off, with all of my new found energy, I have lost 5 pounds!

This entire situation has convinced of 3 things. (1) Don't be apprehensive about going to the doctor. If the quality of life isn't what it used to be and you don't know why, get to a doctor. (2) Get some form of exercise. Even a 15 or 20 minute walk in the evening before you go to bed can help you fall asleep and get a better quality night's sleep. (3) Go to LPA events. You'll learn a wealth of information just talking to someone you have never met in your life. It is amazing what happens when you talk to other LP's, share stories about your life with one another, and room with a person who has never been to an LPA district regional.

If you have any questions about sleep apnea or CPAP machines or anything else in this article feel free to e-mail me at accgrubby@yahoo.com

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