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Category: Dr. Litrel’s Blog

August 9, 2017

Insecurities, Relationship Issues, and Pelvic Health
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If you’re considering vaginoplasty, labiaplasty, or other pelvic surgeries, you probably have a lot of questions – and you should! Dr. Litrel has been performing these types of procedures for twenty years and even has a board certification in Female Pelvic Medicine and Reproductive Surgery in addition to his OB-GYN certification. He believes that the best patients are well informed, and does his best to answer all the questions that come his way.

Here are 10 recent questions he answered on an online forum.

1. I am very insecure about my vagina and the color of it. Is it normal? I’m afraid to have sex.

Your appearance is perfectly normal and does not have any issues that require intervention from a cosmetic surgeon. Your insecurity is normal as well to some degree.  Everyone has some fear about social rejection, the feeling that others will not like or love us. This is really a spiritual issue, learning to love ourselves and love others, growing daily in our abilities in this arena. This is what makes life meaningful and fulfills our purpose in life: love.

When it comes to sexuality –  the sharing of our bodies with another in a pleasurable and intimate manner – the insecurity that one feels can prevent us from extending ourselves in this way.  This is painful because sex and intimacy and pleasure are so important to enjoy life.

But as a doctor who specializes solely in the care of woman, the common problem that women experience is not that they can’t find sexual partners, but rather that they choose the wrong sexual partner. Or too many. For men, in many and most cases sex is the end. Sex and orgasm itself is the goal.

Women like sex and orgasm, too. But for women, sex is really the beginning – the beginning of a powerful and important relationship – and the beginning of New Life (pregnancy). This is why so often women are broken hearted by the way they are treated by men. Men get sex – and eventually leave for someone else.

Thus it’s important for women to choose a partner who is committed to not just his own orgasm and his own pleasure – but one who is committed to you and the future of the relationship that God willing may someday include children.

Bottom line is this: if insecurity about the appearance of your genitals is holding you back from “sex” – when you find the partner who is not just attractive physically but spiritually as well – one who will be committed to you and the future, that person will love you so you will not be so afraid.

So it’s okay to wait to have sex and indeed it’s usually better. It builds a better long term relationship. When a woman waits to have sex not only does the guy think that she’s special, he also thinks that he’s special. And thus the relationship becomes special.

2. Is there any way to make my vagina look new again?

Women sacrifice a lot. Pregnancy and delivery is difficult enough as is raising children.  But the changes that women experience to their bodies are just another painful thing that women must confront. There are office procedures and surgeries that can help you with both sexual function and appearance of your genitalia. As far as specifics are concerned that is something that is tailored to each patients desires and anatomy.

3. Suffering from some mild incontinence and loss of muscle tone in my vagina. Does the Apex M pelvic floor exerciser work?

There are three good things about the apex devices. One is that they can help improve the muscle tone on your pelvic floor and can help with incontinence. Two is that they are done in the privacy of your own home. Three they are safe and won’t hurt you. It’s reasonable to try this before surgery. It’s reasonable to use this afterwards as well.

4. Can any board certified surgeon do a labiaplasty?

I would strongly advise you to wait until you find a specialist surgeon who focuses on labiaplasty. This can be a cosmetic gynecologist or a plastic surgeon. But don’t see someone who does not do a lot of these surgeries. Board certification is about education and passing examinations. But the key is experience and skill rather than diplomas on the walls and initials after your name.

5. Vaginoplasty: Can this surgery be personalized based on size of husband? Do all “holes” end up the same after this surgery regardless of requests?

Your surgery should be tailored to the size of your husband. Sexual issues are usually top-of-mind for women considering vaginoplasty. Thus your experience with your sexual partner is an essential part of the interview, the examination and the performance of the surgery.

6. I recently had vaginal tightening surgery. Is it normal to have a lot of pain afterward?

Everyone responds to the pain of surgery in a different way. Our bodies are different. It’s important to get an examination by your surgeon to make sure that there are not issues. But assuming a normal exam, be assured that everyone will have a different response. Typically by seven to fourteen days patients feel alright. If the pain continues, pelvic floor physical therapy can help. Muscle relaxers can also help if the examination demonstrates tenderness on your pelvic muscles.

7. Would a perineoplasty help with some feelings during sex?

The quick answer is that it will help – some.  Your question shows a sophisticated knowledge of your body and the problems you are having.  Pelvic reconstruction is likely required along with vaginoplasty to give you the tightness you desire. and to correct the anatomic deformities and changes your eloquently describe. There are non-surgical modalities such as ThermiVa that can help. But that may be a waste – it will depend upon your anatomy and the findings on physical examination. Good luck!

8. Can I enjoy sex after my clitoris is removed?

This should not be done for any reason other than the rare presence of cancer.  In some parts of the world there is “female circumcision” where young girls suffer genital mutilation. This is cultural and often the clitoris is not injured in the process. If you are considering a procedure make sure you understand what is being done and why.

9. Is a partial labiaplasty possible?

This is a good question. The truth is that every labiaplasty has to be tailored to a patient’s anatomy and also her desire. So really, you should just receive what it is that you desire rather than a “one size fits all.” Likely you have excess skin adjacent to your clitoral hood or the hood itself is more pronounced than you desire. This is a common problem that can be handled during an office procedure.

10. What are the adverse effects from an overly aggressive labiaplasty?

The Labia Minora come in all sizes and shapes. Our bodies differ. Consider how noses and ears are different sizes and shapes. The main thing that troubles patients with a “botched labiaplasty” is emotional upset with appearance. This can cause issues with sex because if we are not comfortable with how we look then it is more difficult to be intimate with another. There are less common instances when an over-aggressive labiaplasty can cause pain with sex but I would not worry about this. The most important things for sexuality to go well is to be in a loving relationship. This is a loving relationship with another – and also with yourself.

Were you questions among the ones Dr. Litrel answered here? If not, let us know! Ask during your next appointment, or call the office. And you can always check Dr. Litrel’s RealSelf profile where he answers questions about several types of vaginal reconstructive surgery and female pelvic health.

May 11, 2017
Dr. James Cross in the New Northside Hospital Cherokee Atrium

Dr. James Cross in the New Northside Hospital Cherokee Atrium.

James Cross, MD, founder of Cherokee Women’s Health Specialists, was the first OB-GYN in Georgia to offer epidurals to women in labor. He was among the original 17 obstetricians who opened Atlanta’s Northside Hospital. And in 1993, he came out of retirement to single-handedly provide OB services for metro Atlanta’s Cherokee County, delivering babies in the facility that is now Northside Hospital Cherokee. His presence was credited for cutting in half the perinatal morbidity and mortality rate for the county’s babies, a rate which before his arrival had been among the highest in the state.

James Cross, MD, still practicing medicine at 86 years old, has made his mark in Obstetrics History in metro Atlanta over the past half century.

As the glamorous new Northside Hospital Cherokee opens its doors, we thought it was a good time to interview the obstetrician whose memories span six decades, and who has delivered over 15,000 babies during his career in medicine.

Introducing Epidurals To Atlanta’s Pregnant Women: From Texas Air Force Base to the South

We meet with Dr. Cross on the campus of the new Northside Hospital Cherokee, three weeks before the facility is to open. A utility truck outside the wing of the Women’s Center lifts a window washer high against the plate glass windows, while Dr. Cross enters the soaring main atrium and marvels at the hanging chandelier. He shakes his head and laughs. “More like a hotel, don’t you think?” He is cheerful and spry, wearing his white doctor’s coat and remarking he is “happy to do anything” to spread the news about the new hospital. “A hospital makes all the difference in a community,” he says, with the air of someone who has said it hundreds of times.

Born in a small Colorado mining town in 1931, James Cross (“Jim” to friends and family) graduated from college when he was 19. With a degree in Chemistry and the encouragement of his professors, he was in medical school four days later.

OB-GYN Residency Class at Grady Hospital Dr. James Cross

Dr. Cross with his OB-GYN Residency class at Grady Hospital. He is at the far right of the front row.

After three years training in Emory University’s OB-GYN residency at Grady Memorial Hospital, the young doctor was stationed at the Amarillo Air Force base. There he delivered 2,600 babies in four years. More significantly, he learned the then-innovative practice of administering epidural analgesia. Previously, laboring women were given ether to dull the pain of childbirth, resulting in not only sleepy mothers, but also oxygen-deprived babies, who emerged in a ‘twilight sleep” with impaired breathing and a telltale blue skin color. Dr. Cross comments that mothers given ether often slept for hours, or even days, waking up “only when the hairdresser got there.”

Spinal anesthesia, which was later used in place of ether, had equally undesirable complications such as headache, compromised blood pressure, spinal damage, infection etc.

Upon Dr. Cross’s return to Georgia and a practice at Georgia Baptist Hospital, he immediately introduced the use of epidurals for laboring mothers, becoming, he believes, the first physician to employ the technique in Georgia. He says with a smile, “I’m happy to report that epidurals have been used now for decades all across the country.” He comments that the benefits were much reduced side effects over former pain treatments, a drop in the Caesarean rate down to about 5-6%. Furthermore, administering epidurals was delegated to anesthesiologists, freeing obstetricians to attend to critical matters that might arise during a delivery. Best of all, he says, babies came into the world a healthy pink, crying, alert and wide awake. “It was nice to see those babies finally come out squalling,” he exclaims.

He went on to help establish an epidural training program for more than 30 residents over the next decade at Georgia Baptist Hospital.

Northside Hospital Atlanta: Helping To Open the Country’s Largest Maternity Hospital

In 1967 Dr. Cross joined the staff and building committee at Northside Hospital in Atlanta. Three years later, he watched proudly as Northside Hospital Labor and Delivery opened its doors. “There were 17 of us OB-GYN’s when we started,” he relates. “I remember we were shortchanged one delivery room, but it all worked out,” he chuckles. With visible pride, he fondly points out that Northside Hospital Atlanta has today evolved into the largest maternity hospital in the country.

In the interim, Dr. Cross helped found the OB-GYN practice Atlanta Women’s Specialists in 1968, a practice that eventually expanded into four offices, including a residency program with 6 doctors. Over the next two decades, he states, he strove to make sure that no physician at any of those clinics was overworked, overwhelmed, or otherwise “prevented from providing quality care.”

“It was a growing process – one step at a time. If you give patients quality care and are hardworking, they respect you.”

Dr. Cross speaks about his philosophy of care, that he considered every patient “family,” treating each one as such. He says, “you can be honest, but tactful,” to strengthen the resolve of pregnant women to change the way they treat their bodies. He encouraged healthy diets, smoke and drug cessation, careful vigilance of medicinal products, and weight loss. He felt that though women may sometimes be resistant to change, once they begin to take care of themselves – thus insuring the additional health of their unborn children – they realize and appreciate the positive benefits. By approaching them the same way he would any female in his own family circle, they became receptive to his advice and genuine concern.

Dr. Cross also developed a unique approach, whereby pregnancy was not a sole female issue, but a family one, involving fathers and children in the whole process. A post natal care appointment was not attended only by the woman. The partner was also involved, especially when the couple decided that their family was complete and they no longer wished to have children. It was then that Dr. Cross would explain to them both that modern cosmetic and reconstructive surgeries could transform the woman’s internal and external reproductive organs back to the state they were ‘when she was eighteen’, a revelation that often made folks’ “ears perk up like a German Shepherd’s,” Dr. Cross says, smiling and matter-of-fact. He regularly did “at least two such surgeries daily.”

Dr. James Cross smiling at Dad-friendly parking.Raising the Survival Rate for an Entire County’s Newborns

Dr. Cross had begun to contemplate retiring from private practice in Atlanta when he learned of a desperate situation developing in Cherokee County. The county’s local hospital, known then as R.T Jones, was about to lose its certification to deliver babies. Although the staff numbered 50 doctors, no obstetricians remained in this small facility on Atlanta’s rural outskirts. Women in the community were forced to travel long distances for prenatal care and deliveries, driving the morbidity and mortality rates among pregnant women to a whopping 9 1/2%.

To Dr. Cross, the community’s situation seemed dire. The correction would be a Herculean task. Dr. Cross believes that at the time, Cherokee’s 9 1/2% morbidity and mortality rate was among the highest in the state.

With “no hesitation,” he responded to the distress call. “When you see that red flag, you come charging.” Thus in 1993, at the age of 62, Dr. Cross ran straight into his next challenge.

He began in solo practice. For two and a half years, he took calls around the clock, bringing prenatal OB care to the county’s women, delivering their newborns safely.

But in 1994, Dr. Cross faced a setback. Treatment for a bowel obstruction led to the discovery of malignant lymphosarcoma. Confronting a debilitating bout with cancer, he completed extensive chemotherapy, then jumped right back into obstetrics. “I had a nurse stand by at the ready with a basin in case I had to get sick,” he relates. Post-treatment side effects continued to plague him, but he doggedly continued to work, refusing to abandon his post in the growing county.

In 1996, Dr. Cross incorporated his practice, Cherokee Women’s Health Specialists, as the clinic grew to serve the OB-GYN needs of the local population. Perinatal morbidity rates had plummeted drastically. But delivering over 90 babies a month had become a staggering effort, and he began to look for help.

Help came. Dr. Michael Litrel had just completed his OB-GYN residency at Emory University, and joined Dr. Cross in 1997 as his first partner in Cherokee County. A few years later, the hospital began negotiations with Northside Atlanta. And in 2007, R.T. Jones Hospital was bought by Northside, officially becoming Northside Hospital Cherokee. Today, that hospital and the numbers it serves, have grown exponentially, bringing about the need for a larger and more technologically advanced facility which will hold its grand opening in May.

Looking Back – and To the Future

At the time of this interview, Dr. Cross’s wife of 65 years, Becky, was in intensive care following a health crisis. Speaking of her condition off and on throughout the interview, Dr. Cross relates their story in bits and pieces.

In 1952, a young Jim Cross was working as a dog catcher in Canton, when he noticed a beautiful young lady who stepped off the bus at the same stop daily. “I thought to myself, ‘Boy, she is one great looking gal.’” He eventually introduced himself, learning that they did not live too far apart from each other and had several friends in common, including her ex-boyfriend who happened to play on the same baseball team as Jim at the time. The friendship between Rebecca and James evolved until one day he decided to propose. Still in medical school, he told her “I’m starting to run out of money. Why don’t you get a job or two and we can get married?” Dr. Cross relates that Rebecca answered ‘yes’ in a heartbeat. They have been married 65 years.

Dr. Cross expresses deep gratitude for his ’Beck’, narrating how the love, support and patience of his ‘soul mate’ carried them through the lean and busy years. When times got better, she gave him 5 children (none of which he delivered). Together, the Cross family managed to find time to travel all over the globe, forging precious memories that continue to keep them close.

Dr. Cross delivered over 15,000 babies throughout his years as an OB-GYN. Asked about regrets, he relates with wistful melancholy only one story – losing a young mother to an aneurysm. “The child survives today, but we had to take the mother off her life support system a week after the birth.”

Questioned about what technology has contributed most to women’s health, Dr. Cross names ‘computers’ without hesitation. He also credits the fetal monitor and belt for accurately pinpointing any problem during labor, allowing doctors to address those immediately, saving lives and avoiding tragedy. He applauds the co-operation between medical schools which now share information with each other to better medicine and save lives. His personal favorites, however, are the many laser and manual surgical instruments that have been introduced over the decades. “I’m like any fellow with a new toy,” he admits. “I just love to try out new ones to see what they can do.”

Time to Retire—Or Is It?

Dr James Cross at Women's Center of new Northside Cherokee Campus

Dr. James Cross at the Women’s Center of the new Northside Hospital Cherokee Campus.

In 2006, at the respectable age of 75, Dr. Cross delivered his last baby and walked away from everything that had been his career for the past 5 decades.

Dr. Cross stayed retired for three years. “I was never so bored in my entire life.”

When an offer came from Northside Hospital Cherokee, inviting him to join their radiology department in dye studies, Dr. Cross relates that he didn’t walk, but “ran” to get his certification. He is presently called in on an emergency basis 6 to 7 days a month.

He also accepted a position in Marietta specializing in pain management and addiction medicine, where he works every Thursday and Friday, ministering to approximately 75 patients. He has been there for the last 9 years and indicates he has no plans to stop any time soon. At 86 years of age, Dr. Cross still exercises for an hour every day and appears just as dedicated to his newest ventures as he was to Obstetrics.

James Cross, MD, was recently given an honorary staff membership position at Northside Hospital Cherokee.

When asked if looking back, he would do anything differently, Dr. Cross smiles and shoots out, “I’ve been so darn busy, I haven’t had time to think about that.”

Such is the reply of a man not so much reflecting on his long life, but continuing to live it, instead.

December 6, 2016

There is a clear relationship between cosmetic surgery and health. For the majority of us, there are things about our appearance that we find displeasing. Perhaps it’s the shape of our body, or we think we’re too fat, our waist is too big, or a woman might think her breasts are too small, or too big.

Whatever it may be, there are common surgical techniques in our modern era that allow us to transform the shape and appearance of a person’s body. If this leads to a person liking the way they look more, then perhaps cosmetic surgery can improve a person’s happiness and sense of well-being. This in turn, can lead to improved social relationships since someone who is more content with themselves often enjoys more success and happiness.

The Shadowy Side of Cosmetic Surgery
But there is a shadowy side to cosmetic surgery that anyone who is considering such operations should be aware of.  There are many patients who have gotten operation after operation only to find that they’re still not as happy as they’d hoped. The issue at the core is that our health and happiness in life cannot be exclusively about the way your body looks in the mirror. Anyone who lives their life with this thinking will inevitably suffer, especially during the inevitable aging process.

It’s an interesting phenomenon, unique to human beings, that we judge the way we look.  A dog or cat or squirrel does not spend time looking in the mirror and judging itself. The difference between human beings and other life forms on earth, as we understand it, has to do with our self-awareness.

woman-looking-in-mirror-photoFrom a metaphorical sense, this is what is meant in the Bible in terms of eating from the tree of knowledge. The garden of Eden is a metaphorical representation of the time in our existence when we were not aware of our appearance or how others might judge our appearances.

Judgment Call
We have all experienced this lack of awareness in our own lives and it usually occurs during our childhood. This was a more blissful time, before the awakening of sexual desire. But then all of this changes with puberty, because we become acutely aware of our own self and the physical attraction we feel toward the opposite gender. It’s then when we most become aware that not only are we judging ourselves, but others are judging us as well.

This can be a painful time, when we conclude through rejection from others that we are not worthy of love. We learn to dislike ourselves and sometimes even hate who we are. This, of course, is not a healthy way to live.

Perhaps a skillful cosmetic surgeon can change the appearance of the face or body we see in the mirror. Perhaps these changes can help us feel better. But if we simply do not like ourselves because of childhood pain, no amount of cosmetic surgery will lead us to health, no matter how skillfully performed.

December 1, 2016

Dr. Litrel Explains Cosmetic and GYN Glossary Terms in Plain English

dr-litrel photoVaginoplasty: Tightening of the entire vaginal canal from the opening to the cervix (or the apex of the vagina, if hysterectomy was performed).

Hymenoplasty: Restoration of the hymen to create virginal anatomic state, which can be done at the time of vaginoplasty, if patient desires.

Cosmetic Surgery on the External Genitalia

Labiaplasty: Reshaping the labia minora or inner lips for improvement in appearance and to diminish labial irritation with clothing and during sex.

Clitoral Hoodectomy: Removal of excess skin covering the clitoris to create a better appearance and to help with clitoral orgasm.

Perineoplasty: Reshaping the external opening to the vagina for a smaller, more youthful appearance. This is performed during vaginoplasty or can be done without vaginoplasty, if vaginal tightening is not desired.

Labia Majora Reduction: Reshaping the labia majora or outer lips for a better appearance.

Female Reconstructive And Reparative Surgery (Usually Covered By Medical Insurance)

Anterior Repair: Repair of cystocele or bulging of bladder using natural tissue or biological graft or synthetic material.

Posterior Repair: Repair of rectocele or bulging of rectum using natural tissue or biological graft.

Enterocele Repair: Repair of enterocele or the sagging of the top of the vagina using natural tissue or biological graft or synthetic material.

Incontinence Repair: Repair of leakage of urine using native tissue, biological graft or synthetic material.

Endometrial Ablation: Outpatient or in-office procedure to diminish or eliminate menstrual bleeding without changing hormone status.

Hysterectomy: Removal of uterus to stop periods and pelvic pain associated with menses and sexual intercourse (pelvic pain with thrusting motions). Or, to remove tumors or pathology once childbearing is complete. During this procedure, removal of fallopian tubes (or salpingectomy) is strongly recommended to decrease the risk of future cancer.

Oophorectomy: Removal of ovary or ovaries for pelvic pain associated with sex or menses or is chronic or for cyst or mass. These are the organs that secrete hormones so removal of both will result in surgical menopause. Removal of one ovary will not affect hormones. Removal of one ovary is recommended once a woman is in menopause if hysterectomy is performed to decrease risk of cancer. If a woman has significant chronic pain on one side of her pelvis during her cycles or sex or chronic, removal of that ovary is considered.

Enterolysis: Minimally invasive (laparascopic or robotic) removal of internal adhesions of bowel to pelvic organs that cause pelvic pain with sex, menses, bowel movements or is chronic in nature.

Removal/Fulgurtion of Endometriosis: Minimally invasive (laparoscopic or robotic) removal and destruction of endometriosis lesions that cause painful menses or pain with sex or is chronic.

Salpingectomy: Removal of tubes for sterilization. Note: Tubal ligation without removal of tubes is not recommended because tubal removal will decrease future cancer risks but tubal ligation will not.

August 16, 2016

dr litrel interview part 3 graphic
An Interview With Michael Litrel, MD, FACOG, FPMRS – Part 3 of a 3 Part Series

Guiding Principles
My philosophy as a doctor is the mother principle—in that you treat all your patients the same, and always keep in mind how you would want your mother, wife or other loved one to be treated. If your mother is on that operating table, you’d want the surgeon operating on her to bring his A game. For me, an A game is not just about being in one place and doing well, it’s about availability, continuous improvement, compassion, learning the latest technology and methods, follow- up, etc. so I’m giving my patients the best possible care and aftercare.

The Doctor/Patient Relationship
Apart from the mother principle, the patient’s attitude tends to guide me. My principle is that I do my very best and I’m as honest as I can be. I try to do it in a way where people can be receptive. Sometimes it works very well and other times, well, not so much. Physician-patient compatibility is very important.

For example, I recently had a patient with life-threatening blood pressure issues, and she really didn’t want to hear anything I had to say. She was being completely non-compliant by not taking her prescribed medication to combat dangerously high blood pressure readings. She became impatient, even angry with me, changing the subject to something else each time I tried to discuss the severity of her situation and the importance of following my recommendations.

On the other hand, another patient reached out to me in desperation. She described how her son was heavily into drugs and how her father was seriously ill. The situation was causing devastation to her, both mentally and physically. Apart from understandable emotional turmoil, she was compensating for the difficulty in her life by overeating and was rapidly gaining weight.

Dr. Litrel with patient photoI listened to her because I truly sympathize and care about the struggles she’s going through. I gave her the best advice I possibly could. It was clear that she was receptive to everything I was telling her and would follow my advice.

The non-compliant patient made me realize that our doctor/patient relationship was a mismatch and was going nowhere. I knew I would probably decide not to see her again, and I’m okay with that. My heart is telling me that she would be-or should be-better off with another doctor, and I’m okay with that too.

However, the troubled mother was appreciative of the help I was trying to give her. I knew that, unlike my other patients, or those that I see over the years for just an annual exam, she would remain in the forefront of my thoughts. I would remember her son’s name, follow up with her regularly, stay in touch, and even pray for her because I’m genuinely concerned. I don’t doubt she truly wants my help. I can only help those people who want to accept my advice and, in turn, help themselves.

Talking with Inhibited Patients
With shyer patients who are more reluctant to discuss their problems, I simply confront the issue. I basically just tell my patients, “Look, I completely understand that it’s very embarrassing sometimes to talk about sexual or genital issues. It’s humiliating if you ‘poop’ or ‘pee’ on yourself, don’t know what an orgasm is, or if you’re ashamed of the way you look. Whatever it is, I know some of these things can be difficult to talk about. That said, I’ve heard and seen it all, so now I’m going to get the information I need from you. Sooner or later, I’m going to find everything out anyway, and we’re eventually going to have a trusting relationship so the more you tell me now, the more comfortable you’re going to be, and the more I can help you.”

If I just acknowledge the fact that it’s an awkward or socially embarrassing subject, people tend to relax a little and speak more freely. Then, once I do an exam, my knowledge and experience guides me to ask more direct, delicate questions based on my visual findings—questions like, “Do you need to touch your vagina to defecate? Do you leak stool? Are you sexually active? Do you urinate when you cough, sneeze or jump? Do you have a sensation like your bottom is coming out? Does your back hurt a lot?”

Because I’ve been practicing for so long, I can duplicate the anatomical findings with the physical symptoms. This makes them think, ‘Oh, he knows that, so maybe this is a normal thing!’ When that connection is made, we can discuss and build a trusting relationship.

Surgery
My philosophy is that, unless surgery is absolutely necessary, I discourage it. If you must have surgery, do it for the right reasons. I feel that patients seeking operations to improve their sexuality or the appearance of their genitals can be extremely vulnerable, impressionable and overly trusting of people who might want to take advantage of that vulnerability for their own profit.

Since the internet has come into our lives, we’re often led to believe that there’s only one solution to all our problems. A place that sells widgets will try to convince you that widgets will solve everything that’s wrong with your life. Desperation causes people to believe that so they buy that widget only to find out it’s not a cure-all. It’s the same thing with surgery. It’s not always the answer to everything simply because it’s radical and is made to sound like the perfect answer to everything.

Dr. Litrel Surgery Pic I don’t subscribe to that way of thinking. Again, I rely on the ‘mother principle’, going on the premise that if this was my mother, wife, sister or daughter seeking help, I would recommend surgery only when surgery is indicated. I wouldn’t want my mother or my wife going somewhere and being talked into surgery simply because that’s how the provider makes money. There’s a higher degree of ethics that’s required, and that’s to do your very best and treat people with as much love as possible. If you honor that, your patients will thrive and you’ll have a very happy career.

Cosmetic Gynecology
I feel that a lot of plastic surgeries promise unrealistic results, but because I deal solely with women’s problems, I understand that quite often, these desired results will not happen. In my opinion, altering genital appearance for visual enhancement only is much like the case of Michael Jackson, who pursued surgery after surgery, turning his original attractiveness into an almost garish version of his former self. Plastic surgery did not solve his underlying problems of low self-esteem. Unnecessary cosmetic gynecology is no different.

For me, cosmetic gynecology is all about making women more comfortable with their bodies. A lot of women come to me devastated because they don’t feel like they’re good enough. Some have given an important part of themselves to a husband or father of their children for years and have been made to feel substandard. And suddenly they’re faced with separation or divorce. These women seek cosmetic help so they’ll feel attractive, desirable and confident enough again to have a good sex life with someone else in future. I see these things all the time.

Prayer, Spirituality and Health
It’s already been documented that I pray with my patients when they ask or need me to, usually before a surgery when they’re frightened and more vulnerable. I’m happy to do it. I pray all the time. It’s part of my life, much like breathing to me.

As a doctor I can alleviate a lot of the physical suffering, especially in my areas of expertise, but much of the pain we have is not of the body, it’s of the soul.

Prayer is very basic and healthy. If you’re not praying, then you’re not really listening. I’m not saying prayer as in asking for something. I’m saying prayer as in listening to what God wants from you and if you listen, I think things will go pretty well. You need to have good relationships with people around you, have loving relationships with family and God, and for me, prayer is a very important part of that – to be faithful and to strive to listen to what God wants me to do. I think that’s a really important factor in maintaining good health.

An Interview With Michael Litrel, MD, FACOG, FPMRS – Part 2 of a 3 Part Series

Of all the specialties you could have chosen, why did you choose obstetrics and gynecology?
I was quite surprised myself that I chose OB/GYN. I really hadn’t thought of it as a specialty before I attended medical school because I was more inclined towards surgery. However, when I delivered my first baby, it was such a miraculous moment in my life. It was 3:00 in the morning, and I remember it distinctly. I was in awe that this child actually came from a woman’s body. Ten seconds later, as I was placing that baby into that little infant warmer, I realized that I wanted to participate in this miracle; that I was going to be an obstetrician. It was a profound moment for me, and I can’t begin to express how much great personal satisfaction and enjoyment I’ve received over the years by taking care of women and women’s issues.

Your wife Ann also works at Cherokee Women’s. Do you find it difficult to separate work-related issues from home life, or do you find it can strengthen a relationship?
Ann works on public relations for the clinic and I have my medical practice so yes, we work under the same roof and our paths do cross but we each tend to our own professions. I’m a doctor, something I’ve wanted to be since the age of seven and Ann is, first and foremost, an artist.Dr. Litrel and Ann photo

In answer to the second part of your question regarding separating work-related issues from home life, I think it’s very important to be married to your best friend and someone you trust implicitly. Ann is both of those to me.

We have a strong, healthy relationship and have been married for 28 years. Like any normal couple, we have our ups and downs, but we know how to apologize and go on from there. We’ve grown together and share similar interests. We agree on many things, including our relationship with God, and about becoming better people. As we advance through life, we continue to support, encourage and help each other. We’ve known each other half our lives so I wouldn’t say being a doctor and discussing work-related issues makes either my job or my marriage harder, any more than Ann being an artist and sharing her passion for it impacts either of those things.

You have an identical twin brother named Chris. When growing up, did you find that you and he shared that proverbial ‘brain’.
As identical twins, he and I understood each other so well that we didn’t learn to speak early or verbalize our thoughts to other people.

Dr. Litrel, Chris and Mary photoHowever, we’re very different. My brother is a lawyer by trade, and a lawyer’s thought process is entirely different from a doctor’s. Physicians focus more on immediate problems, whereas attorneys think three years ahead of time. Still, we’re very close and I rely on his counsel a great deal.

If you decided to retire tomorrow, what would you do?
Do you mean if I stopped practicing medicine? Well, I love what I do so as long as I’m healthy enough to keep doing it, I don’t really want to retire unless I absolutely have to. If anything, as I get older, I’ve become a better surgeon so I’d like to continue for as long as possible.

My other passion would be writing and speaking about the relationship between health and spirituality, something that’s very important to me. That’s one of the reasons I was drawn to the care of women and their health—because what life event could possibly be more spiritual and meaningful than the birth of a child?

I chose to specialize in surgical gynecology because human beings grow inside of a woman’s body, and sometimes you need a surgeon that can bring them safely into the world. I enjoy it, not only for the concrete aspects of surgery, but also for the deep spiritual meaning of this process known as the creation of a life.

We can clinically describe how a single cell turns into a newborn baby over 280 days, but the process itself is miraculous. It’s a testimony to the fact that our lives have deep purpose and deep meaning, and that God grants us life.

If you were to write another book, what topic would you choose?
As it happens, I’m currently working on a book on pelvic reconstructive surgery, but I’m also tying it in with the correlation between health and spirituality. Women not only endure suffering and damage to their bodies, but also to their souls. We all do. So the book I’m writing expands on that subject.

Women have unique human problems because of the nature of creating new life inside their bodies, and there’s suffering that comes from that process. So from that perspective, I’m writing about the nature of surgery in terms of when to have it and when not to have it. I’m also writing about the nature of health since health is not only about the physical but about the sexual and spiritual aspects as well.

I’d like to educate patients on the fact that we’re not human beings having spiritual problems, but that we’re spiritual beings having human problems. These human problems we all sometimes have call for the attention of a surgeon.

Do you like to travel? If so, where was your favorite place?
One of the things I like about practicing medicine is that I don’t have to travel anywhere. People from all over the world come to see me. I guess I’m more of a homebody than I am a traveler. I like keeping my life pretty simple. I have traveled and visited many different countries, but it’s not my favorite thing to do. I’ll go, but I prefer to stay home.

As a busy OB/GYN surgeon, I’m sure the demands can be overwhelming. How do you deal with those demands – both at work and at home?
I try to manage my schedule in such a way that I can always be in top form whenever I have patient duties. When I see my patients, I remain completely focused and concentrate on them. I also make sure I leave openings in my schedule to allow for free personal time. That way, I know that I can continue to do what I do indefinitely to prevent burn out.

Instead of allowing myself to get overwhelmed, I try to set up my calendar in a manner that guarantees I can be in peak mental condition all the time, thus insuring that I give the best care I possibly can. I’m 50 years old so I know myself well enough to know what works for me.

To unwind after work hour, Ann and I will often go for a walk around the neighborhood for about 40 minutes. We may go to the gym for some exercise, or out to have something to eat. Our favorite date is going out for a glass of wine, an appetizer, some dessert, and maybe catch a movie. That’s probably been our favorite type of date for the last thirty years.Dr. Litrel and Ann photo

I think we all need to give ourselves personal time to build up a relaxed, spiritual reservoir so that we can make good choices. To me, good choices are eating right, exercising, taking my wife out, having friends over, laughing and enjoying life—that’s MY relaxation.

Coming from an Asian-Italian background, how did you combine the two worlds when it came to traditional customs, beliefs and holidays?
Since I have a mixed ethnicity, I always had a few problems in the sense of fitting in. I was born in 1965 and there weren’t that many Chinese-Italian people out there back then. Although we’ve come a long way as a society in the sense that people are much more tolerant of interracial marriages today than they used to be, it was a bit difficult for me at times when I was growing up.

I probably chose my profession, because as a kid, I didn’t fit in too well with the world around me. I think that’s one of the reasons I was so drawn to medicine. In medicine, it’s not about skin color, ethnicity, wealth, or socioeconomics. It’s about helping and healing people.

As for holidays and customs, my mom’s father and stepmother lived in New York City. They were vegetarian Buddhists. For Chinese New Year, my step-grandmother would make a traditional Chinese meal, after which we would go into the city and celebrate. When fireworks were still legal, we would light them and throw them at the dragon. I remember how much fun that was.

As for the other side of my family, my dad had a lot of Italian friends—in fact his business was Italian food manufacturing. He worked with a lot of Italians, so we spent most of our time in their environment. New York is very rich in Italian flavor and community, so we got a lot that particular ethnic exposure too.

I still have Italian friends in New York. My grandparents have since passed away, so I’m not as in touch with my Chinese roots these days as I am with my Italian ones.

What is your very first childhood memory?
I remember when I was 3 years old we were moving to the house that would become my childhood home. I remember driving down that block and coming to the house that I would grow up in.

Ok, I just have to ask: When you watch medical movies or TV shows, do you find yourself mentally correcting the inconsistencies?
When I was younger, I used to think about all the things they were doing wrong. Now I simply sit back and enjoy what I see on the screen. I’ve come to understand that they’re just trying to create drama, and I recognize that movies and TV are all about the story.

When I was training to be a resident I used to watch ER—and that was actually a very good show. Michael Crichton was asked to be a consultant on that show because he was a Harvard trained doctor. It was a good series but sometimes it was just too much. To draw viewers, they would try to condense all these improbable situations into a one-hour episode of heightened drama and sensationalism. A lot of it was very real but it was just too intense. I DID enjoy it though. I also used to like M*A*S*H*. I still watch medical shows today because it made people aware of what it’s like to be a doctor, or a doctor in training.

What inspires you to continuously educate yourself and want to learn more? Did you have a mentor?
I think I became a doctor because I wanted to matter to other people. I also think that perhaps childhood pain is the root of my deep desire for my life and my actions to matter.

For me, life is about evolving, learning and constantly getting better and better. I don’t think my motivation to learn can be attributed to any one person. I’ve had excellent teachers and mentors throughout my life, and I feel blessed to have had them, but I don’t think that I can ascribe sole mentorship to any one person.

I think the best way to live is to always improve one’s self. I’m hoping my children have learned that from Ann and me. I pray they will always strive for self-improvement in their lives. I think that the people who don’t try, who don’t aspire to progress, who choose to remain stagnant in their viewpoints—these people become trapped in the belief that they are always right, when in fact, they can be tragically wrong.

May 26, 2016

dr-litrel-photo
An Interview With Michael Litrel, MD, FACOG, FPMRS – Part 1 of a 3 Part Series

One of your areas of specialty is Cosmetic Gynecology, especially vaginal rejuvenation. Can you expand a little on the subject of vaginal rejuvenation?
Originally, as female reconstructive surgeons, we would operate on the vagina or internal and external genitalia. We took care of medical issues such as bulges or weakness that prevented the organs from working properly.

Vaginal rejuvenation is a more recent elective surgery to enhance the visual appearance of a woman’s genitalia. Over the past twenty years, the field of Cosmetic Gynecology – especially vaginal rejuvenation – has become the fastest growing niche in plastic surgery. As the popularity increased, we began to see patients who’d been encouraged to undergo plastic surgery – from surgeons who don’t specialize in women’s pelvic anatomy. We’d find ourselves called in to correct whatever mistakes had been made in those procedures – but the problems were not always ‘fixable.’ It became obvious that the best thing we could do was to offer Cosmetic Gynecology ourselves, and at least insure that the women who came under our care could avoid the irreversible damage from inexpert surgery, and receive the benefits of surgery from Pelvic Reconstruction Specialists.

Apart from esthetic merits for visual genital distortions, or internal adjustments that restore tautness and sexual pleasure, what other conditions can be corrected, with these procedures?
When it comes to external cosmesis, which is surgery performed outside the body, we mostly treat conditions like elongated genitals or labia which may interfere with clitoral stimulation. It’s mostly anatomical—things are too long, getting in the way, disrupting sexual pleasure or causing orgasmic inability.

Vaginal surgery consists mostly of correcting “bulges,” be they bladder, rectal or intestinal bulging. We increase the caliber of the vagina to allow for better sexual sensation. Since the vagina leads to the internal sexual reproductive organs, if there’s pain or bleeding or scar tissue, lots of times those things have to be corrected surgically as well.

Sexual interest and gratification often diminish over time, due to a number of reasons such as lack of lubrication, the loosening of vaginal tissue and muscle, etc. Can pelvic reconstruction or vaginal rejuvenation give women a renewed sense of sexuality and confidence—and if so – how?
I think it’s a very individual thing. I’ve taken care of thousands of women and sexuality issues can vary. They can come from anatomical differences between partners, hormonal issues– even lack of awareness of proper technique. The list is endless, so I’m not going to say “have surgery and it will fix everything.” I’ve seen the full range of what causes problems, and I deal with them all on an individual basis.

As an example, I saw a patient recently who came from a neighboring state. After asking questions about the pain she was experiencing, I examined her and found there was nothing physically wrong with her. After speaking with her, I was able to pinpoint that the real problem stemmed from sexual abuse. I’m able to treat the anatomical problems, but a lot of these complaints simply must be addressed through counselling. I certainly wouldn’t recommend surgery in her case, but would guide her to other venues of help. It’s a complicated subject and doesn’t really have one answer.

Are the benefits of pelvic reconstruction and vaginal rejuvenation permanent, or does time eventually cause the original problems to recur?
I’ve seen patients I’ve operated on 10 years ago, and they’re doing great. For a lot of anatomical problems, if we fix them and they don’t suffer damage, they stay fixed. For instance, if a woman has a normal sex life and doesn’t have a baby, she probably won’t need surgery, and then, if it’s a cosmetic thing, such as labial elongation (hypertrophy), then once you fix that, it’s not going to grow back. It’s not common to have to re-operate.

For the cosmetic parts, however, sometimes you have to perform a few nips and tucks six months or a year later. But typically, that’s not necessary either. As for the tightening operations, once you do it, you’re done.

Many people might describe the procedures we’ve covered as “frivolous,” “unnecessary,” “a waste of money,” etc. Their assumption might be that you need to accept yourself “the way you are.” Can you describe the positive physical and psychological impact these procedures have had on some of your patients during your extensive career?
Fifteen or twenty years ago, I probably would have said the same thing. I remember I was very much against breast implants at one time, but over years of practicing, I noticed that women with these implants not only looked better, but felt wonderful about themselves. We all want to feel good about ourselves.

Now, in the field of Cosmetic Gynecology, with procedures such as vaginoplasty or, labiaplasty, the reason we, as female reconstructive surgeons are in this field, is because we know we’re the best at fixing it and we know that it’s not just about cosmetic surgery. It’s functional as well. Unlike a breast implant, face lift, or even a tummy tuck, none of which really have a function, internal and external genitalia are functional. Whether it’s sex, urination or defecation, there’s a biological function that’s dependent on the correct anatomical restoration of a woman’s body. So in terms of ‘frivolous,’ well, if you’re fixing a bulge here or there because a woman’s bladder is dropping or leaking, or you’re fixing the rectum bulging out, you can also do a tightening operation because the patient desires it for their sex life. I don’t think a good sex life is frivolous. I think it’s an important part of a relationship and it’s an important part of the way a woman feels about herself.

Real Self PicThe word ‘surgery’ can be frightening and intimidating. It usually sparks the fear of pain, long convalescence, operative and postoperative complications, etc. On average, what is the recovery period for most of your procedures?
Typically – because we do less invasive surgery with laparoscopes and robots – one to three weeks. Certainly some healing processes can go on for three months, but after one to two weeks, people generally feel pretty good.

At one time, the standard treatment for conditions related to pelvic prolapse was a hysterectomy. It’s now possible to treat Pelvic Floor Disorders with pelvic reconstructive surgery. How has the specialty of pelvic surgery changed since you began? What conditions are fixable that women forty years ago would just suffer with?
Nowadays, the biggest changes have been the minimally invasive laparoscopic surgeries. We can visualize things better. We can access things and also repair things less invasively. Additionally, surgery is less risky than it used to be—better antibiotics, smaller holes. Tumors and organs can be removed with much tinier incisions. We do a lot more uterine saving surgery as opposed to hysterectomies nowadays.

What diseases, conditions or illnesses prevent a person from being a suitable candidate for pelvic reconstruction or gynecology cosmetics?
We have office procedures so that we can make things look better and work better without doing any surgery. If someone is sick with underlying medical problems, I don’t think they’ll be presenting with issues of vaginal laxity or problems of cosmetic appearance. They have bigger issues such as being unable to breathe, walk, etc. Typically I don’t see patients whose medical problems prevent them from having surgery. We can do more minimally invasive things for patients today.

I had a patient recently from North Carolina who was convinced I would have to perform countless surgeries. As it happened, all I had to do was a ThermiVa, a procedure which is a low frequency energy treatment we deliver in the office. It requires (3) thirty minutes treatments over a period of three months. I also have an 82 year old patient suffering from diabetes, and I’m still able to do something to help her.

Other than natural processes in the body such as aging, giving birth, etc., can your procedures repair such things as birth defects, accidental injuries, or physical trauma—and can these things be corrected even years after the damage has occurred, or is time of the essence?
Birth defects occur during birth and we certainly have to perform reconstruction because of that. This is not done in childhood, but when the person is diagnosed as an adult. If you’re referring to something like an anatomical variance, for instance, something like size and shape, or a congenital problem such as not having a uterus, vaginal septums, having two uteruses, or a hymen that doesn’t allow blood flow, typically, we do not address these issues until a woman is older. In fact, we may not become aware of them much before 15 years of age.

Defects can also happen during such occurrences as miscarriages. Typically, injury is not common. Unlike breaking an arm or something like that, the uterus and a woman’s genitals are very well protected, because they’re in the midline of the body and the center of gravity. So if injury does occur, it’s usually quite easy to repair.

To prevent such problems as infections, flaccidity, sexual discomfort, or sexual disinterest, what can women do to maintain personal gynecological health, other than general cleanliness, yearly pap smears and Kegel exercises?
I think that probably the most important thing that women can do is limit their number of sexual partners and just be sexually active with people that are faithful to them, love them and want the best for them. I think multiple partners are the number one cause of the problems that women have. If you marry someone, and have a good sexual monogamous relationship with them, it would solve most of the problems we see.

I have a 22 year old patient who is beautiful. She’s had several sexual partners. I did cosmetic surgery on her and some tightening, but she hates herself because of things her partner said to her regarding her genital appearance. Had she waited for the right, committed partner, he most likely would not have said anything and accepted her the way she is.

Many physical issues also come with a related psychological issue such as fear, shame, religious inhibition, etc. As a women’s health specialist, how do you personally deal with the psychological deterrents to put your patients at ease?
I think we’re all a little inhibited. It’s just part of being a person. Inhibitions tend to disappear when you’re in the process of having a baby come out of your body. Nothing will stop you from pushing out that baby. My specialty is OB/GYN, and my subspecialty is reconstructive surgery, so I’ve delivered thousands of babies, and women are generally comfortable with that. Many of my patients have gone through a lot, and I’ve gotten very close to them, but I think that’s only due to good communication. People want someone to help them, and if you let them know it’s okay to feel a certain way, then it’s okay to feel and express the pain, etc. They just need to be nurtured in such a way that we can open up the lines of communication.

May 24, 2016

incontinence photoOveractive Bladder Syndrome, also referred to as OAB, is an uncontrollable need to urinate, often at the worst possible times.

For most of us, when the bladder fills to about half its capacity, the urge to void is triggered. Much like a snooze button on an alarm clock that lets us sleep awhile longer, we can hold off until we’re closer to a bathroom, or the timing is more convenient.

Not so for OAB sufferers. Their urgency is more like the constant demand of a malfunctioning alarm clock without that button—intense, shrill and non-stop until it’s turned off. OAB sufferers feel more like their bladders are overflowing. They don’t have the luxury of waiting, needing relief immediately. If they’re unable to void right away, leakage may occur.

OAB is unbiased. Whether you’re at work or play, it disrupts concentration, performance and pleasure, negatively impacting your life. In time, those afflicted with OAB may become depressed, withdrawing socially.

What Causes Overactive Bladder?

No one really knows, but it’s believed that involuntary contractions of the detrusor muscle in the bladder transmits false messages to the brain.

Symptoms

  • A sudden, inconvenient urgency to urinate that is difficult to control: Just as your child is about to blow out those birthday candles or receive that diploma, you suddenly you have to run, not walk, to the nearest toilet.
  • Frequent urination (more than 8 times daily): Your bladder seems to control your life. You need to know where every bathroom is located when you go out. Maybe you even carry a change of clothing, “just in case”.
  • Voiding two or more times nightly, disrupting sleep (nocturia): You awaken during a delectable dream or restful sleep more than once to urinate.
  • Involuntary, uncontrolled leakage (see also urge incontinence): You can usually hold it in, but just barely, and sometimes experience embarrassing drips.

Contributing factors

  • Overweight or obesity
  • Stress
  • Drinking large amounts of caffeine, alcohol and other liquids
  • Nerve related conditions such as Parkinson’s, Dementia, Diabetes, spinal cord injuries, Multiple Sclerosis, and strokes.
  • Chronic pelvic pain
  • Limited mobility (being unable to move freely or quickly)
  • Some medications

Age may contribute to, but does not always cause Overactive Bladder Syndrome. Never assume you’re doomed to live with OAB based on the number of years you’ve roamed the earth. Speak to your gynecologist. Don’t be ashamed. They’ve heard it before—often. They can help.

Diagnosis

You will need to provide your doctor with your medical history, including all drugs, vitamins and supplements you are taking. A physical examination will also be necessary.
Sometimes, a urine culture, ultrasound, and neurological tests may be needed to rule out any sensory or reflex problems. If necessary, you might need more extensive analysis such as:

  • Urodynamic testing (studying bladder, sphincter and urethra performance; measuring urine flow, bladder pressure, and residual urine left after voiding)
  • Cystocopy (using a scope to study the bladder and urinary tract).

You may be asked to keep a journal that includes information like fluid intake, urinary outflow, any leakage, and a time chart of bathroom visits to assess your condition more accurately.

Treatment options

  • In milder cases, your doctor may recommend the following:
  • Drink less: Fluid is vital to the body, preventing dehydration and maintaining proper kidney function, but too much can exacerbate OAB symptoms. Try to cut back on diuretic beverages such as coffee, tea and alcohol, limiting yourself to eight cups of water daily. Avoid liquids too close to bedtime so you can finish those happy dreams.
  • Use liners or pads: Annoying, we know, but they help with trickles, stains and odor.
  • Lose a little weight: It’s not easy, but it can make a difference. Extra weight increases pressure on the pelvic muscles, causing more urination.
  • Teach your bladder who’s boss: Bladder re-education is a method that trains you to urinate at certain times, eventually allowing more time between bathroom visits. Your doctor can guide you, teaching your bladder to obey you–not the other way around.
  • Kegel exercises and biofeedback: Kegels strengthen pelvic floor muscles. Recommended biofeedback devices can help you pinpoint those muscles. Kegels can be done anywhere, are painless, sweat-free, and can be beneficial for OAB.
  • Double void: Sometimes trying to urinate again shortly after the first void may coax some shyer little droplets to make an appearance.

Medications and Treatments

Other treatments may include:

  • Prescribed Medication (Antimuscarinics, anticholinergics)
  • Gentle electrical stimulation (ThermiVa)
  • Bladder Injections ( botulinum toxin A)
  • Vaginal weight training

For more resistant cases, surgery, bladder augmentation, or the use of catheters may be necessary.

Overactive bladder does not have to isolate you. Help is available. Speaking to your doctor is always the first step to overcoming the problems associated with this syndrome, restoring your confidence, happiness, and quality of life.

March 10, 2016

by Michael Litrel, MD, FACOG, FPMRS

Dr. Litrel April Fools article graphicThe year my sons were seven and ten, I asked for my wife Ann’s help playing an April Fools’ joke on them.

Sunrise on the big day found me crawling like a Ninja across the floor of my eldest son Tyler’s bedroom. With barely a sound, I rolled on to my back and shifted my body directly beneath his bed. I took a deep breath, and then, using all my strength, began shaking the entire bed frame.

Ann’s timing was perfect. She burst into the bedroom. “Tyler!” she shouted. “Get up! It’s an earthquake – it’s an earthquake! Go downstairs – HURRY!”

Tyler hardly moved. “It’s okay, Mom,” he mumbled, still half asleep. “It’s just Dad under my bed.”

I was demoralized, with only bruised knees and a scraped back from my efforts. But it was not going to be for nothing. Nursing my wounded pride, I hushed Ann and went to the next room. “Let’s try it on Joseph.”

But by the time I had crawled under Joseph’s bed, Ann reported that Joseph was smiling, his eyes closed, pretending to sleep.

Luckily, I had prepared a backup trick the night before. I’d slid a rubber band around the kitchen sink nozzle so it would spray as soon as the water came on. It pointed up to the exact spot for dousing whichever of my beloved offspring washed his hands first.

Tyler came downstairs still half asleep.

“Would you please wash your hands before you eat,” I reminded him. It was hard to hide the eagerness in my voice. I watched Tyler as he came to the sink and reached for the soap. He stopped, looked at the faucet, and yawned.

“You know, Dad,” he said with a trace of patronization, “if you use scotch tape, it won’t show as much.”

I wasn’t in the mood for advice. “Just be quiet, and let’s wait for Joseph,” I replied testily.

“AAUGHH!” screeched Ann. Oops. While I was distracted, Annie had turned on the water. Her pajamas were soaked. I apologized profusely, but Ann was not amused.

Well, at least I’d gotten someone.

But my real quarry was Tyler. He was just too cocky for his own good. I spent the day mulling it over, playing a few jokes to pass the day. Pregnant patients made the easiest targets.

“Gosh, I hope you have two girls’ names picked out.”

Or, “Wow, we haven’t had triplets in the practice in four or five years.”

Back at home that evening, Tyler wouldn’t fall for anything. I found myself growing amateurish in my desperation.

“There’s a spider on your shoulder!”

“Your teacher just called. You’re in trouble!”

Tyler just rolled his eyes. April Fools was obviously beneath him. Indeed, he hadn’t played a single joke on me all day. I finally gave up and trudged upstairs to bed. Just as Ann and I climbed between the sheets, we were met with an impediment.

Tyler had short-sheeted our bed.

Ann was dead tired. She began to complain and laugh simultaneously as she stripped the bedcovers to remake the bed. I tried to shush her so Tyler wouldn’t have the satisfaction of knowing his trick had succeeded.

Dr. Litrel photoBut it was too late. I could hear him snickering outside our bedroom door.

My mind was unsettled. Although I was tired, I lay awake in bed for a while, unable to sleep. Finally, after some honest introspection, I came to a resolution which allowed me to drift off at last.

Just wait ‘til next year.

 

Excerpted from Dr. Litrel and his wife Ann’s book of “he-said, she-said” stories about love and family.  A MisMatch Made In Heaven: Surviving True Love, Children, and Other Blessings In Disguise is available in the office, and online at www.createspace.com/4229812

February 18, 2016

Dr. Michael Litrel volunteers in Honduras photo
by Michael Litrel, MD, FACOG, FPMRS

When my son Tyler was fifteen, I brought him with me on a church mission trip to Honduras. It seemed an inspired idea: I was seized with a vision of him forsaking his Xbox for a transformative week of caring for poor people in a third world country.

Twenty of us boarded the plane headed for rural Central America. Our physical task was to repair homes. Our spiritual task was to learn and teach about God’s love.

Tyler was shocked by the poverty. Forty people lived in the remote village in mud and stick huts. They had no running water or electricity. Wandering the village were dogs so emaciated you could count each rib.

Over the days that followed, Tyler took me to the side several times to sort through his feelings. How could we have so much at home when others in the world have so little?

I was proud of him, growing up, asking the right questions… But as it turned out, he was still an obtuse adolescent. On the last day, we faced a grueling three-mile hike through the steaming jungle to the work site. Tyler assured me he had filled all our water bottles. But when we arrived, I discovered only three of the eight bottles were full. Tyler had gotten lazy and just hadn’t bothered.

I was livid. We had an entire afternoon of physical labor ahead. Don’t you realize we have four THOUSAND pounds of cement to mix? How can we work without water? Blah, blah, blah…

I’m sorry, DAD!!! I GET it! Tyler threw up his hands in exasperation.

I could tell Tyler was more angry than sorry. But I stopped and sulked away, muttering dark thoughts under my breath. I had been proud that Tyler had chosen to come – the youngest in the group by five years. Heaven knows it was gratifying to see his hands finally off the game controller and wielding a shovel full of dirt.

But I didn’t want to hear any adolescent fibs about filling water bottles.

Our project was a hut with a dirt floor, to be replaced with cement. Twenty bags of mix had already been carried to the site. The choice of tasks were these: carry buckets of water from the stream, mix the cement on the ground, carry the wet cement into the hut, or lay down the floor. There were eight of us. It was back-breaking work.

Holding water in cupped hands photoThree hours later, we lay exhausted under the hot equatorial sun. A feeling of discouragement began to creep over us. The floor was only a third done, and we were running out of both cement and energy.

I slumped on a stool. A small village girl named Amalia crept quietly next to me. Her dress was worn, her face dirty, but her smile was glowing. She was one of eight children who lived in this tiny hut. A cement floor would keep her young body off the ground at night.

Tyler rested motionless, his back against a tree. His work efforts had been listless at best. But I kept my criticism to myself. At least he was here.

Just when the job seemed hopeless, a few neighboring villagers arrived to help. Recharged, we resumed mixing cement, carrying bucket after bucket into the hut. Somehow, we now had so much that we could not only cover the entire dirt floor but even make a front porch.

Remarkably, too, our water bottles never ran out. Tyler and I had enough to last all afternoon.

It was a strange and wonderful day in Honduras. Tyler and I had partaken in a kind of miracle: plenty of cement, a floor for Amalia, and even enough water.

For me, it was a spiritual reminder that we are always given enough – an ironic lesson to learn while helping a family whose belongings could fit in the trunk of my car.

It was only later, as I was falling asleep, that I figured out – Tyler had left all the water for me.

Dr. Michael Litrel photo

Excerpted from Dr. Litrel and his wife Ann’s book of “he-said, she-said” stories about love and family.  A MisMatch Made In Heaven: Surviving True Love, Children, and Other Blessings In Disguise is available in the office, and online at www.createspace.com/4229812

 

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