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Concerns over Surgical Treatment for Pelvic Organ Prolapse

There have been several concerns raised by urologists and gynecologists regarding the risks associated with a surgical procedure used to treat Pelvic Organ Prolapse (POP). This particular procedure uses a product called transvaginal mesh, or vaginal mesh, to treat symptoms commonly associated with POP. Unfortunately, these mesh products have been linked to thousands of cases of serious health complications.
There are lawsuits pending in nearly every state, and several major medical device manufacturers, such as Bard and Johnson & Johnson, have begun recalling their vaginal mesh products after the Food and Drug Administration (FDA) issued its most recent warning.

What is Transvaginal Mesh?

Transvaginal mesh is typically made of synthetic materials. It is used like a hammock to provide support to the pelvic floor muscles and prevent organs from dropping into the vaginal canal. While it seemed like a great solution when it hit the market about a decade ago, it wasn't long before complications began to arise. An estimated 10 percent of all women who have surgery using a vaginal mesh product to treat prolapse will experience some form of complication. The FDA has issued multiple warnings labeling vaginal mesh products as risky and warning doctors and patients of the complications associated with its use.
Women who have suffered permanent and debilitating damage have filed a vaginal mesh lawsuit, seeking compensation them for their medical bills, as well as their pain and suffering.

Complications Associated with Transvaginal Mesh
The most common complication associated with vaginal mesh products is their tendency to erode and protrude into the vagina and other organs. In the worst cases, the mesh products can puncture organs, like the uterus and the bladder. This is called organ perforation. If the bladder is punctured, it can cause permanent incontinence.

It is also common for the human body to reject foreign objects, so many women find that they are plagued by chronic inflammation and infection. They can experience generalized pain in the vagina and pelvic region and may have pain or discomfort during sexual intercourse. Sometimes the mesh begins to contract, or shrink, which can also cause pain and discomfort.

Less Risky Surgical Alternatives

There are surgical procedures that can significantly reduce a woman's chances of health complications. These surgeries use a woman's own tissues, rather than vaginal mesh products, to provide support for tissues and organs. These procedures have significantly fewer reports of health complications than their vaginal mesh counterparts.

There are also non-invasive methods that may be able to treat POP. These are best suited for women with mild to moderate cases of POP. They include:

  Physical Therapy - Exercises, such as Kegel exercises, Yoga and Pilates, can help to strengthen key tissues and reverse the symptoms of POP.

  Lifestyle changes - Excessive weight and smoking have both been linked to POP, so healthy lifestyle choices can improve the symptoms.

  Vaginal pessaries - When properly fitted and inserted into the vagina, pessaries have had success in relieving symptoms of POP and preventing incontinence.
Women deserve the right to choose the best and least risky form of treatment for their medical situation.



HPVs (Human pappilloma virus) can infect and cause disease at any site in stratified squamous epithelium, either keratinizing (skin) or non- keratinizing (mucosa). The clinical problems encountered with such infections can be broadly divided into cutaneous warts, genital warts, oral warts and laryngeal warts.        Warts are a very common problem in practice, particularly among children. It can affect any part of the body. In countries with highly developed medical services, referral rates of warts to dermatology clinics have greatly increased in the last four decades.

Incubation period   

Common and plantar warts: The time of acquisition of the infection can seldom the ascertained. An estimated period ranges between a few weeks and more than a year.    

Genital Warts: Incubation period of 3 weeks to 8 months, average 2.8 months. Perinatally acquired HPV infection may not manifest as genital warts for up to 2 years.
Laryngeal Warts: Only 57% of cases of laryngeal papilloma in children are diagnosed by 2 years of age. 


In genital warts infectivity is highest early in the course of the disease. Any sexual contact of a patient with genital warts is likely also to be infected. There is no reliable information on the infectivity of common and plantar warts, but experience suggests that it is substantially less. The infectivity of maternal genital HPV as regards laryngeal papilloma in the child seems low. 

Modes of Transmission    

Warts are spread by direct or indirect contact. Impairment of the epithelial barrier function, by trauma (including mild abrasions), maceration or both, greatly predisposes to inoculation of virus, and is generally assumed to be required for infection, at least in fully keratinized skin, as in the following examples: ·        

  • Plantar warts are commonly acquired from swimming pool or shower- room floors, whose rough surfaces abrade moistened keratin from infected feet and help to inoculate virus into the softened skin of others.·        
  • Common hand warts may spread widely round the nails in those who bite their nails or periungual skin, over habitually sucked fingers in young children, and to the lips and surrounding skin in both cases. ·        
  • Shaving may spread wart infection over the beard area. ·       
  • Occupational handlers of meat, fish and poultry have high incidences of hand warts, attributed to cutaneous injury and prolonged contact with wet flesh and water.        
  • Genital warts have a high infectivity. The thinner mucosal surface is presumably more susceptible to inoculation of virus than is thicker keratinized skin, but in addition lesions were noted to be commonest in sites subject to greatest coital friction in both sexes. 


The characteristic histological feature of viral warts is vacuolation in cells in and below the granular layer, often with basophilic inclusion bodies composed of viral particles, and eosinophilic inclusions representing abnormal keratohyaline granules. This cytopathic effect may show detailed features typical of the HPV type involved and is almost always accompanied by epidermal acanthosis and often papillomatosis.

Clinical features                                    


Common warts (excluding plantar warts) are due mainly to HPV 2. They range in size from less than 1mm to over 1cm in diameter, and by confluence can from large masses. They are characterized by firm papules with a rough, horny surface.

Site - Commonly situated on the backs of the hands and fingers. 

Age - In children under 12 years of age. A single wart may persist unchanged for months or years, or large numbers may develop rapidly after an interval. New warts may from at sites of trauma, though this kobner isomorphic phenomenon is usually less marked than in plane warts. However, multiple warts around the nail folds are often seen in nail biters.       

Common warts are usually symptomless, but may be tender on the palmar aspects of the fingers, when fissured or when growing beneath the nail plate. Warts around the nail folds or beneath the nail may disturb the nail growth, and warts on the eyelids may be associated with keratitis or conjunctivitis.       

About 65% of warts disappear spontaneously within 2years and tend to do so earlier in boys. Neither the patient’s age nor the number of warts present influences the course. Regression of common warts is asymptomatic and occurs gradually over several weeks, usually without blackening. Malignant change is extremely rare. 


Site - As suggested by the name, they occur mainly on the soles of the feet. Most plantar warts are beneath pressure points, the heel or the metatarsal heads. In older girls and women they occur predominantly beneath the forefoot and toes. They are sometime found on the palms of the hand. 

Appearance - A plantar warts at first appears as a small shining ‘sago-grain’ papule, but soon assumes the typical appearance of a sharply defined, rounded lesion, with a rough, keratotic surface surrounded by a smooth collar of thickened horn. If the surface is gently pared with a scalpel the abrupt separation between the wart tissue and the protective horny ring becomes more obvious, as the epithelial ridges of the plantar skin are not continued over the surface of the wart. If the paring is continued, small bleeding points, the tips of the elongated dermal papillae, are evident.      

Mosaic wart is so described from the appearance presented by a plaque of closely grouped warts on the sole with a polygonal outline and a rough surface.      

Pain is a common but variable symptom. It may be severe and disabling but may be absent, and many warts are discovered only on routine inspection. Mosaic warts are often painless.    

The duration of plantar warts is very variable. Spontaneous regression occurs sooner in children than in adults and is delayed if hyperhidrosis or orthopaedic defects are present.     

The number of warts present does not influence the prognosis, but mosaic warts tend to be persistent. Regression is occasionally clinically inflammatory, and often culminates in blackening from thrombosed blood before the lesion separates, but in many cases simply takes the form of apparent drying and gradual separation. 

Differential Diagnosis –

  • Plantar warts are often confused with callosities or corns, with which they may indeed be associated.
  • Callosities have a uniformly smooth surface across which the epidermal ridges continue without interruption. In cases of doubt the horny layer should be gently pared.
  • Corns occur on pressure points on the toes, soles or interdigital skin. When the surface is scraped it shows the absence of papillomatous surface typical of plantar warts. Corns are most painful when pressed from top as compared to the wart in which the pain is felt on pressure from the top as well as the sides.


Site - The face and the backs of the hands and the shines are the sites of predilection. Children are most commonly affected. 

Appearance - They are smooth, flat or slightly elevated and are usually skin- coloured or grayish- yellow, but may be pigmented. They are round or polygonal in shape and very in size from 1 to 5 mm or more in diameter. Contiguous warts may coalesce and a linear arrangement in scratch marks is a characteristic feature.       Regression of plane warts is usually heralded by inflammation in the lesions, causing itch, erythema and swelling, such that preciously unnoticed warts may become evident. Depigmented haloes may appear around the lesions. Resolution is usually complete within a month. 

Differential Diagnosis - In differential diagnosis, lichen planus causes most difficulty. It is relatively less common in children, favours the flexor aspects of the forearms, is unusual on the face and is often itchy. The mucous membranes may be involved. The flat, polygonal papules are lilac-pink and smooth and may show wickham’s striae. In contrast, the surface of plane warts has a stippled appearance under the hand lens. The lesions in molluscum contagiosum are pearly in colour, look like solid vesicles, and when squeezed, cheese like material is demonstrated.


Site - Commonly seen in males, on the face and neck, irregularly distributed, and often clustered. Digitate warts, often in small groups, also occur on the scalp in both sexes, where they are occasionally confused with epidermal naevi. Isolated warts on the limbs often assume filiform shape.

Appearance - The lesions are flesh coloured or somewhat darker, rounded or oval papules or nodules. The size of these varies from lentil seeds to split peas (somewhat bigger). Their verrucous surface is very typical; once seen it is seldom missed. On the scalp the wart may have a cauliflower like appearance. The warts do not itch but the subungual warts may be painful. Koebner’s phenomenon represented by linear group of warts following inoculation of virus into the scratch may be seen. In the beard region, they may take the form of finger like processes: filiform warts.  

Differential Diagnosis -   

A single common wart should be distinguished from Butcher’s or postmortem wart (tuberculosis cutis verrucosus), which is marked by induration around the periphery of the lesions. Verruca vulagaris should be distinguished from seborrheic warts, which are multiple, circumscribed, flat elevations covered with dark, greasy scales. They occur mainly on the trunk, forehead and temples


The term condyloma acuminatum (condyloma= knuckle; acuminatum= pointed), pl. condylomata acuminate, was originally used to emphasize the difference between ano- genital warts, which are usually protuberant, and the flatter syphilitic lesions, condylomata lata. It became an accepted term, mostly in the American literature, for viral anogenital warts.      

With recent developments in the understanding of HPV disease, it is clear that the term is used variously to denote (i) the classical protuberant type of anogenital wart only; (ii) all clinically identifiable HPV disease of the anogenital region including flat warts on the external genitalia and cervical ‘flat condylomas’; (iii) all clinical lesions due to the HPV types usually associated with genital warts, including those in extragenital sites, for example the mouth. 

Site -  The area of frenulum, corona and glans I men, and the posterior fourchette in women, correspond to the likely sites of greatest coital friction. 

Appearance - They are often asymptomatic, but may cause discomfort, discharge or bleeding. The typical anogenital wart is soft, pink, elongated and sometimes filiform or pedunculated. The lesions are usually multiple especially on moist surfaces, and their growth can be enhanced during pregnancy, or in the presence of other local infections. Large malodorous masses may form on vulvar and perianal skin. This classical ‘acuminate’ (sometimes called papillomatous, or hyperplastic) form constitutes about two- thirds of anogenital warts.     

Patients with genital warts frequently have other genital infections. These are mainly minor conditions such as candidiasis, trichomoniasis and non- specific genital infection. The duration of anogenital warts varies from a few weeks to many years. Recurrences can be expected in about 25% of cases, the interval varying from 2 months to 23 years.

Differential Diagnosis –

Differentiation is from condylomata. In long standing cases, gaint condyloma accuminatum of Buschke and squamous cell carcinoma must be excluded by microscopic examination. Genital warts are often acquired along with other venereal infections and as such testes for syphilis and gonorrhea should be carried out.


Invasion of viral warts in genetically predisposed persons, manifested by profuse coalescent eruptions of verruca plana type lesions, usually on the limbs. 


Warts are something very peculiar. Some, specially, if they are numerous, sometime heal very rapidly, whereas others isolated warts, sometime bid defiance to all treatment. This is one of the important manifestations of sycotic miasm.    

The following points should be noted very carefully during case taking:  


  • After gonorrhea: Thuja.
  • After having consumed too much salt: Nitri spiritus dulcis.
  • After abuse of mercury: sarsaparilla.
  • After syphilitic infection: aurum met.
  • After injury: Bellis perennis.

Previous Treatment       

It is essential to know whether patient has attempted to cauterize with the help of the following: ·        

  • Acetic acid.       
  • Caustic potash.·        
  • Fluoric acid.·        
  • Silver nitrate.·        
  • Burning with the help of Agarbatti (a perfume stick used in India).

If it is so then it should be antidoted as follows:

  • Aliments after cauterization: Caust, Nit-ac, Thuj.
  • Use of Acetic acid, Caustic Potash and Fluoric acid preferably in high potencies.
  • For bad effects of Silver nitrate – Use Natrum mur. In high potencies. 
  • When Agarbatti is used, then to neutralize its ill effects, use Carbolicum acidum  or Causticum.
  • When electric cautery is used for cauterization, it should be antidoted with drugs like Carbolicum acidum, Causticum, Radium bromatum and X-ray.


  • Face·        
  • Fingers·        
  • Palms, etc.     

  • Flat·       
  • Fleshy·        
  • Hard·        
  • Horny·        
  • Pedunculated·        
  • Smooth, etc.

Whether warts are associated: ·        
  • With or without inflammation.·        
  • With or without itching.·       
  • With or without bleeding.·        
  • With or without suppuration.·        
  • With or without ulceration.·        
  • Tender or non- tender.

Important Characteristic Sensations            

You should always enquire about e.g.:
  • Burning.
  • Pulsating.
  • Stinging.
  • Stitching.
This is very important when the wart is isolated.    

The colour of the warts

  • Sometimes the colour of the wart also helps us to select remedy indirectly: ·         Red: Calc Carb, Thuja.  ·        
  • Brown: sepia, Thuja.·        
  • Grayish brown: Conium.     

It is strongly advised not to recommended to the patient any local application for the treatment of warts, e.g. application of lime, homeopathic mother tinctures or remedies like Salicylic acid, Fluoric acid, for the following reasons:  ·        
  • It is against the basic principle of homeopathic.·        
  • Recurrence rate is very high.·        
  • Since the cause lies within, it is futile to cure disease externally. 

Treatment Review·       

  • I have observed that majority of cases get cured, where only, constitutional remedies were prescribed and occasionally those remedies, which do not produce warts in its proving, have frequently cured the cases at the beginning should be on a constitutional background.·       
  • Falling to respond to the above method a drug should be selected taking into account the local signs and symptoms. If this also fails then only one should take help of empirical or specific medicine. ·       
  • It is always wise to restudy the case at least three times before seeking these specific medicines.·        
  • Ficus carica, Calcarea ovi testae and Calcarea calcinata are three good homeopathic remedies that I have found useful in my practice.


CAM- Complementary and Alternative Medicine

Cancer is never easy. Never! Those diagnosed with terminal cancer must face even more. Between handling the realization of their illness and the possibility that time is running, out, treatment can be brutal.

For example, mesothelioma treatment, like other cancers, includes chemotherapy, radiation therapy, and often surgery. Most patients diagnosed with mesothelioma already have the latter stages of the illness, and dealing with treatment side effects may seem like too much.

Fortunately, some cancer patients find alternative treatment options that work for them. 

What is CAM?

CAM stands for complementary and alternative medicine. According to the 2007 National Health Interview Survey, 38% of Americans use Cam in some form or another. Alternative medicine is used instead of conventional methods, and complementary medicine is used along with conventional methods.

Are there different kinds of CAM

Natural Products include dietary supplements like herbs and probiotics, which can help with food digestion. You can find probiotics in foods like yogurt.

Mind-Body Meditation consists of using the mind to control how the body functions. Examples of Mind-Body Medicine include meditation, yoga, deep-breathing exercises, guided imagery and tai chi

Manipulative and Body-Based Practices focus close attention on bones, joints and tissues, as well as “circulatory and lymphatic systems.” Types of Body-Based practices include spinal manipulation, and massage therapy.

Is CAM dangerous?

Like anything else in the world, a good thing can be turned ugly. To avoid being hurt by CAM, especially if you have been diagnosed with a terminal illness, make sure that you discuss options with your doctor. It’s important to stick to predetermined doses and prescriptions. Cross-check you CAM practitioners, with your doctor and do your research before you finalize!

- Krista Peterson