Advanced OB/GYN FAQs

The American Cancer Society recommends that women with a lifetime risk of breast cancer of 20% or greater be screened annually with breast MRI in addition to mammography regardless of breast density. For more information on calculating a woman’s lifetime risk of breast cancer, visit https://www.cancer.gov/bcrisktool/.  In addition, genetic counseling can help determine the lifetime risk of breast cancer and thus help a woman decide if additional breast cancer screening is appropriate for her.

Factors that greatly increase the risk of breast cancer include:

• The BRCA gene mutation
• A family history of a first-degree relative who has a BRCA gene mutation (for those individuals who have not been tested)
• Li-Fraumeni, Cowden/PTEN, or Bannayan-Riley-Ruvalcaba syndrome
• History of chest radiation between the ages of 10 and 30
• A history of more than one first-degree relative with breast cancer
• A personal history of invasive breast cancer or ductal carcinoma in situ (DCIS)
• A personal history of lobular carcinoma in situ (LCIS)or atypical hyperplasia

The American College of Obstetricians and Gynecologists (ACOG) does not recommend routine use of alternative or adjunctive tests to screening mammography in women with dense breasts who are asymptomatic and have no additional risk factors (Committee Opinion Number 625, reaffirmed 2017).

Studies have shown that breast ultrasound and breast magnetic resonance imaging (MRI) can help find some breast cancers that cannot be seen on mammograms.  Women with dense breast tissue are advised to discuss whether additional breast imaging is appropriate for them.

Unfortunately, there are not any clear guidelines for helping patients with dense breasts decide whether to undergo additional testing.  Additional tests carry risks as well as benefits; the patient is undergoing a costly procedure both in terms of expense and in terms of fear and anxiety in response to the additional screening.  Additional imaging such as breast ultrasound can lead to additional procedures such as breast biopsy, and only a very small percentage of those biopsies will actually find cancer. Finally, breast ultrasound and MRI may not be covered by insurance.

In recent years, numerous states have passed legislation that requires mammography providers to inform women when they have dense breast tissue.  It is thought that dense breast tissue may impact a woman’s risk of breast cancer in one of two ways. First, the density of the breasts may decrease the ability to detect cancer on a screening mammogram.  Second, there have been studies showing that dense breast tissue may be an independent, slight risk factor for breast cancer, although others argue that the relationship between breast density and cancer risk is not entirely clear.

For more information on dense breast tissue, visit:

• https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/mammograms/breast-density-and-your-mammogram-report.html

Patients have the option to choose digital breast tomosynthesis as an initial screening modality. Digital breast tomosynthesis, commonly known as 3D mammography, has been shown to increase breast cancer detection while decreasing recalls and biopsies.  3D mammography eliminates the view of some overlapping tissue and may better clarify the reading of the mammogram for the radiologist.

For more information about 3D mammography, visit http://www.breastcancer.org/research-news/benefits-of-3d-mammograms-last-over-time.

Currently, screening mammography remains the most useful tool for breast cancer detection and consistently has demonstrated a reduction in breast cancer mortality.  The American College of Obstetricians and Gynecologists (ACOG) recommends offering screening mammography to average-risk women beginning at age 40 and annual or biennial screening mammography based on the patient’s preference between the potential benefits of early detection versus the harms of testing.

For more information on breast imaging, visit:

• https://www.acog.org/Patients/FAQs/Mammography-and-Other-Screening-Tests-for-Breast-Problems
• https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/mammograms/mammogram-basics.html
• https://www.sbi-online.org/endtheconfusion/PatientResources/ThingsToKnowAboutBreastImaging.aspx

Breast self-awareness focuses on having a sense of what is normal for your breasts so that you can tell if there are changes and report them to your doctor.  Changes that should be reported include breast lumps, skin changes, noncyclic breast pain, and bloody or clear nipple discharge.

Light is used to target and destroy the hair follicles responsible for hair growth without harming the surrounding skin.

Laser hair removal can remove hair on the face, arms, underarms, chest, back, legs, and bikini.

Laser hair removal works on all skin types and most hair colors. Since the laser targets the dark pigment of the hair root, darker hair is best. Laser hair removal does not work well on white, blood or red hair. Please call Advanced Ob/GYN for a consult today.

The length of time depends on the area of hair removal. The underarms may take 10 -15 minutes, while the legs may take 45 minutes.

An average of 6 – 8  sessions, 8 weeks apart is recommended for laser hair removal for best results. Because hair grows in cycles, multiple sessions are necessary to get all the hair follicles in a given area.

Laser hair removal is a permanent REDUCTION in hair, not a permanent removal of hair. It is not uncommon to need maintenance treatments once a year even, after an area has been treated. The reason, the laser targets current hair follicles and these may change, new follicles can develop with hormonal changes.

Most people describe feeling a “snap,” like a rubber band snapping at the site of treatment.  Everyone’s pain tolerance is different.

Advanced Ob/GYN recommends that the hair be as short as possible prior to your appointment.  Please do not wax, tweeze, or thread prior to your appointment, as this will remove the hair follicle that the laser is targeting.

Please call Advanced Ob/GYN for pricing. Laser hair removal is much more affordable than you think.

You can resume regular activities immediately after treatment.  You do not need to let the hair grow out in between treatments. Shaving will not affect the next treatment.

Typical side effects of laser hair removal include a mild sun burn like sensation or redness of the treated area.  This may or may not be accompanied by minor swelling immediately following a treatment.  Using a good moisturizer and sun screen will help reduce these side effects.  Our knowledgeable staff will help you find the right product for you.

Stretch mark treatment – typically 3 and 5 treatments are need to reduce the appearance of stretch marks. We can improve the discoloration and stimulate the production of new collagen to improve smoothness in the area.

Surgical and Acne Scars – The procedure involves the use of fractional laser light, which breaks down scar tissue and triggers the production of new tissue.

• Wrinkle Reduction
• Reduction in sun spots
• Facial Vessels and pigmentation clearance
• Improve tone and texture of skin
• Rosacea

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*Women in the study either experienced natural menopause or induced menopause as the result of hysterectomy or drug-induced suppression of ovarian function (chemotherapy, radiations, anticancer drugs such as Tamoxifen)

Yes, MonaLisa Touch® treatment is particularly well suited for patients who cannot, or prefer not to receive estrogen therapy.

Please call Advanced Ob/GYN for pricing at (713) 465-5966.

Dr. Fogiel and Dr. Lane are certified in performing the MonaLisa Touch®  procedure.

The MonaLisa Touch® is appropriate for any female who has gone through menopause, as well as those who are experiencing post-menopausal symptoms as a result of a hysterectomy or breast cancer treatments.

Patients should refrain from sexual activity for 2-3 days.  Your doctor will determine a post-procedure regimen that is right for you.

Patients should expect to come back annually for a maintenance treatment.  MonaLisa Touch® was first available outside the US where more than 5,000 patients have been treated worldwide with up to an 18-month follow-up.

Most patients feel improvement after the very first treatment, although the procedure calls for three treatments that are generally spaced over a 12-week period.

Patients receive three treatments, spaced six weeks apart, which each take less than five minutes to perform.

The procedure is virtually painless and requires no anesthesia.  Some patients may experience some discomfort the first time the probe is inserted, but the actual treatment is not painful.  Many patients report that it feels like a gentle vibration.

The MonaLisa Touch® is an in-office procedure performed by an obstetrician/gynecologist.

A multisite study was conducted by Dr. Mickey Karram, Director of Fellowship Program on Female Pelvic Medicine & Reconstructive Surgery at The Christ Hospital, Cincinnati, OH and Dr. Eric Sokol, Associate Professor of Obstetrics and Gynecology at the Stanford University Medical Center.  Preliminary findings from a trial evaluating the laser treatment on postmenopausal women* and breast cancer survivors experiencing vaginal health issues show positive results.

The trial assessed the use of CO₂ fractional laser therapy on 30 women with vaginal health issues due to natural or induced menopause.   All of the patients in the trial were treated with The MonaLisa Touch® laser.

MonaLisa Touch® implements CO₂ laser energy that is delivered via side-firing probe inserted into the vaginal canal.  A two-part pulse targets surface (epithelial) tissue and deep (lamina propria) tissue to promote vaginal mucosal revitalization.

MonaLisa Touch® is a medical laser that delivers controlled energy to the vaginal tissue to revitalize the cells in the vaginal mucosa (vaginal tissue) so that these cells make more collagen, an essential ingredient in vaginal cell health.

Even with the passage of time, many women still retain their youthful energy and enthusiasm, but post-menopausal changes can affect a woman’s quality of life in unexpected ways.  Hormone replacement therapy may not be the best option for a lot of patients, as treatment outcomes can be uncertain.  Now there is an alternative therapy for vaginal revitalization that can help millions of women who are silently suffering and unable to undergo other treatment options.

Yes. Protecting yourself from mosquito bites is the only way to prevent infection with West Nile virus. In addition to wearing protective clothing such as long-sleeve shirts and long pants, use insect repellents. Repellents containing active ingredients which have been registered with the Environmental Protection Agency (EPA) are considered safe for pregnant and breastfeeding women. EPA registration means that EPA does not expect the product to cause adverse effects to human health or the environment when used according to the label. Of the products registered with the EPA, those containing DEET, picaridin, IR3535, and some oil of lemon eucalyptus and para-menthane-diol products provide longer-lasting protection.
Use just enough repellent to cover exposed skin and/or clothing. Heavy application does not give you better or longer-lasting protection. Do not apply repellents under your clothing. Wear long-sleeve shirts and long pants, and apply the repellent to the clothing and small areas of exposed skin. Wash off the repellant once you return indoors.

The short answer is YES. Relying on breastfeeding to suppress ovulation is effective only for women who exclusively breastfeed. It may not suppress ovulation beyond six months after delivery or for women who have had a period since delivery. If you are not sure whether you meet the recommended criteria to use breastfeeding as birth control, check with your doctor.

The Neonatal Intensive Care Unit (NICU) at Memorial Hermann Memorial City Medical Center has breast pumps and refrigerators in every private room. Lactation consultants are available to assist you in this process.

Breastfeeding mothers should understand that their infants may eat more frequently than formula-fed infants because human milk empties the stomach faster than formula. Newborns will nurse 8 to 12 times or more in 24 hours for 10 to 15 minutes per breast. Breastfeeding should occur every 1.5 to three hours, where the interval between feedings is calculated from the beginning of one nursing to the beginning of the next.

We encourage breastfeeding newborns on demand. The idea of allowing a baby to “cry it out” does NOT apply to newborns. Your baby should settle into a more predictable schedule when he is older, but you should be prepared to nurse your infant frequently in the beginning.

Most healthcare providers and lactation consultants encourage patients to avoid the use of a pacifier or bottle until breastfeeding is well established. In most cases, parents can safely wait about two weeks before introducing a bottle with expressed breast milk.

Breast engorgement is caused by inefficient or absent draining of the breast. It may occur 3 to 7 days postpartum, or it may occur later as the result of a delayed or missed feeding. Frequent breastfeeding or pumping can help to avoid and to treat engorgement. Warm compresses or a warm shower may facilitate milk removal, and cold compresses may decrease swelling and pain.

Early, mild nipple discomfort is common among breastfeeding women. Nipple pain beyond soreness or discomfort beyond the beginning of a nursing episode may be an indication of suboptimal breastfeeding technique. Correct latch and positioning are crucial. If you are still experiencing pain, we encourage you to contact your physician or speak to an outpatient lactation consultant to adjust and optimize latching techniques.

Nipple shields, which are made of latex or silicone, may be used to help an infant latch on to a flat or inverted nipple. They may also be helpful for engorged breasts, sore nipples, or transitioning a premature infant from tube feeding to breastfeeding. The lactation consultants at the hospital will be able to advise you on whether a nipple shield may be helpful for you.

We discourage pumping or nipple stimulation prior to delivery.  Stretching or rolling the nipples during pregnancy may result in oxytocin release, which may stimulate uterine contractions.

Cervical dysplasia (also known as cervical intraepithelial neoplasia) is abnormal tissue growth in the cervix (the narrow, lower portion of the uterus).  The dysplasia may be discovered on an abnormal Pap smear or colposcopy.  Some types of cervical dysplasia can progress to cancer if not treated.

The American College of Obstetricians and Gynecologists recommends that girls should have their first visit with a gynecologist between the ages of 13 and 15 years for health screening and education. Topics of discussion may include: menstrual cramps, menstrual irregularities, eating disorders, tobacco or alcohol use, or early sexual activity. Most adolescents will not require a pelvic exam at their first visit.

The Papanicolaou test, which is more commonly referred to as the Pap smear, is a screening test used to detect potentially pre-cancerous and cancerous processes of the cervix.  Women should follow a schedule of regular Pap smears beginning at age 21.  At Advanced OB/GYN, we will advise you on the appropriate screening schedule based on your age and results of prior Pap smears.

Appointments can be made as soon as you have a positive pregnancy test. Initial OB appointments after 20 weeks (5 months), are considered high risk and will be subject to review by the doctor to determine acceptance for OB care.

The best time to perform this ultrasound is between 28 to 30 weeks of gestation. Please inquire with our office for referrals.

At this time we do not except any Medicaid plans.

The doctors would love to deliver all of their own patients, but in the cases that it is not possible, they receive help with their call group.

Dr. Fogiel and Dr. Tejml are the physicians in the office. However, they share evening and weekend call with a call group.

Our office can usually schedule an appointment for routine gynecological care within 3-7 business days. Same day emergency appointments are available upon request.

Yes! Advanced Ob/GYN welcomes all new obstetrical and gynecological patients.

Please call our office during working hours. You will need to have your pharmacy number available. To ensure that you receive your medication in a timely fashion and to decrease unwanted anxiety, we ask that you not delay refill requests until the last minute. Allow our office 48 hours to process your prescription.

Most test results are given by phone by either the doctor or the medical assistant. You may also be contacted by email to view the Patient Portal for results. There are some instances where the doctor may have you return to the office to discuss results and treatment options.

A pap smear is a screening test for precancerous and cancer of the cervix. A woman should have their first pap smear at age 21.

We deliver at Memorial Hermann Memorial City Hospital only.

The American College of Obstetricians and Gynecologists recommends that girls should have their first visit with a gynecologist between the ages of 13 and 15 years for health screening and education. Topics of discussion may include: menstrual cramps, menstrual irregularities, eating disorders, tobacco or alcohol use, or early sexual activity. Most adolescents will not require a pelvic exam at their first visit.