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IMS Menopause Live

5 minutes with Professor Steven Goldstein

20 March, 2018

Member of the IMS Board

The IMS Board works tirelessly to support the aims of the Society and to ensure that the best educational resources and updates on research are available to all the membership. However, do you really know who they are? This new occasional profile series gives you the opportunity to learn more about each Board member, providing a personal perspective and insight into the people who represent the leadership of the Society.

Steven R. Goldstein MDProfessor Steven Goldstein

Is Professor of Obstetrics and Gynecology at New York University School of Medicine and Treasurer of the International Menopause Society.

I’ve been reading

Cells are The New Cure by Robin L. Smith, MD and Max Gomez, PhD. This is a cutting-edge look for an intelligent lay-audience by two scientists about the current and future use of stem cells.

I’ve been researching

Making the diagnosis of abnormal uterine bleeding/postmenopausal bleeding truly ‘point of care’. In some cases, this means sonohysterography and, in other cases, these new disposable office hysteroscopes.

My team

Since I am not subspecialty trained, I do not have a ‘division’ but am able to call on very astute colleagues from all major areas of Ob/Gyn in my institution at New York University School of Medicine.

An anecdote

I recently had a total knee replacement. I was signed up to be done by the head orthopedist at the number one-rated orthopedic hospital not only in New York, but in the United States. I subsequently had another opinion with a doctor at my own institution. He performed not only an X-ray of the knee but a scan of my lower extremities. It was clearly obvious (even to my untrained eye) that the polyethylene in my 15-year-old right hip replacement had almost worn through. He informed me that, if this were allowed to totally wear through so that the titanium implants rubbed on each other causing them to loosen, that this would be a major problem. Needless to say, I switched physicians and had my knee fixed and am in the process of planning a revision on my hip as well. The lesson is, we must see the whole patient and not just use such tunnel vision as the first surgeon exercised.

An interesting case

I was once asked to perform a transvaginal ultrasound on a sterile gorilla at The Bronx Zoo when they were moving the animals to a different portion of the facility. Once anesthetized, the animals were brought into the zoo’s hospital where various medical specialists evaluated the gorillas. This one female gorilla had never become pregnant. Dressed in hospital gown and glove, I began to perform a transvaginal ultrasound. The adult female gorilla has a short stubby vagina and axial uterus. This made visualization of the pelvis virtually impossible. They say that necessity is the mother of invention. I put the probe into the rectum, turned it 90 degrees and got beautiful images of the endometrial echo which was thin and there were ‘streaked’ ovaries. If there ever were such a thing as a Turner’s Syndrome in a gorilla, this was it. With the head veterinarian, we wrote a paper that transvaginal ultrasound was of limited value in the species gorilla gorilla gorilla. Since that time, in young virgins and older patients with a stenotic vagina, I have routinely performed transrectal ultrasound with great success.

 

I’m worried about

The movement towards medicine practiced by protocol and guidelines. These work well for populations but not necessarily for individuals. We no longer seem to espouse the virtues of individualization, judgement and experience.

I’ve been thinking

A lot about the IMS. It is evolving into a society with the ability to truly make an impact world-wide. As the internet shrinks the world, there is huge need for disseminating information on menopause to clinicians and to patients who previously had little access. This is a main challenge of the IMS going forward.

In my spare time

When not recovering from orthopedic surgery (ten so far with one more to go), I like to golf (not very well), and have season tickets to the New York City Ballet as well as St. John’s University college basketball team.

A thorn in my side

The way regulators sometimes label products. Case in point, denosumab (marketed in the United States as Prolia). The patient information sheet lists side-effects and the first one is ‘back pain’. The pivotal study, which actually is in the same document but in the doctor portion, says (now remember these were women with osteoporosis, average age 73), ‘As an adverse event, over 3 years, 34.7% of the treatment group reported back pain versus 34.6% of the placebo group.’ I literally once handed the information sheet to a patient, whose response was, ‘Back pain? Why would I want a drug that causes back pain? I already have back pain.’ What the pivotal trial really tells you is that approximately one-third of women average age 73 with osteoporosis will have a history of back pain. But to tell patients that this is a ‘side-effect’ is unfair and misleading.

What challenges me

My physical limitations. I was a former competitive squash player and marathon runner. I now have a seven-level spinal fusion from T10 to S1, two total hip replacements, one total knee and am relegated to golfing (with a cart) and the elliptical for my cardio fitness. Fortunately, my supratentorial body part seems to be functioning as well as ever.

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