Insu Kong, MD

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:        “Jim, I understand that not only are you here to educate other       physicians and learn about laparoscopic procedures at the AAGL but       you’re also here because you’re past President of the International       Pelvic Pain Society and, in fact, sitting on the Board of Directors of       that society.  Can you tell me       a little bit about that society and what it might be able to offer       patients with chronic pain?”              

:        “Chip, I’m glad you brought that up.        John Slocumb

is now our new President starting today at this       meeting, and he is now taking the reins of the International Pelvic Pain       Society which is a society dedicated to helping patients with pelvic pain.        In fact, this society has 250 members around the world, and those       members are dedicated to helping women with pelvic pain.        They have a website which you can contact - IPPS or 

       and they can help women whose pain has really caused them dysfunction in       their lives.  Some of the       companies that are involved, for instance, are Inlet Medical, which is       involved in helping women with pain with intercourse and pain with deep       dysmenorrhea with the UPLIFT procedure.        They can be contacted at inlet.org and they produce resource       material.  Everest Medical is       helping out, and one of the companies that have been mentioned with an       InterStim device provides for neuromodulation is Medtronics, and they’re       involved in trying to help women with pelvic pain.        So there is a society of professionals which is dedicated to this       problem.”              

:        “And patients are able to reach this society through their       website?”              

:        “Yes, patients can reach the society and its members through       their website.”              

:        “And that would be?”              

:        “Great, thank you very much for that information.”              

Articles

OBGYN.net Conference CoverageFrom American Association of Gynecological LaparoscopistsOrlando, Florida, November 2000

International Pelvic Pain Society

:        “Jim, I understand that there’s been a lot of advancement in       our understanding of some of the premenstrual problems women suffer with -       the problems of anxiety, loss of control, depression, and crying that       sometimes can be exactly tied to the menstrual cycle.        Can you tell me really what PMS is?        Is it a hormone imbalance?  What’s       wrong with these women?”              

:        “Let me start with your first comment, there have been some       remarkable developments.  The       FDA has actually approved Sarafem, which is Eli Lilly’s product for the       treatment of premenstrual dysphoric disorder.        Sarafem is a medication, which is dedicated to the treatment of       premenstrual dysphoric disorder.  Now       what is premenstrual dysphoric disorder – some women will develop what       we call ‘premenstrual syndrome’ which is symptoms of anxiety,       depression, bloating, breast tenderness, and feeling out of sorts during       the second half of their cycle.  We believe this is related to progesterone and estrogen       secretion but in relationship to the brain tissue and to serotonin levels.        It turns out that Sarafem is what we call a ‘serotonin reuptake       inhibitor,’ and a serotonin reuptake inhibitor can actually treat those       symptoms but we use it for those women where the PMS becomes premenstrual       dysphoric disorder.  So       what’s the difference – the difference is premenstrual dysphoric       disorder causes interference with the person’s life.        They can’t work, they can’t study, their inner personal       relationships get affected, in fact, it’s more than PMS - it’s gotten       to the point where they can’t live their life properly.        There are two advantages to this, as you know, one is breast       tenderness, which is very difficult to treat as well as bloating and in       fact this medication reduces symptoms of both the physical symptoms of       breast tenderness and bloating during that second half of the cycle.        So besides all the anxiety reduction, the depression reduction, the       improvement in their feelings, and the improvement in their inner personal       relations, we get some physical benefits for those patients too.”              

:        “Is this a medication that patients have to take all the time?”              

:        “They can take it in a low dosage all the time or at the same       dosage only two weeks of each month, which I have found works fine if they       start it with their time of ovulation and take it up to the first day of       their cycle.  It does reduce       their symptoms so they can take it intermittently or all the time.        I found it worked very well.”                      

:        “Are there a lot of side effects with this new treatment?”              

:        “Extremely minimal and it starts working reasonably soon so there       are very few side effects.  It’s       long tested, it’s a very good medication, and my patients have really       appreciated it.  If people       contact Eli Lilly, they can get information on this.        They can also contact their physician about this medication because       it is newly approved by the FDA for this disorder.”              

:        “That’s really exciting, Jim.”              

:        “It is; it’s very exciting.”              

:        “Hi, this is Jim Carter, and I’m here at the AAGL meeting  in Orlando.  I’m a physician in Mission Viejo, and I happen to be  fortunate to be with Dr. Charles Butrick, I call him Chip from Kansas  City, Missouri who is an expert in the field of pelvic pain.  Chip,  could you tell me about some of the new developments in this area of  using electricity to help people with pain using what they call       neuro-stimulation?”                            

:        “Jim, it’s really fascinating in that we have so many  patients that suffer with chronic pain primarily because their spinal       cord and the nerves that go to and from that spinal chord are  “wound up” or overly excitable.  The most common symptom that we’ll see  in our practice is the symptom of urgency frequency syndrome, problems  of vulvodynia with vagina burning and irritation, and  the problems of  chronic pain associated with the pelvic floor that tenses up so tightly  that it causes constant pain, difficulty urinating, having intercourse,  or passing stool.  Now, we realize that we need to  calm down those  nerves that are so overly excitable or what we call ‘up-regulated’ and  the best way to calm them down  appears to be is       neuromodulation.  There are several ways to do that but Medtronic,       Inc. ( 

  ) has developed the technology we refer to as ‘InterStim’. These nerves  are actually down - regulated through the passage of current through  the S3 or S4 nerve roots ( these are nerves down near the tailbone.)   There’s a little battery that is then implanted under the skin,  typically in the buttocks area, and through that electrode and battery  we can program electrical current to calm down these nerves that are  obviously the source of the patient’s pain.  I’ll sometimes have  patients call me within a few hours of the placement of a little wire  just in the office to test to see if it works; they’ll call me and say  that their interstitial cystitis they’ve had for twenty years is gone.”                     

:        “So this is a device that Medtronics has developed which is  really primarily for what we call ‘urgency frequency syndrome’ - people  with urgency and frequency of urination but it also has been found to  be effective in the hands of very skilled practitioners in pain areas.   This is a very exciting development, I understand that if people are  interested in how they can get their problems resolved with this urgency  frequency syndrome or with their pelvic pain, they can contact you in  Kansas City, Missouri at your clinic.  Which group are you with?”       

:        “I’m the Director of the Urogynecology Center and that’s  part of a private practice outside of Kansas City in Lenexa, Kansas but  they can also contact through the website that Medtronics offers a very  nice chat room and education about       InterStim.”       

:        “Thank you very much.  I have to speak with personal thanks  for Dr. Butrick, he took care of my niece who was in Kansas City, and I  really thank you for all the help you gave her.”              

:        “Thank you, Jim.”              

Pelvic Pain

click             here for RealAudio/Video version

       "Hello, my name is Chip Butrick, and we're here speaking with Dr.       Insu Kong. Today we're going to talk about a new technique that Insu has       been using for problems that are retroverted uterus and uterine prolapse.       Can you tell us a little bit about the symptoms that patients would have,       Insu, if they have problems with that kind of concern?"
       
       

 "Yes, the       people with the retroverted uterus usually complain of dysmenorrhea - a       painful period and dyspareunia - which is painful sexual       intercourse."
       
       

       "Now what can be done for those kind of problems?"
       
       

 "In the       past, many gynecologists have used open surgery to lift the uterus. Now       there's a new procedure called the 'uplift.' We can do this with a       laparoscope, which is very small, normally in a two-millimeter incision on       the skin, and we can do this procedure very quickly without having to open       the abdominal wall."
       
       

       "How is this procedure done - is this all, again, through the       laparoscope as an outpatient?"
       
       

 "Yes,       through the laparoscope and as an outpatient, and it could be done in       conjunction with other procedures because the procedure only takes about       ten minutes to complete."
       
       

       "And yet after this brief procedure, the success rate for pain with       intercourse and menstrual cramps would be…?"
       
       

       "Significantly reduced. I have seen many patients who had pain with       intercourse completely gone with this simple procedure."
       
       

       "Have you seen any complications? Is this a risky procedure to       undergo?"
       
       

 "No, it's       very non-risky because the needle size is only about one or two       millimeters - so there is no injury that could occur."
       
       

       "Fantastic - so then for patients with problems of pain with       intercourse or dysmenorrhea and where the doctor feels that the uterus is       tilted backwards, this is a new technique that sounds very       successful."
       
       

 "Yes,       very much so."
       
       

       "Fantastic. I wish you luck, Dr. Kong."
       
       

From American College of Obstetricians and GynecologistsPhiladelphia, Pennsylvania - May, 1999

Author | Insu Kong, MD

Articles

International Pelvic Pain Society

PMS

Pelvic Pain

The Uplift Procedure for Treatment of Retroverted Uterus and Uterine Prolapse