January 16, 2008

It is clear that my hands have been full. While all of these things were occurring, I somehow maintained a very busy practice and personal life. What I have come to realize is that much of my life has been a matter of being at the right place at the right time. None such better example was the bond I formed with Dr.Omar Rashid and the impact he had on my future practice of Obstetrics. I truly love this man. When I came to Syracuse in 1998, we worked together and cared for a large Obstetrical service. After a year, he was forced to retire early due to debilitating arthritis and we are still pals to this day. Over this time, I saw a continuity of pregnant patients I had not experienced before. As with everything I consistently do, I like to study and analyze it. I try to take everything down to the smallest level of understanding. It's just how I have always been.

So with all this Obstetrics, I became puzzled with the scurge of premature birth. It became apparent to me that as I studied certain ultrasound variables during the pregnancy, the more it seemed the problem might just be a simple anatomical defect. I began devising a management protocol in my head to test this hypothesis. However, much evidence and many cases would be needed in order to prove it true. And further, something was needed to effectively account for the most extreme cases of premature birth. This is where my buddy Omar comes in.

One Friday, I was sitting around the office idle. Omar said he was going to the surgery center to do a case. I decided to tag along because he was going to do a cerclage, which is a stitch that is placed in the cervix during early pregnancy as a prophylaxis against premature birth. Having been trained in this procedure, I knew that exposure was key and figured it was a good opportunity to give him a hand. He then started the procedure and began by taking a scalpel to the cervix. I was flabbergasted and asked him what in the hell he was doing, as this was not part of the procedure I was taught. He said that he was doing a shirodkar cerclage. "A shirodkar cerclage?!", I exclaimed. "No one knows how to do a shirodkar cerclage." He said, "well I do." And with this I went on to see one of the most important things I have ever been privileged to learn. This is a procedure that very few people know how to describe nevertheless how to do. It is very technically demanding and takes a lot of guts to execute given the fact that you actually incise the tissue covering the cervix. I just knew of its name and nothing else. Nearly 100% of Ob/Gyn residents learn how to do what's called a McDonald cerclage which is procedurally easier to do. This is all I learned before this pivotal day.

After seeing him do this, I decided that I needed to assimilate the shirodkar cerclage into my practice. And now with nine years of experience, I have really refined the technique. The more I studied this procedure the more I realized that this was one of the missing components in proving my hypothesis correct. In fact, it covered the most important one in dealing with the extreme cases of premature birth. Cervical cerclage has never been shown in any study to be effective in preventing premature birth. These studies primarily look at the McDonald variety and also fail to recognize the fundamental etiology for preterm birth so as to provide additional methods of prevention.

Over the past six years, I have implemented an extensive protocol within the practice with the objective of completely eliminating preterm delivery and/or its morbidity (long term illness from this prematurity). This was to include multiples as well. In this time, we further substantiated the hypothesis with the case of a lifetime. I have no doubt that God sent me this case. This is just what he does. You just have to be looking for it. I call this pregnancy the missing link or the linch pin in proving the hypothesis correct. The clinical story is long but this case clearly established for this investigator the cause of premature human birth through what we observed by ultrasound during her pregnancy. Others authors and investigators have been close and have seen some of the things I have observed in many of my other cases. The totality of the protocol and the fundamental comprehension of what is occurring anatomically is the difference.

Understanding of the mechanisms of this anatomical basis has grown so much amongst everyone on my staff that we have literally eradicated preterm delivery due to preterm labor from our practice. The objective for any patient reagardless of history is to get them to a point in the pregnancy when their delivery and subsequent discharge are coupled with their baby going home with them. This includes multiples as well. In fact, in 2004-2005, we had ten sets of twins all pregnant at the same time. Every single one of them was put on the heightened protocol. Every single one of them went to term. This is unprecedented as have been the last six years.

Premature birth has been the subject of much attention in the media over the past few years mainly because of the cost to society. And it's getting worse. By being able to eliminate preterm delivery or its morbidity, it would obviously have an enormous impact. I knew I had the concept and the protocol. And I absolutely knew that the shirodkar cerclage was the primary key in prevention when done a certain way. However, I needed the data and the statistical evidence to support what I had observed and what I had accomplished. The problem was that one needs a lot of time, experience and knowledge in order to properly compile data for any type of scientific analysis. I knew how to show it with the medical evidence. But how to do it with numbers and equations required a comprehension well beyond anything I knew. This very obstacle is what kept me from moving forward with any attempt at publishing my findings. I literally prayed for a solution in order to get this information formalized. Man, were my prayers answered.

Enter Dr. Scott Cameron. What can I say about this man of God. He is purely a gift from Him to all humanity. Such a good guy is he that he literally moves everyone that gets to know him. Someone, upon meeting him just once, said that he was dripping with the Holy Spirit. He is truly a great dude with the coolest Scotish accent and is absolutely brilliant. We got to know each other two years ago when I was caring for his lovely wife during her first pregnancy. Scott is a local medical student with a Ph.D. in pharmacology. He was a rising star in the field of cardiovascular drug development. However, he followed a heartfelt calling to become a physician.

This past summer, Scott, without any provocation, asked if he could come into my office for a six week formal medical school rotation with the sole objective of compiling my data. He just knew that it had to be done and that it was no simple task for just anyone. He and I discussed my theories during the pregnancy one year earlier. And I knew that he did some bench work in the past with his Ph.D. I simply had no idea what I was about to witness come out of this man. His knowledge of data analysis and the methodology of scientific paper writing was God sent. There is no way I could have ever accomplished this without him.

The results of the study were equally as luminous. I now had the missing piece of what I needed to clearly illustrate the foundational cause for preterm delivery and a proven means by which to prevent it. We hurriedly wrote an Abstract to meet a deadline for submission to ACOG (American College of Ob/Gyn) for consideration as either a short speaker or poster presentation at next year's national conference. We were restricted to 250 words so it was hard to chop off over 200 words from the original draft version. For some reason it was rejected. I would speculate that the data was too hard for ACOG to believe as being valid. This was disappointing since we were hoping to bring this info to anyone who wanted to question, test or criticize any of the concepts and/or protocols.

The science behind the protocol has so far proven to be bullet proof. We continue to have the same success to this day regardless of patient history or lack there of. In the coming year, I plan on writing an extensive paper on this subject of premature human birth. This will describe in detail the science of why it occurs in the first place and the means by which to prevent it. I give thanks to the Lord for the wisdom and insight he has given me to have achieved these findings. Below is the Abstract which was written and submitted to ACOG.

ACOG Abstract