Q. I had an abnormal Pap smear. Now my doctor wants me to have a colposcopy. What can I expect during this procedure?
A. Pap smears help determine if you might have cancer, or a precancerous condition, of your cervix. When a Pap smear raises such suspicions, the next step is a colposcopy.
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Colposcopy is generally safe and painless. It takes about 15 to 30 minutes and doesn't require anesthesia. During the procedure, your doctor examines your vagina and cervix using a colposcope. This is a portable instrument with a light and magnifying glass.
Colposcopy basically accomplishes three things. First, it lets your doctor look directly at your cervix. Second, the light and magnifying glass let the doctor see things that the naked eye cannot. Third, it lets the doctor remove any suspicious-looking tissue.
Your doctor may ask you not to take aspirin for a week before the colposcopy, so that that you won't have excessive bleeding if tissue is removed. Don't douche or use vaginal creams or medications the day before the procedure, since that can make it harder for the doctor to get a good look at your cervix.
It's important to let your doctor know if you may be pregnant. Also, tell your doctor about all of the medications you take. Finally, don't schedule the procedure to occur when you are likely to be having your monthly period. Obviously, menstrual bleeding also can obscure the doctor's view.
The colposcopy is similar performed in a similar manner to a pap smear. In some cases, your cervix and vagina may be rinsed with a vinegar solution or iodine stain to make abnormal areas easier for the doctor to see. The vinegar tends to turn any precancerous tissues white.
Next, your doctor will look through the colposcope to examine your cervix and vagina.
If the doctor sees any areas that look like they might be a precancerous condition, or cancer itself, the doctor will remove a small piece of the tissue (called a biopsy). The doctor may use a local anesthetic to numb the biopsy area. But you may experience some cramping and/or discomfort.
Any tissue removed during the procedure will be sent to a specialist (a pathologist) for examination. The tissue is treated with special chemicals and stains, and then examined under a microscope. The specialist will notify your doctor if any cancerous or precancerous changes are discovered.
Following your colposcopy, you can return to your normal activities right away. It is a simple procedure, and if it discovers a precancerous condition, that condition can be treated and cancer prevented.
Q. I have a heart arrhythmia. My doctor wants me to get an ICD. What do I need to know before agreeing to get one?
A. ICD stands for "implantable cardioverter-defibrillator." It is a small device that is surgically placed in your body. An ICD can save your life -- but it can also complicate your life.
Why was the ICD developed? Sometimes the heart develops dangerous irregular rhythms. Two, in particular, are life-threatening. The most dangerous is ventricular fibrillation (VF). When a heart develops VF, it stops pumping. It just quivers; it's in cardiac arrest. With no blood circulating to your brain, you lose consciousness. If no blood reaches your brain for more than 4 minutes, your brain dies.
Another dangerous rhythm is ventricular tachycardia (VT). Your heart beats rapidly, and your blood still circulates -- though less effectively than with a regular rhythm. Unfortunately, if VT is not corrected, it often turns into VF.
About 60 years ago, Harvard doctors invented the defibrillator, a machine that delivers a shock to the heart. They showed that the shock could quickly return a dangerous heart rhythm to normal. The shock was delivered by two paddles placed on a patient's chest. Obviously, the defibrillator could help you only if your dangerous heart rhythm was diagnosed and treated within minutes of its starting. You had to be in a medical setting, or emergency medical technicians had to get to you very quickly.
In recent years, machines to deliver these shocks are also located at airports, on airplanes and in other public places. Still, most people who develop VT or VF are nowhere near a defibrillator.
Enter the ICD, which has two basic functions. First, it reads your heart rhythm and spots a potentially dangerous one. Second, it sends a jolt of electricity to your heart muscle to end the dangerous rhythm and restore a normal rhythm. The only people for whom an ICD is recommended are people who have had VT or VF, or who have a heart condition that greatly increases their risk of developing these dangerous rhythms.
When you have an ICD placed in your body, it's as if the doctor with the paddles is always with you. It can be life-saving. However, some people become anxious or depressed by the possibility of having a shock at any time -- even though they need it, and even though it may save their life.
ICDs don't last forever. The pulse generator needs replacement every three to seven years, but it's a pretty simple procedure. Occasionally, the wires to the heart need to be replaced. This is a bigger procedure, requiring anesthesia. Some states have driving restrictions for people with ICDs.
Finally, ICD recipients have for years been told to avoid magnetic resonance imaging (MRI), because it could damage the ICD. A recent study found that certain adjustments of the ICD before the MRI can often solve that dilemma.
In many cases, the benefits of an ICD outweigh the drawbacks. But before you give your OK, talk to your doctor about an ICD's potential to save your life -- and also alter the quality of it.
• Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: AskDoctorK.com.