by Gordon Nary
Gordon: When and why did you join St. John Cantius Parish? Dr. Caruso:
St John Cantius parish had been mentioned to my wife and I for a number of years. However, my wife attended the Lessons and Carols presentation in 2008 and I followed up with attending a daily Mass, and we have continued there ever since. It is the fact that they were instrumental in my return to the Church and the fact that at every Mass you will hear the faith preached from the pulpit. The Canon’s themselves have befriended my children as well as my wife and me, and that has been an incredible experience.
Gordon: St. John Cantius has an exceptional number of ministries and programs. Can you share which of them you have found especially beneficial for your spiritual life and why?
Dr. Caruso: St John Cantius is particularly good at introducing the truth and good through immersing you into the beauty of the Church. Whether it is the environment of the church building, or the beauty of the altar, the clear teaching of the stained glass windows or the prayerful presentation of the works of Musical Masters within the context which they were originally created, each comes together to move the spirit. I have also discovered, perhaps for the first time in my life, the pure benefit of the sacrament of confession. I have also found the open access to the priests and brothers within the Canons to be beneficial as well.
Gordon: What initially interested you in studying obstetrics and gynecology?
Dr. Caruso: I went to medical school planning to be an oncologist. I had been inspired while in graduate school by a hematologist/oncologist and wanted to follow in her line of work. However, on my first clinical experience with in the oncology ward, and it did not click. I rotated through each of the clinical fields, and when I came to obstetrics and gynecology I found a field with much happiness and a good balance between medicine and surgery.
Gordon: Where did you have your residency and could you share with our readers the most challenging experience that you faced during residency?
Dr. Caruso: I started my residency in a county hospital in Long Island New York. The year I started, we were the first class in years that they had recruited that was made up of all American Graduates. While, at the time, I was a more “social” Catholic, I found myself sickened by the family planning rotation. While I never supported the idea of abortion, and they stated that they would respect that, I found myself in situations that would make it hard to avoid getting involved.
One might be the only one available and under orders to place laminaria, which was the first step in the termination protocol. They got around the objection by saying that the procedure was not a direct step in the process. At the time, I was a little more liberal, and grew up in the Kennedy era where the idea that while I would never support such activities myself, I could not tell someone else how to act. We did leave New York, however, before I would have had to do the actual family planning rotation
Gordon: What interested you in also pursing your studies in endocrinology and Infertility?
Dr. Caruso: For as long as I can remember, I wanted to be a doctor, and my mother would direct me to news stories that would stoke the interest in medicine. With that in mind, I was fascinated with the news reports when Louise Brown (the first IVF baby) was born and especially when Elizabeth Carr (the first American IVF baby) was born, as their family was from New England, where I grew up. In high school, I actually applied to work in, what turned out to be, the reproductive biology laboratory at the Massachusetts General Hospital.
I actually forgot about all this until I rotated through the reproductive endocrinology department at Rush Medical School when I was a resident. I loved the investigation and the possible happy outcomes. I also really liked working with the couples and the way in which the hormonal systems work together.
Gordon: When and why did you open A Bella Baby Obgyn and why did you choose St. Anne as you practice's patron saint?
Dr. Caruso: The idea which became A Bella Baby OBGYN was originally hatched after my “reversion” in 2008. I presented the idea of a practice which supported natural means or gently help in conception, did not offer artificial contraception or sterilization, and did not refer for abortion to each Catholic hospital in the area. Each gave me the same response; that the idea was interesting, but not financially viable. After some time, I was offered the opportunity to open the practice within the walls of my first practice, and we have been taking care of women here for about a year.
St. Anne, and Mary’s mother, held a special place in my heart. I have reflected on the childhood of the Blessed mother several times and know that she and her mother are praying for us here. St Gianna Molla is the other patron of the practice. As a physician and mother, she represents for me the idea in redemptive suffering.
Gordon: For our readers who my not be aware of how medical protocols are developed, could you provide us with an overview of what evidence-based protocols are, and how obstetrics and gynecology protocols may have evolved over the past several years?
Dr. Caruso: Medicine is thought of both as a science as well as an art. In order to see the best position one must be able to combine both of these ideals into a workable solution that’s discussed between physician and patient. Approximately 100 years ago, the art was the centerpiece of medicine. But since that time slowly but surely scientific investigation has led to new ideas about the best sort of treatments that may be available to patients. This is led to the explosion and therapies which are available. Indeed there are many journals there are only designed to communicate new research to each and every specialty that exists in medicine. In these journals of the results of research done in multiple different environments and multiple different countries even that provide new information.
Medicine is thought of both as a science as well as an art. In order to see the best position one must be able to combine both of these ideals into a workable solution that’s discussed between physician and patient. Approximately 100 years ago, the art was the centerpiece of medicine. But since that time slowly but surely scientific investigation has led to new ideas about the best sort of treatments that may be available to patients. This is led to the explosion in therapies which are available. Indeed there are many journals that are only designed to communicate new research to each and every specialty that exists in medicine. In these journals are the results of research done in multiple different environments and multiple different countries even that provide new information.
If we combine the information from some of the studies and find a pattern, then a new treatment to an improved treatment might exist. This is the center of what is called evidence-based medicine. The fear on modern medicine is that this might overtake the actual training of physicians and lead protocols that people can follow from any directive. But in general, for the most part it does seem to be improving the care and longevity of people.
Obstetrics and gynecology is a field that has changed greatly over the course of the last 20 years. Guidelines for the care of women have changed, as well as the way in which we approach pregnant women, young women, and women who are going through the changes of life. Perhaps the greatest changes in obstetrics and gynecology over the last 15 years center on the use of hormonal contraceptives to treat a multitude of benign conditions, with the ultimate effects of reducing a woman’s potential for pregnancy, and find new ways where they might encourage more people to perform medical and surgical termination.
Gordon: You also serve as Medical Director of the Women's Care Center in LaGrange, lL where you may have to address questions on the protection of human life. Based on your role as a national leading advocate for the protection of embryo/fetal life. What are, in your opinion, the factors that are affecting the attitudes of many couples' commitment to the protection of human life?
Dr. Caruso: My work with the multitude of pregnancy resource centers in the Chicagoland area, has showed me that there is a subset of women who find themselves in crisis pregnancies, who are actively seeking the support that will allow them to carry on the pregnancy and care for their children.
In my opinion, there are several factors involved in the decision that these women might ultimately make. The primary concern appears to be economic. There’s a concerned they will not be able to care for the children. It involves both fears of the future, as well as practical concerns about formula and clothing.
There is also the fact that many of these women have been with men who whether being scared or have a problem with commitment and abandon these women once if they know she is pregnant. This offers an additional pressure for these women, which can be addressed by the features of the centers.
The centers also offer the opportunity for these women to increase their self worth. They help them to learn parenting skills they give them support during the course of the pregnancies and they maintain a relationship with them throughout the pregnancy and beyond.
Gordon: There have been increasing concerns by the CDC and other national leaders on the risks associated with the Zika virus, and there have been increased pressure by some to abort the lives of those who may be infected. How are you and your colleagues planning on addressing this challenge?
Dr. Caruso: The current comments about the Zika virus have led to a confused outcry from many women of reproductive age who are considering or potentially open to the possibility of pregnancy. The question is what is the likelihood that any reproductive age one would be bitten by a mosquito that is carrying the virus.
Why I am very sensitive to the possibilities of Zika, I am also thoughtful of the other types of infections which can occur in pregnancy as well as the other viruses that can be carried by mosquitoes, such as the West Nile virus. There is some question as to how far North this particular mosquito will travel in the summer months, and I do believe the local communities will be fastidious in their insect abatement programs this summer.
While the Centers for Disease Control has stated that the virus is a cause of birth defects, it is relatively difficult to identify those who have been exposed, and there is no guarantee that if you have woman is bitten that the child will be affected. As I noted before, there are a multitude of infections which reflect of these women can contract that would be as dangerous or more.
I do believe that the response of the government and in the Centers for Disease Control is either indirectly or moderately directly designed to be in line with the population Council, and once again feed the social opinion that few or no children is the answer. Likewise I do believe it is possible with someone that may be so affected that if they visited a country which was thought to be in the Zica endemic areas, that they would just choose to abort the children rather than carry them. By do think this is a possibility, I think it is far more likely that these women are either contracepting before they go away, or will partake in contraception for a period of time before and after they traveled to these areas.
My own approach is to discuss the virus, how it is transmitted, and give them suggestions about how to avoid getting bitten by mosquitoes. I recommend that they regularly use a mosquito repellent that is safe for pregnancy, and avoid having standing water on their property. If they are bit by a mosquito that they believe is from an infested area, there is testing available, but I do tell them that they should consider this if they have concerns after being in the area. However I do believe this is a problem that isn’t as large as being portrayed, and it’s important we step back and really think about what it is we are recommending to people.
Here is the Catholic Bioethics Center's position on the challenges of Zika virus.
Gordon: Among your many specialties is the reversal of tubal ligation. Could you comment of the risks and success of this procedure?
Dr. Caruso: Reversal of tubal ligation is a procedure which I wish really we did not need. I do believe it is sad that so many women make a permanent decision early in reproductive life only to be in a future situation where they would like to make another choice.
Tubal ligation reversal is not as easy as doing the tubal ligation in the first place. It does require that the fallopian tubes have enough remaining to be successfully repaired. This may not seem to be a problem, but most tubal ligations are done with the idea that it is a permanent solution. As such they are done in a method that would make repair difficult if not impossible.
However, if there is enough fallopian tube to bring together the procedure itself is relatively major microsurgical procedure. It can be done in an outpatient basis using a procedure known as laparoscopy, or the very small incision. The biggest risks are of anesthesia, infection, and bleeding. There is also the possibility that the fallopian tube will not remain open. The area where there’s tubes are brought together may scar, and may make the tubes no more functional than they were before the procedure was done.
There is also a possibility that the damage may cause an ectopic pregnancy in the future. While it is not common, it is a risk that needs to be discussed prior to doing the procedure.
Once the procedure is done, if no pregnancy occurs in about six months, there is the recommendation to check for tubal patency and normalcy of the uterine cavity using a radiological procedure known as a hysterosalpingogram.
Gordon: Please share with our readers your experience with the side effects, risks of, and your position on in vitro fertilization?
Dr. Caruso: In vitro fertilization is a procedure which has revolutionized the reproductive world. To the people who have achieved pregnancy using this procedure, it is seen as a godsend. However, there are number of people who never conceived with this procedure, and they are largely left forgotten. These couples typically will travel between fertility centers seeking the match that might create an environment that would improve the chances of pregnancy. Unfortunately, there are some who will never find this outcome.
As far as a procedure is concerned, the first problem is that there is a significant number of drugs used in order to complete the procedure. Typically the woman is put on all contraceptives to time the beginning of the next medications. Then she is placed on one of several different types of medications for upwards of two weeks to create a number of follicles, which will be drained using a needle while the woman is sedated to isolate the eggs.
The significant problems that may occur in this point relate to the possibility of blood clots, the lack of ovarian response, the possibility that there will be a problem with the sedation, the fact that the ovaries may bleed once they are punctured, the possibility of vaginally bleeding.
in the laboratory typically the embryos are created using the sperm from the mail as well as the exit of been obtained through the aspiration. These are cultured for 3 to 5 days, and then a selection of these embryos is placed back into the uterus. While this procedure does have minimal side effects, the number of embryos placed can lead to perhaps one of the largest side effects of the procedure, which is multiple pregnancy.
A multiple pregnancy is considered an occupational hazard of reproductive treatment. Even if one embryo is transferred, there is a 1.5% chance that it will split and create a twin. Putting additional embryos into the uterus at transfer does increase the risk slightly. Guidelines have been created for the number of embryos to be transferred depending on the age of the woman. In most fertility centers these guidelines are typically followed, however there are times in which more aggressive treatment may be carried out. This comes at the attendant risks of multiple pregnancies.
Pregnancies that are achieved by in vitro fertilization, are also considered by most obstetricians as high risk. Both anecdotally as well as in studies IVF pregnancies show increased complications of every sort.
In vitro fertilization has created an alternative pathway for the marital bond. Whereas 50 years ago, many women married and children were generated from that union exclusively, we now see that any two people can come together and if they have the right gametes can achieve a pregnancy by some means and create a family.
Gordon: One final medical question which is often not discussed. How does diabetes impact pregnancy?
Dr. Caruso: Diabetes is an extremely interesting topic. The inability for the body to control sugar is one of the central long-term problems of the world. The first problem that comes from diabetes is the possibility that the abnormal sugar may make it difficult to conceive. Insulin resistance and diabetes are linked, and without tight control of the sugar pregnancy becomes what ethical to achieve.
If the sugar is uncontrolled and the patient becomes pregnant, there’s an increased risk of preterm labor, preeclampsia, as well as specific birth defects that are related to the diabetic state. While people have pre-existing diabetes might have a larger baby the normal, these babies tend to be smaller.
More common are people who develop diabetes while they are pregnant. This is typically determined in the second trimester. Most are treated with diet alone, but sometimes oral agents as well as insulin are administered. These babies tend to be larger, because the high levels of sugar across the placenta, which induced the baby’s production of insulin which is a growth hormone. As a result once the baby is born and the sugar is no longer being supplied, the sugar falls because the baby continues to make the high insulin and the sugar falls.
Gordon: Any predictions on whether the Cubs will win the pennant this year?
Dr. Caruso: I am rooting for a Cubs/Red Sox world series. It would have everything. The young upcomers for both teams, The ex= Red sox factor with Lester, Ross and Lackey, David Ortiz against Jake Arrieta, and the two most beautiful ball parks in baseball!
Gordon: I know that many of our readers will join me in thanking you for this interview and will pray for the protection and health of all pregnant women..