Did you do your Pap prayer?

An excerpt from Pet Goats and Pap Smears.

Joy is a vibrant twenty-six-year-old woman who comes in for a physical. On her exam, she shows me a worrisome mole on her left shoulder. I recommend she return for removal. After the excision, I call her back to my office for results.

“You have a melanoma. We got it just in time, but I’m sending you to a dermatologist who will perform a wider excision—just to be safe. You should be fine.”

She’s concerned, but relieved. “What should I do?”

“We don’t know the exact cause of melanoma. It’s not like other skin cancers. You can get melanoma in areas of the body that are not exposed to the sun. A friend of mine [the illustrator of this book] developed melanoma inside her vagina—on her cervix!”

“So what do I do?” she begs.

“Keep your immune system strong. Avoid sunburns and carcinogens. Eat healthy. We’ll do skin checks every year.” As Joy’s physician and friend, I’m also relieved. Melanoma can be fatal and metastasizes quickly. Had she waited a year, she could be dead.

Joy returns for her annual exams. It’s been four years since her melanoma removal.

I call her with results the following week. “Your Pap smear looks great, but your test for human papillomavirus (HPV) reveals a high-risk strain that can predispose you to cervical cancer.”

“What should I do, Pamela?”

“Don’t worry. Though ninety-nine percent of cervical cancers are caused by HPV, most HPV infections resolve spontaneously. And most sexually active adults have had HPV. It’s the most common sexually transmitted infection in the world.”

“Weird. A sexual infection can cause cancer?” she asks.

“Yes. HPV-induced cancers can occur in the vagina, vulva, anus, and penis. It’s also linked to cancers of the tongue, tonsils, and throat!”

“So what can I do to prevent getting cancer from the HPV infection?”

“There is an HPV vaccine that is approved for males and females age nine to twenty-six and is best given before any sexual activity. Since you’ve already been exposed, keep your immune system strong. Avoid smoking, alcohol, and carcinogens. Eat healthy. Be monogamous. The fewer partners the better! Come back next year and we’ll do your Pap and HPV test again. Your body could clear the infection on its own.”

“Is there anything else I can do?”

“Are you religious?”

“I have a spiritual practice,” Joy says. “One of the things I do is meditate. Sometimes at an altar, such as my love altar.”

“After your meditation, I’d like you to do a prayer to clear this virus from your body.”

“Great. That’s a wonderful idea.”

A year later, Joy is back for her physical, repeat Pap, and HPV test.

“How are things going?”

“Oh, I’m in love! We are living together and things are great!”

“Awesome, Joy!”

As I perform her exam, I share the latest breakthroughs in Pap smear technology. “Joy, when I first trained, we had to twirl a small wooden spatula around the cervix and smear cervical cells and mucus onto a glass slide. Then we had to spray it right away with lots of hairspray!”

“Yuck!” she says.

“It was disgusting. I spent years coughing up hairspray fumes after Pap smears.”

“But why hairspray?” Joy asks.

“It’s a fixative for the cells. But some samples were still not adequate for analysis at the lab. So we’d have to call patients back for another smear and spray.”

“Oh, that sounds awful,” Joy says as I’m doing her Pap.

“Now we use a liquid Pap test. We rotate this little wiggly broom around the cervix and then swish it in this container of preservative solution. The lab can retrieve as many samples as they need from the liquid. They can do your Pap and HPV test, plus test for gonorrhea, chlamydia, herpes, cystic fibrosis—all from this tiny jar!”

“Amazing!” Joy exclaims.

“And no hairspray!” I add.

As Joy gets dressed, I label her specimen, drop it into a biohazard bag, and hand it to her.

“Here’s your Pap. Take it home. Drop it off at the lab down the street in the next thirty days. You don’t need to refrigerate it. Place your Pap on your prayer altar. You and your partner can do a special prayer together every night to release the HPV from your body.”

“We’ll do it, Pamela!” she says.

One month later I call Joy. “Did you do your Pap prayer?”

“Yes. We did it every evening and it brought us closer together. I really appreciated that we were able to connect spiritually.”

“Great. You’ve got a normal Pap smear and no HPV!”

Pamela Wible pioneered the community-designed ideal medical clinic and blogs at Ideal Medical Care. She is the author of Pet Goats and Pap Smears.

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  • http://www.facebook.com/ninjanights Sara Livingston

    Riveting..I could not stop reading!! So many interesting stories and knowledgable information! Thank you sharing Dr.Wible! No wonder so many are so inspired!

  • elizabeth52

    I think women should take a look at evidence based programs, they are far better for our health and sometimes no testing is even better. I don’t share the unbridled enthusiasm for cancer screening and if it doesn’t meet my risk v benefit test, I’ll pass…I’ve found we can’t rely on official sources of information….often incomplete or/and misleading.

    The Finns have the lowest rates of this rare cancer in the world and send far fewer women for colposcopy/biopsy, their program produces far fewer false positives, since the 1960s they’ve had a 6-7 pap test program, 5 yearly from 30 to 60. The States and Australia both seriously over-screen which provides no additional benefit, but sends risk through the roof, they both have huge referral and over-treatment rates.
    The Dutch had the same program as the Finns, but will move with the evidence and introduce a new program…they’ll offer women 5 hrHPV primary triage tests at ages 30,35,40,50 and 60 and ONLY the roughly 5% who are HPV positive and at risk will be offered a 5 yearly pap test. Those HPV negative and not at risk can’t benefit from pap testing, and that’s most women, they’ll be offered the HPV primary triage program and there is also a self-test HPV device already in use (and being used elsewhere as well)…those HPV negative and no longer sexually active or confidently monogamous may choose to stop all further testing. Some older American women have had 35 or 40 pap tests, just absurd, and Australian women are still being pressured to have 26 or more…very poor advice that risks your health.

    The new Dutch program will save scarce health resources and identify the small number actually at risk (save more lives) while sparing the masses of not-at-risk women from a lifetime of unnecessary pap testing and the risk of a false positive, excess biopsy and potentially harmful over-treatment. (which can damage the cervix and lead to cervical stenosis, cervical incompetence, infertility, premature babies, miscarriages, c-sections and cervical cerclage etc)
    Using both HPV and pap testing on all women is wasteful, unnecessary, and leads to confusion and over-investigation, the HPV test should stand alone as the primary screening test for those who wish to test…and pap testing reserved for HPV positive women.
    Another major concern, there is no respect for informed consent in women’s cancer screening and that must change.
    I think this rare cancer has been used to justify a huge and harmful industry in the over-treatment of CIN, so much damage and distress has been caused to huge numbers and as Finland has shown, it was unnecessary, most of this damage was avoidable with an evidence based program and some respect for informed consent…and now there is no excuse, almost all of the damage can be avoided by offering women an opportunity to find out whether they are at risk and might benefit from a 5 yearly pap test…am I HPV positive or negative?
    Why would a HPV negative women wish to endure a lifetime of unnecessary pap testing and the risk of a false positive and over-treatment?

    Excess is harmful…also, using coercion (no Pill without pap tests) to force women into testing should be stopped…this negates all consent and is way beyond unethical…all cancer screening is elective and carries the legal and ethical requirement of informed consent.
    No country has shown a benefit pap testing those under 30, but young women produce the most false positives – these rare cases will occur whether you screen or not. In Finland and the Netherlands young women are properly advised, they are advised to see a doctor with any persistent and unusual symptoms. HPV testing is not recommended either as 40% of those under 30 would test positive, almost all are transient and harmless infections that will clear within a year or two, at age 30 only 5% are HPV positive and these are the only women who can benefit from a 5 yearly pap test.
    Women should look at the evidence for routine pelvic and breast exams, neither are recommended here or in many other countries, I’d have refused them anyway – the routine breast leads to excess biopsies and there is no evidence of benefit and the routine pelvic exam is of poor clinical value in asymptomatic women and carries risk, even unnecessary surgery, it is not a good screening test for ovarian cancer. Your Dr Carolyn Westhoff partly blames this exam for your high hysterectomy rates and the loss of healthy ovaries.
    Women need to be terribly careful negotiating the medical world and find a doctor who’ll work with you and operate in your best interests.
    HPV Today, Edition 24, sets out the new Dutch program – registration is required and is free.

    • PamelaWibleMD

      Excellent review of information. You certainly have my attention and will now research what cancer screening programs have been instituted in other countries. Fascinating & much appreciated!

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