Medical Monday: Breaking News from the World of Obstetrics and Gynecology

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The Graham-Cassidy Bill leads the policy news this week. This is the GOP's last ditch attempt to repeal the ACA (Affordable Care Act). It has been simplified down to one key point : redistributing Federal funds for Medicaid expansion and insurance subsidies as State block grants. The bill was introduced by two GOP Senators, Lindsey Graham of South Carolina, and Bill Cassidy of Louisiana, and with support from others. 

During the week that the Graham Cassidy bill has been around, it has been scrutinized. The Kaiser Foundation has determined that the redistribution of funds in those plan would be quite unequal between States. Consider that different States expanded Medicaid more than others, and some did not expand it at all. What States would stand to have taken away would therefore vary. Overall Federal spending on health care would drop by more than 100 billion dollars between 2020-2026 under this plan. Many physician groups have also criticized the plan. Most notably, ACOG (the American College of Obstetricians and Gynecologists). Eleven Governors including some from the GOP have come out against the bill as well. 

It is unclear if there will be enough votes to pass this bill. More than 50 are needed. Toward the end of the week Senator John McCain has stated he will not support it, and that alone may doom it. Remember that Senator McCain was recently diagnosed with brain cancer this last year, and is therefore deeply involved in the health care world. 

The deadline to pass this bill is September 30th. But it will only be brought to the floor if it is determined beforehand that it will pass. This deadline is needed in part because insurance companies and insurance commissioners need to settle on rates which the commissioners will approve and that will keep the insurers solvent. 

The Iowa legislature voted to forego Federal Funding just so they could deny funding to Planned Parenthood. Now the Iowa Department of Health and Human Services is beginning a collection of data about the effects that this is having. They are trying to determine if defunding Planned Parenthood has reduced access to reproductive health services for Iowans. Seems bass ackward to me. 

In a interesting and positive turn, State Senator Ray Ward, a Republican out of Bountiful, Utah  has proposed a bill that would allow Utah Medicaid recipients to have a postpartum IUD placed while they are still at the hospital. This would bring the red state in line with all but 6 other states which lack this law. 

On to the medical news. 

How bad is the opioid crisis ? It is so bad that death from opioid overdoses is skewing our life expectancy gains statistics. 

Women and opioids are a special case. It turns out opioid addiction and sexual violence are closely linked. In these cases, police are seldom called due to the presence of the drugs and fear or retaliation. 

Speaking of drugs, ACOG has come out with a new Committee Opinion. In this latest document, they have stated clearly that pregnant and breastfeeding women should not use marijuana. 

In the this-makes-perfect-sense department, a new study out of Harvard has shown that adequate sleep and adequate support protect against postpartum depression. That said, even those with high levels of support can get postpartum depression. For example, Ivanka Trump has recently shared her story of postpartum depression. 

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An insulin pump may give better control to pregnant diabetics than conventional prick and inject methods.We currently use insulin pumps in non-pregnant diabetics, but have not until now, seen evidence about their use in pregnancy. 

There was a recent Apple event with new product announcements. In it, mention was made of the Apple watch, and the app called Health Kit, and their potential for ultimately helping patients like diabetics. Fast forward only a few days later when I attended Stanford MedX conference. We heard from a young diabetic woman who solved her own problem. Using small cheap components and a little home built computer set up called raspberry pi, she combined a blood glucose sensor with some dosing software and an insulin pump to create her own “ artificial pancreas”. We heard her presentation as an example of what an empowered patient could do. Empowerment plays a huge role in healing. 

The opposite of empowerment is psychological trauma, with resultant PTSD. It turns out that this sort of thing significantly increases one’s risk of being diagnosed with lupus. Lupus is a serious autoimmune disorder characterized by inflammation of the joints and many other tissues. According to a study published in the Journal Arthritis and Rheumatology, trauma even without PTSD are than doubles the risk of getting the disease. Those with PTSD are three times more likely than their peers to get lupus. Nearly 55,000 women’s questionnaires were examined over a 24 year period. This news reinforces the already widespread advice that stress management is important. 


Stay tuned for more exciting news from the world of Obstetrics and Gynecology, next week, on Medical Monday. 


Wellness Wednesday: Post Election Stress Disorder

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PESD is not a diagnosis listed in the DSM-5, the widely used manual of psychiatric diagnoses. And yet professionals and ordinary people are seeing it. The morning after the election, I saw and heard about it everywhere, from people on both sides of the aisle. Yes, that’s right, from both sides of the aisle. 

I have heard from hither and yon that people felt that our presidential election was a choice between lesser evils. How sad and disturbing to wake up and have a lesser evil for your President elect. How sad to have members of a family or friends fighting, arguing and estranged. 

While there may not be such a thing as PESD, there certainly is PTSD, and the signs are clear: 

  • sleeplessness
  • undue tearfulness 
  • nightmares
  • intrusive memories of past traumas
  • disinterest in food or inability to eat

Women have been particularly affected. Regardless of politics, no woman has supported Trump’s vulgar and abusive treatments of women. To seat him in the highest office in the land has made many of us feel vulnerable, on an institutional and cultural level. Election is endorsement, and endorsement is usually approval, though in this election, it certainly has the feel of concession. Events of this campaign show that while our society has made great strides toward fairness and decency towards everyone including women, sexism is still alive and well. 

Today’s sexism is not as bold as it once was. Nowadays, it can be workplace bullying, or being passed up at meetings or for raises. It is unwanted subtle advances. It does not have to be “pussy” groping, though now that has officially been recategorized at the highest levels as “locker room talk”. It is being made to feel odd because you were a girl who was also a math and science nerd. 

Lucky for you, I am a math, science and numbers nerd. And I don’t feel the least bit odd. Here is what the numbers had to say, before the election even took place: 

  • 10 % of women suffer from PTSD. 
  • 31% of women suffer form an anxiety disorder
  • 12% of women suffer from depression
  • 25% of women will experience a sexual assault in their lifetime
  • 33% of women report having experienced sexual harassment in the workplace
  • 100% of women report experiencing some type of sexual harassment in their lifetime. 

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Are we women really doing so well ? The number are roughly half this for men for PTSD, anxiety and depression. The election has caused us to collectively and individually revisit much of what has troubled us.

What to do ? 

First of all, this needs to be taken seriously. It needs to be taken seriously on a personal and a societal level. If you know someone who was derailed by the election, make yourself available. Practice empathy and be a good listener. Do not debate politics, or ask about the the innermost workings of their mind or heart. Suggest general stress reduction techniques like regular meals, exercise, yoga, and sleep. Suggest a visit with a counselor or physician if there is genuine disruption in health or regular life activities. Do not force a plan on them. Do not add to their overwhelm. I am guilty of constantly trying to fix people even if what they really need is space. If you try to help too much, it feels like you are trying to take control and this is disempowering, pretty much the last thing they need.  

I learned a new phrase when researching this post. It is, HOLD SPACE. This means to create a safe space for someone, a space where they will not be judged, and where no one will try to change them. It is space where they can be heard. It is unconditional support. I will be researching this gem of a concept further. 


Have a better week. The holidays are coming. Take some time to plan to make them low stress and lovely. 


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