Medical Monday: Breaking News from the World of Obstetrics, Gynecology and Women’s Health

ZIka virus news continues to be front and center. Zika virus causes an illness which is usually mild or moderate but is strongly associated with the development of a severe birth defect known as microcephaly. It is also associated with a post illness paralysis called Guillaine Barre.

This weeks changes include new mandatory reporting of confirmed case for all states in the US. Calls for Zikus virus research funding are being made. The WHO ( World Health Organization) has declared that the virus is spreading explosively. They have convened an emergency meeting, and in a rare move, has declared the virus a global health emergency. Brazil is the worst affected, the over 4000 cases of microcephalic babies born through the end of January.  Additionally Brazilian health authorities are fearing a wave of illegal and unsafe abortions among women who have no access to contraception or insecticide. Florida has declared a health emergency over Zika. Health workers in Texas have confirmed the sexual transmission of the virus. 

Brazil is using the military to spread insecticide.Two vaccine approaches are underway but will not likely be ready this year. Additionally genetically engineered mosquitos are being released into the wild, to sharply reduce the mosquito population. The US Senate plans to meet about the outbreak and plans to work closely with ACOG ( The American College of Obstetricians and Gynecologists) to address the problem. 

In other news, ACOG has issued a statement urging Ob/Gyns to support new mothers whether they breastfeed or not. In the same brief, it continued to advocate for policies that support a working woman’s right to breastfeeding. 

In more breastfeeding news, the Lancet has reported research indicating that if “nearly every new mother breastfed, that more than 800,000 children’s lives would be saved each year and that thousands of future breast cancer deaths would be avoided." Compelling ! 

Stay tuned for more breaking news from the world of Ob/Gyn. Thanks for reading !

Wellness Wednesday: The Medicine Cabinet

A well stocked medicine cabinet will help your family feel their best. It will also help them get better more quickly from everyday ailments like colds and minor injuries. Here are some dos and dont’s you will want to know when playing doctor. 

First the dont’s. 

• Don’t keep any out of date medications, prescription or otherwise. 
• Don’t disregard handling instructions. Some prescription medications require refrigeration. 
• Don’t store medications of any kind in unlabelled bottles. Throw out anything whose identity is the least bit uncertain. 
• Don’t fail to take your whole prescribed course of medication. You will not get better as quickly. Even worse, in the you may foster the development of antibiotic resistant bacteria. Think about it. If you only take the first 4 days of a seven day course of antibiotics, you will kill all the easily killed bacteria, and leave the more resilient ones to repopulate your body. If you take all your medications correctly, you should not have any “ left over” in the first place. 
• If you had surgery or an injury, and you were prescribed narcotic pain pills, use them only when you need to. If you are better and no longer need them, dispose of them. Don’t keep them just in case. 

How do you dispose of old medications ? It turns out this is not as easy as it sounds. 

Check out this comprehensive guide from the Food and Drug Administration. 

http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm101653.htm

Now the Do’s 

Do have simple non-narcotic pain relievers handy and in their original bottles.

• Acetaminophen, aka tylenol for aches, pain and fever. Can be taken on an empty stomach and during pregnancy. 
• Ibuprofen, aka motrin or advil also for aches pain and fever, but with an anti-inflammatory component as well. Should not be taken on an empty stomach or during pregnancy. 

Do have upper respiratory remedies. 

• Nasal decongestant for daytime (These are non sedating.) 
• Nasal decongestant for nighttime. (These can be the sedating ones)
• Cough suppressant i.e. dextromethorphan 
• Zinc containing cough lozenges which are low on sugar. 
• Lots of herb teas and broth mixes for hydration. 
• Lots of kleenex, and a reliable thermometer. 
• A peroxide containing mouthwash for use after brushing and flossing, but just before bed. (Key to prevent and kick those sore throats ! ) 

All of these measures will actually help you get better more quickly as well as provide comfort. Most upper respiratory infections are viral and self limited and do not require antibiotics. However,  but if one is bad or persistent, call your doctor. There is no reason to hesitate. 

For allergic reactions: 

• Benedryl capsule in case of a minor allergic reaction like rash. They are sedating. 
• EPI pens if anyone has a serious allergy or asthma or lives in a place where there are bees or other stinging species (OK everyone should have an EPI- pen in their house.).  Consult with your doctor about this since they will need to order it. 

Stomach rememedies are trickier.

• Tums or Rolaids are not the best for heartburn, since they are calcium carbonate. These give short term relief of stomach acid, but then go on within the hour to stimulate the production of more gastric acid. Try prilosec OTC. Speak to your doctor if stomach acid symptoms are more than a rare event. 
• For loose stools, do not automatically turn to Lomotil. You can make yourself sicker this way. The cause of lose stools must be determined before a motility lowering agent can be given.
• DO push liquids by mouth and by soaking a tub of water to stay hydrated until you can get care and get better. Liquids which contain a little something ( electrolytes, sodium, sugar) are best. Think broth or soda water with fruit juice. Elelctrolyte replacement drinks are ideal. 

For skin, eyes, hair and teeth : 

(All these should be junk free, and by that I mean free of artificial fragrance, coloring, etc)

• Gentle cleanser 
• Gentle exfoliating scrub 
• Moisturizer for face and some for body; For body I prefer a mix of cocoa butter and coconut oil. 
• Alpha hydroxy acids are evidence based treatments for the younger set.
• Retinoids and vitamin C serums are evidence based treatments for the over 40 crowd.
• Strong water resistant sunscreen in plentiful quantity, as well as sunscreen lip balm. 
• 1% hydrocortisone cream for minor rashes where skin is intact. This will suppress itching but impair healing, so use it sparingly and wash your hands afterwards. 
• Eye moisturizer in little sterile vials for dry eyes or to help with removal of a foreign body, 
• Bandaids, tape, gauze, antibiotic ointment for cuts and scrapes. You do not need alcohol for wounds, or even peroxide. Minor wounds are best cleaned with warm soap and water. Anything more extensive goes to the doctor. 

Did you know oral health is key to avoiding other illnesses ? Do stock the following: 

• Toothpaste with fluoride and some grit 
• Wide waxed dental floss for use every night, maybe even when you are in the shower. 
• Peroxide containing mouthwash

For Hair: 

• Shampoo, used gently and only at the scalp if your hair really needs it ( Dry hair does not ! ) 
• Conditioner, every time, for all hair types. 

This should be a good start to your well stocked medicine cabinet. 

Next week we will have a little more fun and talk more in depth about hair health. 

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

The Zika virus continues to spread. There is increasing evidence that Zika infection causes microcephaly in the unborn as well as post viral paralysis Guillaine Barre syndrome. Every day there is new information about the outbreak, and the CDC ( Centers for Disease Control) is the best place to learn about it.

Unfortunately, there is yet no hint about treatment, and a vaccine is 1-2 years the making at best. The WHO ( World Health Organization )has warned that ZIka is likely to spread to every country in the Americas except Canada and continental Chile. As of this last Friday, January 29th,  the World Health Organization has reported 31 cases in 11 United States states and 1.5 million cases in Brazil alone. The WHO estimates that the virus could affect 4 million people by the end of 2016. About half of those will be women and an unknown percentage of those women will be pregnant.

In other news ACOG, the American College of Obstetricians and Gynecologists, has updated a “ Committee Opinion” which it distributes to all of its physician members. According to lead author, Dr. Allison Stuabe, "the goal is for OB/GYN's to own breast-feeding as a part of reproductive physiology”. The paper advocates that breast-feeding support should begin during prenatal care when breast-feeding can be discussed in clinic. Breast-feeding is still underutilized in this country and the world over. 

The American Heart Assoication has issued a report saying that “heart disease remains undertreated and under diagnosed in women”. It goes on to explain that "The causes and symptoms of heart attacks can differ markedly different between the sexes". Compounding problems is that “ women are under represented in clinical trials for heart disease ", occupying only about 1/5 of the slots. Moreover the report indicates,"even when women are included in trials, researchers do not often parse out the gender specific data that could deepen scientists understanding of how the disease affects women”

Last year the Gynecology community was startled by the revelation that ovarian cancer is now thought to originate in the Fallopian tubes. Accordingly, ACOG made a recommendation that they be removed in the course of surgery for other benign indications. However, a new study through Yale indicates that only slightly more than 5% of eligible surgeries utilize this recommendation. In all fairness, this is relatively new information and the efforts to disseminate it were fairly modest. Additionally taking the tubes out takes extra time at surgery and entails a certain amount of extra surgical risk. I was once told by an old professor of mine that it was not good to be either the first one on the block or the last one on the block to adopt a certain new surgical technique. 

This time the USPSTF (The US Preventive Services Task Force) has done something right. They have come out with a strongly worded recommendation to screen all adults for depression. They have gone on to particularly mention the need to screen all pregnant women and new mothers. They are basing this recommendation on new data indicating that maternal mental illness is more common than previously thought. New research indicates what has been called postpartum depression may actually begin during pregnancy and that left untreated these mood disorders can be "detrimental to the well-being of children". It is interesting that in the past the USPSTF has required proof of benefit to recommend any given intervention. Maybe today's announcement is a sign they will also begin using common sense.

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

Wellness Wednesday: Winter Skin Care

Most people know to be careful about skin care in the summer. But did you know the winter poses special challenges as well ? Take a look at these facts and recommendations to winterize your skin care. 

Facts: 

• Despite snow, humidity in the winter air is often quite low, drying out the skin. 
• Glare from white snow on an overcast day can produce UV damage comparable to bright sunshine. 
• Indoor heat from any source is drying to the skin. 
• Winter wind is especially drying. 
• Skin can get so dry that is peels and cracks, making it vulnerable to becoming inflamed or even infected. 

Recommendations: 

• Cleanse more gently in the winter. Do not use a lathering wash. Get rid of harsh astringents. Exfoliate less frequently and more gently. Do not use hot water, only warm, and limit the time of baths and showers which can strip skin of natural oils. 
• Apply a more substantial skin protection and moisturizer in the winter. Chose an oil based, rather than a water based moisturizer since they are more protective. According to the American Academy of Dermatology, lotions and creams containing olive, shea and jojoba are helpful. Lanolin and glycerin are also helpful. My favorite is a mix of cocoa butter and coconut oil. 
• Wear sunscreen as a matter of policy. Use actual clothing or fabric to protect the skin in the winter outdoors. 
• Change out of wet socks and shoes promptly as they can be very irritating to skin. 
• Wear a nonirritating layer between skin and wool. 
• Control your indoor environment. Avoid baking yourself by the fire (guilty!). Consider a humidifier (but don’t let moisture build up on your windowsills). 
• Stay hydrated. Ensure your diet has enough healthy fat in it, i.e. olive oil, nuts, avocados, etc. 
• Consider skipping shampoo unless your hair is dirty or oily. Do use conditioner. 
• Chose a lasting lip balm for lips.  
• Don’t forget to get some eye drops for dry eyes.

Happy midwinter. 

references:

https://www.aad.org/public/skin-hair-nails/skin-care/dry-skin

http://greatist.com/health/healthy-winter-skin-hair

Medical Monday: Breaking News from the World of Obstetrics, Gynecology and Women’s Health

Good Monday.

Zika virus takes front and center this week as the CDC (Centers for Disease Control) has issued a travel alert "urging pregnant women not visit Brazil and about a dozen other countries in the region where mosquitoes have spread the Zika virus.” As of Friday the list of countries includes “ Brazil and 13 other countries and territories in Latin America and the Caribbean: Colombia, El Salvador, French Guiana, Guatemala, Haiti, Honduras, Martinique, Mexico, Panama, Paraguay, Suriname, Venezuela, and Puerto Rico. This is especially unfortunate since Brazil will be the site of the summer Olympics this August.

Zika virus is spread by mosquitos. Women who are infected by it have symptoms such as fever, rash, muscle aches and pink eye. If they are pregnant, their unborn babies are at high risk to be infected and born with microcephaly, a condition where they are born with abnormally small heads, small brains, and often a short lifespan. Women who have been infected by Zika virus cannot spread it to other women since it is spread by mosquitoes. 

Concern has been raised about an association between Zika infection and post viral Guillaine Barre Syndrome. This is a post viral paralysis that is usually self limited. Researchers in Brazil have noticed a significant uptick in the incidence of this syndrome and estimate that the Zika infection raises the odds of getting Guillaine Barre about 20 fold. 

El Salvador has been hard hit with this virus, documenting nearly 5400 cases so far in 2015. Pregnant women have been advised to remain fully covered to avoid getting bitten. Imagine the apprehension that is going to develop over this. Salvadoran authorities have also advised women to refrain from getting pregnant for the next two years.

So far pregnancy, travel and clothing restrictions are some of the only measures I have heard of to prevent spread. Additionally, genetically modified mosquitos are being produced to reduce the mosquito population in affected areas. 

Aside from the sheer gravity of the situation and these recommendations, it is interesting to consider the societal consequences of a span of time with NO BIRTHS for 2 years. 

All of the other news pales in comparison to this, and so I am going to leave you with the thought that Big Pharma all over the world is doubtless burning the midnight oil trying to cook up a drug or a vaccine. Let us pray they succeed. 

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

Good Monday. We start out with good news, noting findings reported at the World Diabetic Congress that those who breastfeed have a substantially lower risk of developing type two diabetes later in life. 

Northern hemisphere readers will note that the CDC ( Centers for Disease Control) has reported that this year's flu activity, so far, is relatively low. They also note that slow starts aren't unusual and those that haven’t yet gotten a flu shot should get one, especially since this year’s vaccine is good match. 

USPTF (The United States Preventive Services Task Force) has once again released it’s version of guidelines for breast cancer screening. They are, predictably, lax, and recommend individualization for women of average risk before age of 50, and every other year between 50 and 74. They have chosen this age range of screening since they state their data show this is the age range “ of greatest benefit” from mammograms. This is no doubt true since this is when most cancers are diagnosed. However, what they cannot seem to understand is that women want ALL the benefit that mammograms can confer. Think about it. Their recommendations would condemn any woman below 50 of average risk to having her cancer detected only when it became palpable. Of course mammograms detect them far earlier, when they are more curable. 

Women want ALL the benefits mammograms can confer, and yes, they understand all such diagnostic tests must be weighed against their risks. But in this case, the risks are so small. They are the risks of biopsies for concerning findings which come back negative for cancer. They are also, according to the USPTF, the risks of fear and discomfort of the procedure. I have seen two and a half decades of patients and I have never heard one patient cite these risks as even coming close to outweighing the benefit of screening for cancer. Where does the USPTF get the idea that these particular risks are so important or that women even care that much about them ?

The good news is that the controversy has hit the airwaves and the blogosphere. NBC, the Washington Post, the NY Times, and Newsweek, among others, all covered it. ACOG (The American College of Obstetricians and Gynecologists) maintains a recommendation of annual mammograms after 40, and the American Cancer Society recommends annual mammograms from 45 on. ACOG plans to convene a conference to sort out the issue once and for all. 

Group B strep is an important pathogen for moms and newborns. A new vaccine against it is under development. 

Big news: Ovarian cancer actually seems to arise in the tubes. The data for this is sufficiently compelling that ACOG is recommending removal of the tubes with preservation of the ovaries when applicable. 

The CDC reports that the average age of first time mom’s is at an all time high, being 26 years and 4 months. This can be attributed, at least in part, to fewer teen pregnancies. 

In sobering news, a new virus called Zika is causing birth defects in the Caribbean and South America. It is spread through mosquitos. The CDC may warn pregnant women not to travel in that region. I’m sure we’ll hear more about efforts to deal with this in the near future. 

The effort to develop personalized vaccines to treat ovarian cancer is in the early stages. This work is on the desk of the FDA as we speak. 

Wow, so much happening ! Stay tuned for more breaking news from the world of Obstetrics and Gynecology next week on medical Monday. 

Food Friday: Staples of the Fridge and Freezer

As promised, this week we are going to see how the healthy fridge and freezer look. The lists below are my idea of what you will need to put together healthy meals and snacks all week long for you and your family.

Take a critical look at your fridge and freezer. How healthy are the contents ? Can you tell what the contents are, or how old they are ? Let’s hope so, otherwise send it to the compost. Take a gratifying step further and clean out the whole refrigerator. Here are some tips to having what you need, being sure of it’s safety, and making it easy to prepare healthy meals and snacks. 

• Shop twice a week
• Buy only healthy items such as those listed here. 
• Make a deliberate point to use what you buy. Do not plan a meal without looking in the fridge first. Factor in the what needs to be used as well as the balance of the meal. Do not, however,  be tempted to save a couple bucks and use questionable items. 
• Make sure to have a set of good clean containers to use for subdividing bulk purchases and for storing leftovers. Containers which hide their contents tend to go unused and spoil. 
• Have a couple sizes of ziplock bags also for subdividing bulk purchases and for storing leftovers. Sometimes it’s easier to store things this way instead of in a giant clear box. 
• Label and date all your unlabelled containers. 
• Search for recipes or even techniques which use your healthy ingredients, and keep them simple. 
• Use your freezer to enhance your nutrition. Buy good food on sale, in bulk and in season, divide it strategically and freeze it. 

Here are some healthy contents which should be in your fridge and freezer. 

The freezer

nuts: i.e. cashews, pecans, almonds, walnuts

pestos in ziplock bags

frozen concentrated juices i.e. orange juice concentrate for sauces

chili paste, clearly labelled

coffee or cacao (raw chocolate) bean

bags of frozen fruits, home made or store bought, for pie, cobbler, tarts, smoothies

frozen vegetables such as corn and peas

fish, meats, poultry, in bulk or divided by you into single servings

bulk items like ziplock bags of garlic cloves

ziplocks of good leftovers which you can’t use quickly enough

dried fruits which are moist and apt to spoil

cheeses : block parmesan, shredded cheddar, shredded parmesan

ice creams and sorbets

The refrigerator

Dairy:  

milk, half and half, cream, butter,

certain oils like toasted sesame  

soft cheese: cottage cheese, cream cheese, ricotta, mozzarella

hard cheese: cheddar, pre-sliced and shredded, shredded real parmesan

eggs- at least two dozen

Meats, poultry and fish which are thawing, marinating, preserved, or leftover. 

Cultures for home made yogurt, yeast to make bread

Vegetables:  

salad greens like romaine, spinach, arugula, cooking greens like kale and chard,

Hard vegetables like carrots, beets, cabbage, broccoli, asparagus, zucchini, cucumbers,

red and other various colored peppers

vegetables ad infinitum  

Fruits:

Strawberries, blackberries, blueberries, other soft fruits like pitted fruits, i.e. peaches, apricots, etc (Tomatoes, bananas, apple and oranges are stored at room temperature ) 

Condiments:

pickles, sweet and dill, olives, ketchup, mustards, mayonnaise, salad dressings, opened jams, jellys, chutneys, salsas, Worchestershire sauce, soy sauce, Siracha or other hot sauce, lime and lemon juice, fresh ginger, garlic

It takes some time to adjust your meal planning, cooking and eating habits to include all the good things all of the time and very few of the bad things very seldom. But having fridge, freezer, and pantry filled properly will help. It is also necessary to realize that healthy eating takes a little extra time at first. But healthy cooking, once learned is minimalistic simple cooking, and can be made to be very time efficient. 

I hope these lists will help healthy eating become easy and enjoyable. 

Wellness Wednesday: Workout Shoes

Since last week’s Wellness Wednesday post, you have all, no doubt, done your week long analysis of how you spend your time. I trust you have been able to scrounge up 30 minutes per day, 6 days per week, for some real exercise.

After time, the next thing you’ll be needing is decent exercise shoes. So I thought I would make a brief post about choosing workout shoes, which should pique your interest in studying the matter further and help you steer clear of expensive trendy nonsense. 

I have consulted the world renowned authority Footlocker. No, actually, the American College of Sports Medicine has put out some nice pamphlets which I will share with you, and you will have the knowledge you need. Before those links I’d like to throw out a few factoids to, as I said, get you interested. 

• 85% of people wear shoes which are too small. 
• Shoes should be purchased later in the day when feet are the largest. 
• Running shoes should have minimal drop between the heel and toe. 
• Excessive padding, “ motion control” or “ stability” components interfere with a normal foot's motion, but those with flat feet may need “ motion control” shoes. Those with very high arches may need more cushioning. 
• A woman’s shoe of size 8 or less should weigh 8 ounces or less. 
• Pronation while running is normal; it is a natural shock absorber. Stopping normal pronation may cause foot or knee problems.
• There should be at least half inch between the toes and the end of the shoe. 
• Running shoes need to be replaced every  350 miles or so. 
• When you buy new workout shoes, break them in gradually. 

Links: 

ASCM information on Selecting Running Shoes

ASCM information on Selecting and Effectively Using Running Shoes

Next week in Wellness Wednesday: Workout Clothes

Have a great week !

Wellness Wednesday: Time and Goals

We each have goals. What would it be like to accomplish them ? What would it be like to accomplish a lot of them ? Some people do. These are people with good time management. 

It occurred to me that before I discuss exercise on this Wellness Wednesday blog, I should discuss the one thing my patients say they need before they can exercise: more time. We all have one lifetime of time. What matters is how we use it. Everyone knows this, so what is the problem ? 

Most people are not fully aware of how they spend their own time.

They are not as factually familiar with how they spend each hour as the think they are. I have found that everyone thinks they’re busy, and everyone thinks they're active. People are less sure if they are efficient in their day. This is the territory I suggest we explore at this point in the New Year. 

We are talking about time management. Have you ever had a class in this ? Few people have. It seems like it would be a good idea right at the beginning of high school. Or how about right now, in the blog post ? 

Here is your mini class on time management, complete with some handouts and homework. 

• Obtain a notebook to document this process. 
• Record your present schedule, down to the hour, for one week. Include everything from housework to Facebook. Wear a watch all week so you will have realistic estimates of time. 
• Make a list of goals, for the week, month, quarter, year and five years. 
• Order the goals by priority.
• Assess your week long log and see where you are misdirecting or wasting your time. 
• Realign your schedule with your priorities. Include a spot for 30 minutes of exercise 6 days per week. 
• Record what happens the next week and repeat. 

Now this is a VERY simplified version of a time management class. It is, however, the essence of the process. It only works however, if you are absolutely truthful with yourself about how you spend you day’s time and absolutely truthful about what you really want. 

I hear so much about not “ having enough time” to exercise, or to shop for healthy food, or to prepare healthy meals, that I decided to address it head on. 

For those interested in more, there are really so many great resources on the web, from Lifehack.org, to books by Harvard Business Review. 

Here is a one page handout on the subject. Click on the title below to download. 

"Time Management" from the Stanford Center for Teaching and Learning

For extra credit, here is an awesome self assessment and time management tool from University of Kentucky. Click on the title to download. 

"The Successful Person's Guide to Time Management"

This should be be printed, filled out and used. 

Class is dismissed. Homework is due next week! I’d love to hear how you do. 

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

Good Monday and Happy New Year. ACOG (The American College of Obstetricians and Gynecologists) has once again reiterated the newer recommendations regarding cervical cancer screening. They have stated that “ Women ages 30 to 65 at "average risk" for cervical cancer should receive co-testing with cytology and HPV testing every five years or screening with cytology every three years”. ( Cytology just means sending cells with a pap and co-testing means DNA testing for HPV, Human Papilloma Virus via the same sample.) I would like to emphasize a couple of aspects of this statement: the phrase “ average risk”, and the idea that they are talking about sending specimens to the lab. 

Average risk is not precisely defined, and this is ok, since it gives clinicians room for applying clinical judgement to individual patient cases. Average risk does not certainly include those patients, who are by virtue of disease or medication, immunocompromised. It does not include those who have recently had precancerous cells in the cervix, vagina or vulva. In my opinion it does not include those who have a significant smoking habit, since smoking is tightly associated with accelerating the progress of HPV disease. I do not believe average risk includes those with alcohol or drug problems since these patients can have poor immune function and struggle with satisfying recommended follow up protocols. In my opinion, average risk also should not include those with high risk sexual habits, such as having unprotected sex or large numbers of partners. But does the media ever highlight any of these things ? I have not seen it. 

These ACOG recommendations are about the recommended sampling frequency for cells on the cervix. They are not a statement about the frequency of annual exams or even pelvic exams. Those proceed on their own schedules for their own separate indications. The media has not done a good job at highlighting this important distinction. After all, a woman is more than just her cervix. 

The Journal of the American Medical Association (JAMA) has received a request from a group of researchers to retract their own study from the Journal on the grounds that they have discovered that the lead researcher has falsified data about the usefulness of nitroglycerin for improving bone density.  Kudos to those whistleblower researchers. 

South Carolina Department of Health and Environmental Control (DHEC) will revise its regulations concerning the practices of licensed midwives, what we call lay midwives, meaning those who are not Certified Nurse Midwives. The DHEC was picketed by about 50 midwives. ACOG has said that while women deserve the right to chose where they deliver, they should be informed of the risks and benefits of the choices, including the two to threefold risk of neonatal death while delivering outside the hospital. (This data came from a study reported in the New England Journal of Medicine (NEJM) and involved a study of 80,000 pregnancies in Oregon.)

Let’s think a little more about that statistic on neonatal death. Neonatal death is defined as the baby dying in labor or in the first month after birth. Why would such a terrible thing happen in the hospital ? High risk pregnant patients come to the hospital. High risk mothers may have very early labor, ruptured membranes, or severe preeclampsia, all resulting in deliveries so early that babies are far more apt to die or have serious morbidities. This is the source of neonatal death in the hospital, not the average pregnant women who comes in for labor or induction.  On the other hand, most licensed lay midwives restrict their practice to low risk patients, with none of these aforementioned problems. And yet many more of their patients end up with dead babies, despite the fact that hospital caregivers are dealing with these sometimes insurmountable obstacles. Problems which are solved by a simple medication in the IV, or the use of forceps, or even a C Section in the hospital, result in death when the same problems occur outside the hospital.

Speaking of neonatal death being two to three times more prevalent among those who birth at home, did you ever consider that this is a group average ? What happens when you unpack that group ? It turns out that first timers delivering at home have a 14 fold increase risk of first apgar score of ZERO, which is tantamount to neonatal death. And while the multiparous patients (women with multiple prior births) may do better with labor, they are much more prone to hemorrhages and other maternal complications, which are not even addressed in this statistic. 

So beware of the medical reporting in the popular media. Don’t take those statistics at face value. Remember the actual human realities behind them. 

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

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

Medical Headlines took a bit of holiday break just like us, so today’s report will be brief. 

The Journal of Pediatrics recently presented research that has shown that many new parents use car seats incorrectly. The most common mistakes are straps too lose and chest clips placed too low. Anyone with doubts can just stop by any labor and delivery or pediatric clinic for an on the spot demonstration of the correct technique. 

In the good idea department, the American Journal of Public Health reports that young pregnant women  might get significant benefits with group prenatal care. The study groups ranged in age between 14-21 and received either traditional prenatal care or group prenatal care. Those receiving care in the group setting were 33 % less likely to have a small for gestational age baby. Personally I think it would be fun to instruct young women in a group setting. 

In the frustrating and dangerous section, Reuters has reported on Canadian study retrospectively comparing 11,000 low risk women who had home birth with 11,000 low risk women with hospital birth. Their endpoints were still birth or death. For these endpoints, there was no significant difference in outcomes, with the incidence at home being 1.5/1000 versus 0.94/1000 in the hospital. There are two glaring problems with drawing a conclusion from this: 

1. The incidence of stillbirth and neonatal death is small in both cases, so comparisons of even large numbers cases are relatively unrevealing.

2. We care about many more outcomes than still birth or neonatal death. For example, we care about near death of the baby or the mother, brain damage, post partum hemorrhage, retained placenta, postpartum infection, and so many more grave life altering things. The truth of the matter is that neonatal and perinatal medicine is so good now that no matter how badly a case is managed, modern medicine can almost always salvage it enough so that it does not qualify as a stillbirth or a neonatal death. Badly managed cases requiring intensive perinatal and or neonatal care that do not result in stillbirth or death are definitely things I should think everyone would want to avoid, but nonetheless are NOT on the radar of this study. For that matter badly managed cases that require intensive perinatal and or neonatal care that do not result in stillbirth or death but that DO result in bad outcomes like brain damage are not also reflected in this study’s conclusions. How helpful is that ? And yet, what is the Reuter’s headline ? “ Home Births May Be Safe For Low Risk Pregnancies “ Really ?

From the “ clues on the trail” department, we have the following two tantalizing tidbits. One, it turns out that there is some sort of association between gum disease and breast cancer. Those with gum disease have a 14% increased risk of the disease. Add smoking and it jumps to 20-30 % and that means smoking ANYTIME in the last 20 years. Yikes ! information like this could ultimately help us understand how breast cancer arises or persists. 

Two, Metformin, a common medication to help with ovulatory dysfunction, polycystic ovary syndrome, carbohydrate intolerance, and diabetes, “can block the release of toxins from the placenta when preeclampsia is present." Wow cool. Now someone smart needs to figure out why.

Ending with heartwarming news, the journal Pediatrics has presented research showing that “ kangaroo care” benefits premature and underweight babies in several measurable ways. Kangaroo care is prolonged skin to skin contact, and it is associated with half the risk of serious infection, 78% lower risk of low core temperature, and 88% lower risk of dangerously low blood sugar. 

So go hug your kid and have a happy new year. 

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

This weeks news is all about the facts and figures. Statistics is like pie. It is all about how you cut it. That is to say, the real meaning of raw data is challenging to correctly interpret. A great deal of the message from a study depends on how the data is presented. Be wary about drawing conclusions from studies where none can be drawn. 

The CDC report indicates that the number of abortions in the United States has hit a record low compared to 1990. This is true for all ethnic groups.

A new study has hit the press indicating that use of SSRIs, common antidepressants, in the first trimester is NOT associated with increased risk of autism spectrum disorders. Nonetheless the study also showed babies whose mother’s took SSRIs were 75% more likely to get autism than than their peers. Whether this is related to the mom’s condition, the medication or something else is totally unknown and cannot be known from this study. 

In the strange, counterintuitive and questionable department, a new observational study published in the Journal of the American Medical Association shows more complications among those with a planned C section compared to those with an emergency C section done after labor. This is against what has been show before, and against common sense. Authors at the NYT Blog Well speculate that somehow the labor is “ good” for babies. You just as well might speculate that people who chose elective C sections are less healthy to begin with. No conclusions can be drawn, although many will be. 

New findings in the Journal Cancer Epidemiology show that while cancer rates are declining in developed countries, they are increasing in the developing parts of the world. With development comes smoking, and more obesity, which increase the risk for certain cancers. 

The now ancient Women’s Health Initiative, which gathered data on a great many things, has been mined once again. This time it has revealed an association between smoking and infertility. No surprises there. 

I guess I am not the only one who doubts the work of the USPTSF on the issue of breast cancer screening and mammograms. Over 60 lawmakers, headed by Representative Debbie Schultz of Florida, have included a provision in the new budget requiring that the US government officially recommends breast cancer screenings at age 40 rather than 50 as the UPTSF does. Looks like they feel American women are willing to undergo some increased anxiety and discomfort in exchange for earlier detection, longer life, and less mortality. 

A new study out of Britain once again raises the question as to whether the use of the Ca 125 blood test can help detect ovary cancer and save lives. The results are by no means conclusive, but they will provide an impetus for much needed additional study. 

Back to pie. This week I hope you have several kinds, pumpkin, cherry and whatever is your favorite. Merry Christmas week ! 

Wellness Wednesday: Body image

Hello Angels. Did everybody watch the Victoria’s Secret Fashion show last week ? I did. It is a provocative female fest of the first order and boy does it provoke a lot of conversation. So thank you VS for stimulating conversation around the world. 

I am a doctor and am first and foremost interested in health: physical health and mental health. So that is my filter. And through that filter, this is what I see, and it isn’t all pretty. 

I see that many women of all types and sizes have poor body image. I have seen umpteen conversations in the blogosphere running along the following lines: “ The VS show made me feel bad about myself.” I wonder if these women feel the same way after watching the Olympics or the Cirque du Soleil ? I wonder if they are aware that these models train like professional athletes, boosting their calorie and protein intake way up to build muscle and compensate for the long hard workouts that they must do. Many women are 5’10 or more and have pretty faces, but few can achieve this level of discipline and training.

I am not so unsophisticated that I do not realize that the VS show is essentially marketing and that it sends mixed messages to and about women. Yet, it would be nice if we could all watch Olympics, gymnastics, or even the VS show and be inspired to be our best selves. 

I am certain this chronic problem with poor body image is something we inherit from our culture, and that we are retaught every generation. Historically, we women have been property, and most generally utilized for our physical attributes. Is it any wonder this is still how we define ourselves ? Although the problem of our self worth came from without, the problem is now within us. Likewise,the solution can only come from within each of us. It is for each of us take a hard look at ourselves and count our own strengths. We need to learn to define ourselves in our own terms, and value ourselves as whole people. We all know none of us is perfect, mentally or physically. However, we must learn to celebrate what we are and to learn to enjoy the process of making ourselves better all the time.

Through my filter, I see that women of all descriptions hurt one another with fat shaming and thin shaming. Women already have to deal with objectification, abuse, unequal pay, glass ceilings, and sexism. The last thing they need to be doing is undermining each other.

I see people outside the health profession mistake all sorts of things: slim for anorexic, obese for “ big boned”, obese for "womanly" and muscular for unfeminine. I even hear some of these things from people in the health sciences. None of these analyses are helpful to the cause of the physical or mental health of women.  None of these critiques allows for the fact that there are many body types. None of them asks the right questions about fat percent, muscle mass, bone density, strength, nutritional status, menstrual health and other truly relevant parameters. 

I am very concerned about eating disorders in young women. However, I see them very rarely. But, numbers wise, prevalence wise, I am profoundly more concerned about the obesity epidemic. This will end up causing no end of disease related suffering as women of this generation come into middle age and older. We as women have to come to terms with the need for good nutrition and regular fitness. We need to get back in touch with strong female physicality.  If we cannot get in touch with our physicality, we become oblivious to our bodies and avoid them outright and they get less and less healthy with each passing year. 

Strong healthy physicality in women, and I mean mature adult women as well as young women, lends confidence to the mind as well as the body. What does physicality mean ? To me it means, being in touch with your body. This means being able to honestly assess your bodies strengths and weaknesses with the help of your doctor and maybe even a trainer. It means standing in front of a mirror without clothes. It means getting on a scale and doing a waistline measurement. It means accepting where you are at the present moment and knowing you have the power to better yourself.

Physicality means having the courage to try new things with your body, new exercises, new sports. Sports ! Yes… I believe all women need sports and competition in their life. It builds confidence in all things, because sports teaches you how to try and try again. Sports teaches you how to practice, even how to train, however modestly. 

Your physicality extends to other people. It asks you to acknowledge your own sexuality, and to ask whether it is in a reasonable state. 

Physicality bears on how you present yourself to the world. You may not wish to become a materialistic fashion slave. But….. do you neglect your own appearance and present yourself poorly to the world ? Do you neglect your hygiene ? Do you dress down or to be invisible ? Is your posture poor ? Think about these things and take responsibility for yourself. Love what is, shower it, brush it, put some cream on it, then dress it up to show your best self. 

Physicality extends to the natural world. It asks that you get out in it and feel it with all your senses. When learn to use your body in the natural world, the natural world will, in return, sculpt you into a better adapted creature. 

It is good to embrace health and beauty in all forms. True beauty is health. You have the power to make some of your own. 

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

There is some sobering news in this week's collection. 

Findings from Sweden published in the Lancet indicate that babies from women who gained a large amount of weight in pregnancy are at increased risk of stillbirth and infant death compared to others. This work is an impetus to study the issue in more depth, since there is no clear indication of why this is it the case. 

A study presented at the World Diabetic Congress has shown that about 10 % of teens with type 2 diabetes in the study got pregnant over at 6.5 year period. Any women with diabetes in pregnancy are at high risk for complications. Pregnant teens with diabetes are at especially high risk. It was noted that these pregnancies frequently have poor outcomes. 

A study published in the Journal of Clinical Electrophysiology has indicated that women who were overweight at age 18 have a greater risk of sudden cardiac death. This persists irrespective of later weight loss. Those with a body mass index (BMI) in the high 20s have a 33% greater risk.. Those with  BMI over 35 quadruple their risk. 

New research indicated that 62% of all Ob/Gyns are now women ! That even counts the old ones : )  

Speaking of doctors, new research published in JAMA, the Journal of the American Medical Association indicates that about 29 % of all medical residents have depressive symptoms or depression during their training. The general population comes innate about 6.7 %. Of course this is all about long stressful work, sleep deprivation but also about hierarchical structures and bullying. In my opinion, a lot would have to change for this to be different. 

Omigosh this post is so dismal it is sounding like a parody but I kid you not, researchers from Oxford, namely statisticians and medical epidemiologists, have now asserted that happiness has no direct effect on mortality. They say the idea that unhappiness causes illness is a really a case of illness causing unhappiness. 

Data crunching at the CDC has concluded for 2010 and from 1976 until 2010 pregnancy and abortion rates have fallen to record lows. 

Dame Sally Davies (Yes, ladies she is a Knight of the British Empire ), the Chief Medical Officer in England, has declared obesity the greatest threat to women’s health and to that of future generations. She has declared it a national priority. 

Finally, in a bit of progress, the FDA has updated the required pregnancy and breastfeeding labelling for prescription medications. 

Maybe the world's researchers wanted to get all the bad news out of the way before the holidays. I can't wait for next week. Stay tuned. You can't make this stuff up. 

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

Until recently, the only treatment for preeclampsia is delivery. However, a new study is underway to test Recombinant Human Antithrombin to manage early onset ( 23-30 weeks) preeclampsia. As the same suggests, this medication acts by inhibiting abnormal blood clotting and inflammation, two components of preeclampsia. If this helps, this will be the first medication to directly address this common and serious disease. 

In the unbelievable department, The Government Accountability Department (GAO) has discovered something concerning at the National Institute of Health (NIH) . They have discovered that the NIH does not, in their research, always keep data on sex, thereby making it impossible to determine whether or not an intervention or exposure affects men and women differently. Those of us from the world of Ob/Gyn can tell you that rather often, the same factor will affect men quite differently than it will affect women. 

Here’s your reference http://www.gao.gov/products/GAO-16-13

The Radiologic Society of North America heard research results indicating that the recent Medicaid Expansion has boosted rates of breast cancer screening in low income women. Assuming these and other women do not pay too much attention to the USPSTF ( US Preventive Services Task Force) recommendations of later and less frequent mammograms, we may soon see increased rates of early detection and eventually, longer survival. 

ACOG (The American College of Obstetricians and Gynecologists) has made its strongest statement yet on pregnancy, stating not only that it is safe, but that it is recommended on a daily basis and should be the norm. 

OB/GYNS all over the world are nodding on this one. The Journal of the American Medical association has indicated the WHO's (World Health Organization) optimal rate of C section at 10% is too low. As C section rates rise to 15%, the study shows maternal and infant deaths decrease. In fact, maternal and infant deaths continue to decline through about 19%. This is the sweet spot, meaning where maternal and infant well being are at their highest. In the US about 33% of births happen by C section. This probably has to do with many things, including our culture, patient preference, doctor’s risk tolerance, the medico-legal climate, and the obesity epidemic. We can improve. 

Sobering : False positive mammograms may be linked to a higher risk of breast cancer later in life. The group in question is those whose mammograms indicate the need for a biopsy but then whose biopsies are negative. These women, despite negative biopsies, have a 39 % higher risk of breast cancer in their future that women who didn’t require a biopsy. I wonder how this finding will factor in to the recommended frequency of mammograms. So many authorities are weighing in on how frequently they should be done. ACOG still says every 1-2 years after 40. 

It turns out that giving flu vaccine to pregnant women in the second and third trimester benefits not only the mom but at least have of the unborn babies as well. Bonus ! 

Stay tuned next week for more breaking news from the world of Ob/Gyn ! 

Wellness Wednesday: Cold Weather Workouts

Now that the temperatures are dropping and the outdoors is frosty, there are a few cold weather tips you need for working out outside. 

• Chose safe routes. Avoid iced over rivers of uncertain stability. Winter roads can be icy. One winter run of mine a few years ago landed me in a CT scanner, since I slipped, fell and hit my head on the ice. All was well, but it was no fun and showcased my imprudence to all my friends in the emergency room. Plowed roads or snowpack can work well, but you still have to be on your guard for black ice. Despite your best efforts, you may fall and injure yourself, so always carry your cell phone or go with a buddy. Some have suggested a loop close to home so you are are never far if you have to limp back. 
• In your first excursions of the cold season, go for less time than you usually do, to see how you adapt. You can always work up gradually later. This is especially good advice if you have asthma or other medical conditions. 
• Don’t forget sunscreen, especially in bright snow white conditions. Likewise wear appropriate eye protection for sun, snow and ice .
• Warm up and cool down as always. However, in the case of cold weather, do it inside. 
• Dress in layers, so you can stay warm but not overheat and sweat too much. Start with a wicking layer, followed by insulation, and then a shell. Always include a hat, which adds warmth without bulk and can help prevent frostbitten ears if it has earflaps. Consider a neck gaiter to keep the mouth and nose warm. Absolutely wear gloves to prevent frostbite. 
• Check the forecast before you go, factoring in not only temperature but precipitation and windchill. Tell someone where you are going and when. 
• Have an indoors workout alternative if it is just too challenging out of doors, preferably an indoor alternative at home, such as a workout DVD you can do in your living room or basement. 
• Do not mix alcohol with any workout. Be aware that alcohol degrades decision making, and masks symptoms of hypothermia. 
• Know and recognize the symptoms of frostbite, whiteness, tingling and pain. Know, recognize and heed the signs and symptoms of hypothermia: shivering, confusion, fatigue and slurred speech. Hypothermia is medical emergency and must be corrected right away. 
• Avoid cold weather exercise in the face of dehydration, inadequate calories or sleep deprivation. These can limit your bodies ability to thermoregulate. 

Working out outdoors in the winter requires extra preparation and mindfulness. However, there are some major benefits: Winter workouts produces a bigger endorphin boost than working out in warm weather. You burn more calories in the winter and train a bit harder. And it is invigorating to be out in the weather, and the landscape is often stunningly beautiful. Getting outside in the winter is important for fitness, but it also improves attitude and mood as well. All in all, is it something you should add to this season’s workout mix. 

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

California and Oregon will soon allow pharmacists to screen patients and prescribed birth control pills. While the American College of Obstetricians and Gynecologists considers this a step in right direction, they believe they should be available over-the-counter, plain and simple. While it is true that low dose combination birth control pills can have medical complications in a very small percent of people, by and large their health benefits far outweigh their risks.

As most of you probably are already aware, hepatitis C has a new medical treatment which provides a cure in a very high percentage of people. However, hepatitis B has remained a challenge, and in particular, we have had to deal with the problem of vertical passage of the virus from mother to baby during pregnancy, labor and delivery. However recently at the meetings of the American Association for the Study of Liver Diseases, new research was presented. In the course of a randomized controlled trial, a drug called Tenofovir was shown to be able to reduce vertical transmission. 

Yet another encouraging recommendation about exercise in pregnancy has been released. According to the American College of Obstetricians and Gynecologists, nearly half of US women gain too much weight while they're pregnant. We all know that women who gain too much weight in pregnancy are very uncomfortable. However they also have higher rates of miscarriage, premature birth, stillbirth, and babies with birth defects. They’re also more likely to have heart problems, sleep apnea, gestational or pregnancy associated diabetes, preeclampsia also known as toxemia, and abnormal blood clots. They are at higher risk for cesarean section. So there are ample reasons to find ways to control this weight gain. 

The new memo released by ACOG advises pregnant women to exercise regularly and more often than they currently do. The memo states that while walking is the best exercise, jogging, Pilates, yoga, cycling, swimming, and other forms of exercise are perfectly acceptable. ACOG cautions against contact sports such as skiing, and other specialized sports such as scuba diving.

More good news: it appears that breast-feeding for two months or more reduces a gestational diabetic’s risk of developing type II diabetes later in life by 50 %. Moreover, the risk of diabetes lessens as the patients breast-fed longer.

Finally, here is some good news that initially sounds a lot like bad news. Since 2010, there has been a significant increase in the number of women under age 26 who have received a diagnosis of early-stage cervical cancer. In the next age group, 26-34, the numbers were unchanged. What changed for the younger age group? The answer is the availability of insurance. One of the features of the ACA, The affordable care act, was to allow children to stay on their parents insurance plans through the age of 26. Most likely the increase in diagnoses came from increased compliance with recommended screening, i.e. pap smears. Once again, we are reminded that appropriate screening leads to early diagnosis, which leads to less invasive treatments, fewer complications, and higher rates of cure. 

Stay tuned for more breaking news from the world of OB/GYN next week on Medical Monday.

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

Happy Monday on this short week ! This week in honor of Thanksgiving I plan to apply the filter of gratitude to the news that I feature. Let’s see how this works out. 

The LA Times recently reported on the actual C Section rate in the US ( 33%)  as compared to the theoretical ideal of 15 %. An ACOG (American College of Obstetricians and Gynecologists) spokesman indicated that this discrepancy was largely about risk tolerance of the involved parties. Gratefulness filter: Le’t be glad we live in a place where C sections are readily available to those who need them. 

Findings coming out of the African American Cancer Epidemiology Study indicate that black women with the healthiest diets were 34 % less likely to develop ovarian cancer that their counterparts who ate the most unhealthy diet. Gratefulness filter: Diet is an easy factor to modify !

Findings presented at the American College of Rheumatology indicate that Denosumab was superior to Zoledronic Acid ( Zometa) at restoring low bone density due to osteoporosis. Gratefulness filter: This is great news for all with low bone density ! 

The Supreme Court rejects the case against Planned Parenthood. Justices Scalia and Thomas dissent. Gratefulness filter: Let is be glad we live in a country that respects free speech of differing parties, that observes due process and the rule of law. 

About 10 % of all new mothers suffer from post partum depression. New York is rolling out a ambitious program which will require that all expectant and new mothers will be screened for depression. Gratefulness filter: Thank goodness awareness is increasing about this important and treatable problem. 

Rhode Island has a new state mandate requiring HPV vaccine for youngsters. Nearly three quarters of seventh graders received it by the start of the school year. Gratefulness filter: Thank goodness we have a way to prevent cervical cancer. 

Count your blessings this week and stay tuned for more news from the world of OB/Gyn next week on Medical Monday ! 

Medical Monday: Breaking News from the World of Obstetrics, Gynecology and Women’s Health

The HPV vaccine has recently been vetted at the European Medicines Agency (EMA, the equivalent of the FDA). The EMA concluded that the benefits of Cervarix and Gardisil outweigh the risks. CDC (Center for Disease Control) Director Tom Frieden estimates that increasing the HPV vaccination rate to 80% would prevent 50,000 cases of cervical cancer in women.

Echoing results from last week, a study published in the Journal Hypertension has shown that those who had high blood pressure in pregnancy double their risk to develop the condition later in life. For diabetes, the risk quadruples.

Our largest and most foundational study on postmenopausal hormone therapy, the Women's Health initiative, (2002) was noteworthy for the fact that overall “estrogen plus progestin hormone replacement therapy" increased risk of "heart disease and breast cancer”.

Well the devil is always in the details, and sometimes angels too. It turns out that age makes a big difference the development of heart disease risk. If you “unpack" the data, you will see that women between the ages of 50 and 59 actually had a protective benefit to using hormone therapy, while women over 60 did not have the same advantage. Is interesting to remember that in this study all study participants  had never before taken any postmenopausal hormone replacement therapy. Therefore those who were 60 and older entering the study were beginning their hormone therapy approximately 10 years after the onset of menopause. Some researchers believe that it is that block of time after menopause but before initiation of hormone therapy in which silent atherosclerotic developed. If this is true then cardiovascular disease manifesting during the course the study would not really have been caused by the hormone replacement under study. Optimistic speculation leads us to wonder if women over 60 would do as well as their younger counterparts if they're hormone therapy has been started at the onset of menopause. It would be nice to know whether or not it is the youth of the women that caused them to do well with hormone therapy in their 50s or the fact that they started their hormone therapy immediately after the beginning of menopause.

It is interesting to note that age at the beginning of the study did not affect a woman's risk of breast cancer. Use of "estrogen plus progestin hormone replacement therapy” was and is clearly associated with increasing risk of breast cancer. (The same cannot be said for those who are able to use estrogen alone as their hormone therapy.) The lead investigator in this most recent study, Dr. Joanne Manson, indicated that "for every 1000 women per year not using hormone therapy, about 3 develop breast cancer” versus 4 out of “every 1000 women” using combined estrogen plus progestin hormone therapy.

A recent study has shown that only about half of women visited the dentist during pregnancy. Dental care in pregnancy is critical since many oral and tooth diseases have a direct impact on the pregnancy including increased risk of preterm labor.

Former Republican representative from Georgia Phil Gingrey has criticized the recent US Preventive Services Task Force (USPSTF)  recommendations on mammography citing the differing recommendations of the USPSTF, the American Cancer Society, and the American College of Obstetricians and Gynecologists. He has urged for more time to study the basis of these differing recommendations, so that we can "analyze the research and arrive at a medical consensus”. He has introduced a bill entitled “Protect Access to Life-saving Screenings”, (PALS). This bill would place a two year moratorium on the USPSTF recommendations.

I am all for this and I dare say a great deal of unpacking the data will be necessary here. What will be important in the conversation is identifying the “harms" of screening. And please don't talk to me or the breast cancer survivors in my life about fear of and pain from mammograms, which have been cited by the USPSTF as harms. Besides this, it will also be imperative to study endpoints, not only survival, meaning and lack of death, but years of life. It seems like a subtle distinction but it seems to have been lost on the US Preventive Services Task Force thus far.

Support has come out for treatment of subclinical hypothyroidism (low thyroid) in pregnancy. A new study presented at the International Thyroid Congress has shown that treatment with synthroid or Levothyroxine in pregnancy for those with subclinical hypothyroidism “was associated with decreased low birth weight and Apgar scores". It was not however associated with a significant decrease in miscarriage. This will probably tip the wobbling scales in favor of universal thyroid testing in pregnancy. 

Any study recently published in the December issue of Obstetrics and Gynecology has shown that yoga is safe even late in pregnancy. Study participants were put through various yoga postures and measurements were taken of heart rate, blood pressure and other vital signs for mother and or baby. Although mothers often opted for various modifications of their poses, no ill effects were found.

In more happy news, the United Nations and the World Bank jointly issued a report Thursday noting that maternal death rates have dropped 43% worldwide since 1990. This is attributed to better access to higher quality health and sex education services.

Stay tuned for more news from the world of OB/GYN and women's health, next week on Medical Monday.

Medical Monday: Breaking News from the World of Obstetrics, Gynecology and Women’s Health

Happy Monday ! This week, in addition to reading the news and doing your normal workweek, you get to start seriously preparing for the holidays.  Enjoy the process !

Postpartum depression is in the news again, and this is a good thing. “ Shots” blog by NPR ( National Public Radio ) has run a story about a woman, Paige Bellenbaum,  who went through this. She has since recovered and has become an activist on the subject, and helped to write a bill in New York “ aimed at educating more families on the symptoms of maternal depression.” The bill also promotes screening through the Pediatrician's office. Early treatment for postpartum depression is, of course, more effective. 

Research findings presented at the NCI ( National Cancer Institute’s) annual conference underscored that increasing parity ( the more children you have ) reduces risk of ovarian cancer. The first child reduces the change of this cancer10% and each subsequent birth reduces it 8% more. While no one would decide the number of children they wanted based on this, it is interesting and may spur further research about how ovarian cancer comes into being the first place. Hopefully this will ultimately yield clues on how to prevent and treat this awful disease. 

New research published in the Journal of Diabetes Care indicates that women with central obesity (higher levels of abdominal fat) are more likely to develop pregnancy associated diabetes here. Of course it is also known that women who get gestational ( pregnancy associated diabetes) are more likely to get Type 2 Diabetes later in life. Moral of the story: Get in good shape and at your correct weight before pregnancy and in-between each delivery. 

Also hot on the trail of gestational diabetes (GDM), s study presented at the Conference of the Society for Endocrinology indicates that women who are sedentary in the first trimester are more likely to get GDM. They defined sedentary as sitting more than 6.5 hours per day. Has anyone ever tried a standing desk ? Personally I think the best thing at work is to alternate siting and walking about at frequent intervals. Also naps, mid afternoon. Wouldn’t that be cool ? 

The CDC ( Center for Disease Control) reports that half of pregnant women are gaining too much weight in their pregnancy. IOM ( Institute of Medicine ) recommendations indicate women with a normal BMI ( body mass index) gain about 18.5 an 24.9pounds. Smaller women should gain more and larger women should gain less. 

Wow this week's news sure had some common themes. 

To help you stay in the know very quickly, don’t miss Medical Monday.