Posts Tagged ‘Women's Health’

Week in Review: (May 29 – June 4, 2001) Eye Opener Health, Law and Medicine Blog

Saturday, June 4th, 2011

From the Editor:

We didn’t get to post as many blogs as usual this past week due to the simple fact that our lawyers/blawgers were spread around the country doing depositions and meetings, in court and getting ready for some major trials coming up very soon.

Sometimes the real practice of law (which is what we do when we’re not on WordPress blawging away) just gets in the way (read – big smiley face).

Brian Nash

 

Here’s what our blawgers wrote this past week. We hope you enjoy! Oh – thanks for stopping by too.

Summer Vacation Checklist: Add Vaccination to Your List

By: Theresa Neumann

Ahhh, summer vacation is coming. Passport? Airline tickets? Three 1oz containers? Zipper-lock bag? Sunblock? Camera? Vaccination status?

Summer is typically the busiest time for vacationers to explore new territories, or even old ones. Granted, the economy has replaced some travelers’ grand plans with much more modest ones, but many are still planning trips to Mexico and other foreign destinations. The summer is also a big time for missionary groups to head to under-served areas to provide assistance and medical care. The events of September 11th have forever changed travel for the United States and countries all over the world. There is now a new concern…..your vaccination status! Read more

The Grief of Losing an Unborn Child

By: Mike Sanders

For parents who have lost an unborn child, the sense of grief is no different than if the child had been born and then died. Unfortunately, our society seems less sympathetic to the loss because there is no infant that we have seen and gotten to know. We all recognize the agony of losing an older child. Even if we haven’t experienced it ourselves, we can at least try to understand how sickeningly awful it must be. We can then offer our support and love and condolences to those who have experienced it. With an unborn child, however, it’s different. We have a tendency to minimize the grief associated with losing an unborn child, as if the fact that the child wasn’t yet born makes him or her less real. Even medical providers are guilty of this. I’ve had women tell me that their doctors tend to treat miscarriage or stillbirth as a medical condition, not the loss of a loved one. For the parents of such children, however, the loss is deep and real and long-lasting. Read more

Legal Boot Camp: The Story of Mark and Susan – Common Law Marriage in Maryland

By: Jason Penn

Mark and Susan had been living together in a small apartment in Baltimore for 12 years. Both of their names were on the lease and they share a used car to commute back and forth to their jobs. Both names appeared on the utility bills and although they never had an actual “ceremony,” they always considered themselves to be husband and wife. Mark and Susan always assumed that the state of Maryland would consider their relationship to be a “common law marriage.” Ten months ago, Susan began experiencing unfamiliar stomach pains. Her doctor assured her that she was fine and that no follow-up examinations were necessary. Six months ago, Susan was diagnosed with an aggressive form of cancer. Tragically, Susan died last week. Mark is certain that Susan was the victim of medical malpractice and wants to file an action for medical malpractice. Mark is now concerned that his common law marriage might not be valid.  Is it? Read more

Home Births: Increasingly Popular But Are They Safe?

By: Sarah Keogh

Many little girls grow up fantasizing about what they want to be when they grow up; perhaps they want to be the President, or an artist, or a doctor, or an architect. Others might be daydreaming about being a princess or an astronaut. However, I do not know of many little girls who grow up dreaming about how they would like to bring a child into this world. Yet once these girls grow up into adults, many of them feel strongly about having a birth plan that is just as magical as all of their other dreams. Images of a comfortable labor or a display of womanly strength may play a role; perhaps they want music or a particular image available to them. Some want as few interventions as possible, while others would prefer an epidural at the hospital door. No matter what vision of childbirth a woman has, the desired end result is almost universally a healthy child. Read more ….

Sneak Peak of the Week Ahead

  • Two Sessions (yes, it’s almost summer) of our Legal Boot Camp Series –
  • Parents of children with Cerebral Palsy – Part II
  • Loss of Consortium – some things about this claim you need to understand
  • ….AND even more….

Have a Great Weekend, Everyone!

Week in Review (May 8 – 13, 2011) The Eye Opener Health, Law and Medicine Blog

Saturday, May 14th, 2011

From Brian Nash (Editor)

It was another busy week of blogging at Nash & Associates.

The topics of the week were wide-ranging: special needs kids and man’s best friend; Ovarian Cancer – tips for getting the best care; school’s responsibility for informing parents when a child is in danger from themselves or others; stroke – particularly in the African-American community; and the role of social media in general and in our firm for getting the word out about wonderful charitable and civic organizations.

This past week also saw the posting our a new White Paper by Marian Hogan on a very real problem in many of our nation’s hospitals – patient controlled analgesia (PCA). Marian’s piece explores the risks and benefits of this great form of pain relief for hospital patients. Unfortunately, many of the practices in hospitals raise serious concerns about the level of monitoring of PCA in terms of patient safety.

See what strikes your fancy and then click the blog’s title, photo orread more” to view the entire article. Enjoy – and – as always – thanks for stopping by!

PCA Patient Controlled Analgesia: Is it Safe in Today’s Hospitals?

Author: Marian Hogan

Patients who undergo a surgical procedure in a hospital are often placed on intravenous pain medications after the procedure. These medications, such as morphine or other opioid narcotics, are frequently delivered by a pump mechanism that can be regulated by the patient. This is termed a PCA or patient controlled analgesia pump.

Studies have found that there are roughly one half million or more in-hospital cardiopulmonary arrests (IHCA) in the U.S. every year and that approximately 80% of those patients who suffer an in-house cardiopulmonary arrest do not survive, or sustain permanent and severe brain injury if they do live. Read more>>

 

Dogs a huge help for special needs kids

By:  Mike Sanders

Dogs and kids just seem to go together. Whether it’s running around the yard and roughhousing or just sitting quietly watching TV together on the sofa, dogs seem to gravitate toward kids. For some special needs kids, however, dogs are more than just a friend and play buddy; they are actually a daily caregiver.

The idea of service dogs for disabled children is a little-known yet burgeoning niche in the world of special needs. Everyone knows about service dogs for the blind. I have to admit that until recently, I had never even considered service dogs for other disabilities, let alone children. Then a friend of mine whose son is autistic mentioned that she was thinking about getting an autism service dog for her son. I was puzzled. Her son suffers from sensory processing disorder so I didn’t understand what a dog would be able to do for… read more>>


 

Ovarian Cancer

 

Ovarian Cancer – five tips to make sure you get the medical care you need

By Jon Stefanuca

Did you know that more than 21,000 women are diagnosed with ovarian cancer in the U.S. each year? An astonishing 15,000 women die from ovarian cancer each year. Despite numerous advances in healthcare, the mortality rate for ovarian cancer has not improved in the last 30 years. Simply put, ovarian cancer is the deadliest of all gynecologic cancers. If the cancer is diagnosed in its early stages (i.e. before it spreads to other organs), the five-year survival rate is . . . read more >>

 

School’s Duty to Parents: Is Your Child at Risk?

By: Sarah Keogh

Recently, I have been thinking quite a bit about schools. My son is going to start kindergarten in the fall and my daughter just started preschool last week. While both of my kids are still little, over the years children end up spending many of their waking hours each week at school. The school becomes as much a part of their lives as home for most kids. As parents, we put trust in the school that they will be keeping our children safe and healthy while we are not around to supervise. But do the schools recognize that trust and live up to it?

I was recently made aware of a situation involving a teenager who was having some health concerns. Her parents had first noticed that their daughter… read more >>

 

Brother, will you help me? If you don’t this stroke might kill me

By: Jason Penn

Mother’s Day is in the rearview mirror.  This past Mother’s Day someone told me a story about how their grandmother fell ill.  It was the holiday season, and as she climbed the ladder to decorate the tree, things took a tragic turn. She stumbled, lost her balance and fell.  She seemed “off.” A few short hours later, at the hospital, it was revealed that she had suffered a stroke. Read more >>

 

Social Media and Spreading the Word about Those Who Do So Much Good for Those in Need

By: Brian Nash

Recently my wife and I attended an event held by a newly formed Baltimore organization known as Rebels with a Cause. Frankly, I have to admit, I hadn’t heard of this organization before. According to the event flyer published by the person we are sponsoring, this is a local group of bicycle riders who are joining the Ride for a Feast 140 mile bike ride from Ocean City to Baltimore, MD. (Whew! Glad I’m only a sponsor).

Saturday night came and we traveled to Gertrude’s, a restaurant at the Baltimore Museum of Art which provided the venue for a pre-event gathering of this group of dedicated, good-cause-driven riders. Read more >>

 


Sneak Peak of the Week Ahead

Some topics we’ll be covering next week….and then some…

  • the “debate” rages on about breast milk.” Jason Penn takes an interesting look at this issue in light of some recent, fascinating work done at Johns Hopkins.
  • a report of a new HIV study, but what are the possible implications for medical implications under controlled studies
  • acquired brain injury – what is it all about – what is its impact?
  • … and more….

Have a great weekend, Everyone!






Having an epidural when you deliver your baby? 3 Questions to ask the doctor!

Monday, April 4th, 2011

Be your own advocate - ask questions!

Thousands of women will have an epidural today to help them through their labor, and many of them will have a running epidural after they have their baby delivered. This is especially true in the time period for those who have had a C-Section.

There’s no doubt that epidurals have been a wonderful tool for doctors to provide patients with relief from the pains of labor and the pain and discomfort following delivery – mainly after a C-Section.

Because they have become so commonplace in hospitals throughout this country – and the world – they seem to have been taken for granted as being “safe” – not just effective. For the most part – they are safe, but they clearly have significant risks associated with them.

Some reports claim that the overall complication rate for epidurals is 23%. These complications range from very minor (e.g. some nausea, vomiting, itching, headaches) to the most major of complications – death of the mother and/or her baby. In between these two extremes lie some very devastating injuries to both a mother and her baby. Just some of those reported are damage to the mother’s spinal cord leading to motor (ability to move legs) and/or sensory (ability to feel sensations) injuries, bowel and bladder dysfunction, foot drop and a host of other potential – thankfully rare – complications.

There is a popular book that many expectant mothers have considered their bible over the years – What to Expect When You’re Expecting, which is now in it’s fourth edition, according to Amazon.com. While no doubt this has been a valuable resource for many moms-to-be, one medical author takes some exception to the section on epidurals:

Epidural anesthesia has become increasingly popular for childbirth. The popular book, What to Expect when You’re Expecting, for example, portrays epidurals as perfectly safe. The risks, however, may be greatly underplayed.

It’s been many decades (four in one instance) since I personally went through the “birthing” process as a parent-in-waiting. I must admit, I have not purchased or read the latest edition of this book so I cannot vouch that this portrayal of epidurals being “perfectly safe” is still the message of this popular book. Obviously it was at the time of the quote by this Canadian medical writer.)

What expectations do YOU have for your special day?

I suspect that many of you are like I was in envisioning what your experience will be like when the day arrives. You have your bags packed, back-up coverage in place if needed, car gassed. The moment arrives and off to the hospital you go. You register, get in your room, the fetal monitor is applied, and you pass the time remembering (or trying to remember) all those things you learned in your birthing classes. Your epidural is placed and all goes smoothly. Finally, the time comes for you to deliver your new bundle of joy. You make it through some angst of birth, see your new addition through tears of joy and relief and get ready for the onslaught of family and friends, who want to see the new arrival to your family. After you and your baby are cleared for discharge, off you go to your home, ready to begin your “new life” of nurturing, educating, parenting – aglow with images of pride, joy and a world of opportunities ahead. Hopefully, that’s exactly how we all hope it works out for you and your family.

To increase your odds that this scenario plays out, I would strongly suggest that you not take for granted the part about your epidural going smoothly. While there are probably many other questions you may think to ask – or should think to ask – here are three suggestions I have for you based on my seeing (as a lawyer) what can happen when the epidural doesn’t go smoothly.

How an epidural is performed

Here is one example available on the internet (YouTube) to show you just how an epidural is done. Unfortunately, it is a bit difficult to understand the speaker (at least for me), but having looked at several videos, I think it gives you a pretty good idea of how this procedure is performed by the anesthesiologist.

httpv://www.youtube.com/watch?v=_WRccCADReY&feature=related

“Have you reviewed my medical history, Doctor? Is there anything else I can tell you?”

Some of the known risks of having epidural anesthesia are connected to your medical history. Sure, you’re assuming that the medical history you gave to your OB during the prenatal visits and to the intake nurse when you arrived at the hospital has found it’s way to your medical record. You’re also assuming that your medical history has been carefully reviewed by the anesthesiologist whose about to put the epidural in your back. Is it there? Has it been carefully reviewed? Ask! There are conditions (e.g. spina bifida, scoliosis, certain heart valve problems, sickle cell anemia, etc.) that can increase your risk of a complication from an epidural.  Are you taking or have you recently taken any type of anti-coagulant such as heparin or coumadin? Make sure your anesthesiologist is aware if this is the case since these drugs can increase the risk of a bleeding complication. You don’t want to have a collection of blood around your spinal cord – believe me!

“When should I expect to move my legs or bend my knees? How long will I feel numb?”

In most instances, epidural are given to provide analgesia – pain relief (sensory block) during labor and at times for post-delivery (C-Section) pain relief. They are not intended to block your motor function – that is, your ability to move your legs, flex your ankles, wiggle your toes, flex your hips or bend your knees. During a C-Section the drugs being used for delivery are many times different drugs from the ones you are getting via your epidural infusion. You will have a different block so that surgery can be performed safely. You will likely have both a sensory and a motor block! You need to understand the difference.

These anesthesia drugs (the ones given during your surgery) will usually wear-off (varies depending on the drugs and from patient to patient) in a period of 1 to 4 hours. You will typically be in a post anesthesia care unit (PACU) during your recovery phase from anesthesia.

Key: you should not be discharged from the PACU if you are unable to at least bend your knees. There is a scoring system (Bromage) that the nurses and personnel in the PACU will typically use after examining your ability to move your legs, bend your knees, wiggle your toes, flex your hips, etc. to determine if you can safely be discharged from the PACU or if you need to be seen by a specialist in anesthesia to determine if you have a potentially significant complication.

“What exactly should I expect to feel like if I have an epidural running after I deliver my baby?”

I simply cannot stress enough how important it is for you to understand exactly how you should be feeling after you have been discharged from the PACU to your room. Don’t ask your family or friends; they don’t know – unless they are anesthesiologists. There are so many free, uneducated opinions out there that are simply wrong!

One further piece of advice: do not ask the nurse what you should expect to feel like. There is absolutely no doubt that there are many  very experienced and highly capable nurses out there taking care of moms. Unless you intend to ask for and analyze your nurse’s background, training and experience in anesthesia, don’t do it. The drugs used in administering epidural analgesia can vary significantly. The dosing (concentration, volume per hour, etc.) can also vary. Only a specialist in anesthesia can answer your questions correctly!

Know what to look for so that if there is some change in your condition or you start to encounter a feeling or loss of function or sensation, you can tell your nurse or doctor immediately so that you can be examined right away!

I suspect many parents are so caught up in the labor process, or are so exhausted after the delivery or so caught up in the wonderment of having their baby that these issues relating to an epidural may not be very important. If you are in your 20′s, 30′s or 40′s, how important is it to you that may not be able to walk for the rest of your life? It can happen – rarely, thank goodness, but it can happen. I have been involved in cases in which this is exactly what happened! Frankly – I don’t want to see it happen to anyone else. It is incredibly tragic for a mom, a dad and their child – trust me!

One last point before we leave this discussion on post-delivery (post-operative) analgesia. Some hospitals (the number appears to be declining due to concerns about the inadequacy of monitoring) use what is known as Patient Controlled Anesthesia epidural analgesia. Simply put, this is a device (they vary depending on the manufacturer) permits the patient to push a button a infuse a pre-determined dose of drugs (e.g. bupivacaine and fentanyl) into the epidural space for additional pain relief. A patient is actually limited as to how much drug can be used in the course of an hour (determined by what in called a lock-out interval and maximum dosing parameters per hour). While a fixed lower amount of drug flows each hour (known as the basal rate), many patients may require more relief than the basal rate provides.

That being said, if you find yourself pushing the PCA button numerous times during the course of an hour, you should bring this to the attention of your nurse or doctor. Don’t wait for them to hopefully check the machine to see how many times you pushed in the last hour (many forget to do this!). Be pro-active. If you are pushing your PCA button a number of times in the course of an hour, even though you can’t really overdose yourself because of pre-set limits by the anesthesiologist, this may be an indication that something needs to be checked. For instance, the catheter may have become displaced; the drugs may not be distributing equally; you may be having some problem that someone needs to investigate. Don’t keep hitting the PCA pump; hit the call button!

Get information about the risks, benefits and alternative to an epidural!

Having been there (i.e. childbirth) as a father four times, I know – at least from my perspective – how difficult it is to concentrate on issues such as risks, benefits and alternatives involving an epidural. Common sense tell me the ideal time to have this discussion simply cannot be while mom is in labor. If that’s the only chance you have, then fine – take the time and make the effort and have a real discussion with the anesthesiologist. Even if you just cover the 3 items I have suggested above, that will take you a long way.

I have made this suggestion before, but I’ll make it again: make arrangements to meet with someone from the anesthesia department before you get to the hospital to delivery your baby. Don’t be shy or concerned that you don’t want to bother anybody. Bother somebody! There really are an awful lot of wonderful doctors and CRNA’s, who would be willing to meet with you, educate you and answer your questions.  It’s your health,  your body, your future – so protect it!

There clearly are more than “3 questions” you should ask. Many of you have been through this. Many of you have medical training and experience. What questions do YOU think a mom-to-be should ask about their epidural.

 


 

5 Questions to Ask Your Obstetrician Before You Go to the Hospital

Wednesday, March 9th, 2011

Having our baby

Once the special moment comes for you to go to the hospital to deliver your baby, there’s so much that goes on that it just may not be the best time to remember questions you wanted to ask your obstetrician. I’ve been there four times – so, as they say, been there done that! I’ve also had a number of cases that made me stop and think – “I wonder if some of the issues that my clients encountered could have been avoided if they had asked some questions before they wound-up in labor in hospital?” As you can well imagine, that is perhaps not the best time for a Q and A session.

This past weekend, I posted somewhat of a survey on our Facebook Page and Twitter asking our friends, fans and followers what questions they wished they had asked their obstetricians before they arrived at the hospital. I also have a number of moms, who work in our law office; so I put the question to them as well. The responses received provided some interesting food for thought, which I thought I might share with those about to have their baby.

Who will be delivering my baby?

This was one of the most frequent questions making the list. A number of women complained that they wish they had known that their primary obstetrician was not going to be the delivering doctor. Turns out that physician was being covered the day/night these moms delivered. While they may have met all the members of the practice (if it was a group practice), they were not particularly happy when their primary obstetrician wasn’t there for the delivery. The problem is compounded when their primary obstetrician was off and being covered by someone they had never met before. Suggestion: find out as best you can what the chances are that there will be coverage by someone you’ve never met before you arrive at the hospital. You may want to make an appointment to meet that potential covering physician if this is a concern.

When will I see my obstetrician at the hospital?

One of the cases we are handling somewhat arose from a situation that raises this as an issue. You get to the hospital, you’re admitted, you’re placed in bed, monitor attached – you’re good to go. But – where’s your doctor? Does he/she even know you’re there? When is your obstetrician coming to see you? Several of the women who responded said this was a real concern and wished they had discussed this with their doctor before they sat in bed waiting and waiting for their doctor to arrive. They also wondered – if there was no direct phone call before going to the hospital, just how could they be sure their doctor was notified that they had arrived. In one instance, one obstetrician claimed she didn’t know the patient was even in hospital for more than 4 hours! This woman had to undergo an emergency C-Section when the doctor allegedly figured out she was there. Suggestion: confirm with the hospital staff after you arrive that your doctor has been notified that you have arrived and ask when you might expect for your doctor to arrive and examine you.

Who will be doing the circumcision of my baby boy?

A number of parents indicated that while they had discussed whether their newborn son would have a circumcision, it hadn’t crossed their minds to ask – “Who will be doing the procedure?” If this is an important consideration, and you would like an answer not only as to “who” but “what experience” they have, think about covering this with your obstetrician beforehand. While some physicians are very good at performing this procedure, others are not so good. There have been a number of infant penile injuries that we have happened in the hands of – well let’s say – less than skilled physicians.

What will happen if for some reason I require general anesthesia but I’ve recently had a meal?

One of the common orders for a patient who will undergo general anesthesia is that they be NPO (nothing by mouth – liberal translation) for hours prior to surgery. While you may have planned to have an epidural or natural childbirth, some conditions involving you and/or your baby (non-reassuring fetal heart tracing, placental abruption, etc) can occur that may change the “plan” and require that you undergo a different form of anesthetic management. Suggestion: if such a situation should arise, you will be seen by an anesthesiologist first. Perhaps you will have a discussion about possible alternatives for anesthetic management, but I can virtually assure you, that will not be the best time to have a coherent, meaningful discussion. Some have suggested, based on their experience, that asking for and having a meeting with anesthesia personnel before going to the hospital for delivery is time well spent. You can usually have such appointments made through your obstetrician’s office and have a meaningful discussion of the various alternatives, risks and complications at that time.

How long will the effects of my epidural anesthetic last after delivery?

It’s been pointed out to me that while some hospitals have discontinued the practice of providing pain relief (analgesia) post-partum by use of PCA (patient controlled analgesia) pumps, some hospitals still continue that practice. Regardless of what the hospital’s practice may be, there is usually a very consistent practice/protocol for when a woman who has had an epidural should be discharged from a recovery room/area. This is when she is able to bend her knees, move her hips and flex her feet in both directions. Suggestion: ask your obstetrician what his/her practice is for providing you pain management/relief after you deliver your baby. Will you have an epidural running to provide that relief? When should you expect to get return of your ability to use and feel your legs? Don’t guess – you could suffer what is known as a prolonged block, where the anesthetic, for various reasons, is taking too long to wear-off and affecting your neurological functioning. If your obstetrician doesn’t know, then consider talking to specialist in such pain relief techniques – the anesthesiologist at the hospital where you will be delivering your baby. While you’re there, you may also want to discuss what the risks, benefits and complications of epidural, spinal and general anesthesia are so that you are aware of these issues in advance.

What suggestions do you have?

This is only a partial list of a number of suggestions made by our readers and staff. What suggestions do you have? If you have already been through childbirth, are these matters or issues you wish you had discussed before you went to the hospital? If you are about to have your first child, are these issues, concerns or questions you might share? We – and our readers – would really like to hear from you. There is no substitute for experience – or so they say.

Image by corbisimages.com


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Pregnancy Gingivitis: Simple ways to avoid risk for you and your baby.

Friday, February 25th, 2011

I recently came across a website that offers a lot of really good advice for parents-to-be, and I’m happy to promote it on our blog. You may want to visit The Pregnancy Zone and bookmark it for future good reads. If you are a long-time reader of our blogs, you know by now we are really into sharing health and safety information with our readers. As we say on our Twitter page, we are lawyers trying to get the word out so you never need people like us

A recent post on The Pregnancy Zone brought to my attention a condition that, quite frankly, I was not all that familiar with - pregnancy gingivitis. Gingivitis is probably a condition that you are already familiar with. Simply put, it is a form of periodontal disease, which involves inflammation and infection that destroys the tissues that support the teeth, including the gums, the periodontal ligaments, and the tooth sockets. What I didn’t realize is that it has a real potential risk for moms-to-be and their babies. Watch this video by Dr. Jaimie Johnson for a better understanding of why it is important to not overlook this basic element of your prenatal care.

httpv://www.youtube.com/watch?v=c8Uip6hr3vM

So why is this so important? Premature delivery is the primary reason.

At least a couple of major studies have shown that there is a link between gum disease and premature birth. Researchers of one study who published their results in The Journal of the American Dental Association found that pregnant women with chronic gum disease were four to seven times more likely to deliver prematurely (before gestational week 37) than mothers with healthy gums.

Mothers with the most severe periodontal disease delivered the most prematurely at 32 weeks. The researchers’ study did not address if treating gum disease would reduce the risk of preterm birth, adding that more studies need to be conducted to answer this question. Their main findings, however, support the results of another study that also showed that premature, underweight babies were born more often to mothers with gum disease.

Source: WebMD:

What also drew my attention to this topic was a story of a mom, who suffered a stillbirth at full term. The best cause for how this could have happened, according to her doctors, was that the bacteria from her dental condition had directly affected the placenta, leading to the death of her fetus in utero.

What is a bit disturbing about the WebMD post is the statement that the study “did not address if treating gum disease would reduce the risk of preterm birth, adding that more studies need to be conducted to answer this question.” Clearly, some blogs and videos on this topic indicate that there is a treatment-risk reduction benefit. It does seem to make common sense, doesn’t it?

Would love to know if you have any information to share about any other studies, ongoing research and the like on this topic. Sure seems that – at a minimum – getting good dental care during your pregnancy is sound advice and surely worth the effort in case there is a direct cause-effect-treatment relationship perhaps is the case.


What you need to know about digital vs. film mammograms

Tuesday, February 22nd, 2011

In a recent report published in the journal Radiology, the findings of a research group from Barcelona, Spain, provided women and the medical community with some key information about the use and efficacy of digital mammography. As reported in DoctorsLounge, the researchers, headed by Maria Sala, M.D., Ph.D, concluded that digital mammography had a lower false-positive rate than screen-film mammograms; however, there was “no significant difference in the cancer detection rate between the two, according to [the] study.”

If you are unfamiliar with this new technology, here’s a video presented by WellSpan HealthSource. See what they believe some of the benefits are for digital mammography.

httpv://www.youtube.com/watch?v=_TLhjsFeQDg

Here’s the statistical information regarding false-positive and detection rates between these two modalities of mammograms.

The researchers found no significant difference in the cancer detection rate between the two modalities, with the screen-film detection rate at 0.45 percent and digital at 0.43 percent. The false-positive rate for screen-film mammography was 7.6 percent but for digital mammography the rate was 5.7 percent. Digital mammography also had lower recall rates and was less likely to result in a false-positive result leading to an invasive procedure. The lower false-positive risk remained even after results were adjusted for women’s characteristics, screening program characteristics, and time trends.

Who should undergo digital mammography?

Dr. Michael Wu, of the Palo Alto Medical Foundation, has an informative post on the issue of who the best candidates are for digital versus film mammography. He gives a synopsis of the groups, as reported by The New England Journal of Medicine, who are the best candidates to undergo digital mammograms.

Those who benefited:

  • Women < 50
  • Women with dense breast tissue
  • Women who were premenopausal or perimenopausal.
  • Those who did not appear to benefit:

  • Women > 50
  • Women post-menopausal
  • Those without dense breast tissue
  • Dr. Wu’s post also addresses issues such as cost effectiveness and radiation exposure differences between the two methods of digital and film mammograms. What may be of interest to many women is that the actual technique (which I understand can be painful for many women) is the same. Perhaps further development of devices and systems will lower this problem – hopefully – in the future. Needless to say, the discomfort for 20 – 30 seconds is far outweighed by the benefits of early detection of breast cancer.

    3-D Mammogram recently approved by FDA

    It was also recently reported by PRNewswire that the FDA recently approved the first 3-D digital mammogram (tomosynthesis scans) system. Hologic, Inc., a leader in the development, manufacturing and distribution of medical devices, including medical imaging systems and the company whose system won this approval, ran a series of clinical trials using this new 3-D mammography system.

    Undoubtedly beaming with joy over having his company’s product be the first to be approved, Rob Cascella, President and CEO of Hologic, has this to say about this new medical weapon in the fight against breast cancer:

    Our Dimensions 3-D takes advantage of all of the benefits of digital mammography and quite simply makes it better with the combination of fast, high quality 3-D breast imaging. We believe tomosynthesis has the potential to change how screening and diagnostic mammography is performed, and over time will prove invaluable to the earliest possible detection of breast cancer and in the reduction of unnecessary diagnostic interventions.

    it will be very interesting to see if the recent study in Spain by Dr. Sala and his colleagues is taken further by his group or other researches to examine whether this newer 3-D technology will further change the landscape in lowering false-positive rates or – even more important – increasing the early detection rate for breast cancer.

    Some basic, highly disturbing facts about breast cancer:

    The PRNewswire release also provides the following information about breast cancer:

    One in eight American women will develop breast cancer sometime in her lifetime. In 2009, an estimated 192,370 new cases of invasive breast cancer were diagnosed among American women, as well as an estimated 62,280 additional cases of in situ breast cancer. Over 40,000 American women died from breast cancer in 2009. Only lung cancer accounts for more cancer deaths in American women. The stage at which breast cancer is detected influences a woman’s chance of survival. If detected early, the five-year survival rate is 98 percent. At this time, there is no sure way to prevent breast cancer, which is why regular mammograms starting for most women at age 40 are so important.

    This video by one of the country’s premier institutions for cancer treatment, MD Anderson Cancer Center, provides some very useful information and some excellent suggestions for undergoing a mammogram.

    httpv://www.youtube.com/watch?v=Y-GmNmPeqHQ

    Readers’ Information

    There is no doubt that many physicians, researchers and women have exceedingly superior knowledge of these techniques, systems, risks and benefits, and the like. Have any of you been involved in this research? Have you  had or do you know someone who has undergone digital mammography? What information can you share with our readers about this new technology? We invite you to share this information and spread the word by sharing this post with you friends. As we always say, being an informed patient is essential to improving your health and survival.

    High-paying Jobs for Women Cause Women to Pay a Price in Cardiovascular Health

    Thursday, November 18th, 2010

    High-paying jobs typically equate to high-stress jobs for most individuals, that is, fast-paced jobs with a lot of responsibilities and little creativity.  As women have entered the workforce and fought for equality in all types of employment situations, they have slowly and gradually been successful in most venues; we have yet to see a female President of the USA.  Some jobs are much more creative allowing the expression of individual skills while others require strict adherance to company policy (or parent company policy), little decision-making ability, and productivity-driven payscales.  These latter types of jobs, regardless of the gender of the employee, often lead to job strain, a type of psychologic stress that seems to have potent effects on an individual’s health.

    This week, the great city of Chicago (a bustling hub-bub of big corporations and highstress jobs) hosted the American Heart Association’s annual meeting.  Abstract 18520 was presented; it was titled, “Women with High Job Strain Have 40 Percent Increased Risk of Heart Disease.”  The study elaborates on details related to job security and the types of cardiovascular ailments.  This was a landmark study, funded by the National Institutes of Health (NIH), called the Women’s Health Study, and it followed 17, 451 women and their development of cardiovascular disease over a 10-year period.  Previous studies related to stress and cardiovascular disease have focused on men.

    Women with high job strain were at a 40% increased risk overall of heart attack, ischemic stroke, coronary artery bypass surgery, balloon angioplasty/stent and even death!  The increased risk of heart attack alone in these women was 88%! The study further delineates that even women in high stress jobs who have significant control over decision-making are also at an increased risk long-term of cardiovascular disease.  Women who suffer job insecurity (fear of losing one’s job) are at risk for particular risk factors that contribute to cardiovascular disease (high blood pressure, high cholesterol, obesity), but no direct correlation to the end-effects of cardiovascular disease could be statistically supported.  This truly supports the notion that psychological stress plays a role in the development of cardiovascular disease.

    The National Women’s Health Information Center is a government-sponsored organization that collects information on all types of women’s health topics and offers up-to-date information and advice on the topics.  In the Heart Health and Stroke section, the statistics are numbing; coronary artery disease is the number 1 killer amongst women while stroke is the number 3 killer of women.  In other words, women are 4 to 6 times more likely to die of heart disease than of breast cancer according to the American Academy of Family Physicians (AAFP).

    Interestingly, breast cancer has much more awareness and publicity as compared to women and heart disease.  This is surprising since the symptoms of heart attack or angina pectoris in women are often atypical, much like the silent growth of microscopic cancer cells in women’s breasts.  Women, for whatever reason, do not necessarily experience the “crushing chest pain” that most people equate with a heart attack; they might develop generalized fatigue or weakness, lightheadedness, back pain, upper abdominal discomfort or simply a feeling of nervousness or anxiety.

    Hmm- try being a highly-stressed 48-year-old female executive telling an ER doctor that you are feeling anxious and a little short of breath; you will be given paper bag for breathing and a Valium pill to take instead of an EKG, aspirin, oxygen and nitroglycerine.  A male would most likely get the second treatment!  Litigation involving this aspect of medicine often involves a failure to diagnose the disease.

    Now, let’s get back to this landmark Women’s Health Study.  There is finally a long-term study that reports some very frightening statistics for women.  It is time for women to start advocating for themselves and performing primary interventions such as exercise, healthy weight maintenance, smoking cessation, low-fat/high fiber diets, and routine physical exams.  Both the AAFP website (linked above) and the U.S. Food and Drug Administration website offer tips for reducing women’s risk of heart attack and stroke; they will soon have to incorporate job-related stress as potential risk prevention interventions.  Employers, as well, might need to re-examine work policies and provide stress-relief activities for their employees, especially of they do not want to lose them to premature death and disability.

    Another abstract presented at these same American Heart Association Scientific Sessions in Chicago addressed a controversial but nonetheless seemingly stroke-protective intervention.  From men’s and women’s  studies, mild to moderate alcohol consumption on a daily basis is associated with a reduction in risk of heart attack, but women were limited to one alcoholic beverage per day.   Abstract 19870 titled, “Alcohol Consumption and Risk of Stroke in Women,” concluded that women who consumed moderate amounts of alcohol on  a daily basis were not at an increased risk of stroke and may be healthier overall in the long-term.

    The women in our office got a good laugh when these studies were placed side-by-side since our conclusion was that the boss should sponsor a happy hour on a weekly basis! All kidding aside, these new data offer both  some chilling reality checks and some hope that more research regarding modern women’s health topics will be on the horizon.  One thing is for sure — there needs to be more awareness, advocacy and primary prevention!

    What programs do you have at your workplace for stress reduction?

    Photo from the-invisible-gym.com

    Editorial Comment (Brian Nash): To all employees (especially the women!), there will not be a firm-sponsored, weekly Happy Hour. Nice try, though.

    Can Breastfeeding Prevent Diabetes? – New Study Reveals Strong Correlation.

    Tuesday, September 7th, 2010

    Researchers found that women who breastfeed for a month or longer are less likely to develop diabetes later in life.  According to Dr. Schwartz from University of Pittsburgh School of Medicine, the risk for developing diabetes is almost doubled in mothers who have never breastfed.

    It well known that infants benefit tremendously from breastfeeding.  Among many other benefits, breast milk provides perfect nutrition for the baby’s fragile gastrointestinal tract. The milk is also an abundant source of antibodies that strengthen the baby’s immune system.  A recent study indicates that breastfeeding may also be beneficial to mothers

    The reason for this correlation appears to be the mother’s ability to lose weight more rapidly and effectively after pregnancy. As part of a normal physiological course, most women gain abdominal fat during pregnancy. However, retaining this fat buildup for a prolonged period of time after the pregnancy can lead to a series of medical complications. Abdominal fat has been linked to heart disease, metabolic disorders, and diabetes.

    According to the study in question, breastfeeding appears to be very effective in reducing post partum abdominal fat and the risk of developing diabetes after the pregnancy.  If you are an expecting mother, consider breastfeeding.  It is extremely beneficial to you and your newborn.

    Contributing Author: Jon Stefanuca

    Menopause – New information from the North American Menopause Society

    Thursday, July 1st, 2010
    Deciding how one approaches menopause and dealing with the manifestations of hormone loss in daily life are quite challenging for women entering this time in their lives.  Bombarded with advertisements from drug companies, nutrition supplement manufacturers, a multitude of publications and authors writing on the subject, one hardly knows what is best and safe.  Many women are finding reliable solutions and directions in solid research based answers provided through the North American Menopause Society.
    NAMS is recognized as the preeminent resource on menopause for both healthcare providers and the public.  It is a leading non-profit organization whose sole mission is to promote health and quality of life for all women approaching and enduring this time in life.  NAMS has been around since 1989 and has a large, strong worldwide membership in 50 countries.  They are responsible for organizing major scientific meetings, reviewing and publishing key research data through monthly newsletters, a professional journal, and website position papers on hormone therapies. Their journal entitled Menopause is now ranked as the top OB/GYN professional resource. They have an impressive award winning website, notably absent of advertisements, that is visited by over 100,000 visitors per month.  Every aspect of menopause is addressed in an easy to follow format for the professional as well as the general public.  In 2007, they published their 3rd edition of Menopause Practice: A Clinician’s Guide, a best-selling industry reference source. Their Board of Trustees is represented by all key health disciplines. Society publications and position papers are developed and published through extensive consultation with an esteemed medical advisory panel.

    Beginning in 2002, the Society began publishing their position statements on menopausal hormone therapy (HT).  Their goal was to spread research findings on benefits and risks of various therapies including bio-identical hormones for menopause-related symptoms and disease prevention over the span of a woman’s life.  This week NAMS released updated recommendations for the use of prescription hormone replacement therapy used in the USA and Canada.  These recommendations continued to build on prior research findings published in 2002, 2004, 2007, and 2008 dealing with a host of topics:  hot flashes, sleep deprivation, vaginal dryness and atrophy, sexual function, urinary tract infections, changes in body weight, osteoporosis, heart disease, stroke, venous thromboembolism, diabetes, cancer, and dementia.

    According to NAMS, over the last two years, there has been accumulating scientific evidence that various estrogen and progesterone products, routes of administration, and timing of therapy confer differing benefit-risk profiles over a woman’s lifetime.  Hormone therapy, appropriate and beneficial for early menopause, will not provide the same benefits as the woman ages.  As diseases emerge with aging, using hormone therapy either as a new or long-term treatment may have a less acceptable benefit-risk ratio.  Benefits and risks in post-menopausal women should be carefully reviewed by the practitioner and discussed with the  patient.  This also applies to a host of diseases where data is simply not available, inconclusive, or has shown risk under study.

    The science over the last two years also is now very clear:

    • Hormone therapy  is not recommended for women with histories of endometrial cancer.
    • In breast cancer survivors, estrogen only therapy has not been proven safe and might raise recurrence risk.
    • Intrauterine systems cannot be recommended for endometrial protection in estrogen-only therapy users.
    • When hormone therapy is discontinued after several years of use, bone-mineral density should be assessed, and medication to prevent fractures should be initiated, if appropriate.

    Other NAMS recommendations come from research on heart disease.  Prior data showed hormone therapy did not offer heart disease protection.  However, when taken by younger women (age range, 50–59) or within 10 years after menopause, current data shows no increased risk for coronary heart disease (CHD).  In fact, emerging evidence suggests that estrogen-only therapy begun early in menopause actually might lower CHD risk.  There are many variables in this data, but the evidence is not showing heart health harm.  The latest recommendations also reveal that “because incidence of disease outcomes increases with age and time since menopause, the benefit-risk ratio for HT is more likely to be acceptable for short-term use for symptom reduction in a younger population. In contrast, long-term HT or HT initiation in older women may have a less acceptable ratio.”

    In final and noted by NAMS, recent studies generally show that hormone therapy is associated with low absolute risks — although anxiety about its use seems to remain high among women in general (as well as among many clinicians). This updated NAMS position might help clinicians provide individualized education and treatment for menopausal women.

    Ovarian Cancer – The Smear Test Won't Tell You Much

    Sunday, February 28th, 2010

    According to an article published by the UK Press Association, a UK study revealed that one in three women mistakenly believe that a smear test can diagnose ovarian cancer. The test is also known as Papanicolaou test, Pap smear, Pap test, or cervical smear.

    [The smear test] is a screening test used in gynecology to detect premalignant and malignant (cancerous) processes in the ectocervix. … In taking a Pap smear, a tool is used to gather cells from the outer opening of the cervix (Latin for “neck”) of the uterus and the endocervix. The cells are examined under a microscope to look for abnormalities. The test aims to detect potentially pre-cancerous changes (called cervical intraepithelial neoplasia (CIN) or cervical dysplasia), which are usually caused by sexually transmitted human papillomaviruses (HPVs). The test remains an effective, widely used method for early detection of pre-cancer and cervical cancer. The test may also detect infections and abnormalities in the endocervix and endometrium.

    While the smear test is customarily used to diagnose cervical cancer, it is not very helpful in diagnosing ovarian cancer. Cervical cancer and ovarian cancer are distinct medical conditions with distinct symptoms. Cervical cancer refers to malignant tissue developing in the cervix – the organ, which connects the uterus and the vagina. Last year, there were about 4,070 deaths associates with cervical cancer. The smear test is effective in diagnosing cervical cancer.

    Ovarian cancer refers to malignant tissue in one or both of the ovaries. Last year, there were about 14,600 deaths associated with ovarian cancer – a much higher mortality rate when compared to that of cervical cancer. Symptoms of ovarian cancer include, but are not limited to : abdominal pressure, abdominal distention, urinary urgency, abdominal pain and discomfort, indigestion, constipation, changes in menstruation, lethargy, and pain during intercourse.

    According to the article,

    Almost one in three women (29%) mistakenly believe a smear test will pick up signs of ovarian cancer. …  Only 4% are confident they could spot symptoms of the disease themselves and many believe it is less common than cervical cancer. … The poll of more than 1,000 women found that twice as many (66%) had been given information about cervical cancer as those who had details on ovarian cancer (33%). Of women diagnosed with ovarian cancer, more than half (56%) did not know anything about the disease beforehand.

    These numbers reveal a dangerous misconception about ovarian cancer. Many more women are diagnosed with ovarian cancer than cervical cancer. Moreover, many more women die as a result of ovarian cancer than as a result of cervical cancer. Early diagnosis is key in both instances. In this regard, being knowledgeable about these medical conditions can be a matter of life and death. Be mindful that a smear test is not helpful in diagnosing ovarian cancer.

    Contributing author: Jon Stefanuca