October, 2009

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Why getting the HPV vaccine (Gardasil®) makes sense

Friday, October 30th, 2009

Too often, the Internet is filled with rumors about the dangers of vaccines. And those rumors are typically based on misinformation, disinformation and fear.

That’s been the case with Gardasil® (Quadrivalent Human Papillomavirus  (Types 6, 11, 16, 18) Recombinant Vaccine), the vaccine that protects girls and young women from the human papilloma virus (HPV).  Many people who have HPV may not show any signs or symptoms.  This means that they can pass on the virus to others and not know it. A male or female of any age who takes part in any kind of sexual activity that involves genital contact is at risk.

While all medicines carry some risk, the benefits of being vaccinated against HPV far outweigh the small potential dangers.

A large part of the backlash against this vaccine may be due to an effort by the drug’s manufacturer to make vaccination mandatory.

Do I believe that young girls and women should be forced to get the vaccine? Absolutely not. Coercion would be a mistake. And that attempt by the drug maker appeared, in this physician’s opinion, to place profits above the right to make a personal choice.

But, getting past the bad decisions of pharmaceutical companies, let’s look at the benefits for our daughters and ourselves. We know for a fact that HPV is connected to cervical cancer. And we know for a fact that cervical cancer is a horrible disease.

So, if you can get a vaccine that will largely protect you against HPV, then getting vaccinated is an absolute no-brainer. Gardasil® protects against four types of HPV: two types (Types 16, 18) that cause about 70 percent of cervical cancer cases, and two more types (Types 6, 11) that cause about 90 percent of genital warts.

The HPV vaccine is typically offered to girls and women between the ages of 9 and 26.  Given in a series of three injections (initial vaccine, another in two months and the last in six months).   For adolescents and younger, I would recommend discussing the vaccine with your gynecologist when your daughter comes in for her first gynecologic visit, which should be between 11 and 12 years of age. That first visit is only for an introduction to a gynecologist and a pelvic examination is not performed. It is a “get acquainted” visit and it is then that the benefits of the vaccine should be discussed.  Gardasil® is most effective if you can vaccinate before a woman risks being exposed to HPV … in other words, before she becomes sexually active.

As a woman gets older, her body isn’t as susceptible to the damage of HPV, so vaccinating isn’t recommended.

– Yvonne S. Thornton, MD, MPH

ANNOUNCING: My new memoir, the sequel to The Ditchdigger’s Daughters, to be published by Kaplan Publishing

Monday, October 26th, 2009

This is the news I’ve wanted to share with you for months but I had to wait until the contracts were signed. Now I can shout it to the world.

My new memoir, SOMETHING TO PROVE: Memoirs of a Ditchdigger’s Daughter, by Yvonne S. Thornton, M.D., with Anita Bartholomew, will be published by Kaplan Publishing in Fall 2010.

The book sold at auction, meaning that more than one publisher wanted to publish it. I decided to accept Kaplan’s offer over the others because the team at Kaplan really seemed to get what I was saying and what I was about. And Kaplan has published a number of other memoirs by physicians and medical professionals, so I feel that it’s a good match.

SOMETHING TO PROVE: Memoirs of A Ditchdigger’s Daughter, builds on the foundation of my earlier book and shows that what was true as I was growing up is true today: despite bias, despite setbacks, with hard work and determination, we can accomplish whatever we set out to do.

The book begins with the challenges I encountered when, in the early 1980s, I entered what was still an all white boy’s club of academic medicine. Although I faced bias for both my gender and color, I had a secret weapon: my father’s wisdom. The essence of what he drummed into me as a child was that, as a female, and an African-American, I’d have to work twice as hard as anyone else to be thought to be half as good (a sentiment that later became a mantra for the women’s movement). And I did.

SOMETHING TO PROVE will also document how I handled the personal struggles that every working mother must confront, of juggling a career and family life.

And because I’m a specialist in high-risk pregnancies, SOMETHING TO PROVE will offer plenty of edge-of-your-seat medical drama.

It won’t focus solely on the challenges though. Yes, I’ve dealt with setbacks and pain, but I have also enjoyed great success in my career. I have a supportive, wonderful husband, and two children who are poised to follow their parents into careers in medicine.

And that’s the ultimately uplifting message of SOMETHING TO PROVE, in life lessons passed down from my father to me, and from me to my own children.

It’s been a great journey and I look forward to sharing it with you in SOMETHING TO PROVE.

– Yvonne S. Thornton, MD, MPH

Is baby fat a “pre-existing condition? Really?

Tuesday, October 13th, 2009

You may have read the news that a family in Colorado was told their 4-month-old son would be denied health insurance by Rocky Mountain Health Plans because of a pre-existing condition: he was too chubby.

The child in question, baby Alex Lange, weighs just 17 lbs and is 25 inches long. That puts him in the 99th percentile according to the CDC but his pediatrician says the baby is perfectly healthy.

Although the insurance company’s spokesperson, Dr. Douglas Speedie, agreed that a baby can be healthy at little Alex’s weight, he said that the line has to be drawn somewhere. “It’s a calculation based on height, weight, and a fudge factor.”  But he also said “We’d like to see health care reform so that these things go away.”

Just think of that for a minute. Why does a health insurer claim there is a pre-existing condition where none exists? And if an insurer acknowledges that this is a flawed decision-making process, why doesn’t it act on its own to make “these things go away”? Does this make sense to you?

Me neither.

And that illustrates why we need health care reform. Right now, insurers can claim people have “pre-existing conditions” that they don’t actually have, and make other arbitrary decisions to deny people care. That must change and insurance companies will not change on their own … well, except in cases where their decisions are so ridiculous that they make the nightly news.

In baby Alex Lange’s case, the negative publicity convinced the insurer to reverse its decision. But the reason that Alex’s story got so much attention is that his daddy works for the NBC TV affiliate in Colorado that broke the story.

Most other people just get stuck with the insurance company’s arbitrary decisions.

– Yvonne S. Thornton, MD, MPH

Should women do a breast self-exam each month?

Friday, October 9th, 2009

Most women know that mammograms save lives. A news story this week reported that three-quarters of breast cancer deaths occur among those women who did not get regular mammograms.

So, getting a mammogram is a no-brainer. It should be part of your annual exam if you’re over 50; women between 40 and 50 should get mammograms every 1-2 years. If there is a history of breast cancer in your family, you should start mammograms at age 35.

But what about breast self-exams?

Finding no evidence that breast self-examination saved lives, and “increased physician visits and higher rates of benign breast biopsies,” as a result of self-exams, the Canadian Task Force on Preventive Health Care recently recommended excluding routine self-examination from breast cancer screening.

So what do you do now? Does this mean that you can forget all those reminders your ob-gyn or family practice doc give you at each visit to check your breasts monthly?

In my view, no. Although cancer is much more likely to be discovered via mammogram, one of my patients did discover a cancerous lump through a routine self-examination. Even if she hadn’t, I’d still say, do the self-exam. However, don’t get excited and frightened because you “feel something.” Most “lumps” are totally benign (such as a fibroadenoma) or it just might be fibrocystic breast disease, which is benign and not cancerous. However, in any case, you need to be further evaluated by an experienced clinician.

Just remember, it has to be you examining your own breasts, not your boyfriend, not your husband. Because that way, you’ll get to know your own breasts and you’ll recognize if there’s some change.

– Yvonne S. Thornton, MD, MPH