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Gynecology Board Reverses Male Patient Ban

Thursday, February 20th, 2014

Back in December, I covered the issue of gynecologists treating male patients at high risk for certain types of cancer. At that time, the American Board of Obstetrics and Gynecologists had disallowed the practice. However, in response to protests from both patients and doctors, the board has lifted the ban and said that gynecologists who choose to do so are free to treat men.

The board’s executive director issued the following statement: “This change recognizes that in a few rare instances board certified diplomates were being called upon to treat men for certain conditions and to participate in research. This issue became a distraction from our mission to ensure that women receive high-quality and safe health care from certified obstetricians and gynecologists.”

This past fall, gynecologists who chose to treat male patients were ordered to stop and threatened with loss of certification for noncompliance. The board prohibited treatment of male patients with the exceptions of newborn circumcision, transgender patients, and men who were part of a couple undergoing fertility treatments.

The decision was made then in order to protect patients and uphold the integrity of the specialty of gynecology. This was due in large part to gynecologists who were branching out significantly into other areas, such as cosmetic surgery, for instance, and even advertising their services and identifying themselves as “board certified” without specifying that they were gynecologists. This practice could have misled patients who believed that they were being treated by board certified plastic surgeons, or other types of specialist.

However, one group of patients that the directive directly affected was men at high risk for anal cancer. The gynecologists who treated them said that not enough doctors had experience in this type of screening, and they feared the ban would interfere with patient care as well as government-funded studies aimed at determining the effectiveness of these cancer screenings.

In December, the board relented and agreed that gynecologists could continue to treat their current male patients, but not accept any new ones. And after further pressure, the board in January stated that the ban on treating male patients no longer existed. Gynecologists are now free to treat male patients as long as they devote “a majority” of their practice to gynecology – a change from the specific 75% that used to be the minimum portion of a gynecologist’s practice that must remain within the specialty.

Interesting, since the board’s own definition of what a gynecologist is includes, “Obstetricians and Gynecologists provide primary and preventive care for women and serve as consultant to other health professionals.”

Some are calling the board’s decision a victory for patients, but is it? As I stated back in December, “…there is no reason that I can see why the specialty of gynecology should expand into unrelated disciplines. The very reason why we have specialties is so that specific areas of medicine can be studied thoroughly and the treatments we are able to provide kept up to the minute. A gynecologist should specialize in gynecology – delivering babies, taking care of women. Other practices and treatments are important and helpful, but they aren’t gynecology.”

– Yvonne S. Thornton, M. D., M. P. H.

Can You Safely Buy Medications Online?

Monday, February 10th, 2014

In a study of internet users conducted recently by the FDA, researchers found that while 20 percent of the participants had used the Internet to buy prescription medications, 29 percent reported being unsure of how to buy medicines online safely.

Medications can be bought safely online, but the patient must be aware of the dangers and be able to determine which Internet pharmacies are legitimate and which ones are not. The stakes are high, since if you put your trust in the wrong website, you could end up with a medicine (over the counter or prescription) that isn’t safe to take.

Making this determination isn’t as easy as it seems. Websites that sell potentially dangerous drugs often have a very professional and legitimate look. However, no matter how professional a website looks, it could be run by an illegal operation, which may sell drugs that are unapproved, contain the wrong ingredients, contain too little or too much of the active ingredient, or even contain dangerous ingredients.

So how can you avoid these risks while taking advantage of the convenience of online shopping? For starters, the pharmacy you choose should be located within the United States. It should be licensed by the state pharmacy board in the state where the website is operating. You can find a list of boards here. A licensed pharmacist should be available to answer questions, and the pharmacy should not be willing to sell you prescription medicines without a prescription. Finally, the website should provide contact information and you should be able to contact a live person by phone if you need to.

Another way to protect yourself is by being sure to check the appearance of the medicine before you take it, including its shape, size, color, and packaging, as well as its smell and taste. Some medications found online may be too strong or weak, past their expiration dates, labelled incorrectly, shipped incorrectly, or outright counterfeit.

Counterfeit drugs present a special danger because they are often difficult to identify and there is often no way for the buyer to know what is in them. They may not be effective for their intended purpose, or they may contain the wrong amounts of ingredients or even the wrong ingredients, period. This can be extremely dangerous and lead to harmful side effects. The fake packaging on these types of products can look quite legitimate. This is why it is so important to make sure to buy medications online from a trustworthy source.

And if you need one more reason not to trust online pharmacies without thoroughly investigating them first, how about identity theft or credit card fraud? Never give any website your personal information, such as credit card information, medical history, or social security number, unless you are sure the website is legitimate and will protect your information.

The take-home message from this blog entry is that I strongly discourage buying ANY prescription medications online.  Your local pharmacist has your history and is aware of any potential interactions with other medications that you have been prescribed, which could be life-saving.   Are you willing to risk your life to save a few dollars?   Think about it.

– Yvonne S. Thornton, M. D., M. P. H.

Cancer Deaths Down; More Progress Still Needed

Monday, February 3rd, 2014

Great news: the death rate from cancer is falling. Over the past 20 years, cancer deaths have decreased dramatically and steadily. After peaking in 1991, deaths from cancer have fallen 20%. That’s well over a million deaths prevented over 20 years!

The American Cancer Society’s research shows progress – for example, middle-aged black men are the group with the largest decline in cancer deaths – but also the need for continued research and improvements in care, as cancer deaths are still more common in black men than in white men. Experts estimate that there will be over 1.5 million new cases of cancer in the US in 2014, about 586,000 of which will result in death.

The divide in cancer cases and deaths between races and ethnicities is starkly evident when one considers that even though the rate of deaths has been effectively cut by half in middle-aged black men, their deaths from cancer are still significantly more common than those of white men. The lowest rate of cancer deaths is seen in Asian Americans. Even more deaths could be prevented if the knowledge we now have about fighting cancer were applied across all groups of people – including the poorest subset of the population.

Lung cancer continues to top the list of fatal cancers, along with breast, colon, and prostate cancers. These four cancers alone are responsible for almost half of all cancer deaths in the US, with lung cancer causing more than a quarter of cancer deaths. Researchers estimate that this year, these four cancers will be the most common cancers diagnosed.

Still, the rates of not only deaths but new cases of cancer are also falling. One reason is that more people are having regular colonoscopies, during which pre-cancerous polyps can be removed and full-blown cancer avoided. Lung cancer occurrence has also decreased, thanks in large part to declining numbers of smokers.

Doing Your Part

The number of new cancer cases as well as the number of deaths from cancer can be further reduced by individuals taking a proactive approach to preventing cancer – or catching it early. This is one reason why your annual appointment with your gynecologist is so important; cervical and other cancers can be detected and treated in the early stages, before metastasis complicates your prognosis. Screening for other types of cancers, such as breast cancer and colorectal cancer, is also highly effective at detecting cancer early on. Most cancers are highly treatable when caught early. Free and low-cost cancer screenings are available in many states.

You can further reduce your cancer risk by getting an HPV vaccine and/or a hepatitis B vaccine; ask your doctor if these are right for you. Besides getting regular preventive medical care, avoiding tobacco, limiting sun exposure and avoiding tanning beds, keeping alcohol use to a minimum, getting plenty of exercise, and eating lots of fruits and vegetables can all go a long way toward helping your prevent – and fight – cancer.

– Yvonne S. Thornton, M. D., M. P. H.

Exercise May Spell Relief for Migraine Sufferers

Monday, January 27th, 2014

Some people who suffer from migraines say that exercise can bring on the severe headaches, but a recent study shows the opposite – that exercise may, in fact, help prevent them. In the study, three groups of participants were observed. One group took the drug topiramate, which is commonly prescribed for migraines; one group practiced relaxation exercises; and one group exercised for 40 minutes three times a week.

After three months, no significant difference was observed between the groups in terms of the presence of migraines. All three groups showed a decrease in the number of migraines they got, suggesting that exercise may be just as effective as drugs at preventing migraines.

For people who know all too well the pain and misery of a migraine, it’s worth a try. It’s probably true that there is no one “right” approach that works for everyone; different people will find that different approaches are effective for them and some trial and error is inevitable in most cases. What is true is that as long as you have no physical contraindications, exercise usually won’t hurt and is a safe and healthy activity for most people.

Migraines can be difficult to diagnose, as they have several variants. In general, they are severe and even disabling headaches affecting about 22% of women and about 10% of men. Migraines can affect a person’s ability to go about his or her daily routine for hours or even days at a time and can be difficult to treat, so the information that exercise may help prevent them is good news for those who haven’t had much success with drug treatments or relaxation exercises.

A typical migraine can produce severe, throbbing pain, visual disturbances, nausea, vomiting, and sensitivity to sound and/or light. Many people find that once they have a headache, physical activity can make it worse, so finding ways to prevent migraines is important. Migraines may occur anywhere from once a year to several times a month.

The exact cause of migraines is not well understood. There is no shortage of theories, however, and they range from changes in the trigeminal nerve (a main facial nerve) to serotonin imbalance. Food sensitivity may play a role in some individuals. Another factor, particularly in women, may be hormonal fluctuations. Stress and heredity are also suspects in some cases. Still other possible triggers include sleep disturbances, barometric pressure changes, altitude changes, bright flashing lights, and strong smells such as gasoline or paint.

There are two main types of drug treatment used by migraine patients: those that treat an existing migraine and those that aim to prevent migraines from occurring in the first place. In individuals who have found that they aren’t responsive to drug treatments, regular exercise just may provide a new avenue to explore for the prevention of the debilitating headaches.

– Yvonne S. Thornton, M. D., M. P. H.

Is It Safe to Get the Flu Shot During Pregnancy?

Monday, January 13th, 2014

If you are pregnant, chances are that you are questioning everything that goes into your body, and for good reason. It’s your job during pregnancy to nurture and protect your baby from a wide range of potential dangers. During the winter months, you may be wondering whether the flu vaccine is among those dangers.

It’s not. The fact is that it is completely safe for pregnant women to get the flu vaccine. In fact, getting vaccinated against the flu could make a big difference in your baby’s health; it could even be the difference between life and death. The CDC (Centers for Disease Control and Prevention), the American Academy of Pediatrics, the ACOG (American Congress of Obstetricians and Gynecologists), the American College of Nurse-Midwives, and numerous others all strongly recommend that pregnant women get flu shots.

Getting the flu while pregnant can cause serious complications. Pneumonia is one major concern. Pneumonia is potentially life-threatening and could be a risk factor for preterm labor. In addition, there is evidence that when you get the flu shot during pregnancy, your baby may continue to benefit from this protection after birth. Also, if you avoid catching the flu yourself postpartum, then your baby is less likely to be exposed to it at all. And protecting your newborn from the flu is important, because the flu is particularly dangerous for young babies, who can’t be vaccinated themselves before they are six months old. (Therefore, not only you but other family members as well should get flu shots.)

The flu vaccine may have no side effects at all, or you may notice mild side effects such as mild pain, tenderness, or redness at the site of the shot. Some people notice muscle aches, nausea, fever, or headaches after the shot, but these generally only last a day or two. Allergic reactions are extremely rare.

Anyone considering the flu shot, including pregnant women, should tell their doctors or anyone who is administering the shot if they have severe allergies to eggs or anything else that may be present in the shot. It is important to note that pregnant women should receive the flu shot, and not the nasal spray, which contains live flu virus.

Pregnant women can get flu shots at any point in their pregnancy. Getting vaccinated as early as possible to avoid being unprotected when flu season begins is best. However, if you have avoided getting the vaccine because you were concerned about safety during pregnancy, go ahead and get one even if it is later in the season. Flu season can last well into the spring, so even women getting vaccinated later on can still benefit.

Lately there has been some concern among people getting vaccinated about thimerosal, a preservative used in some flu shots. However, the CDC has uncovered no evidence that thimerosal presents any risk whatsoever. Besides, the benefits of getting a flu shot far outweigh even any theoretical risk. If you are worried, though, don’t let it stop you from getting a flu shot; ask your doctor about thimerosal-free vaccine. If it isn’t available in your area, go for the regular flu shot, and don’t worry – it’s much safer than not getting one at all.

– Yvonne S. Thornton, M. D., M. P. H.

Thyroid Problems and Pregnancy

Monday, January 6th, 2014

The thyroid gland is one that most people never give much thought to – until it causes problems. The gland itself is about two inches long and shaped like a butterfly. It sits in the front area of the neck just below the larynx with one lobe on each side of the windpipe. Along with the other components of the endocrine system, the thyroid’s job is to produce hormones. It can also store these hormones and release them into the bloodstream.

The hormones produced by the thyroid are very important, as they affect metabolism, weight, breathing, nervous system functions, muscle strength, body temperature, and menstrual cycles. If the thyroid produces too much or too little hormone, nearly every organ in the body can be affected. Hypothyroidism is underactivity of the thyroid; overactivity is called hyperthyroidism. Because the thyroid affects the menstrual cycle, a woman with a thyroid disorder may find it more difficult to get pregnant.

If a pregnant woman has a thyroid problem, there are special considerations to keep in mind. A woman with thyroid disease can certainly have a healthy, normal pregnancy and baby if she talks about this problem with her doctor, educates herself on the ways in which the thyroid is affected by pregnancy, stays up to date on her thyroid function testing, and takes the proper medications on the proper schedule.

How Is the Thyroid Affected by Pregnancy?

The thyroid gland is basically responsible for controlling our body’s metabolism.  It is regulated by a hormone known as thyroid-stimulating hormone or TSH, which is secreted by the pituitary gland. Pregnancy causes the production of many hormones, one of which is human chorionic gonadotropin (hCG).  In early pregnancy, the growing placenta makes human chorionic gonadotropin (hCG).  HCG increases the production of progesterone, which is crucial for the growing fetus and without it may increase the risk for miscarriage. What does hCG and TSH have in common?  Well, they are two different hormones;  one (hCG) plays an integral role in maintaining pregnancy while the other (TSH) regulates the thyroid gland.  However, hCG can mimic TSH , causing the thyroid gland to become hyperstimulated.  It turns out that the molecular structure of both of these “different” hormones are very similar. 

Both are composed of two different protein subunits. One of those protein subunits is called “alpha” and the other “beta.” The alpha subunits of hCG and TSH are identical but the beta subunits are different; but not by much.  The beta subunits of hCG and TSH are about 40 percent identical.  Given that mechanism, very high concentrations of hCG can actually stimulate the thyroid gland sending it a message to become hyperactive. In other words, hCG can sometimes act like TSH, which is the reason an elevated thyroid function test in the first trimester (which may be interpreted as an overactive thyroid), should be repeated in the second trimester when the levels of hCG have stabilized.

The fetal thyroid becomes active at 12 weeks. Until then, it depends on the mother’s supply for brain and nervous system development.

The thyroid also becomes slightly enlarged during pregnancy, but not enough to be viewed as abnormal during a physical exam. If a thyroid is noticeably enlarged, this could be a sign of thyroid disease. But again, thyroid problems are tricky to diagnose during pregnancy, because the thyroid hormones levels are higher than normal and also because fatigue and other symptoms of thyroid disease are often similar to normal pregnancy symptoms.  That is why subspecialists, like myself, known as maternal-fetal medicine specialists, may need to be called upon by the midwife or obstetrician when caring for a pregnant woman with suspected thyroid dysfunction.

How Is Pregnancy Affected by Thyroid Problems?

Depending on whether you are dealing with hyper- or hypothyroidism, uncontrolled thyroid disorders in pregnancy can cause a number of health risks to mother and baby, including congestive heart failure, thyroid storm, neurologic deficits in the fetus, miscarriage, fetal growth restriction or neonatal Graves disease (hyperactive thyroid function in the newborn).   Thyroid disease has an autoimmune component and other autoimmune diseases also need to be ruled out.  Antibodies (TSI—thyroid stimulating immunoglobulins) from a hyperactive, hyperthyroid patient can cross the placenta and cause fetal goiter.

For these reasons it is extremely important that a woman with a thyroid disorder optimize her health by eating a balanced diet with iodized salt, taking a prenatal multivitamin that contains iodine (which the thyroid uses to make hormones), and taking the appropriate medication to control symptoms and regulate hormone production.  Up to 10% of postpartum patients develop new-onset of Graves disease or autoimmune thyroid dysfunction.  In my practice, patients who were six weeks postpartum all underwent thyroid function testing.  It is not the standard, but, after diagnosing several patients with thyroid dysfunction, I did not want to miss an abnormally functioning thyroid gland in any of my postpartum patients.  Thyroid conditions often require lifelong monitoring, but with the right medical attention, are easily controlled.

 – Yvonne S. Thornton, M. D., M. P. H.

Managing Urinary Incontinence

Thursday, December 26th, 2013

Urinary incontinence refers to the loss of bladder control and is a very common problem. Unfortunately, it is also a very embarrassing problem for many women, and so they often just live with it rather than discussing it with their doctors – which is too bad, because there are effective treatments available, and some of them are very simple.

Urinary incontinence can be mild or severe, ranging from the occasional leak upon sneezing or coughing to having such strong, sudden urges to urinate that you can’t make it to the toilet in time. If incontinence is affecting your day to day activities, please don’t hesitate to talk to your doctor about it. He or she has heard it before, and some simple medical treatment or even just lifestyle changes in some cases can make a huge difference. There are several different types of urinary incontinence, for example:

Stress Incontinence: Leaking urine when pressure is exerted on the bladder, such as through laughing, sneezing, coughing, or heavy lifting. Childbirth and menopause often result in stress incontinence. Obesity is a very common culprit.

Urge Incontinence: An intense and sudden need to urinate. Women with this type of incontinence often experience involuntary loss of urine and “not making it” to the toilet in time. The bladder contracts and in some cases the woman has only a matter of seconds to reach a restroom. This type of incontinence can be caused by a variety of health problems such as UTIs (urinary tract infections), stroke, Parkinson’s or Alzheimer’s disease, and multiple sclerosis. 

Overflow Incontinence: Women who have trouble emptying their bladders completely may experience overflow incontinence, or the frequent or constant leaking of urine. A women with this type of incontinence may not be able to empty her bladder and may be able to produce only a weak stream of urine; typically, this is caused by some type of damage to the bladder – for example, nerve damage caused by multiple sclerosis or diabetes.

There are also cases where women experience more than one type of incontinence. To be sure, it can feel embarrassing to tell your doctor you are having a problem with incontinence. But this is a much better option than suffering in silence. For starters, incontinence may be a symptom of a more serious problem. It can also seriously affect your quality of life, especially if you are restricting your activities and limiting social interactions.

What Causes Urinary Incontinence?

Incontinence can be temporary or permanent, mild or severe. It can be caused by a number of different things. Sometimes, temporary incontinence or isolated incidents can be caused by alcohol, caffeine, or over-hydration; it can also be caused by a UTI and in this case, it goes away as soon as the infection is treated.

When incontinence is persistent, it may be caused by an underlying physical condition or problem, such as an undiagnosed urinary tract infection , pregnancy, hysterectomy, neurological disorders, or obstruction of the urinary tract by a stone or tumor.  The most common reason is just aging and not pregnancy or the mode of delivery.   As stated here back in May, nuns have the same prevalence of urinary incontinence as mothers.


See Your Doctor for a Solution

Often, women with urinary incontinence are most comfortable talking to their gynecologists first. In most cases, your gynecologist can help you with this problem; in certain cases, he or she may need to refer you to a urogynecologist or other specialist. When you go to your appointment to discuss your problem, be prepared with some information that your doctor is sure to ask you for. For example, your symptoms in detail and a list of all medications you take (including vitamins). Also write down questions you have so you don’t forget them once you are in the doctor’s office.

The type of treatment recommended will depend on your individual symptoms and the type of incontinence you are experiencing. Your doctor will most likely suggest the least invasive treatments first, and often, these are quite effective. He or she may suggest that you try certain techniques such as bladder training, double voiding, diet and fluid management, or Kegel exercises.

If these are not effective, there are medications available that can help. There are also medical devices such as urethral inserts and pessaries that can be helpful. Sometimes, urinary continence may require surgical treatment.

To reduce your risk of developing urinary incontinence or to prevent yours from worsening, maintain a healthy weight, do regular Kegel exercises, don’t smoke, and avoid foods known to irritate the bladder such as caffeine and alcohol. You will almost certainly be glad that you talked to your doctor about your incontinence. Go make your appointment now and you’ll be one step closer to relief.

– Yvonne S. Thornton, M. D., M. P. H.

Preventing HPV Infection

Monday, December 23rd, 2013

Human papillomavirus (HPV) is the most common sexually transmitted infection (STI). HPV can lead to a number of serious health problems, such as genital warts and some types of cancer. Many people who have HPV do not know it, because it often causes no symptoms. HPV should not be confused with either herpes or HIV. While these can all be transmitted through sex, they cause different problems and produce different symptoms.

Anyone who has ever had sex has potentially been exposed to HPV. Remember – not everyone who has it is even aware they have it. At least half of all people who are sexually active will get HPV at some point. This statistic remains constant even in the case of people who have only one sexual partner in their entire lifetime.

Most commonly, HPV is transmitted through vaginal and anal sex. It does not discriminate between straight and homosexual couples. Furthermore, even if years have passed since contact with an infected person, HPV infection can still be present. In rare instances, HPV can be passed from a pregnant woman to her baby during delivery. In addition, one person can contract more than one type of HPV.

In most cases, HPV will go away on its own without causing any serious problems. Sometimes, however, the infection will stick around and cause serious issues such as genital warts, cervical cancer, or other types of cancer.

According to the CDC (Centers for Disease Control), HPV is the main cause of cervical cancer in women. There are about 12,000 new cervical cancer cases each year in the United States. Cervical cancer causes about 4,000 deaths in women each year in the United States. There are about 15,000 HPV-associated cancers in the United States that may be prevented by vaccines each year in women, including cervical, anal, vaginal, vulvar and oropharyngeal cancers.  In addition, about 7,000 HPV-associated cancers in the United States may be prevented by vaccine each year in men.  Approximately 1 in 100 sexually active adults in the United States have genital warts at any given time.


Should You or Your Daughter Get an HPV Vaccine?

Individuals can reduce their risk of getting HPV by getting vaccinated. As with any newer vaccine, there have been rumors regarding dangerous side effects. However, the fact is that the HPV vaccine has been shown to be safe and effective, and since at least 70% of all cervical cancers are caused by HPV, it is absolutely recommended that people who are able to get the vaccine do so. Gardasil is one vaccine that should be given to girls and young women between 11 and 26 years of age. Another available vaccine is Cervarix. The vaccines are given in the form of three doses (injections) administered over a period of six months; for the best protection, it is important to receive all of the doses (injections).

Sexually active individuals can also choose to lower their risk by using condoms. It is possible for HPV to affect areas that the condom does not cover, so realize that condoms are not 100% effective against the transmission of HPV. A vaccination is recommended even for people who always use condoms and plan to continue to do so.

Gardasil is also licensed, safe, and effective for males ages 9 through 26 years. CDC recommends Gardasil for all boys aged 11 or 12 years, and for males aged 13 through 21 years, who did not get any or all of the three recommended doses when they were younger. All men may receive the vaccine through age 26, and should speak with their doctor to find out if getting vaccinated is right for them.


The vaccine is also recommended for gay and bisexual men (or any man who has sex with men) and men with compromised immune systems (including HIV) through age 26, if they did not get fully vaccinated when they were younger.


Finally, limiting the number of sexual partners a person has can reduce their risk of being exposed to HPV; so can choosing a partner with few or no previous partners. But again, even if only have one sexual partner ever, you still have at least a 50% chance of contracting HPV – so, in you are in the appropriate age range, you should still receive the vaccine if possible.

– Yvonne S. Thornton, M. D., M. P. H.

Women with High Blood Pressure Who Smoke Have Greater Risk of Aneurysm

Monday, December 16th, 2013

Subarachnoid hemorrhage (SAH) is a cerebrovascular catastrophe that kills 40 to 50 percent of sufferers. A ruptured intracranial aneurysm is the most common cause of SAH. Sometimes, aneurysms are found and treated before they have a chance to rupture. Furthermore, some aneurysms will never rupture. However, there is no way to tell which ones will and which ones won’t. In addition, research now shows that women who smoke and have high blood pressure are more likely to develop SAH. Twenty times more likely!

This discovery is important because it sheds some light on how to decide whether to treat a person with an unruptured intracranial aneurysm. If we know that a female patient with high blood pressure who smokes is significantly more likely to develop SAH than a male patient with normal blood pressure who doesn’t smoke, and intracranial aneurysms are found in both, then it may be that the woman needs to be treated while the man does not. This is an important step in being able to predict which aneurysms are likely to rupture and which aren’t.

The study also revealed three previously unknown risk factors for SAH: elevated cholesterol levels in men, and maternal history of stroke and previous heart attack in either gender. These results show that the risk factors for SAH appear to be similar to the risk factors for other cardiovascular diseases.

It is already known that lifestyle risk factors have a significant impact on the life expectancy of a person who has survived SAH. Now, it is becoming clear that those same risk factors increase the risk of SAH in the first place. Therefore, quitting smoking and taking steps to lower high blood pressure are especially important in both preventing SAH and increasing life expectancy if it does occur.

Of course, this is just one more item to add to the list of reasons why you should quit smoking. Smoking is a well-known health risk that people can choose not to expose themselves to. Cigarettes contain over 4000 chemicals, at least 400 of which are known toxic substances.

Among the most harmful products in cigarette smoke are tar, which is a carcinogen; nicotine, which is addictive and is thought to increase cholesterol levels and carbon monoxide, which replaces oxygen in your bloodstream. An individual’s overall health risk from smoking depends upon a number of factors, including how much the individual smokes, whether the cigarette has a filter, and how the tobacco has been prepared. More research is needed before it will be clear whether these same factors affect a person’s SAH risk.

As for hypertension, it is known to be potentially damaging to several body systems, including the arteries, heart, brain, and kidneys. Talk to your doctor about your blood pressure and/or smoking to find solutions for lowering your blood pressure, helping you quit smoking, or both.

– Yvonne S. Thornton, M. D., M. P. H.

Obsessive-Compulsive Disorder and Pregnancy

Monday, December 9th, 2013

Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by unwanted, recurring thoughts or fears (obsessions) and the behaviors a person develops to try and stop the fears from coming true (compulsions). People with OCD get into cycles of obsessive thoughts which are followed by compulsive behaviors. The compulsive behavior brings temporary relief from the anxiety, but only temporary. Soon the obsession and its accompanying anxiety return, and the cycle starts all over.

For example, a person might repeatedly wash his or her hands, clean the house, or check things such as locks or light switches. Sufferers are aware that there is no need for the behavior, but they are unable to stop themselves from repeating it. OCD can be very time-consuming and cause more anxiety or stress, rather than reliving it. In severe cases, it can stop people from leading normal lives.

Pregnancy and OCD have a relationship that is not yet well understood. Sometimes, a woman experiences OCD for the first time during pregnancy or following childbirth. Also, some women who have existing OCD may find that their symptoms worsen during pregnancy or in the weeks or months following childbirth. Still other women find that their symptoms improve during pregnancy.

OCD and depression are commonly found together; new mothers with OCD may be more likely to experience postpartum depression, or they may experience postpartum depression that is more severe. Among the general population, OCD is thought to affect about one in 100 people; about twice that number are affected during pregnancy and after childbirth. 

How Do You Know if You Have OCD?

Worries and fears are normal and common among pregnant women or new mothers. Such thoughts and fears usually do not signal OCD. However, OCD could be a concern if the anxiety is overwhelming or if it leads to needless and repetitive behaviors.

Fears that the baby is in some kind of danger are common among pregnant women with OCD. A woman may be afraid that she will somehow harm her baby herself, and therefore develop compulsions to try to protect her baby. For example, she may stop eating certain foods she believes may harm her unborn baby, even if her doctor says they are safe to eat. Or, after the baby is born, the new mother may compulsively check on the sleeping baby. She may constantly clean areas the baby has contact with, or she may even avoid spending time with her baby.

Why Is OCD More Common During Pregnancy?

The reason for this is not fully understood. Often, the reason for OCD cannot be pinpointed, even when pregnancy is not a factor. In some cases, it could be that new mothers feel the added pressure of the extra responsibility having a new baby places on them. Or, it may be that a mother suppresses negative emotions because she is “supposed” to be experiencing a joyful event. It is also possible that changes in brain chemistry play a role, or that hormonal fluctuations have an effect.

If you think you may have OCD, ask your doctor about it. He or she can refer you to someone who is trained to help people with OCD. Talking to someone who understands what you are going through is usually very helpful.

– Yvonne S. Thornton, M. D., M. P. H.