Women’s health issues

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A Family History of Heart Disease Doesn’t Have to Be Your Future

Monday, May 21st, 2012

Heart disease is a growing problem in America.  It is the leading cause of death in both men and women, and is even more of a problem for African Americans.  For many Americans the tendency towards heart disease runs in the family, and with their fast food addiction and sedentary lifestyles, the risk only increases.  Just because you may have a history of heart disease in your family though, doesn’t mean it’s a fate you have to suffer.

Jennifer Sedbrook, an OSF Cardiovascular Service Line Leader, says that “We can control all but two of the factors that affect heart disease; family history and age.”  OSF (Order of St. Francis) Healthcare is a nonprofit Catholic health care corporation that operates a medical group, hospital system, health plan, and other health care facilities in Illinois and Michigan.  According to OSF, There are other important factors which can also increase our risk though, and those include our BMI, or body mass index, blood pressure, cholesterol, and weight.  It’s important to be aware of your body and to know each of these numbers, so that if there is a change, you can alert your doctor.  Additionally, if you know your body mass index and, consequently, weight are not where they should be, you can be proactive.  By eating healthy and committing to a regular exercise routine, you can drastically reduce your risk of heart disease.  This, along with controlling the amount of stress in your life, will decrease your cholesterol and blood pressure.

Ann Ripsom, one woman in a family of 7 siblings, has lowered her own risk factors by quitting smoking, joining Weight Watchers, and getting regular check-ups with her doctor.  She decided to get involved with the OSF Women’s Heart Ambassadors after losing three of her brothers to heart disease.  Three of her other siblings have also suffered from major heart issues.  Despite such an intense family history of heart problems, Ann does not show signs of the disease and is working to help others decrease their factors too.  She says that the most important thing to do is to take control of your risk factors and do not ignore signs your body may be giving you. In addition, people need to know the various symptoms of a heart attack, which can include chest pain, jaw pain, pain in either arm, nausea, sweating, disorientation, and fatigue.

More than 616,000 people died of heart disease in 2008 alone.  That accounted for 25% of the deaths in America that year.  By becoming educated about your risk factors, these kinds of deaths can be prevented.  Knowing this information and taking steps toward prevention is the most important thing you can do.  So find out what your numbers are, start eating healthy, and above all, get active.  Don’t let your family’s history determine your future.

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

 

 

 

Don’t Want Kids? Why Haven’t You Told Your OB/GYN?

Monday, May 14th, 2012

Back in my mother’s day, women were expected to grow up and raise a family.  Nowadays though, modern women view having kids as more of an option.  In fact, more and more often women are choosing to forgo the family experience in exchange for a demanding or prestigious career.  There is no longer a societal stigma for not having children.  It is truly a choice.  Oprah Winfrey, two recently-appointed female Supreme Court Justices, Condolezza Rice, and even our Surgeon General are childless.  While I can say firsthand that it is possible to have both a career and children, I can certainly relate to the ambitious young women out there who want different achievements than those of their mothers’ generation.  While these young women may have decided beyond a doubt that they don’t want children, for some reason, they’re not sharing this information with their OB/GYNs.

Many people see OB/GYNs as physicians who perform annual exams or take care of matters concerning pregnancy.  While these are important parts of our job, they’re not the sole aspects.  We are here to provide support and advice when it comes to a variety of women’s health issues.  Just because you’ve decided not to have kids, doesn’t mean we don’t have anything more to tell you.  In fact, OB/GYNs can give you valuable information concerning your permanent birth control options.  Although so many women are opting out of pregnancy, they continue to use contraception methods that are temporary, not always effective, and sometimes, risky to their health.  With average use, condoms have a failure rate of 17.4 percent and the pill has an 8.7 percent failure rate.  In addition to the pregnancy risk, hormonal birth control increases a woman’s risk for blood clots, strokes and heart attacks.  Yet, those who don’t want kids or those who don’t want any more kids, continue to take the risk.

As stated in my women’s health book, “Inside Information for Women”, the most common form of contraception among couples is sterilization.  While most have heard about invasive procedures like vasectomies and tubal ligations, only 12 percent were aware that other options existed.  Because, in the final analysis, whoever carries the child is the one who is going to be the one most concerned about birth control, it is more usually the female partner rather than her mate who elects sterilization. There is more than one type of sterilization for women though, including sealing fallopian tubes using an instrument with an electrical current, closing them with clips, clamps, or rings.  A new method of sterilization (Essure®) involves inserting spring-like coils into the tubes through the cervix around which tissue grows to block the tubes.  President of AAGL and practicing OB/GYN, Dr. Linda Bradley believes that more women would choose a permanent method if they were simply more educated on the matter.  She cites the insert procedure (Essure®) as being 99.8 percent effective and a lot less invasive than a tubal ligation.  She notes the insert method, for instance, as being a “non-surgical permanent birth control procedure [that] offers women the option of no incisions, no hormones, no general anesthesia and no slowing down to recover.”  It’s a fairly new procedure, just ten years old, but it is gaining in popularity among those who have learned about it.

Wherever you are in your reproductive plans, it’s important to share them with your OB/GYN.  They can give you information you may not have considered, guide you in your decision making, and help you make the healthiest and most informed choice regarding your reproductive health.  The next time you and your loved one debate over who should get that permanent birth control procedure, include your OB/GYN in the conversation.

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

WHAT’S WRONG WITH THIS PICTURE?

Friday, May 11th, 2012

2012 -- The All-Male Leadership of ACOG

I just returned from the 60th Annual Clinical meeting of ACOG (Women’s Health Physicians).  I can’t explain it, but after being a member for over 30 years, it bothered me to no end to see ALL men on the dais as representatives of women’s health as if women couldn’t make policy about their own health.  When I was a resident, 95% of obstetricians were male.  Now, women comprise over 46% of practicing obstetricians and almost 80% of the OB/GYN resident physicians, YET all you see in the  governing body and officers (who set policy for the care of women) are 12 elderly Caucasian males.   Their very presence as leaders do not reflect the diversity of the ACOG membership today, yet there they are. No Blacks, No women, No minorities.  It’s as if ACOG were stuck in a time warp of 60 years ago!!  Since 1951, there have been only two female Presidents of the College and the last one was almost twenty years ago!  It seems so anachronistic and so wrong.

The male obstetricians have had the power to dictate and oversee women’s health for decades and it appears that they are NOT relinquishing it to any female any time soon; even if it pertains to women’s health!! It is a shame that in the 21st century, no one at ACOG (American College of Obstetricians and Gynecologists) is reaching out for inclusion of women and minorities in its upper echelons.  A picture is worth a thousand words.

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

Introduction of ACOG’s leadership

Are Cesareans the Lazy Way Out?

Thursday, May 10th, 2012

The process of giving birth has certainly evolved over the years.  Women can now opt for an assortment of painkillers, choose to do a home birth, and even substitute doctors for midwives.  The most recent trend though, seems to be cesarean deliveries.  Instead of enduring hours of labor, being coached by the doctor, and toughing out a natural, vaginal birth, babies are getting the quick way out.  Is this increase because of concerns for the mother’s or child’s health, or simply because obstetricians are looking for the lazy way out?

Right now, one out of every three births happens through cesareanIn 1965, only 4.5% of births were cesareans.  Why the big increase?  Unfortunately, it’s not a result of medical need.  Instead, 29% of Obstetricians polled in a survey said, “they were performing more Caesareans because they feared lawsuits.”  (Some other physicians, myself included, happen to be of the mindset that it is more about convenience, on both the parent and physician side, than anything else. It takes serious stamina to stand by and coach a woman through thirty hours of difficult labor. And I do it because I love my job. I am a warhorse, and I am there for my patients.) Because they’re concerned about being held responsible for potential harm to the baby from vaginal labor and deliveries, they would rather opt for cesarean deliveries.  While this kind of labor may be quicker, it is by no means safer.  A cesarean is an invasive surgery that is actually more likely than a vaginal birth to pose a risk for complications that might, “put the mother back in the hospital and the infant in an intensive-care unit.”  Some hospitals are not giving moms all the information.  Instead, they offer the cesarean as a casual choice in order to skip providing long-term labor support, to get through the labor as quickly as possible, and to avoid malpractice claims.  Cesareans are also much more expensive, consequently, making hospitals more money.  While there are women who do need cesareans for valid medical reasons such as breech for first-time Mom’s, high-order multiple births in one delivery, cephalopelvic disproportion (the baby’s too large for Mom’s pelvis) or eminent danger to the mother (such as hemorrhage) or fetus (sudden abnormal heart rate), these do not make up nearly enough of the more than 30% cesarean rate.  That means that the majority of cesareans are happening because obstetricians are choosing them, not mothers.  If Mother Nature wanted our babes to be born by Cesarean, she would have put a zipper on our abdomens.  The consequence of this increase in Cesarean births (some by maternal request) is the increase in maternal death and Cesarean hysterectomies in subsequent pregnancies due to hemorrhage caused by abnormal placental location and uterine rupture.

This is why it’s so important to become as informed as possible about child birth before making any decisions.  Make sure you have a caring, ethical obstetrician who is willing to give you all the information you need to make the safest choice for you and your child.  If they recommend a cesarean, ask them about their reasons and whether or not it is medically necessary.  Remember, it is your body, your baby, and your choice.

— Yvonne S. Thornton, M. D., M. P. H.

Early Menopause is Bad News for Women and Their Bones

Monday, May 7th, 2012

Let’s face it.  None of us looks forward to getting old, but we try to do it with as much grace as possible.  For some women though, menopause, a hormonal change that should come later in life, comes sooner than expected.  Instead of dealing with hot flashes, night sweats, mood swings and all the other symptoms of menopause in their 50s, they’re facing it in their 40s or even younger.  And as if early menopause isn’t bad enough, studies now show that it increases their risk for osteoporosis and even shortens their life expectancy.

Swedish researchers from Skane University Hospital in Malmo conducted a study of almost 400 women over the course of just under 30 years.  They found that of the women who started menopause before the age of 47, 56 percent developed osteoporosis compared to just 30 percent in the women who started menopause later in life.  Women suffering from osteoporosis are at greater risk for bone fractures, bone pain, and loss of height due to bone loss.  Their findings also showed that women who had undergone early menopause had a greater risk of fragility fracture and death with a rate 17 percent higher than the women with later menopause.  The rate of fractures in women with early menopause was 44% compared to 31% in those women who entered menopause later.

The cause of early menopause is not yet clear, though there seems to be a link between it and premature ovarian failure, hysterectomies, chemotherapy, and possibly even stress.  Premature ovarian failure has been associated with Fragile X syndrome, so there may be a genetic link. Unfortunately, preventing and reversing early menopause is not yet possible, but there are ways to decrease your risk of osteoporosis.  The bone masses of most women peaks in their 20s.  You can increase yours by getting plenty of calcium, vitamin D and exercise.  A balanced diet and thirty minutes of weight training or other moderate exercise every day can make big difference when it comes to your bone health.

The association found between early menopause, osteoporosis, and death is causing some to call for more studies to determine a more definite correlation. The higher mortality rate in women with early menopause does need further study in order to address the confounding variables, such lifestyle, medications and smoking.  In the meantime, we should take the results as a warning to take care of our bodies, particularly our bones, as early as possible.

— Yvonne S. Thornton, M. D., M. P. H.

Women Are Enduring More and So Are Their Hearts

Thursday, May 3rd, 2012

There was a time, when women stayed home to care for the children, did not vote, and did not make money of their own.  Luckily, we’ve since achieved a sense of equality as citizens.  Unfortunately, that equality has not come without a price.  As modern day women, we work just as hard as men, but on average, still earn less.  We parent just as much as men, and often as not, more because it is ingrained in us to try and be that Hallmark mom, but still must bear the burden of pregnancy.  We deal with the emotional, physical, and economic stresses just as much as men, but now, studies show that our hearts do not get as much help during these stressful times.

Researchers at Penn State conducted a study to find out how the heart and blood pressure of men and women differed when presented with mental stress.  All subjects were given the same problems and were monitored carefully to see how they dealt with the pressure.  The hearts of both men and women started working harder as the stress mounted, as was expected.  The amount of blood flow to the heart increased in men in order to make up for the extra work, but it did not increase in women.  This was a surprising discovery.  Professor Chester Ray, who led the study, believes this “shows women may be more susceptible to experiencing a cardiac event with mental stress compared to men.”  With heart attacks being much more common in women than in men, their results are helping doctors understand why.  Hopefully, these findings will encourage more women to seek a doctor’s advice when they feel stress that seems to be affecting their heart.

What does this boil down to? It boils down to the fact that women need to begin to realize that they need to demand the help that they deserve and need. We simply cannot be everything to everyone all of the time. We need to set priorities, and stick to them. My new memoir, “Something to Prove” chronicles my life as a woman who balances career, home and family; hopefully serving as a roadmap for other adventurous women.  Different times in our lives call for different priorities. Being a harried mother may be just as stressful as meeting an office deadline or being the sole caretaker of infirm parents or performing difficult surgery.  We are not superwomen, though if you look at what a majority of women accomplish on a day-to-day basis, we might as well be; even without the additional pressure that put on ourselves trying to “do it all”. All women who have children have one job, if she works outside the home, then she has two jobs, and if you are also cook, cleaner, and overall the “go-to” person, you might just have three jobs. And this is considered normal… It’s no wonder women are stressed.   

Although psychological studies have shown that women feel they are “expected to possess many diverse traits and behaviors, such as being both competitive and nurturing, compliant and assertive, and to appear in control without any signs of vulnerability,” they need to realize these expectations contradict themselves and are simply not realistic.  If your lifestyle has caused you to deal with inordinate amounts of stress, your mental, emotional, and physical health will suffer if you don’t make a change.  A study at the Chinese University of Hong Kong found that women who had more satisfying jobs and home lives were less likely to develop as much mental stress, even though they had the same amount of responsibilities as others.  I love ballroom dancing and I twirl around the dance floor each week with a cha-cha or tango in order to de-stress and have a creative outlet.  In other words, find something that you love doing and it won’t take quite as much of a toll on your health.  With this in mind, you can still be a modern day woman and take on numerous responsibilities, but you shouldn’t be afraid to ask for help when you need it.  As a physician, author, wife, and mother, I know that finding this balance can be difficult, but your heart is worth it.

— Yvonne S. Thornton, M. D., M. P. H.

When Did My Uterus Become Politicians’ Business?

Tuesday, May 1st, 2012

As a working mother, I have made many decisions over the years regarding my health and the health of my family.  Those decisions were always made after careful consideration that included years of education, the beliefs of my family, and my own personal needs.  Not once during those processes did I ever consult with or even consider that politicians should also be debating those decisions.  It is shocking how much interest the government is suddenly taking in women’s reproductive health.  What should be personal choices made by American women, have now become the focus of debates for men who are looking for political gains and who frankly don’t have the biological parts necessary to even consider these topics.

Because Rick Santorum felt the need to prove his belief in traditional family values, he mentioned that women who are the victims of rape, should, “make the best of a bad situation,” in regard to their unwanted pregnancies.  While this may have helped him get a few more conservatives on his side, it did nothing to stop the suffering of women who, if he had his way, would continue to live out their traumatic experience by carrying and delivering the children of their attackers.  Trying to prevent unintended pregnancies altogether is even too much for Committee Republicans to keep their hands off of these days.  They would like to eliminate $12 billion of healthcare funding that would otherwise go to preventive services.  This would reduce access not only to birth control, but also cancer screenings and other types of care and services, especially those used by low-income women.  Republican Candidate Mitt Romney would like to create tax cuts that would benefit millionaires, hoping to spur job growth, but those cuts would come at a cost to programs that help women.  Obama seems just as puzzled by this as many American women, saying, “These are folks who claim to believe in freedom from government interference and meddling. But it doesn’t seem to bother them when it comes to a woman’s health.” The absence of women in power has become very obvious because of these issues.  Hopefully, they will inspire more women to vote and maybe even to run for office.

No matter what her position, every woman has the right to make her own decisions regarding her health, including her reproductive health.  Pressure from politicians, employers, and religious organizations should have no influence on her decision.  It is up to each individual woman to decide what beliefs to follow.  That’s why it is so great to be American in the first place.  We have certain freedoms that allow us to live our lives the way we choose.  While talking points like women’s reproductive health can mean big business for bureaucrats, they’re interfering with the personal freedoms of women and decisions that are, frankly, none of their business.

— Yvonne S. Thornton, M. D., M. P. H.

Childhood Obesity Speeds the Onset of Puberty in Girls

Tuesday, April 24th, 2012

When I was young, even though my Dad wanted to “plump up” me and my sisters so that we would be less attractive to boys, for the most part, sitting down at the family table meant eating a well-balanced meal and reconnecting with each other after a busy day.  This time wasn’t just important for the bonding opportunity it provided, but for the proper nutrition it allowed my sisters and I to receive.  It was there that we learned what a balanced diet was and to appreciate the food we had.  Snacking throughout the day was a privilege and eating snacks between meals was a luxury a poor person could ill afford. Unfortunately now days, it seems that many parents don’t have time for traditional dinners or are unwilling to make time for time them.  Snacks are cheap, ubiquitous and filled with carbohydrates. With so many people reaching for the quickest, easiest foods, families are moving to a culture of convenience and their kids are paying the price.

Childhood obesity is on the rise and it’s having effects in some unexpected areas.  Studies are now suggesting that girls who are overweight start menstruation at much younger ages.  The average age of onset of menstruation (menarche) in the late 20th century was between 12.6 to 12.8 years.  Recently, that age has decreased to 12.43 years.   It has been argued that girls need to reach a critical weight (47.8 Kg) to initiate pubertal changes; it is more likely that what is needed is a shift of body composition, with an increase in the percentage of body fat. The percentage of body fat in children (16%) needs to rise to 23.5% to initiate puberty.  A 2011 study found that each 1 kg/m2 increase in childhood body-mass index (BMI) can be expected to result in a 6.5% higher absolute risk of early menarche (before age 12 years).

Normally, once a young woman reaches a particular body mass index, that tells her body she is of childbearing weight.  This starts the menstruation cycle.  If a young girl, say of about eight or nine, is overweight, she will reach this body mass index much sooner, triggering her body to go into early puberty.  While early childhood obesity is itself a problem, early puberty can also lead to a shortened growth span.  Most girls stop growing a few years after starting menstruation.  If they start this too soon, they will also stop growing much earlier than normal.  If childhood obesity continues to increase, the rise in early maturation is likely to follow.  In 1965, about 5% of kids were considered obese in the US.  Obesity in children has increased three-fold over the past 30 years.  In 1980 obesity in children, ages 6-11, was a mere 6.5% but by 2008 it increased to 19.6%.

Today, about 25 million children are either overweight or obese.  Researchers are finding that increases in the number of girls hitting puberty early seems to be in keeping with these obesity statistics.  The First Lady is even promoting a change in our habits that affect childhood obesity.

Although convenient, fattening foods have flooded the markets; there are still plenty of healthy foods out there.  Parents cannot expect their kids to make smart choices about their diets, especially at such young ages.  It’s up to them to teach their children how to eat, so they can grow up to make good choices for themselves and their own families.  There’s something to be said for those traditional sit-down dinners, because they truly benefit the health of our children in more ways than one.

— Yvonne S. Thornton, M. D., M. P. H.

Sources:

http://children.webmd.com/features/obesity

http://www.helium.com/items/1249193-delayed-puberty

 

 

 

No Breastfeeding; No Guilt

Thursday, April 19th, 2012

I was raised in an era when children were fed Karo Syrup and evaporated milk, and nobody gave my mother a guilt-trip for doing so.  As with many low-income families, she spent much of her time working to provide for our family and would not have been able to stay home to breastfeed.  Somehow though, we all grew up to be healthy, happy adults.  In fact, two of my sisters are doctors and the other is a lawyer and Ph. D., so I’d say we turned out pretty well.  The American Academy of Pediatrics (AAP) though, would like moms to believe otherwise.

When an organization like the AAP recommends breastfeeding, new moms are likely to trust in their expertise and follow suit, assuming the organization has conducted years of research and found conclusive results in favor of breastfeeding.  Unfortunately, that just isn’t the case.  That hasn’t stopped them from publishing an executive summary of their recommendations though.

In their most recent Executive Summary on Breastfeeding and the Use of Human Milk, the AAP cited, “a variety of government data sets, including the Centers for Disease Control and Prevention (CDC) National Immunization Survey, the NHANES, and Maternity Practices in Infant Nutrition and Care.”  These studies merely show how many people are breastfeeding in developed countries, not whether or not this has been beneficial for the children involved.

In fact, there has so far only been one scientific study performed and this is where all of their data is coming from.  Also, the study itself admits that, “Because almost all the data in this review were gathered from observational studies, one should not infer causality based on these findings.”  In other words, they gathered their information from other reports and performed a scientific analysis, but did not do any controlled experiments themselves, so they can’t be certain that the relationship between the health of children and the rate of breastfeeding are actually related.  Even more shocking is the AAP’s blatant disregard for some of the findings in the study.  The AAP Summary reports that, “Adjusted outcomes for intelligence scores and teacher’s ratings are significantly greater in breastfed infants.”  While the study they are citing actually says, “There was no relationship between breastfeeding in term infants and cognitive performance.”  Human breast milk is deficient in iron and Vitamin D; yet, those deficiencies are rarely mentioned when it comes to comparing breastfeeding and formula feeding.  Moreover, the touted immunity conferred to the newborn from breastfeeding has not resulted in better outcomes for breastfed infants.

So why are they so adamant about it?  It turns out; they have spent the past several years urging the Senate to carry out a $15 million campaign to promote breastfeeding at maternity care practices, community-based organizations, and hospitals.  In other words, wherever mothers might be giving birth or receiving pediatric care, their physicians are flooded with propaganda pushing the importance of breastfeeding.  This has led to a lot of pressure on moms who have chosen not to breastfeed, and consequently, a lot of unnecessary guilt.  Mothers have the right to choose the method they feel most comfortable with, and shouldn’t have to feel guilty for that choice.

— Yvonne S. Thornton, M. D., M. P. H.

Sources:

http://www2.aap.org/breastfeeding/files/pdf/Breastfeeding2012ExecSum.pdf

http://www.usbreastfeeding.org/Portals/0/Letters-Comments/2011-03-07-Joint-Letter-BF-Approp.pdf

 

Uterine Artery Embolization for Fibroids (Myoma)

Friday, April 6th, 2012

I have been asked many times the best approach to the treatment of myoma (the correct term for the common term “fibroid”. There are many approaches, most include surgery, i.e., hysterectomy or myomectomy. Recently, a less invasive management has been offered and should be considered prior to surgery. It is Uterine Artery Embolization.

Uterine Artery Embolization (UAE) as another alternative treatment for fibroids (myoma): This latest less radical approach to reducing myoma (fibroids) was first tried in France and has been available in the United States for over a decade.

The procedure entails inserting a catheter (long hollow tube) in the major arteries of the thigh (femoral artery) and threading the catheter to the area of the fibroids. Using an inert material (polyvinyl alcohol) in the form of beads or particles, this material essentially cuts off the blood supply to the growing myoma (fibroid) resulting in shrinkage of the fibroid. Interventional radiologists have promoted this procedure as opposed to gynecologists who have proceeded with much more caution. The known side-effects have been serious systemic infection, excessive bleeding from the catheter insertion site, chronic pelvic pain after the procedure and, in some patients, early onset of menopause. Uterine artery embolization has been associated with decreased fertility.

In August, 2010, the conclusion of a 5-year outcome study from the embolization versus hysterectomy randomized clinical trial (EMMY) was that UAE is a well-established alternative to hysterectomy about which patients should be counseled.

So, if you are a candidate for myomectomy or hysterectomy because of myoma, perhaps a discussion about UAE would be helpful.

——Yvonne S. Thornton, MD, MPH