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Autism Linked to Induced Labor

Monday, September 2nd, 2013

Researchers are constantly trying to find things that might be causing or linked to autism, and inducing labor (intentionally stimulating contractions before labor begins spontaneously) and augmenting labor (making contractions stronger, longer, or more frequent) are the latest suspects. Recent studies show that induction and augmentation of labor seem to be linked to the development of autism in children.

In epidemiological studies of over 600,000 live births, including 5,500 children with autism, researchers studied whether the births were induced, augmented, or both, and whether there was a correlation between that and whether the children had autism.

Children born without induction or augmentation were indeed less likely to develop autism than children whose mothers’ labors were induced, augmented, or both. The studies controlled for factors like socioeconomic status, the health of the mother, and the year of birth. Male children were found to be particularly susceptible to an increased risk of autism when their births involved induction or augmentation.

Further studies are needed, of course, to examine additional potential influences such as underlying conditions, other labor events, and the specific dosing used in induction. And women should not think that this makes Pitocin (the drug commonly used to stimulate contractions) the enemy or be afraid to use it if the situation so warrants. Pitocin (oxytocin) saves lives and prevents days-long labors that can cause serious harm to mother and baby. The increased risk of developing autism is slight, so mothers should realize that, should their doctors deem it necessary, Pitocin is still a safe choice.

Pitocin Not the Only Suspect

Keep in mind, too, that autism most likely has more than one cause. Other studies have shown other possible correlations, such as low levels of certain hormones, certain infectious agents, and some chemicals. Additionally, many parents have been concerned in recent years about a link between vaccines and autism – but studies show that no such link exists (see here and here).  This study, however, did not control for the type of anesthesia or the length of anesthesia.  My theory (for the past twenty years) has been that the prolonged infusion of epidural anesthesia for many hours during the induced or augmented labors (“Where’s my Epidural?”) is the culprit.  Not oxytocin.  Epidural anesthesia DOES cross the placenta.  Therefore, if the anesthetic can interfere with the neural transmission of pain in the mother, then surely it can interfere with the central nervous system (brain) of the fetus, neonate and infant.  The brain continues to develop until five years of age and if there had been an insult during the course of labor, it most likely will be manifested in the form of autism during childhood.  I say this, because my midwifery colleagues whose patients rarely use epidural and the lower socioeconomic moms, who either come in too late for an epidural or do not request it, rarely have children with autism.   However, I also predict that the incidence of autism will decrease in the years to come, secondary to the “new” maternal culture which demands elective cesarean deliveries and therefore, never experiences the many, many hours of labor; or having a gestational host (surrogate), who takes all the risks of pregnancy and labor only to have the biological parents come by and pick of their newborn, like a pizza.

The bottom line is that parents should not endanger their health or the health of their children by refusing treatments that are known to be reasonably safe, like Pitocin (oxytocin) and vaccines. More studies are needed and researchers are constantly trying to fill in the gaps in what we know, but for now, the benefits of Pitocin (and vaccines) are known to far outweigh any potential risks. Talk to your doctor about your concerns and to stay informed of the latest research so that you can make the best possible decisions for your family.

– Yvonne S. Thornton, M. D., M. P. H.

Obesity A Major Cause of Death for Women that Survive Cancer

Monday, July 1st, 2013

A diagnosis of cancer can put a person’s entire life on hold. Fortunately, treatments for cancer, and especially for women’s cancers, are becoming increasingly better at helping women prolong their lives and even enter into remission. This is wonderful news for both doctors and patients that have to deal with this horrible and tragic disease. However, as the rate of women who survive cancer increases, alarming statistics about what can happen after surviving this disease are coming to light.

It has been suggested that one of the main killers for women that survive cancer is obesity. Hormonal changes in women who have received oophorectomies can severely impact their ability to maintain a healthy weight, and in some cases can cause women who have never had weight problems to face weight gain. Additionally, many medicines such as steroids that are used to treat cancer can cause weight gain. This does not even begin to take into account the many emotional and mood changes faced by women who have survived cancer, which can also be a major contributor to weight gain.

So what can a doctor such as myself do about it? How can those who have survived cancer move on with their lives and continue to preserve their health? One study suggests that it is extremely important for those who have been diagnosed with cancer and those who have entered remission to discuss the problem of obesity and how it can factor into a woman’s health after she has begun to recover from such a devastating disease. It is also important for women who have survived cancer to seek the support of other survivors that may be able to help them understand what they face after remission and recovery.

Discussing the other factor surrounding a diagnosis of cancer can be just as important as discussing the disease itself. Whether an individual is a doctor, a patient, or even a close friend or family member of the person who is recovering, the “what comes next” dialogue is an essential part of preparing for a woman’s long-term health prospects. Women should not be surviving cancer only to face further health complications, especially if steps can be taken early on to prevent these issues. Whether it is due to hormonal fluctuations, medication, or an issue such as depression, weight gain can be prevented. The entire community needs to work together to put an end to this growing problem.

– Yvonne S. Thornton, M. D., M. P. H.

Technology in Medicine: Robotic Assistance in Surgeries

Monday, May 20th, 2013

“Robots” are being used to assist in surgeries throughout the world. It sounds like something out of a movie, doesn’t it? The use of this kind of technology in medicine is raising a lot of questions for patients. Some may believe that the more technology that is used during their surgery, the better—others may have problems with the idea of a “machine” doing a lot of the work during a surgery. Doctors and surgeons are divided in much the same way, which is why studies are currently being done to assess the differences between robotic-assisted surgeries and traditional surgery methods.

In one study, women who were scheduled to receive hysterectomies were divided into two groups. One group received robotic assistance during surgery and the other did not. Researchers found that there were no significant differences in the outcomes of the surgeries—however, the robotic-assisted surgeries did take longer to complete. It may not seem like much of a finding, especially for patients, but studies like these may help ease the mind of individuals who worry about advances in medicine and whether or not they will be safe during their own surgeries or medical procedures.

Surgery—especially gynecological surgery—is becoming increasingly sophisticated, and that is good news for patients. Procedures that were once much more invasive can now be performed via laparoscopic methods, with only a few small incisions. While the outcomes at present are still very much the same for surgeries that do and do not use robotic assistance, there is a strong likelihood that in the future, as the technology advances, robotic-assisted surgeries could actually be much more advanced, and have much better postoperative outcomes compared to traditional surgical methods.

On the other hand, robotic surgery is very expensive (The DaVinci system costs 1.3 million dollars) and is labor-intensive (increased operating time), which means the patient is under anesthesia for a longer period of time, which may have serious sequelae.  All this has to be factored into the equation.  As a surgeon myself, the only advantage I see is that the surgeon gets to sit down during the entire procedure.  As a Catch-22, using robotic technology also reduces the training of young surgeons in the traditional approaches to operations, and thus the skill and “tried and true” surgical techniques are lost because they are no longer taught and performed on a daily basis.  The robot may have to be the wave of the future, by default, because surgical residents will no longer be taught how to do surgery the traditional way, and thereby fulfilling the prophesy.

The reason I find this so important to point out is to ease the minds of patients who worry about new methodologies in medicine—the simple fact is that even though surgery is growing more complex, it is also constantly improving in its ability to treat patients with a wide range of problems. While some of the newest trends in medicine may seem like science fiction more than anything else, our surgeons need to know and to be comfortable with both forms of surgery in order to have outcomes most advantageous for the patient.

– Yvonne S. Thornton, M. D., M. P. H.

Are Your Vitamins Contributing to Your Life or Death?

Monday, April 15th, 2013

Remember the good old days of Flintstones vitamins?  We were taught to take one every day so we could grow up strong.  Most of us continued that practice into adulthood, though the types of vitamins and supplements we use have changed considerably from the fruity, chalky prehistoric characters we were used to.  Although your doctor may prescribe supplements and although commercials suggest their vitamins can improve your health, they can actually be detrimental to your health, especially in older women.

It is important to make sure you’re getting all of the vitamins and minerals your body needs to function properly.  However, as we age, our body chemistry changes, which means the types of vitamins and minerals we need most will change as well.  More than 38,000 women were the subject of an Iowa Women’s Health Study concerning vitamin and mineral supplements.  Their results showed that most supplements had no obvious affect, but there were a few that actually increased the mortality rate in older women.  The culprits included Vitamin B6, folic acid, iron, magnesium, zinc, and copper.  Specifically, Iron seemed to be the most dangerous, with 15% of study participants who used it regularly dyeing.  Calcium, on the other hand, seemed to have the opposite effect, meaning it actually decreased the mortality rate.

Although this information may seem frightening, it’s important to put it into context.  Women in particular need Iron, so you never want to cut it out of your regimen completely.  That said, it’s better to get in the form of red meat and green leafy vegetables than in a vitamin.  The same is true of pretty much all supplements.  Your body will do a much better job of processing and using vitamins and minerals that are in food form.  Vitamins, when used on top of your usual diet, will easily put your system out of balance, which is what leads to dangerous levels of one or the other.  Likewise with Calcium, although it is important in the fight against osteoporosis, supplements can be dangerous when not taken in moderation or without the coinciding vitamins your body needs to process it.  In short, unless your physician recommends it, stick to a balanced diet and forget the vitamin supplements.

– Yvonne S. Thornton, M. D., M. P. H.

When it Comes to Protein, You Might Get Too Much of a Good Thing

Thursday, January 3rd, 2013

Everything you consume in life should be done so in moderation. From the things you eat, to the things you buy, to the things you watch, you can most definitely get too much of a good thing in many cases. While protein is generally considered an important part of any healthy diet, studies show that it can be also be harmful when consumed in large quantities.

The Center for Disease Control and Prevention has released statements showing that the female body needs approximately 46 grams of protein daily. Of course, this amount should be adjusted for a woman’s size and activity level, but this amount is the average. For a more specific number, they recommend that you subtract half of your body weight by 10. So, a 160-pound woman needs 70 grams of protein every day. On top of that, you should adjust the number based on the amount of calories you consume so that you are not only consuming protein in a low-calorie diet.

However, many women who are trying to eat healthy think they need to stock up on protein. Low carb diets in particular are often high in protein. In reality, the average American woman is already getting too much, and adding to that already high amount can result in serious bodily damage.

Studies show that too much protein in a woman’s diet can lead to kidney damage in people with already decreased kidney function. Though protein doesn’t have any proven negative effects on women with fully and normally functioning kidneys, it can accelerate damage in those who don’t yet know their kidneys are in danger. Older women are also at risk for kidney problems as a result of too much protein because kidney function naturally declines with age.

If you have a kidney problem, you should be extremely careful about consuming too much protein. Even if you don’t, consuming too much protein can have other negative effects since it hinders the absorption of other important vitamins and minerals in your diet. Protein is a healthy part of the female diet, but only in moderation.

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


Do Failed Emergency Contraceptive Result in Birth Defects?

Monday, December 31st, 2012

As I’ve discussed before, emergency contraceptives should never serve as your main form of birth control. In certain circumstances, the morning after pill is perfectly acceptable. Maybe your usual form of birth control didn’t work, or maybe your sexual encounter was unplanned, or—worse yet—unwanted. Occasional use of emergency contraceptives such as the Plan B pill is fine, especially if it will prevent the birth of a baby that cannot be properly cared for. However, these pills are not always 100% effective in preventing pregnancy. If you took an emergency contraceptive but still got pregnant, you’re probably wondering how the hormones might negatively affect your baby’s health.

Luckily, the creators of the emergency contraceptive already thought of that, and they are designed in a way that will not harm a developing baby should the hormones be ineffective at preventing pregnancy. One study in particular showed that emergency contraceptives had absolutely no effect on the likelihood that a woman would have an ectopic pregnancy. Ectopic pregnancies are extremely dangerous for the woman having it, and most are aborted so that the mother can live through them. They occur when the fetus is growing outside the uterus. If you took an emergency contraceptive and it failed, you are just as likely to have a normal, healthy baby as if you hadn’t taken anything at all. Preventing pregnancy with an emergency contraceptive is just as safe as preventing it with regular birth control, even though “morning after” pills such as Plan B give you twice the amount of hormones as a high dose birth control pill.

While you’ll have a perfectly safe pregnancy if an emergency contraceptive fails, you should absolutely never rely on it as your only birth control. If you know that you are going to be having sex, you should already be on birth control to prevent pregnancy. On top of that, you should be using a condom if you aren’t sure of the sexual history of your partner. Doctors aren’t entirely sure what the long-term effects of high doses of hormones are, so taking pills like Plan B regularly could easily lead to blood clots or strokes. If you need to take an emergency contraceptive in a true emergency, rest assured that it will probably work. If it doesn’t, you’ll soon be the mother of a healthy new baby.

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


When it Comes to Your Salad, Be Picky

Monday, December 17th, 2012

If I lectured you about the importance of adding more salad to your diet, I’d be wasting my time. We all know that fresh vegetables are extremely important to a healthy diet, and women especially will benefit from the nutrients present in the veggies common to salad. If you’re eating a healthy diet, you probably try to add salad to your daily diet by eating one for lunch or dinner on a regular basis. Though they can taste boring when not prepared well, it’s no secret that they are one of the healthiest meals a woman can consume. However, next time you’re making your salad, consider the difference between Iceberg and Romaine lettuce.

Iceberg lettuce does not totally lack vitamins and nutrients, but it is far less healthy when compared to romaine lettuce. If you’re trying to get as many nutrients as possible from your salad, always choose Romaine, because many of the vitamins in the vegetable are essential to the health of the female body. Romaine lettuce contains high levels of folate, which are especially important prior to conception and during pregnancy. A deficiency can cause fatigue and confusion. Some studies have shown that  women who eat more folate are less likely to get certain neurological diseases such as Alzheimer’s. Romaine also contains much more fiber, carotenoids, and vitamin C than iceberg lettuce.

As a general rule of thumb, always choose vegetables that are dark in their color. Romaine is slightly darker than iceberg lettuce, which is a good indication that it is richer in the essential vitamins and nutrients you need. With that said, romaine is a better choice across the board for all women trying to maintain a healthy diet. If you’re really looking to make a power-packed salad, kale would be an even better choice.  One cup of kale has more calcium than one cup of cottage cheese.  Go Figure!

Hitting the salad bar is definitely a step in the right direction, but you can improve your health even more by choosing the right lettuce to make sure you’re getting as many nutrients as possible. Without these nutrients, your body will degrade more quickly and you’ll feel the effects of old age sooner rather than later. Weight loss and exercise will also be more difficult, so be picky when you’re at the salad bar.

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


Vitamin D Helps Prevent Breast Cancer in Black Women

Thursday, December 13th, 2012

As if breast cancer wasn’t frightening and deadly enough, research shows that black women are 41% more likely to die from it. Though they are less likely to get it in the first place, the results are more often fatal when they do. Of course, no one wants to get breast cancer. No matter your race or background, it’s extremely dangerous. However, these findings should be a wake up call for black women to be especially diligent in being tested for breast cancer early on and also to take as many preventative measures as possible. Believe it or not, increased exposure to vitamin D will help.

A recent study explored the link between vitamin D and breast cancer in black women.  According to this case-control study, for black women, it is more difficult for the body to extract vitamin D from its most natural source—sunlight—because the pigmentation in the skin prevents it. However, the results of the study showed that women who had more vitamin D in their systems from external sources were less likely to get breast cancer. External sources include both sunlight and vitamin supplements. Though vitamin D is produced in the body sometimes, that type of vitamin is not the one that protects against breast cancer.  I am somewhat skeptical of this study because it does not consider any confounding variables, such as genetic predisposition and health care disparities in the management of breast cancer in Black women.  The patients were from the Northeast and there were no patients from the Caribbean or southern locales.  However, it is a start and a randomized clinical trial needs to be conducted to confirm their results in African-American women in the Sun Belt compared to those living in areas with less daily sunlight.

If you are of African American descent, it’s important that you start getting mammograms, as recommended, i.e., every one –two years between age 40 and 49 and then annually at 50 years of age.  Early detection is the best way to save yourself from the disease.  Too much sun exposure can be dangerous for the skin, but you should find out how much will allow vitamin D to be processed and utilized in cancer prevention. A supplement containing the vitamin is another good way to reap the benefits of it, and many women’s vitamins do contain small amounts.

In many cases, breast cancer is totally unpredictable and random. It might strike you no matter how you live your life. However, we should consider the results of this study because even if it doesn’t help, it certainly can’t hurt.

– Yvonne S. Thornton, M. D., M. P. H.

Why Aren’t Teens Getting Screened?

Thursday, November 15th, 2012

Teen pregnancy is consistently a major social problem in the United States. While teen pregnancy has been on the decline over the past few decades, it is still an issue and more than 34% of girls will have a baby by the time they’re twenty years old. For that reason, the results of a recent study might be surprising to you. The study showed that when receiving care in the emergency room, only 19% of teen girls across the country were tested for pregnancy. Even those with abdominal pain were given other tests, and some doctors didn’t even bother asking whether or not the girls were sexually active.

Not testing for pregnancy can be extremely dangerous. Of the girls who complained about abdominal pain, 28% were given tests that included radiation.  With that said, although there is stark hysteria when it comes to inadvertent exposure to radiation from diagnostic imaging, a chest X-ray or an X-ray of the abdomen would not harm the growing embryo or fetus.  There is no evidence that suggests that there is increased fetal risk of malformations, growth restriction or abortion from a radiation dose of less than 5 rads.  Most diagnostic imaging procedures using radiation are calculated to be in millirads (one-thousandth of a rad).  Case in point, a chest X-ray exposes the fetus to only 0,07 mrad which is exceptionally small and without any significant risk to the fetus at any gestational age.   Nevertheless, not checking for pregnancy in teenage girls can result in not diagnosing an ectopic pregnancy, which carries with it an increased risk of death to the teenage mother.   Moreover, many medications could also be extremely harmful to a growing fetus.   When shown the results of the study, a few doctors claimed that their resistance to giving a pregnancy test was partly because few teen girls come to the ER alone. When a large number of family members are present, ER doctors don’t want to offend the people in the room. These doctors are almost always strangers to ER patients, so they don’t know the family history or teen’s background.

While you’re probably not an ER doctor, you can still learn from this study and apply it to your own life. Especially if you have a teen daughter, you should always make sure that she receives a pregnancy test before undergoing any other procedures in the emergency room. If the doctor doesn’t offer one as part of his or her diagnosis, bring it up and have your daughter tested. Your teenager might look at you in utter disgust, but the temporary hatred you elicit from your teen is preferable to the potential misdiagnosis and misguided plan of care formulated, which was based on an incomplete evaluation because a pregnancy test was not done.

As an obstetrician, my credo is that any young woman from 12-56 is pregnant until proven otherwise.  Emergency room doctors are trained to test for pregnancy in adult females, so it might slip their mind to test teen girls who come in. However, teen pregnancy is a serious issue, so if you have any control in the situation, always make sure your teen is tested for pregnancy before any other procedures are conducted.

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


Is the Media Affecting Your Appetite?

Monday, October 22nd, 2012

When you hear someone mention eating disorders, you probably think of anorexia or bulimia right away. These are more commonly discussed in the media, but in reality, an eating disorder is any type of distorted relationship with food that negatively affects our behavior. Compulsive overeating is a type of eating disorder, even though it is essentially the opposite of anorexia. Many of us have a distorted relationship with food—I myself am guilty of such a relationship. However, I’m at one end of the spectrum where it doesn’t necessarily interfere with my life. Many women, especially in the Western world, suffer from eating disorders, and numerous studies show that it is directly a cause of skinny role models in the media. Before discussing that cause though, let’s first examine the different types of eating disorders people commonly develop.

Anorexia affects one in every 200 women in America. Studies show that the cause might be linked to traumatic situations. Peer pressure is a major factor, and some studies even show that genetic factors and posttraumatic stress might contribute to a person’s likelihood of developing anorexia. It is the refusal to maintain a healthy body weight and a fear of gaining weight. People with anorexia have an unrealistic body image.

Bulimia is characterized by recurrent binge eating following by compensatory behaviors. Diuretics, vomiting, and excessive exercise often follow binge eating. Binge eating is also a disorder of its own when it is not followed by compensatory behavior, which is considered compulsive overeating. Many studies suggest binge eating is triggered by stress.

So, why do people, especially women in the United States, feel that their bodies are not good enough? In addition to the stress and trauma often behind the disorders, studies suggest that the media might have a large role in the problem. Dr. Anne E. Becker, a professor of Global Health at Harvard Medical School, completed studies to determine the relationship between figures in the media and people with eating disorders. Not surprisingly, the impossibly skinny role models currently in the media heavily influence women and their self-image.

It’s hard to ignore the beautiful women on TV and in the magazines, but it is our duty as mothers and healthy citizens to do so as best we can. Try to maintain a healthy body weight with proper nutrition, and never let the airbrushed women in the media affect your view of yourself.

– Yvonne S. Thornton, M. D., M. P. H.