June, 2009

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Protecting yourself from herpes

Tuesday, June 30th, 2009

The other day, a friend told me a joke:

“What’s the difference between love and herpes?”

I said I didn’t know.

“Herpes is forever,” she said.

While I’m not as cynical as my friend – I’ve been in love with my husband for 40 years and will love him for as long as I live – she’s right about one thing. Once you get herpes, you’ve got it for good.

So, what can you do to protect yourself?

Condoms offer better protection against HIV and pregnancy than against genital herpes. That’s because herpes lesions can appear just beyond the genitalia, in areas the condom doesn’t cover.

If you or your partner has herpes, the best protection against passing it on is suppression therapy – acyclovir or Valtrex. Whenever the infected person feels the tingles and other sensations that usually signal an imminent herpes episode, avoid sexual contact.

And if you’re just starting a new romance, be sure to have a frank talk about herpes and other intimate issues before you decide to take it to the next level. Remember, while it may be difficult at first to determine whether a relationship has staying power, you can be sure that herpes does.

– Yvonne Thornton, MD. MPH

Thank you President Obama for your wise words on healthcare reform

Wednesday, June 24th, 2009

Yesterday, at President Obama’s news conference, a reporter asked whether adding a “public option” – an option that allows people to buy health insurance from the government instead of private insurers – would, as insurers claim, drive them out of business.

The president answered:

“Why would it drive private insurers out of business?… If they tell us they’re offering a good deal, then why is it that the government, which they say can’t run anything, suddenly is going to drive them out of business? That’s not logical.”

As a physician who has seen the ever-escalating costs of health insurance hurt my patients, I have to say, I agree with the president wholeheartedly.

A public option won’t drive insurance companies out of business. But lack of good, affordable healthcare options is forcing people to delay necessary medical care. That means that people are often sicker by the time they see a doctor. Sometimes, it means, by the time they see a doctor, it’s too late for us to help them. That’s a national tragedy.

We must turn the debate away from how to safeguard the insurers’ profits to how to safeguard our families.

I sincerely hope that the politicians and lobbyists will stop playing with people’s lives for the sake of the almighty dollar and, instead, think of the public good and pass real health reform.

– Yvonne Thornton, MD, MPH

For my father, Donald Thornton, on Father’s Day

Friday, June 19th, 2009

Dear Daddy,

You know how much I relied on your guidance as I was growing up. But I wonder what you’d think if you knew that, even now, more than 26 years after we lost you to a stroke on a snowy February day, your wisdom still guides me.

I know you regretted dropping out of school as a young man and, although you seemed content to work 16 hours a day, it must have hurt not to have the opportunity to better yourself.

I know you wanted better for us, your children.

We may have grumbled when we were kids because you demanded so much. You insisted we get the highest grades in our classes. An A wasn’t good enough for you. You expected every grade to be an A+. We had to reach so high that nobody could yank us back down.

People laughed when you told them your five girls were going to grow up to be doctors. Impossible, they said.

And yet, as the first African-American woman to be board-certified in maternal-fetal medicine (high-risk obstetrics), I’m living proof that your dreams weren’t impossible after all.

Your dreams and your demands for us to do our best are the reasons why, among your five daughters, two are now physicians, one, an oral surgeon and another grew up to be a lawyer.

But I owe you for more than my career in medicine, Daddy. There isn’t a problem that I come across in life where I don’t ask myself, what would Daddy do? There isn’t a day that goes by that I don’t think of you. There will never be a time when I will stop missing you.

Even though, I know, you’re very much with me. Even now. Happy Father’s Day.

– Yvonne S. Thornton, MD, MPH

Pregnancy and the pill

Tuesday, June 16th, 2009

For many women, taking the pill is more a matter of delaying pregnancy until the time is right rather than preventing it all together.

So, the big question becomes, how long after you stop taking the pill can you expect to become pregnant? No two women are alike but, generally speaking, pregnancy is possible the next time you ovulate. You may ovulate within two weeks after finishing up your last package of birth control pills. So, theoretically, you could become pregnant almost immediately. However, as we all know, there are many variables. Some couples try for years to become parents without success.

It almost seems an unfair trick of the heavens that it’s sometimes the women who don’t want to become pregnant who easily do.

That means, if you’re dead set against pregnancy, and you stop the pill, you need to begin another form of contraception immediately. I actually recommend that my patients begin using an alternate contraceptive before getting off the pill so they get into the habit of using it.

Otherwise, you may have to get into the habit of changing diapers.

– Yvonne Thornton, MD, MPH

“Is it hot in here – or is it just me?”

Friday, June 12th, 2009

If you’ve ever gotten a hot flash, you know how odd it can feel. Usually, hot flashes don’t have a major impact on a woman’s life but some women suffer more than others. About 80 percent of women experience hot flashes and night sweats, which are short bursts of intense heat of the face and neck. Usually they begin in the early years of the transition to menopause and peak one or two years after the last menstrual period, remain for several years and then resolve over a period of time. I’ve had patients come in to see me feeling downright miserable due to pre-menopausal and menopausal symptoms. Some complain of waking up dripping wet at 2:00 a.m. with night sweats or feeling like tiny bugs are crawling all over them.

These symptoms will pass as your hormone levels adjust but what do you do in the meantime? Other than buying a small hand fan, there’s no single answer. Treatment has to be individualized for each woman. Avoidance of triggers, such as cigarette smoking, hot beverages, foods containing nitrites or sulphites, spicy foods and alcohol, may  help limit hot flashes. Blood pressure medications have been prescribed off-label with some success. SSRIs (selective serotonin reuptake inhibitors) such as Prozac® and Zoloft® or antidepressants such as Effexor® (venlafaxine) also offer relief.  Oral estrogens or transdermal estrogen patches have been found to be very effective in reducing the incidence and the intensity of hot flashes.  However, if estrogen is used, unless you have had a hysterectomy, an additional hormone, progesterone, must be added to the estrogen in order to decrease your risk of developing uterine cancer.  Relaxation techniques, such as deep slow breathing, may also help with hot flashes.

Some women think first of herbal remedies such as dong quai, evening primrose oil or red clover. However, I discourage my patients from using herbs as they’re often ineffective. Soy (a phytoestrogen or plant estrogen) has been touted as a remedy for hot flashes.  However, there is no conclusive evidence  for its benefit and there are no long-term safety studies. If you are convinced that you want to go the herbal route, I strongly urge you to discuss these remedies with your doctor beforehand. Don’t assume that because you get it over the counter, it’s safe. Herbs are not regulated through government health agencies and can have potent unintended effects, and may interfere with other medications or cause harmful interactions.

– Yvonne S. Thornton, MD, MPH

A letter from a reader that touched my heart

Wednesday, June 10th, 2009

I usually blog about women’s health but I wanted to depart a bit from that today because of a letter that a young woman named Jacinta sent me.

Jacinta read my memoir, The Ditchdigger’s Daughters, and found in the story the encouragement she needed to become a doctor herself. But let me allow her to tell it in her own words:

“I am 19 years old. I just finished reading your book and it truly inspired me. I want to work with children in the medical field and reading about the obstacles that you overcame to work in the medical field really encouraged me to work harder to accomplish my dream. The thing that really encouraged me was at the end of the book when you and your sisters were sitting around reminiscing about the things that your dad had taught you down through the years … ‘Daddy was the bow, we were the arrows and he aimed high. He didn’t say midwives, he said doctors. He didn’t say dental assistants, he said dentist.’ He always encouraged you all to be leaders and to be the best at whatever you did. That really stuck with me when I read it.

“I can be a leader. I love kids and I always knew that I wanted to work with them, but I never really decided how I wanted to work with them. So I decided that I would either be an obstetrician or a pediatrician.

“… I watched your interview on C-SPAN and I remember you saying that your father told you that the only person that can stop you is you. Well I’m not going to let me stop me so I decided to work towards all my dreams.”

As those who have already read The Ditchdigger’s Daughters know, my father was a blue collar laborer and my mother cleaned houses for a living. But they were determined to see their five daughters do better. They insisted that we work hard, get as much education as we could, and aim for the top. My father had a dream that we would all become doctors. Two of us are physicians now, one is an oral surgeon, another became a lawyer with a Ph.D.,  and one, a court reporter.

I want to take this opportunity to speak to all those like Jacinta, whose families may not have all the advantages. You can make a better life for yourself. If my sisters and I could do it, you can do it. Believe in yourself and be willing to work harder than you ever imagined possible. Then, work harder still. Stay in school, study like your life depends on it (because, in a way, it does), and don’t let anything hold you back, especially not your own negative notions about the limits placed on you from the outside.

And I want to say thank you to Jacinta. Knowing that my book touched you means so much to me.

It’s letters like yours that have inspired me to begin working on a new memoir that picks up where The Ditchdigger’s Daughters left off. I hope that this book, too, will persuade readers to reach higher, study harder, and pursue their dreams.

– Yvonne S. Thornton, MD, MPH

More media attention for the study

Friday, June 5th, 2009

Forbes reports on my study, showing that obese pregnant women should limit weight gain as does Medline.

Other media outlets giving the study prominent coverage are United Press International, Yahoo News, The Baltimore Sun, US News and World Report, and even the Times of India.

– Yvonne S. Thornton

Oprah and medical advice

Thursday, June 4th, 2009

Let me start by saying that I love Oprah. And I am forever grateful to her for having me on her show because appearing on Oprah helped me introduce my memoir, The Ditchdigger’s Daughters, to a huge audience. I’m sure it contributed to making my book a bestseller.

All that said, I have to agree with this Newsweek article. The authors argue that the medical advice given by some of the guests on The Oprah Winfrey Show is dubious at best, especially the claims about bio-identical hormones made by celebrities with no medical knowledge or training.

– Yvonne S. Thornton, MD, MPH

My study on obesity and pregnancy in the news

Wednesday, June 3rd, 2009

I’m pleased to see that the media is getting the word out: obese pregnant women should be eating healthier diets and limiting their weight gain.

In the past few days, I’ve been interviewed by a number of news organizations about the study. You can see some of the reports at the following links:


The Atlanta Journal-Constitution

Science Daily

The Los Angeles Times

and Health Day

– Yvonne S. Thornton, MD, MPH

Study’s author concerned that new guidelines for pregnant obese women don’t go far enough

Tuesday, June 2nd, 2009

You may have read the headlines last week that The Institute of Medicine (IOM) is changing its guidelines for obese pregnant women. Instead of recommending that women who are obese gain at least 15 pounds during pregnancy, the IOM now recommends a weight gain of 11 to 20 pounds.

It’s a start. But, as the lead researcher of a new study of obese women, pregnancy and weight gain, I’m concerned that obese women are being told to gain any weight.

My study, which is being published today in the Journal of the National Medical Association, found that obese pregnant women who followed a well-balanced diet and gained little or no weight had maternal-fetal outcomes that were equal to or better than those who gained substantial weight.

As a specialist in high-risk pregnancies who has delivered more than 5,500 babies over a 35-year career and supervised the delivery of 12,000 more, I wasn’t surprised by the findings of our study. I know that those extra pounds mean extra risks for both mother and baby. Obesity greatly increases the chance of developing complications in pregnancy such as preeclampsia, stillbirth, and blood clots, among others.

Twenty-three of the more than 200 obese women in our study lost weight. The average weight gained was just 11 pounds. And yet, these women and their babies were at least as healthy as those who put on substantial pounds. There were fewer babies weighing 10 pounds or more, fewer cesareans, and the mothers were less likely to develop gestational diabetes.

You can read more about the study, here.

So, if you’re carrying significant extra weight, forget the old adage about eating for two. Believe it or not, for a pregnant woman of normal weight, only an additional 300 calories per day is needed during her pregnancy – the equivalent to a quart of skimmed milk per day.

– Yvonne S. Thornton, MD, MPH