June, 2010

...now browsing by month


Ready to Deliver and Morbidly Obese: One of My Most Challenging Cases

Wednesday, June 23rd, 2010

A recent article in The New York Times talked about how the obesity epidemic is affecting pregnant women and their babies:

About one in five women are obese when they become pregnant, meaning they have a body mass index of at least 30, as would a 5-foot-5 woman weighing 180 pounds, according to researchers with the federal Centers for Disease Control and Prevention. And medical evidence suggests that obesity might be contributing to record-high rates of Caesarean sections and leading to more birth defects and deaths for mothers and babies.

New York City’s health department reported last Friday that half of the 161 women who died because of a problem with their pregnancy between 2001 and 2005 were obese. Black women were hit hardest, with a mortality rate seven times that of white women. While deaths are extremely rare in pregnancy, the city’s rate of 23.1 per every 100,000 births is twice the national average.

My new book, SOMETHING TO PROVE, is a personal memoir first, but because I’m a maternal-fetal medicine specialist and a surgeon, it also details a number of gripping moments in the operating room.

One of my most challenging cases involved a pregnant patient transferred to my care. When I walked into my new patient’s hospital room, I discovered she weighed more than 500 pounds and her baby was showing signs of distress on the fetal monitor.  The patient needed to be delivered. Let me give you a sense of the challenge with a brief excerpt:

…Many surgeons would begin their cut above her navel in an attempt to avoid that enormous layer of fat, while trying to find the uterus to get the baby out. …The area above the pubis, even in a morbidly obese woman, is usually flat and firm. Instead of a vertical incision from the navel down, I’d lift up the apron of fat and do a horizontal incision just above the pubis. That would allow me to get into the uterus and get the baby out. …We taped her massive belly to her chest, swabbed her with an antiseptic solution, and I went in. I was able to perform the cesarean quickly, without incident or excessive bleeding, and delivered the baby in only a few minutes.

The surgeon who handled the case recounted in The New York Times decided to cut through all the mother’s layers of fat, rather than using my technique of retracting and taping the massive layers of fat, which a colleague dubbed the “Thornton suspenders.” While there might have been excellent reasons for the physician’s decision, I hope more obstetricians learn to use the “Thornton suspenders” for such difficult deliveries in obese moms. Because, as the Times article explains:

… where every minute counted, it took four or five minutes, rather than the usual one or two, to pull out a 1-pound 11-ounce baby boy.

– Yvonne S. Thornton, MD, MPH

My New Memoir – “Something To Prove” – Is Now Listed On Amazon.com

Tuesday, June 15th, 2010

It will still be several months before SOMETHING TO PROVE: A Daughter’s Journey to Fulfill a Father’s Legacy (Kaplan 2010), is on the bookstore shelves. My publisher plans a launch in late December. But, I’m thrilled to say that Amazon.com already has it listed in the “Books” section.

Writing this new book was a response, in a way, to the thousand or more letters, emails, and phone calls, I’ve gotten from readers – women and men, grade schoolers and grandparents – who wanted me to know how much THE DITCHDIGGER’S DAUGHTERS inspired them. You asked to know what had occurred after that book ended. The answers are in SOMETHING TO PROVE, which, as the Amazon description says, picks up where THE DITCHDIGGER’S DAUGHTERS left off.

Most important, SOMETHING TO PROVE shows that what was true as I was growing up is still true today: despite bias, despite setbacks, with hard work and determination, we can accomplish whatever we set out to do.

I can’t wait for you to read it (although you will have to wait, for a little while longer, at least). And I look forward to reading your letters and emails after you’ve turned the last page.

– Yvonne S. Thornton, MD, MPH

Promising Advances In Treating Breast Cancer

Wednesday, June 9th, 2010

As many as 12.7 percent of American women will be diagnosed with breast cancer at some point in their lives, according to the National Cancer Institute. The disease, if caught early, is very survivable. The big questions about treatment have included how aggressively to attack the tumors to keep cancer from recurring.

Two new studies, reported in The New York Times, suggest that a woman’s long-term survival doesn’t necessarily hinge on choosing the most aggressive treatment. And, if that conclusion is confirmed by further studies, it’s very good news, because treatment can come with significant side-effects.

“A new study has found that for certain women getting a lumpectomy, the standard treatment — an operation to remove underarm lymph nodes that can leave them with painfully swollen arms — may not be necessary. Compared with not removing the nodes, the surgery did not prolong survival or prevent recurrence of the cancer.

“And a second study found that a single dose of radiation, delivered directly to the site of the tumor right after a woman has a lumpectomy, was as effective as the six or so weeks of daily radiation treatments that most women now endure.”

Two notes of caution, however. The study on lumpectomy followed patients for five years; the study on radiation followed patients for four years. Breast cancer can recur after five years so we won’t know for sure that less aggressive treatment makes sense unless a longer term follow-up yields similarly promising results. But each study is cause for hope if not yet celebration.

– Yvonne S. Thornton, MD, MPH