February, 2013

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Just a Spoonful of Ginger Makes the Nausea Calm Down

Thursday, February 28th, 2013

Many of my patients ask about which medications are safe for morning sickness during pregnancy. Though many over the counter nausea relief treatments could be dangerous for a developing baby, there are a few that are both safe and effective. After recommending these to women who are fed up with nausea every morning and even throughout the day, I often suggest a much more natural remedy. Studies show that ginger is an extremely effective nausea suppressant and stomach neutralizer.

We all remember sipping ginger ale when we were home sick with a stomach virus as kids. That’s because even the small amount of ginger in the sugary soda is enough to help calm the stomach down and reduce that queasy feeling. If your nausea is interfering with your regular schedule, try getting approximately 1,000mg every day. It doesn’t matter how you get it, so find whichever method works best for you. Ginger soda, ginger capsules, ginger tea, and ginger oil are all great ways to extract the benefits of the root during your pregnancy.

If you’ve tried adding ginger to your diet and you still struggle with regular vomiting, make sure you talk to your healthcare provider about it as soon as possible. Even if you’re dealing with it just fine, frequent vomiting can have serious side effects. It could cause dehydration, a decay of the enamel on your teeth, and a wearing away of the lining in your esophagus. All of these problems, when prevalent during pregnancy, could negatively affect the rest of your and your baby’s life.

While it seems impossible for a root as common as ginger to have a positive effect, try increasing your intake before resorting to over the counter nausea relief. Even medications that have been approved for pregnancy by doctors are not always fully understood, so it’s best to avoid them when possible. However, ginger is completely natural, so it should be the first choice for any woman looking to keep her pregnancy as natural as possible. As long as you don’t go overboard with sugary sodas or ginger snacks, there is no harm in trying this natural remedy for your morning sickness.
 – Yvonne S. Thornton, M. D., M. P. H.

Not Even Your Feet are Spared from the Changes of Pregnancy

Monday, February 25th, 2013

And you thought puberty was bad! When you become pregnant, your body will go through so many changes you’ll be left feeling like you were transported into a different body. Some of the strange bodily changes you’ll experience will go away. The extra curves, the thicker hair, and the pregnancy glow are a result of temporary hormonal changes. However, some changes will last forever. Unfortunately, your stretch marks are in that category, but we’ll save that painful discussion for another time. One surprising change you might notice is a bigger shoe size.

During pregnancy, your body produces large amounts of hormones that are meant to make the pregnancy and birthing process easier. One such hormone is known as relaxin. This hormone loosens the muscles and ligaments, which make your stomach’s expansion easier and will eventually make it easier for your baby to pass through your birth canal. Unfortunately, it doesn’t distinguish which muscles need to be loosened, so it affects all of them at once.

Now that you know what relaxin does, you’ll be able to imagine how it affects your feet during pregnancy. Since the arches of your feet are mainly made up of ligaments, the relaxin hormone will cause them to stretch out as you put weight on them. The bones in your foot will also adjust based on this expansion. After you’ve given birth, the relaxin will leave your body, but your feet will stay at their new, longer length.

Studies show that obese women will experience more of a stretch, so it is more likely your shoe size will change after pregnancy if you’re overweight. Similarly, women who spend a lot of time on their feet will suffer from a more increased shoe size.

Unfortunately, there is no telling how much the relaxin in your body during pregnancy will affect the size of your feet. However, you might be able to minimize it by achieving a healthy weight before pregnancy and spending as little time as possible standing. If your shoe size does go up, just think of it as the perfect excuse to buy more shoes.

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


A Little Known Side Effect of Cesarean Deliveries

Thursday, February 21st, 2013

For women who deliver their baby by Cesarean, there are a few extra considerations that must be taken into account both on the due date and during the baby’s infancy. Whether the Cesarean was elected or required for the baby and mother’s health, there are a few ways in which the outcome differs from a vaginal delivery. Of course, the new mom will need to care for her surgical incisions to make sure they heal properly, and doctors will have to pay extra close attention to a baby’s vital signs during the process. However, there is one Cesarean side effect that few women know about the first time around.

Studies show that babies who are delivered by a Cesarean do not have as much healthy intestinal bacteria as those delivered vaginally. Specifically, the research indicated that Escherichia-Shigella and Bacteroides were not abundant in the gut. These bacteria are essential to a healthy intestinal balance.

The reason the mode of delivery might have an effect is a matter of how the baby might obtain the bacteria. When a baby passes through the birth canal, he or she will come into contact with the vaginal bacteria present in the mother’s body. During a Cesarean, the baby rarely comes into contact with such bacteria, and any contact is usually limited to bacteria found on the skin.

As adults, our gut flora and bacteria can be upset by antibiotics and other medications that upset the natural balance of cells. When a baby is delivered, it is really the first time she is making contact with the outside world, so it’s no wonder the bacteria she ingests will have long-term effects on her internal balance.

Another little-known fact about babies delivered by Cesarean is that they are more likely to make a detour and visit the neonatal intensive care unit (NICU) for respiratory distress or difficulty breathing following their birth.  Why? Because the natural act of compressing it’s little chest during the birthing process by way of passing through the vagina and thereby squeezing out the excess fluid in the lungs is not present during a Cesarean.  This retained fluid, as it were, can cause rapid, distressed breathing of the infant, known as transient tachypnea of the newborn (TTN) requiring time in the NICU for some drying out.  Fortunately, the condition rarely progresses to a more serious complication.

So, Mother Nature, for the most part, does know what she’s doing when it comes to birthin’ babies. The frequency of Cesarean birth has skyrocketed over the past two decades, some for medical indications and more recently, at mother’s (or obstetrician’s) convenience.  Just know that if Mother Nature wanted babies to be born abdominally, she would have put a zipper above the pubic bone.

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

Can A Myomectomy Prevent a Second Miscarriage?

Monday, February 18th, 2013

A miscarriage is a horrible experience for any woman. When the excitement of pregnancy is suddenly cut short by the unexpected news of loss, the grief is difficult to manage. Many women who go through this feel they need many months to heal after the ordeal, but some move on and feel ready to try again right away. Luckily, recurrent miscarriages are rare, but that’s not to say it’s easy to trust that the second pregnancy won’t go the same as the first.

Before we continue, let’s define some terms.  Miscarriage is a lay term for a “spontaneous” abortion, occurring before 20 weeks of gestation.  When most people hear the term “abortion”, they quickly recoil because they believe it to be an “induced” abortion, which is the loss of a pregnancy before 20 weeks by artificial methods.  Fibroid is a lay term for myoma, which is the appropriate term for a benign tumor of the smooth muscle of the uterus. This growth is not fibrous.

Studies show that women who had a miscarriage (spontaneous abortion) as a result of uterine fibroids (myomas) are more likely to have one in their second attempt. However, those same studies show that the surgical removal of said myoma can greatly increase a woman’s chances of having a live birth despite a previous miscarriage.

Fibroids (Myomas) are benign tumors that grow on the walls of the uterus, and they actually affect a significant number of adult women. Twenty-five percent of all women have myomata, with the percentage rising  to 50% in Black women.  When myomas grow into the uterine cavity and thus distorting the inner contour of the womb , they can cause miscarriages (spontaneous abortions). In other locations, such as growing on the outside of the uterus like Mickey Mouse ears (subserosal), they are absolutely harmless and women don’t even know they have them.

Once a doctor diagnoses myomas (myomata) as the cause of a spontaneous abortion (usually in the second trimester), he or she might recommend surgical removal before a second attempt at pregnancy. This surgery is technically called a myomectomy (not fibroidectomy), and it is a relatively safe procedure. Unfortunately, there is a 25% chance the myoma could come back over time, but in many cases, they don’t reappear until years later.   For further information about myomas and myomectomy, you are referred to my book, INSIDE INFORMATION FOR WOMEN on the topic.

If you have had one or more spontaneous abortions, your gynecologist should perform a comprehensive evaluation of your uterus to determine whether or not myoma played a role. This may include a sonohysterogram, and/or a hysterosalpingogram. Most often, spontaneous abortions are totally random, but in some cases, they are caused by an abnormality in the reproductive system. Should your doctor find intramural or submucosal myomata (myoma in the wall of your uterus), you should consider surgery before trying again. While a second attempt at pregnancy won’t make up for the disappointment of the first loss, addressing the problem and correcting it will go a long way in achieving a successful outcome.

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


Osteoporosis Cannot Be Prevented By Calcium Alone

Thursday, February 14th, 2013

Everyone knows how important calcium is in the long-term prevention of osteoporosis. By drinking dairy in your youth, you are building strong bones that will hold up longer against the disease in adulthood. However, few people understand how calcium is absorbed into the body. When you drink a glass of milk, the calcium doesn’t simply soak into your bones on the way down. It must interact with other molecules in your system and bond to them in a way that makes them part of your digestion. Without this bonding, the calcium will simply be flushed out. Unfortunately, many people who try to get enough calcium in their diet don’t get as much as they think they do because it is not properly absorbed. To absorb calcium, your body also needs vitamin D.

Think of vitamin D like the doorman. You can make sure calcium pays a visit to your body by eating an adequate amount, but it will be turned away if no one is there to let it in. To make sure your body actually absorbs calcium and transfers it into your bones, you need to also get enough vitamin D. Studies show that vitamin D and calcium on their own do not effectively prevent fractures in people with osteoporosis.

To learn how much vitamin D you should be getting at your age, make sure you talk to your doctor. He or she will perform tests to first find out whether or not you are deficient in the first place. You can get vitamin D from sun exposure, but you should be careful to avoid too many UV rays at a time. You can also get it from dietary supplements and certain foods such as egg yolks, liver, and fortified milk.

Calcium is certainly important in the prevention of osteoporosis, but vitamin D is equally so. Don’t assume that just because you are getting a lot of calcium, you are safe from weakened bone strength in old age. To prevent the pain and inconvenience of fractures later in your life, start increasing the amount of vitamin D you get today.

– Yvonne S. Thornton, M. D., M. P. H.

Fertility after Forty

Monday, February 11th, 2013

Many of my older patients come to me to find out whether or not it’s too late for them to have a baby. It’s not surprising in the modern world, as many women are waiting to start families until they have reached a comfortable place in their career and financial stability. However, there are risks to waiting. I’ve discussed these risks before, and I don’t necessarily recommend trying to have a baby after your biological clock has proverbially run out of batteries. However, I understand the desire for women older than 40 to reproduce, and it’s okay to try with the assistance of your doctor and OBGYN. The childbearing years (fertility years) typically are from 15 to 44 years of age, according to the definition.

If you’re hoping to have a baby after your early thirties have come and gone, discuss the risks thoroughly with your doctor. You should consider genetic consulting to make sure chromosomal abnormalities aren’t a threat, and you should be in the best shape of your life if you expect your body to take on the task of birth.

Once you start trying, you’ll realize you’re a lot less fertile than you used to be. By the time you turn forty, you only have approximately 2% of the eggs you were born with, so there is less of a chance for successful fertilization.

After age 40, you might want to consider fertility treatments if you’re serious about trying to conceive. Additionally, there are some natural ways you can boost your fertility. By achieving a healthy weight, you will improve the health of your reproductive organs, which is essential in the fertilization process. Eat a healthy diet and stay active. Relaxation is another proven method for enhancing fertility, so enroll in a yoga class and avoid stress when you can

If you really want to give birth after age 40, no one can stop you. Technology allows us to see into the medical future of our babies, so take advantage of it and decide if the risks are worth it. Just remember, conceiving and having a baby after age 40 is one thing.  Raising a child after age 40, is another. We all have different plans in life, and though yours might be riskier than someone else’s, there is no reason for you to deny yourself the joy of motherhood.

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

Eclampsia Has Its Fifteen Minutes of Fame

Thursday, February 7th, 2013

It’s always very exciting when a women’s health issue finds its way into the spotlight through popular media. Though some issues are difficult to talk about and even sad sometimes, talking about them helps raise awareness, which can bring us all closer to effective treatments and cures.

On Sunday night’s episode of the popular series “Downton Abbey,” a main character named Lady Sybil Branson died shortly after she delivered a baby due to a condition called eclampsia.  Eclampsia has been identified as a clinical condition since the times of Hippocrates. The term “Eclampsia” comes from the Greek meaning “lightning” and the description of convulsions or spasms appeared in the medical literature as early as the 17th century. It is a life threatening disorder which kills the baby 30 percent of the time and the mother may die 10 to 15% of time, as seen in the episode of Lady Sybil.

The incidence of eclampsia is high in developing countries, e.g., 13 – 17 per 1000 deliveries in Africa compared to 1 in 2000 in the United Kingdom.  The maternal death rate for the developing countries may be more than 25%.

To understand eclampsia, you should first understand preeclampsia. Preeclampsia is a pregnancy complication that causes dangerously high blood pressure and rapid weight gain. It is an insidious process that is little understood and occurs after 20 weeks of pregnancy.  In its more progressive form, preeclampsia adversely affects fetal growth and causes the baby to be smaller than expected. Women with preeclampsia need to be closely monitored for the duration of their pregnancy. Eclampsia is a continuum of preeclampsia. Women who suffer from eclampsia have seizures during or after birth. In today’s society, with about four million births per year, eclampsia occurs in approximately 1 in 2,000 pregnancies.  In underdeveloped countries, the prevalence of eclampsia is over twenty times higher!

Though the show is set in the 1900’s, eclampsia and preeclampsia still negatively affects women in the United States and all around the world today and there is no known understanding and effective treatment for the condition because there is no animal model and it only occurs in humans.  The treatment for preeclampsia is delivery.  A medicine to control seizures (magnesium sulfate) is used to prevent seizures when preeclampsia is diagnosed, but it still makes for a very risky pregnancy and delivery.  Eclampsia becomes much more frequent as a patient approaches term.  About 50% of eclamptic seizures occur before delivery, 25% during delivery and about 25% within 48 hours after delivery.  In fact, eclamptic seizures may occur up to seven days postpartum.

During your pregnancy, your doctor will perform tests to find out whether or not you have preeclampsia. Usually preeclampsia has no symptoms, i.e., pain or bleeding.  However, if you are in your late second or third trimester and you experience symptoms such as abnormal swelling, sudden weight gain, headaches, abdominal pain, nausea, and vision changes, you should see your doctor immediately. These are all signs that the preeclampsia has progressed, and it’s important that your doctor evaluate your condition with the possible recommendation of immediate delivery.   Eclampsia should be managed in a specialized, well-equipped medical center and not at home (as was the case with Lady Sybil).  A combined team of an obstetrician or perinatologist, obstetric anesthesiologist, and neonatologist with experience in management of eclamptic patients is essential.

The best way to prevent maternal or fetal death due to eclampsia is to make sure all of the doctors and nurses are ready to handle the emergency should it arise.

Now that eclampsia has been discussed in popular media via “Downton Abbey,” more women should seek early prenatal care and should know what to look out for during their pregnancy, so that more might be treated in time, and they and their babies don’t suffer the serious health problems associated with it.

– Yvonne S. Thornton, M. D., M. P. H.

Soy is the Secret to Hot Flash Reduction in Menopause

Monday, February 4th, 2013

There’s no sugar coating it – menopause is the pits. We become more and more irritable until our family members can’t take it, we wake up drenched in sweat in the middle of the night, and we can’t even sit through a movie without taking a few bathroom breaks. Many women would gladly take their periods back to avoid these uncomfortable menopause symptoms. While menopause is largely out of our control, a recent study shows that there is one symptom we can actually reduce by altering out diet.

Hot flashes and night sweats are both considered vasomotor symptoms. They’re caused by the reduction of hormones that are meant to regulate the dilation of your blood vessels. Menopause greatly decreases the levels of estrogen in your body, and your blood vessels will expand quickly for reasons unbeknownst to you in that moment. When the blood rushes through your body, you’ll feel as though you are suddenly sitting inside an oven, which is a hot flash. Night sweats occur for the same reason.

How can your diet control these symptoms? An adjustment in your dietary intake which includes decrease in caffeine intake and avoidance of hot, spicy spicy foods is an excellent start. Research shows that women who eat more soy in their diets experience fewer hot flashes and night sweats. Soy is one of the single best sources of phytoestrogens, which have been shown to have a modest effect on hot flashes, but there are no conclusive evidence-based or long-term studies. For that reason, younger women are advised against eating too much, as the human body can only take so much at a time. However, for women who are going through menopause and have less estrogen than ever before, soy may be the perfect solution. This could easily be the reason only 7% of Japanese women experience hot flashes during their menopause. Their diets are rich in tofu and natural bean ingredients. Considering 55% of American women suffer from vasomotor symptoms, it might be time to take the hint.

As if this news wasn’t good enough, adding more soy to your diet isn’t hard at all. Many of the foods that are rich in soy are also delicious and offer fun alternatives to the usual American diet. To get more soy, consider adding tofu, miso, soymilk, soy nuts, and soy sauce. However, I must admit that soy in these forms is an acquired taste.  I don’t want to be hypocritical, but my palate wasn’t too thrilled with soy intake.  Though it might take time to get used to these new tastes, if you’re not already used to them, they’ll all taste delicious when you consider the alternative.

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