July, 2013

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Researchers Suggesting There is No “One-Size-Fits-All” Approach to Breast Screenings

Monday, July 29th, 2013

Mammograms are universally accepted as the most effective way of screening for breast cancer; however, is this really true? Many women may be surprised to learn that there is more than one method for detecting potentially life-threatening masses in the breasts, and these varying procedures are being used in an increasing number of women in the population.  This is not to say that mammograms are not important or valuable as a detection tool in screening for breast cancers – however, in many cases it may not be effective when used alone, and as new screening technologies are developed and become more widespread an increasing number of women will need to work with their doctors to develop a more personalized approach to breast screenings.

According to a new report in the June issue of the American Journal of Medicine, for many years, mammography has been the sole imaging test recommended for breast cancer screening, and remains the only test proven to reduce breast cancer-related mortality. However, the widespread application of mammography in population-based screening remains controversial, owing to decreased sensitivity in women with dense breast tissue, radiation concerns, and a high rate of false-positive studies, leading to excessive breast biopsies.  Those who image the breasts are adapting to these challenges with the development of new technologies. Low-dose mammography can reduce radiation risk to the breast. Contrast-enhanced mammography can evaluate blood flow in the breast, similar to MRI. Tomosynthesis produces multiple mammographic slices through the breast, similar to computerized tomography (CT scan), and has significant potential to lower recall rates and increase specificity.

The article goes on to say that both whole-breast ultrasound and MRI have been shown to detect additional cancers in certain high-risk populations and will likely be increasingly used in screening women with dense breasts. MRI studies are very expensive and have a high false positive rate, i.e., they have difficulty in identifying a negative on the image as a true negative (without disease) in the patient.  However, a decrease in mortality has not been proven using these modalities.  Molecular imaging in the form of BSGI and PEM of the breast is widely available. Positron emission mammography (PEM) and breast-specific gamma imaging (BSGI) use molecular imaging to increase specificity in cancer detection by demonstrating increased metabolic activity.  However,  due to relatively large whole-body radiation doses (equivalent to 20-30 mammograms), they are not currently suitable for annual screening.

The reason that the same method will not work with every woman is because every woman’s body is different. Variations in the structure of a woman’s breast, the density of her breast tissue, or even the existence of implants may affect the ability of the standard mammogram to fully detect any underlying lumps or irregularities in her breast tissue. Simply put, every woman’s breasts are different, and so too must the screening for every woman be different.

While these advances are encouraging, it is improbable that any of the new technologies will replace mammography for population-based screening programs, because all have significant limitations.  Furthermore, given the heterogeneity of the human population, a “perfect” imaging technology for breast cancer screening will likely never be found.  However, women who feel as if they have different needs should consult with their doctor and ask whether or not there may be special considerations they should make as a part of screening for cancers. However, ultimately the main thing that older women should do is to continue receiving their mammograms regularly as well as younger women (less than 35 years of age) conducting breast self-examinations on a regular basis within the comfort of their own home. In coming years it is likely that the plan of action for women will begin to change depending on individual women’s needs, but the existence of different technologies is still no substitute for the screening methods that are commonly accepted and readily available.

– Yvonne S. Thornton, M. D., M. P. H.

Posted in General health news, Women's health issues | No Responses »
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Talking About Depression With Your Ob-Gyn

Thursday, July 25th, 2013

Depression is one of the most serious and prevalent disorders affecting women in the present day. It is also one of the most underreported disorders affecting women, and the number of those affected by it is increasing every year. Depression affects women of all age ranges and social statuses, and it affects those in poor health as well as those who are seemingly in perfect condition. With depression being so common, and affecting so many, it would seem that Ob-Gyn’s regularly diagnosis this problem in women. However, studies are suggesting that doctors miss a diagnosis of depression in as much as sixty percent of their patients.

Whether the women had a preexisting diagnosis of depression, reported suffering from psychological distress, or simply felt as if they might be depressed, their depression consistently went undiagnosed throughout visits with their Ob-Gyn. The most common signs recognized by doctors included physical manifestations of the disorder, such as weight gains and losses as well as reported insomnia.

Those that did receive a diagnosis were primarily women who were under twelve months postpartum, those under thirty-five years of age, and women who were seeing their Ob-Gyn either to discuss their depression symptoms or as part of a regular checkup. The most common visits in which the depression went unnoticed were visits in which the woman had scheduled an appointment to discuss an existing complaint.

This raises the all-important question—why do so many doctors miss depression diagnoses? There are likely a number of factors, ranging from the feeling of suffers that they are not in need of help to a reluctance to discuss any issues that are not “medical” with a medical practitioner. However, it is important for women to realize that depression is a medical issue, and it is one that can severely impact them throughout their lives—and it can even impact their health directly. Recognize that your mental state is just as important to report as your physical state and, most importantly, persistent feelings of sadness, loneliness, and lack of interest in one’s life are not feelings that must simply be “dealt with”.  Your doctor can help.

– Yvonne S. Thornton, M. D., M. P. H.

Posted in General health news, Women's health issues | No Responses »
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Use of Decongestants During Pregnancy May Be Linked to Birth Defects

Monday, July 22nd, 2013

Women have a long checklist list of products to avoid during pregnancy, from alcohol and caffeine to more serious chemicals that can seriously affect fetal development. However, the effects of certain medicines and other products have largely been unknown. One of the more common medications that women ask if they can use during pregnancy is the simple decongestant—something which most people take for granted. For a woman who is already suffering the discomfort of pregnancy, the idea of asking her to shoulder the burden of a stuffy nose and sinus pressure may seem a little harsh. However, new studies are suggesting that decongestants taken in the first-trimest of pregnancy may be a major item on the “to avoid” checklist, as they have been linked to birth defects.

The decongestants that researchers focused on in the study included both oral and nasal remedies. While the correlations between certain types of decongestants and potential birth defects still requires further investigation, this finding presents and opportunity to discuss one of the more important aspects of obstetric medicine. The simple fact of the matter is that there is no way to know all of the potential risks a woman faces during pregnancy.   Some women may not even know they are pregnant when taking these over-the-counter decongestants.  Therefore, any woman in the childbearing years who is not using effective contraception should think twice about relieving symptoms of an annoying stuffy nose as a trade-off  for increasing the risk of a child with birth defects.

While research has come a long way in identifying major risk factors, a number of other risk factors are still unknowns. This is even more so the case as new products are released into the market, new chemicals make their way onto store shelves, and ultimately pregnant women are exposed to an increasingly wider range of products during pregnancy. It is also a good reminder of the importance a woman should place on responsible behaviors during pregnancy, which include rethinking her normal habits and routines and consulting with a medical professional before taking any medication—even ones that seem fairly mild or harmless.

I hesitate to call women who take these products irresponsible or negligent—after all, not everyone is a doctor and not everybody has the access to medical information that can tell her at a glance what is and is not safe. That is why part of a responsible pregnancy is not only knowing to avoid certain products and materials, but is developing a good relationship with the medical professional in charge of one’s healthcare during pregnancy.

– Yvonne S. Thornton, M. D., M. P. H.

Posted in Childbirth & delivery, Pregnancy | No Responses »
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Sleep Disruption in Postmenopausal Women

Thursday, July 18th, 2013

Do you experience difficulty sleeping? If so, then you are not alone. More than a third of individuals report that they face some difficulty sleeping that leaves them tired throughout the day, whether that is insomnia, discomfort during sleep, or patterns of sleeping and waking in the middle of the night. An individual might have difficulty sleeping for any number of reasons, whether it is simply the fact that they are too busy to get the rest that they need or whether it is the result of some more severe issue related to emotional distress or anxiety. However, a new study suggests that sleep difficulties might be heightened in postmenopausal women.   A person should receive between 71/2 and 8 hours of uninterrupted sleep a day.

In this study, both premenopausal women and postmenopausal women were asked to keep a diary tracking their typical sleep patterns across a two-week period. The results showed that postmenopausal women did show a lessened ability to get the recommended amount of sleep throughout the night. When compared to these women’s workday and leisure day schedules, it also showed that postmenopausal women were more likely to lose sleep related to the stresses of their workday.  Consequently, postmenopausal women had less than 7 hours of sleep compared to their premenopausal counterparts who slept about seven and one-half hours.

It can be easy to brush off studies like these, or to think that you’ll simply make up the sleep later if you are one of those that regularly experiences sleep problems. However, there is more than enough evidence available to suggest that losing sleep could lead toward much bigger problems down the line. Despite the potential risks of going without sleep, insomnia and related issues are still one of the most underreported medical problems that many people, and especially women, face. Be sure that if you are experiencing sleep difficulties, you speak to your doctor about them—especially if these sleep difficulties are concurrent with any other life changes, whether they are medical or emotional.

– Yvonne S. Thornton, M. D., M. P. H.

Posted in General health news, Hormone replacement therapy, Menopause | No Responses »
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Preterm Delivery May Help Identify Risks for Cardiovascular Health

Monday, July 15th, 2013

Do you experience difficulty sleeping? If so, then you are not alone. More than a third of individuals report that they face some difficulty sleeping that leaves them tired throughout the day, whether that is insomnia, discomfort during sleep, or patterns of sleeping and waking in the middle of the night. An individual might have difficulty sleeping for any number of reasons, whether it is simply the fact that they are too busy to get the rest that they need or whether it is the result of some more severe issue related to emotional distress or anxiety. However, a new study suggests that sleep difficulties might be heightened in postmenopausal women.   A person should receive between 71/2 and 8 hours of uninterrupted sleep a day.

In this study, both premenopausal women and postmenopausal women were asked to keep a diary tracking their typical sleep patterns across a two-week period. The results showed that postmenopausal women did show a lessened ability to get the recommended amount of sleep throughout the night. When compared to these women’s workday and leisure day schedules, it also showed that postmenopausal women were more likely to lose sleep related to the stresses of their workday.  Consequently, postmenopausal women had less than 7 hours of sleep compared to their premenopausal counterparts who slept about seven and one half hours.

It can be easy to brush off studies like these, or to think that you’ll simply make up the sleep later if you are one of those that regularly experiences sleep problems. However, there is more than enough evidence available to suggest that losing sleep could lead toward much bigger problems down the line. Despite the potential risks of going without sleep, insomnia and related issues are still one of the most underreported medical problems that many people, and especially women, face. Be sure that if you are experiencing sleep difficulties, you speak to your doctor about them—especially if these sleep difficulties are concurrent with any other life changes, whether they are medical or emotional.

– Yvonne S. Thornton, M. D., M. P. H.

Posted in Childbirth & delivery, General health news | No Responses »
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Further Proof that What You Drink Can Affect Your Urinary Health

Thursday, July 11th, 2013

Urinary health is a bit of a tricky subject for some women to discuss, but it can be one of the biggest issues that many women face throughout their lives. Most women will endure issues such as Urinary Tract Infections (UTIs) or urinary incontinence at some point during their lives, and it is important for women to have a healthy dialogue with their doctor about the ways that they can prevent and treat problems such as UTIs when they occur.

There has long been a consensus among doctors that the amount of fluid intake that a woman has day-to-day, can affect the healthy of her bladder, kidneys, and urinary tract. One of the most important things that a woman can do to maintain her health is to be certain that she is drinking the recommended amount of water throughout the day. However, a new study is showing that the types of fluids a woman takes into her body plays as important of a role in preventing and treating UTIs as the amount of fluid that she drinks.

Caffeine and drinks high in sugar such as sodas are one of the biggest risk factors for both men and women for experiencing urgency symptoms and UTI symptoms. This is in addition to the elevated risks of obesity and diabetes that come with drinking sugary sodas. On the other hand, certain types of fruit juices such as orange and grapefruit may reduce the symptoms of UTIs.   In this observational study, the ingestion of citrus juices had a weak link for significance regarding an actual improvement in lower urinary tract infections or the prevention of a urinary tract infections. Citrus juice ingestion showed more promise in men compared to women.  Recent studies have also debunked the idea of drinking cranberry juice to prevent urinary tract infections.  The best way to reduce the risk of urinary tract infections is to drink more water and refrain from sexual intercourse.  Simple advice, but difficult to follow.

None of this is surprising news for doctors, many of whom have been recommending that women with a history of UTIs avoid caffeinated drinks and sodas, while increasing their water intake, for years. What is probably more surprising is the number of women who still do not know about the effects that caffeine and sugar consumption can have not just on their weight, but on other aspects of their health. This is a clear indicator that more women need to be open about any UTI problems that they may be experiencing so that they can have an open and honest discussion with their doctor about their urinary health. There is nothing to be shy about in this case, especially when such simple measures can be taken to ensure your health.

– Yvonne S. Thornton, M. D., M. P. H.

 

Posted in General health news, Women's health issues | No Responses »
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Not Receiving Influenza Vaccinations Increases Infant Mortality

Monday, July 8th, 2013

There has been a lot of talk about vaccinations in the past several years, and the camp of people on the side of going vaccination-free is getting bigger every year. That is something that frightens me as a doctor, as vaccinations are the single most effective way to prevent disease, not just among individuals but also among the general population, known as herd immunity.  Vaccination acts as a “firewall” in the spread of disease.  In herd immunity, the more folks that are vaccinated against a contagious disease, the less likely a single individual will become infected.

However, part of being a doctor is a willingness to look at all the evidence as it is presented to you. As the debate about vaccinations continues, an increasing number of researchers are looking at the effects that vaccinations have on individuals, and whether they have the potential to do more harm than good among certain groups.

Pregnant women are a group of major concern. There are a lot of steps and preventative measures that a woman must take in order to maintain the health of her child while she is pregnant, and vaccinations have always been recommended to prevent the devastating effects of the Influenza virus. Doctors in one study have conducted research on pregnant women and the influenza virus, as well as the mortality rates in the infants of those that choose not to be vaccinated.  While vaccinations against the Influenza virus pose no significant threat to women or to their unborn children, women who go without the vaccination show much higher rates of infection, and those that were infected show much higher rates of fetal mortality.  Another vaccine, known as Tdap, for tetanus, diptheria and pertussis (whooping cough), should be administered to all pregnant women in their third trimester (27 weeks to 36 weeks) in order to maximize the maternal antibody response and passive antibodies that will protect the newborn.

The results are not surprising to doctors, but they are worrying when you take into consideration the fact that this year, many women will choose not to be vaccinated, and will choose not to vaccinate their children. While many trends are silly but otherwise harmless, this “popular” trend could be absolutely devastating. There are certain vaccinations that should not be performed during pregnancy, such as measles, mumps and rubella (MMR), varicella (chickenpox), zoster (shingles), anthrax, BCG (tuberculosis), Japanese encephalitis, typhoid, yellow fever and smallpox, but women should trust their doctors to guide them in the right direction when it comes to making these decisions about the necessary vaccinations.  Choosing to vaccinate against Influenza, even while pregnant, poses virtually no risks. Choosing not to vaccinate could be a big mistake.

– Yvonne S. Thornton, M. D., M. P. H.

Posted in Childbirth & delivery, Fertility & Infertility | No Responses »
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Reproductive Science Helps Women With HIV-Positive Partners Give Birth

Thursday, July 4th, 2013

Although sexually transmitted diseases are a very serious matter no matter what an individual is facing, HIV is perhaps the most frightening diagnosis for many individuals. Even with vastly improved life-expectancy rates, there are a number of concerns that individuals and those who have HIV-positive partners face throughout their lives. One of the biggest concerns for those who have HIV is whether or not they will have the opportunity to conceive children.

It is absolutely imperative that among couples in which one partner is infected with HIV and the other is not that protection is used whenever intercourse occurs. This means that a couple in which one partner has HIV cannot conceive naturally—at least, not in a responsible manner. However, studies in reproductive medicine have investigated whether or not the sperm of men that have been infected with HIV can successfully impregnate women while still leaving both mother and child HIV-free.

It sounds like a scary and risky procedure, and there has certainly been a lot of debate over whether these kinds of studies are wise. However, this study has shown that there does not seem to be a risk of infection in cases where the male sperm has been “washed” and the woman has been artificially impregnated. This is intriguing news not only for researchers that study the mechanics of HIV, but also for doctors who specialize in reproductive help. It means that there seem to be more options for couples in which at least one partner is infected. Unfortunately, pregnancy among HIV-infected women can still be dangerous, as the virus can transmit to the infant either during pregnancy or childbirth, and much more needs to be done to determine the possibilities for couples during these cases.

Overall, it is intriguing news and it will certainly continue to raise a lot of questions for those that specialize in women’s health and reproductive medicine. However, it is imperative for any couples in which one partner is infected with HIV to realize that it is necessary to seek medical advice when the issue of conception comes up. Even if the possibility for a safe pregnancy is there, it is better to seek the advice of professionals and to avoid any potential infection. Childbirth is a wonderful and a beautiful experience, but currently the best option for these couples is still to seek alternate methods to become parents.

– Yvonne S. Thornton, M. D., M. P. H.

Posted in Childbirth & delivery, Women's health issues | No Responses »
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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.

Posted in Women's health issues, Women's health news | No Responses »
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