November, 2013 browsing by month


Fruit and Vegetable Intake Linked to Lower Bladder Cancer Risk

Thursday, November 28th, 2013

New studies show that a higher intake of fruits and vegetables is associated with a lower risk of bladder cancer in women. One study carried out recently by the University of Hawaii Cancer Center concluded that consuming more fruits and vegetables effectively lowered the risk of bladder cancer in women – worth noting, though, is the fact that no similar decrease in risk was found in men.

Researchers conducted this study to evaluate the relationship among lifestyle, genetic, and dietary factors and cancer risk. Data was collected from over 185,000 adults over a 12.5-year period. Among this group, 581 cases of invasive bladder cancer were diagnosed during the study, with almost three times as many men as women being diagnosed.

After adjustments were made to account for variables that would be related to cancer risk, such as age, researchers concluded that the lowest bladder cancer risk was found in women who consumed the most fruits and vegetables. Specifically, the highest consumption of yellow-orange vegetables and the highest intake of vitamins A, C, and E were the most closely related to lower cancer risk.

Another study had less favorable results, finding little difference in bladder cancer risk among women who consumed more fruits and vegetables, but even this one did find that consuming more cruciferous vegetables was related to a lower risk of bladder cancer. All cruciferous vegetables were found to be beneficial, but broccoli and cabbage in particular were related to a significant decrease in bladder cancer risk.

The findings are not surprising, as researchers have long believed that a healthy diet containing many fruits and vegetables lowers cancer risk. The studies do further solidify this belief, however, although more research is needed to understand the reasons why the benefit of lower cancer risk when consuming larger amounts of fruits and vegetables was found only in women.

In most cases of cancer it is impossible to identify a specific cause, so it only makes sense to do everything you can to prevent cancer from occurring. Eating more vegetables is easy and inexpensive, might help, and definitely won’t hurt. A diet rich in fruits and vegetables is also known to promote overall health and prevent other types of cancer as well.

Signs of Bladder Cancer

Blood in the urine is typically the first sign of bladder cancer. There may be enough blood to change the urine’s color, so if you notice that yours is pink, pale yellow-red, or even darker red, be sure and see a doctor. Often the amount of blood present is small enough that it is only found during urinalysis.

There is usually no pain associated with early bladder cancer, so even if you feel fine, get red- or pink-tinted urine checked by a doctor – even if it is clear the next day. Bladder cancer may also cause more frequent urination, pain or burning during urination, or feeling an urgent need to urinate even when the bladder is empty. Lower back pain is another possible symptom; so is inability to urinate even when the bladder is full.

All of these symptoms can also be signs of less serious diseases, such as non-cancerous tumors, infection, or kidney stones. However, they should all be checked out to rule out cancer and treat the condition that does exist. Bladder cancer, like other cancers, has a much more favorable prognosis when caught early, so don’t hesitate to see a doctor should you notice any of its signs.

– Yvonne S. Thornton, M. D., M. P. H.

Pregnant Women and Work Concerns

Monday, November 25th, 2013

In 2012, women account for 47 percent of the salaried labor force in the United States ( It’s only natural that concerns would arise regarding pregnant women and working. Today, many pregnant women plan to work throughout their pregnancies – probably too many. Pregnancy alone places an extraordinary amount of stress on a woman’s body, and it is extremely important to get enough rest. The decision to stop working can be a tough one, financially, emotionally, and socially, but it may be essential to protecting maternal health and the health of the baby.

If a woman cannot stop working or chooses to work despite the risks, she should be aware of safety precautions that must be taken in order to minimize the risks involved. Even if she sits at a desk all day, she must remember to get up and move around regularly, drink plenty of water, and eat a healthy diet – those office fast-food runs aren’t going to cut it. If she stands for an extended time as a supermarket cashier, hairstylist, bank teller, etc, the pregnancy may be at risk for preterm delivery.  Therefore, she must walk around or sit down every hour or so.  Getting enough iron, calcium and protein may help somewhat with fatigue, but women should realize that fatigue is their bodies’ way of telling them to rest, so that’s what they should do.

Pregnant women should take steps to stay as comfortable as possible, including making sure the chairs they sit in are supportive, that they are not standing for prolonged periods of time, and that they are not doing excessive bending or lifting. Heavy lifting and twisting while lifting should be avoided altogether. Exposure to harmful substances should also be avoided.

A pregnant woman who works should seriously consider ways to cut back on activities in other areas of her life. For example, shopping online can create more time for rest. Or, if possible, hiring a service to clean the house or do yard work or enlisting the help of other family members is a good idea. She should also do everything in her power to get enough sleep, including going to bed early and lying on her side with pillows between her knees and under her belly for maximum comfort and to prevent swelling in her feet.

It will also be important to keep stress under control. Pregnant women should do what they can to reduce workplace stress. For example, making to-do lists and prioritizing tasks can help them take the work day one task at a time as well as identify tasks that can be delegated to someone else. Taking a few minutes alone to practice some relaxation techniques several times a day can keep stress at a minimum, as can having someone to talk to about frustrations.

The bottom line is that women should discuss their jobs with their health care providers to determine whether they need to make other arrangements for the duration of the pregnancy. A woman who is at risk for preterm birth should not work, period – she should be focused on resting with her feet up and drinking plenty of water. Although pregnancy is a normal physiologic process, the workplace may be unkind to a pregnant woman and if that is the case, a pregnant woman should seriously consider giving up her job, if at all possible, or at least cutting way back on her hours.

– Yvonne S. Thornton, M. D., M. P. H.

Women with Eating Disorders More Likely to Have Reproductive Problems

Thursday, November 21st, 2013

According to a Finnish study, women with eating disorders have a greater risk of reproductive problems. Millions of women in the United States alone suffer from eating disorders, and some estimates place the number of women who will have an eating disorder at some point in their lives as high as 10% of the worldwide population. Although eating disorders do occur at most ages and in both genders, they are most commonly diagnosed in women of childbearing age.

The University of Helsinki and the National institute for Health and Welfare carried out the study by examining 15 years of data from over 11,000 women. The startling findings included the fact that women with anorexia were only half as likely as their peers to have children. The study also revealed that women with binge-eating disorder are three times as likely as their peers to have miscarriages.

In addition, bulimics have twice as many abortions as their peers. The exact cause for this was not clear, but it could be that because eating disorders can cause irregular periods; these women may also be inconsistent with contraception use. It’s possible that it could also have something to do with bulimics’ tendency to exhibit impulsive behavior.

Worse still, women with eating disorders continue to have fertility issues even after they appear to have recovered. Women who have ever had an eating disorder, even if they are now recovered, still find it harder to conceive as well as to carry a pregnancy to term.

The study certainly highlights the need for more research on this apparent link, because it’s possible that early recognition and effective treatment for eating disorders may help prevent fertility problems. Currently, only about 1 in 10 people with eating disorders receive treatment. Early intervention and long term treatment may help reduce the ultimate effects of the eating disorder, so increasing the number of those getting treatment is important.

Of course, fertility problems are only one reason why it’s crucial for women with eating disorders to seek treatment, and women should discuss treatment options with their doctors for the physical effects of the eating disorder as well as the psychological and psychosocial effects. Social well-being is just one area of mental health that can be dramatically impacted by an eating disorder. Eating disorders cause numerous physical health problems as well, including problems with heart health, osteoporosis, dehydration or electrolyte imbalances, and tooth decay, to name a few.

People suffering from eating disorders can call the National Eating Disorders Hotline at 1-800-931-2237 for information on treatment and referrals, or they can talk to their doctor about possible treatment options. If you suspect that someone you know has an eating disorder, talk to him or her about it. Eating disorders are serious illnesses that can be life-threatening, so don’t wait to get help.

– Yvonne S. Thornton, M. D., M. P. H.

What Is a Normal Period?

Monday, November 18th, 2013

Women, especially younger women, are usually anxious to know whether their bodies are normal. After all, the menstrual cycle isn’t something you bring up every time you meet another women, so it’s not likely you’ve conducted your own informal research to find out how your cycle compares to those of your friends. Many women have read in books or heard from someone else, like their mother or a doctor, that a “normal” cycle last 28 days and that bleeding lasts for five days. So when their cycle fails to match this textbook version, they worry. Or, women who have always had “normal” cycles see frequency or duration changes happen in their 20s, 30s, or 40s and become concerned that something is wrong.

The truth is that there is a wide range of normal ( when it comes to the menstrual cycle. “Average” means just that – the average of all the possibilities. In the majority of cases where a woman goes to her doctor concerned about menstrual changes or problems, there is nothing wrong. Irregular periods, especially in adolescents, are almost always normal. Even when a cycle is regular, it may be a 25-day cycle or a 40-day cycle, anything in between, or even something outside of this range.

It is a very good idea for women to maintain a calendar or chart in order to keep track of her cycle. This is imperative if a woman is trying to conceive, but even if she’s not, a chart can give her something more reliable than her memory to fall back on should she need to see a gynecologist for any related reason. She will need to be able to tell her doctor when her last period was, whether her cycle is usually regular, and any other information her doctor might need.

When a sudden change in a woman’s menstrual cycle does happen, there are several things that can cause it, such as weight gain or loss, beginning a new exercise program, stress, an interruption of the woman’s normal routine, or even just routine changes that happen with age.

When Concern May be Warranted

If a 16-year-old girl has had no periods at all, there may be a hormonal issue that needs attention. Likewise, when periods suddenly stop in women who have previously had regular periods, and pregnancy can be ruled out, an examination is in order to discover the underlying cause. Unusually frequent bleeding should be investigated to rule out polyps or hormonal issues. Severely painful cramps or unusually heavy bleeding should also prompt a woman to check with her doctor.

Anytime you have a question about whether or not something is normal, check with your gynecologist to be on the safe side. But realize that what constitutes a “normal” period simply means what is normal for your individual body.  Using that as an internal standard is the best definition of “normal”.  And, if something is different “your” normal, then you should seek medical attention as soon as possible.

– Yvonne S. Thornton, M. D., M. P. H.

Options for Labor Pain Management

Thursday, November 14th, 2013

No two women experience labor pain exactly the same way, but one thing is certain: if you go through labor, you will experience pain. The size of your baby, his or her position, and the strength of your contractions all affect the severity and location of your pain; your stress level, including whether you are afraid and how prepared you are mentally and physically for labor, will also have an effect. For these reasons, knowing what to expect and what your options are before you ever have your first contraction is vital. Education and preparedness can allow you to make informed decisions unpressured by the immediacy of pain that you are unprepared to handle.

Lamaze Still the Best Overall Option

Your best bet, all things considered, is a labor and delivery free of drugs of any kind. Lamaze training doesn’t seem to be as en vogue as it once was, but it remains the safest option and, when learned properly, is highly effective. It does not block the sensation of pain entirely, but instead, teaches you techniques for coping with the pain calmly by focusing your attention on your breathing and on some focal point outside of your body. Many women have been pleasantly surprised to find out how effective Lamaze actually is. Perhaps its biggest benefit is its complete lack of potentially harmful side effects – something that cannot be said about drugs used in labor pain management (or any drug, for that matter).

Epidurals Effective But (Somewhat) Risky

Despite the fact that Lamaze costs nothing, is free of risk, and is effective, many women understandably prefer a pain relief method they perceive to be better: the epidural. Epidurals have become so common that these days, almost every pregnant woman plans on having one. Epidurals offer the distinct advantage of blocking pain sensations entirely (some pressure is still felt but it isn’t painful) while leaving Mom wide awake and ready to greet her new baby.

Which sounds great, except for one tiny detail: epidurals are not completely harmless. For starters, they are extremely expensive, although that isn’t much of a deterrent for most women when an insurance company is footing the bill. The much more important issue is that the drug used in epidurals crosses the placenta and can slow the fetal heart rate, sometimes necessitating Cesarean deliveries that would otherwise not have been necessary. There are also potential risks to the mother, including the possibility of needing to be put on a respirator if the epidural blocks more sensation than it is meant to, and other risks such as headache and low blood pressure.

My personal assessment, after delivering 5,542 babies and being an obstetrician for over 40 years, is that prolonged use of epidural anesthesia is associated with the development of autism in childhood.  This is just a theory, based on anecdotal observations; but, I have found that the babies born to mothers who are attended by midwives, who don’t use epidural anesthesia,  are less likely to be diagnosed with autism compared to children who have been exposed for many hours to the drugs used in administering epidural during labor.  It sounds preposterous, but remember where you read it first.

This is not to say that I am against any woman ever having an epidural. But women need to be informed of the risks and provided with the opportunity to learn completely safe alternative pain management techniques, such as Lamaze. If an epidural is chosen, it should not be administered too early in labor – not before the cervix is dilated to at least five centimeters. In addition, the epidural should be stopped once the cervix is dilated ten centimeters and the mother is ready to push; otherwise, she will not be able to push effectively. For more information on this topic, as well as my theory on epidurals and autism, see my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.

The Trouble with Trans Fats

Monday, November 11th, 2013

You are probably aware that trans fats are bad for you. Research confirms this and even shows that in postmenopausal women, higher intake of trans fat is linked to a higher risk of ischemic stroke. In the study, no other types of fats showed the same relationship to ischemic stroke incidence. Interestingly, research also shows that taking aspirin regularly attenuates the risk of stroke even when trans fat intake is high, so you may want to ask your doctor about the wisdom of beginning an aspirin regimen.

The study involved over 87,000 healthy postmenopausal women between 50 and 79 years old and found that, independent of all other factors, including many lifestyle choices, higher intake of trans fats is directly related to higher risk of ischemic stroke. In addition, trans fats have been known to increase a person’s risk of heart disease, high “bad” cholesterol, and diabetes.

If only it were as simple as avoiding trans fats.

Unfortunately, many well-meaning people who read labels diligently and believe they are successfully avoiding trans fats may be in for a surprise. Food labels, it turns out, are disturbingly misleading.

The Food and Drug Administration (FDA) allows food manufacturers to round trans fat amounts down on labels in increments of .5 grams. This means that if a food contains less than .5 grams of trans fats per serving, the label can legally say that it contains none. When you consider that you may consume multiple foods with these misleading labels, and that the amount of each food you eat will often exceed the recommended serving size, you could be consuming a considerable amount of dangerous trans fat – but not have any way to know it.

Because the recommended safe maximum amount of trans fat per day is 1.11 grams, it’s easy to see how you could quickly consume more than this while believing that you are consuming none.

Activists are working to convince the FDA to change its rules on food labels, making it easier for consumers to determine what they are eating and control their intake of trans fats as well as other undesirable ingredients. In the meantime, however, you can make smarter choices by avoiding foods that often contain trans fats, such as commercial baked goods, fried foods, and shortenings.

Also, try this trick for reading food labels: look for the word “hydrogenated” in the ingredient list. The process of hydrogenation (adding hydrogen to vegetable oil in order to keep it from spoiling) creates trans fats. That means that even if the label says the food contains no trans fats, you can be sure that isn’t true if “hydrogenated oil” is one of the ingredients.

You can also avoid these harmful fats by sticking to a diet that contains mostly whole, fresh foods with an emphasis on lean protein and fresh fruits and vegetables, and by avoiding, for the most part, processed, fatty, chemical-laden foods.

– Yvonne S. Thornton, M. D., M. P. H.

Myomas – Also (Wrongly) Known as Fibroids

Thursday, November 7th, 2013

As widely used as the term “fibroids” is, it is, in fact, a misnomer. “Myoma or myomas”  is the proper name for these tumors of the uterine muscle.

Myomas can be many different sizes and are typically hard and rubbery. They grow slowly and can occur at any time in any woman. 25 percent of all women have myomas, while 50 percent of black women do. Fortunately, many of these myomas are small and require no treatment. There can be just one or dozens in one uterus, and each one can be smaller than a pea or as large as a cantaloupe – or anywhere in between.

If your doctor tells you that you have a myoma, there are some questions you should be prepared to ask. You’ll want to know how big it is, how many of them there are, and where in the uterus they are located. Furthermore, you’ll want to discuss any symptoms it may be causing. A diagnosis of myomas often leads to hysterectomy, but sometimes this is an unnecessary overreaction, so talk to your doctor about possible other treatments, or whether treatment is needed at all.

For example, at menopause, myomas often shrink. This is because they are largely dependent on estrogen, so when estrogen output dwindles, myomas shrivel. They may not disappear completely, but if they are small enough and not causing symptoms, then there is often no reason to treat them.

However, some myomas can cause troublesome symptoms such as pain, irregular heavy bleeding, frequent urination, or problems with defecation caused by pressure on the colon. Another problem with myomas is that they can be hard to distinguish from ovarian cysts and tumors. Because they are slow-growing, though, it’s usually fine to monitor their growth through repeated examinations. If they stay the same size over time, this is a good sign. However, a growing myoma is a concern that requires some type of follow-up, usually exploratory surgery.

If a myoma needs to be removed, there are still different options for women and their doctors to explore. A myomectomy isolates and removes each myoma, while a hysterectomy removes the entire uterus. A woman who wants to preserve her ability to have children may opt for a myomectomy, but she should realize that this operation is difficult and complications are likely, so if she is older or certain that she does not want to have more children, then a hysterectomy is a much safer, simpler option.

There are new alternative treatments for myomas that are not recommended for women who still want to have children, because their newness calls into question the wisdom of recommending them; you can find more information about these treatments in my book, Inside Information for Women. But the fact remains that hysterectomy is the safe, rational course of action for myomas in women who do not want any more kids. Therefore, if you are symptomatic, menopausal and/or have completed your family, your  gynecologist may offer the definitive treatment of hysterectomy.

– Yvonne S. Thornton, M. D., M. P. H.

X-Rays and Pregnancy

Monday, November 4th, 2013

Many people are concerned about the effects of radiation from X-rays, such as those used for medical diagnoses. Some people become so worried about this that they refuse even important diagnostic X-rays that they need.

The small amount of radiation emitted by X-rays is actually no more dangerous than naturally occurring radiation, such as that from the sun or when you are flying in an airplane at high altitudes.

Low-energy ultraviolet (UV) rays, visible light, infrared rays, microwaves, and radio waves are all forms of non-ionizing radiation.  Ionizing radiation, on the other hand, is generated through nuclear reactions and can alter chemical bonds. Exposure to ionizing radiation causes damage to living tissue, and can result in mutation, radiation sickness, cancer, and death.

Just remember that diagnostic radiation is measured in millirads, while the concern about harming the fetus or embryo is in rads, specifically more than 5 rads.   That means there is 1000 times less radiation in the average diagnostic chest X-ray and one would need to have a thousand chest X-rays in order to reach one rad.   The National Institute of Child Health and Human Development says that a small amount of X-rays are safe even during pregnancy.  Because the fetus is inside the mother, it does benefit from some measure of protection from the effects of radiation. Pregnant women should, however, make sure that they tell their dentists or other doctors or technicians performing X-rays that they are pregnant so that proper precautions can be taken.   But, receiving an X-ray at a dentist’s office or at the hospital is NOT the same as being exposed to the amount of radiation emitted from Chernobyl or Hiroshima.  People exaggerate the harm of these medical diagnostic X-rays to the detriment of the mother because she may be denied appropriate imaging studies in order to diagnose a medical condition that, in and of itself, may worsen without the knowledge gained from the diagnostic X-ray.

With most decisions you make during the course of your pregnancy, you will want to weigh the risks against the benefits of any particular action and choose the option that is best for you and your baby.  According to the American College of Radiology, “no single diagnostic procedure results in a radiation dose significant enough to threaten the well-being of the developing embryo or fetus.” This statement was made over 20 years ago and it still rings true today.  So, why all the hysteria?  Ignorance and fear of possible lawsuits.  It’s important to remember that with X-rays, often not getting the X-ray will be the more harmful choice. X-rays have been shown to be quite safe, and even if you are still worried about the radiation exposure, keep in mind that your undiagnosed infection, condition, or injury may turn out to be much more harmful and may lead to death.

It is true that there is an abundance of misinformation and dysinformation surrounding the topic of X-rays during pregnancy. With that said, it is a good idea to limit X-rays to those that are imperative. Routine dental X-rays, for example, should wait until after your baby is born, while  X-rays of the lung to rule out tuberculosis or to investigate a troublesome symptom should not be delayed. Remember that X-rays save lives in many cases because of the information they provide for your doctor about your condition.

To reiterate, the fact is that diagnostic X-rays pose no threat to your unborn baby. Especially in the case of one-time X-rays that do not involve the lower pelvis, such as those that image the chest, arms, or legs.  Serial or cumulative X-rays and CT scans are another concern and should be limited during the course of the pregnancy.  MRI’s are not ionizing radiation, but rather powerful magnets which temporarily alter the energy state.

What if you had an X-ray before you knew you were pregnant? Don’t worry. The chance that it caused any harm is infinitesimal.  At that very early stage of pregnancy, the body invokes the “all or nothing” principle.  Either there is no harm at all or the body rejects the abnormal embryo, resulting in a miscarriage (spontaneous abortion).  If you are concerned about X-rays you had early in your pregnancy before you were aware the pregnancy existed, a discussion with your doctor should allay your fears.   Now that you know you are pregnant, be sure your doctor knows it when he or she orders X-rays for any condition. This is important for any treatment a doctor orders such as prescriptions and certain medical procedures as well as X-rays.

Occasionally, a woman may have X-rays to diagnose a mysterious “illness” that turns out to be pregnancy. Fifty percent of all pregnancies are unintended.  Therefore, if you are sexually active, you may be pregnant and you need to discuss that with your doctor before moving on to other diagnostic tests or treatments.

Finally, if your doctor wants you to have X-rays, inform him or her of any other X-rays you may have had in the recent past or before you were pregnant, so that they might be able to look at them instead of ordering new X-rays. This can help you avoid unnecessary X-rays, but again, if you do need X-rays, remember that refusing them is likely to be more detrimental to your health and that of your baby as compared to having an X-ray which could save your life by diagnosing or ruling out the problem.

– Yvonne S. Thornton, M. D., M. P. H.