Not Receiving Influenza Vaccinations Increases Infant Mortality

Written by yvonnethornton on 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

Written by yvonnethornton on 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.

 

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Obesity A Major Cause of Death for Women that Survive Cancer

Written by yvonnethornton on 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.

 

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Among Women, Sexual Satisfaction Only Increases With Age

Written by yvonnethornton on June 27th, 2013

Let’s talk about sex! While sexual activity, and sexual desire for that matter, is usually thought of to be a younger woman’s game, an increasing amount of attention is being given to older women and their sexuality. It has been commonly thought for years that a woman peaks sexually around the age of 30 to 40, and after that experiences a steady decline in her sexual performance and desire until she hits menopause. However, according to some new studies, that might not necessarily be the case. In fact, some studies are showing that as opposed to the more commonly held opinion that older women simply aren’t interested in sex, sexual desire actually increases with age.

But how is that possible? Isn’t sex all just a “hormone” thing? If that were the case, then it would certainly be true that sexual desire may drop among women who are experiencing menopause, or among women who were post-menopausal. However, the study cites a few different reasons as the main cause of rising sexual desire in older women. Older women do not have the same concerns as their younger counterparts. They do not have to worry about birth control or potential pregnancies, and more often than not older women are having sex with life-long partners, a fact that greatly reduces the potential risk of STDs. It should also be taken into consideration that women with life partners are more likely to have an emotional connection with the object of their sexual desire. That emotional connection leads to greater sexual satisfaction when they do engage with their partners.

It is true that as women get older, they tend to have less sex. It is also true that they may experience a lack of lubrication. These are not necessarily factors for decreased sexual satisfaction. In the study, it was found that the act of intercourse was not necessarily the most important way for older women to achieve satisfaction, and other forms of gratification were just as, if not more, important to them than intercourse.

So what does that mean for women? Well, for one thing, it is further proof that growing older does not mean that women have to “throw in the towel” on their sex lives. Women that are not sexually satisfied, that are experiencing pain or discomfort during sex, or who are having any other sex related issues should not just assume it is a natural byproduct of aging. Always speak with your doctor to determine whether or not there is anything that can be done to help you enjoy a happy, healthy sex life, whether you are twenty or eighty.

– Yvonne S. Thornton, M. D., M. P. H.

 

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Studies Show Lack of Evidence that IVF Causes Birth Defects

Written by yvonnethornton on June 24th, 2013

From the moment a woman realizes she is pregnant, she is overwhelmed with worries about the health of her future child. These worries are only compounded when the woman in question has had a difficult time becoming pregnant. Those women who have undergone infertility treatment in order to conceive have perhaps the most difficult task ahead of them as they await the delivery of their child—a wait that is made only more difficult by the belief that many people have that infertility treatments cause birth defects and birth complications at a higher rate than among women who conceived naturally.

It certainly raises a lot of questions. If it were true that births after infertility treatment produced higher rates of birth defects, it would also raise quite the moral dilemma. Do doctors and potential parents have the right to produce children that may suffer health problems and defects? Infertility treatments have been the subject of much debate since the first test-tube baby was born, and many people are still uncomfortable with the idea. However, for millions of parents who would have been unable to conceive, IVF is a blessing. It’s my opinion that everybody has the right to become a parent, and thought it is wonderful that many parents can conceive naturally, it is also wonderful that there is an option for parents who face more difficulty in having children.

Thankfully, studies have shown that the worries people have about children produced through IVF may be unfounded. The rate of birth defects in children born through IVF are no higher than the rates among children born through natural conception once parental factors have been taken into account. People who are still worried about the health “risks” of IVF for children in this day and age need to learn to trust the research rather than the propaganda, and they need to stop spreading misinformation that might lead parents who turn to treatment to conceive to feel guilty about their decision.

– Yvonne S. Thornton, M. D., M. P. H.

 

Posted in Contraception (birth control), Pregnancy | No Responses »
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Do Breast Implants Increase Cancer Risks?

Written by yvonnethornton on June 20th, 2013

Breast implants are one of the most common cosmetic procedures that women undergo, no matter what their age, race, or even social status. There have been a lot of concerns about cosmetic breast surgery over the years, from how they affect breastfeeding to the potential of cosmetic breast implants to obscure breast material on mammograms that could potentially prevent doctors from finding masses. Many doctors have performed studies to assess these risks and determine the outcomes of breast cancer among women who have breast implants.

There does seem to be an elevated risk of mortality in breast cancer among women who have cosmetic breast implants, according to one study.  Although the findings of the study should be viewed with caution,  it is difficult to determine exactly why there is a higher mortality, and whether breast implants are a direct cause of these higher rates.  One theory for the later detection of breast cancer and late stage tumors was that both silicone and saline implants create radio-opaque shadows on mammograms, which impair the visualization of breast tissue.  There is no evidence yet for women who are interested in receiving breast implants that they should forego the procedure. However, women who have or want breast implants will want to be cautious about speaking with their doctor regularly and scheduling mammograms at regular intervals—just as all women should do.

Part of any health care plan is being aware of what your limitations are, and figuring out ways to make up for those limitations. Women who have breast implants should be vigilant in receiving mammograms and breast sonograms after the age of 40.  For women with breast implants under the age of 40, breast self-examination is still recommended, even though a Canadian Task Force has fair evidence that breast self-examination has no benefit in women between 40 and 69  leading to more anxiety and more biopsies.  Never think, however, that there are no care options available for you, no matter what your situation is. The most important step in receiving the optimal care is taking charge of your own health.

– Yvonne S. Thornton, M. D., M. P. H.

 

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Obesity a Direct Cause of Preterm Birth

Written by yvonnethornton on June 17th, 2013

Though mothers shouldn’t be forced to think they need to remain svelte throughout their pregnancies, and shouldn’t be shamed of healthy weight gain during pregnancy, there is one serious issue that women need to keep in mind when they are preparing to become pregnant. It is impossible to plan out every step of a pregnancy, and there will always be unexpected complications that arise during the 40 weeks to delivery. However, there are precautions that women can take to prevent serious problems and to decrease the risk of preterm delivery, according to one study.

One of the biggest risk factors for preterm delivery is obesity in pregnant women. One study in Sweden has shown that not only is preterm delivery a risk, but some obese mothers shown signs of extreme preterm delivery. Even though this cohort study was conducted in a country that is not as heterogeneous as the United States, this is a serious concern, and one that may have serious implications for both doctors and potential parents. The most important thing for everybody involved in a birth with one of these risk factors to keep in mind is that such complications are not only possible, but that they are heightened due to the circumstances. Everybody involved must make plans for the possibility of an earlier birth, and everybody involved should be more open to the possibility of safety measures such as bed rest, gestational diabetes, kidney and heart problems as well as a host of other medical issues that can arise. In general, women who are obese when pregnant will likely need to be in contact with their physician more often than a woman who maintains a healthier weight.

Women who have not yet become pregnant and who are considered obese may want to speak with their doctors about their options before pregnancy. Even a small weight loss can be enough to curtail some of the biggest problems related to pregnancy, while a significant weight loss can have even more lasting effects. However, remember that any weight loss plan must be discussed in detail with your doctor—making yourself unhealthy just to drop a few pounds will not do your or your family any favors.

– Yvonne S. Thornton, M. D., M. P. H.

 

Posted in Childbirth & delivery, Pregnancy | 1 Response »
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Talking With Your Doctor About Sexuality During Pregnancy

Written by yvonnethornton on June 13th, 2013

Pregnancy can be a wonderful experience, but it can also provoke a lot of mixed emotions in women. From joy to depression and anxiety, and just about everything in between, women will likely experience a full range of emotions. Their mental state is also not helped by the hormonal shifts that are taking place inside their bodies as they prepare for pregnancy and birth.

One of the most common complaints among pregnant women is the shift they experience in their sexual desire. It is hard to predict the shifts that will occur—some women may experience heightened sexual urges, while others may experience a drop or a complete lack of sexual interesting altogether. Some studies have shown a tendency for sexual practices to drop trimester by trimester, with an overwhelming majority of women not having sex in their last trimesters. Among the reasons for this seem to be concern in both men and women that sex could potentially complicate the pregnancy or cause harm to the unborn child.

It is up to the woman to decide whether or not she has an interest in sex. However, women should not feel as if they have to suppress their sexuality just because they are pregnant. It is imperative for women to open a dialogue with their doctors and to feel comfortable discussing sexual issues with her doctor. This can vastly help improve her understanding of what is and is not harmful during pregnancy, and can do much to reduce her anxieties.

Many women have a healthy and natural sex drive throughout their pregnancies, and some may even report an increase in sexual interest toward their second and third trimesters. They should not avoid sexual intercourse simply because they feel that it might do harm to their pregnancy. By speaking with their doctors, they can learn whether or not there are any real risks related to sexual activity, and in many cases they will realize their anxieties are unwarranted.

– Yvonne S. Thornton, M. D., M. P. H.

 

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Angelina Jolie News Raises BRCA Awareness

Written by yvonnethornton on June 10th, 2013

Celebrity gossip is usually centered on unimportant things, and as busy as I am I rarely pay attention to any of it. However, I was forced to take pause with the recent news of Angelina Jolie’s double mastectomy, which she decided to undergo after making discovery that she was a carrier of the BRCA1 gene. For once, celebrity gossip might be doing more good than harm. In the past few weeks, talk about the BRCA 1 and 2 genes has gained a lot of momentum.

An increasing number of women are realizing how important it is to receive this screening procedure, especially if they have a family history of breast and ovarian cancers. Many women had certainly not heard about BRCA 1 and 2 screenings until Jolie’s frank discussion of the issue—something which is astonishing, as studies have already shown that testing for the BRCA gene increases awareness in women, leading them to higher rates of surveillance with regular self-checks and mammograms, as well as to a higher rate of preventative operations to reduce their cancer risks, such as Jolie’s double-mastectomy.

In short, the Angelina Jolie story is one piece of celebrity news that I can get behind. It might be a little distressing to think that some women are only learning about such an important topic through gossip magazines, rather than through their doctors, but sometimes it is best to appreciate any help you can get. In this case, if a larger number of women receive genetic testing to determine whether or not they are a carrier of the BRCA 1 or 2 gene as a result of a celebrity news story, then at least it can be said that perhaps our celebrity culture has done something right for once.

Angeline Jolie should, of course, be commended for her strength in speaking so publicly about such an important issue. The fact that she was willing to open up about her experiences in hopes of raising awareness may help many women prevent breast and ovarian cancers.

– Yvonne S. Thornton, M. D., M. P. H.

 

Posted in General health news, Women's health issues | No Responses »
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How Does “Bedside Manner” Affect Patient Pain?

Written by yvonnethornton on June 6th, 2013

You’ve probably heard somebody talk about a doctor’s “bedside manner”. It can be fun to watch television shows such as House, M.D., where the doctor is not-so-nice to his patients, but there is a very real reason that doctors like this are often not successful in the real world, and why part of a doctor’s medical training includes learning how to communicate with their patients and treat them appropriately, especially after a major medical event such as childbirth or surgery.

While you can guess that the way a doctor interacts with their patient can affect their psychological well-being, you might not have considered the fact that the same interaction can influence the patient’s perception of pain. In fact, one study has shown that discussing pain with patients who have had a Caesarean childbirth adversely affects their perception of pain, and can actually make them feel worse.  This raises several important for both doctors and patients as they consider what it means to have a good “bedside manner”.

There are two ways to quantitate the perception of pain.  One is a numerical scale (http://pain.about.com/od/testingdiagnosis/ig/pain-scales/Numerical-Scale.htm) and the other is a visual analog pain scale, also known as the FACES or Wong-Baker scale (http://pain.about.com/od/testingdiagnosis/ig/pain-scales/Wong-Baker.htm),   These pain scales allow the physician or nurse to get a better idea of the extent of the patient’s discomfort.  Still, even with these pain scales, some doctors still will act like “House”.

Talking about pain  is also a complex issue because it forces both doctors and patients to consider how they will manage pain and discomfort after surgery or childbirth. On the one hand, it is important for the doctor to know that their patient is feeling all right, and that there are no potential complications that need to be addressed. Some patients, especially those who have never undergone major surgery before, may feel that certain types of pain are “natural” and will not speak about these issues with their doctor. However, if asking about pain leads to negative effects, it important for doctors to choose their wording carefully in order to acquire the information they need while still aiding in their patient’s comfort.

It is always important for patients to have a doctor whom they feel that they can trust—who they already know through interacting with them has a bedside manner that meets their needs. This is especially important for women who are preparing to give birth, as they will want to heal as quickly as possible so they can begin to care for their newborns.

– Yvonne S. Thornton, M. D., M. P. H.

 

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