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A Simple Survey Could Determine Your Risk for Ovarian Cancer

Monday, October 8th, 2012

As women, we have to go through countless medical tests throughout our lives. Mammograms, pregnancy tests, HIV tests, and bone-mineral density tests are all par for the course when you become an adult. In fact, few women haven’t gotten all of these tests and more. Don’t get me wrong- as a physician, I genuinely appreciate our ability to screen for life-threatening conditions, and I wouldn’t have it any other way. However, as a woman, I understand the patient side of it as well. Wouldn’t it be easier if medical screening tests were simpler? According to a new study, simplicity might just be attainable.

Researchers have developed a new screening tool for ovarian cancer that can be completed in minutes by a simple survey. That’s right, no heavy machinery, foul-tasting chemicals, or drafty hospital gowns required, just a simple pen and paper. The study questionnaire that was tested was based on a symptom-screening index developed in 2006 by M. Robyn Andersen, Ph.D and co-author Barbara Goff, M.D., professor and director of Gynecologic Oncology at the University of Washington School of Medicine. The survey asks women three questions about their current symptoms that have been most commonly associated with women that screened positive for ovarian cancer. A few of the symptoms might be passed off as menopause or menstruation symptoms, so the key in early diagnoses is recognizing the symptoms as they are happening. Some of these symptoms include abdominal or pelvic pain, a sensation of feeling full too quickly, and abdominal bloating. You have to admit, you’d never attribute any of these symptoms to cancer.

Traditionally, ovarian cancer is thought to have no early warning signs, such as bleeding or an abnormal Pap smear, as one sees in uterine cancer or cervical cancer, respectively. In comparison to breast cancer, which is the most frequent cancer in women, with about 212,000 new cases a year, ovarian cancer has only 25,000 new cases a year. But, because there are no early warning signs or tests to detect ovarian cancer, and the cancer has progressed to a more advanced stage prior to diagnosis, the death rate is higher—about 62 percent in ovarian cancer, as opposed to 18 percent in breast cancer and 32 percent in cervical cancer. With that said, this new study takes into consideration symptoms, which are commonly dismissed by many patients and by combining them together, have proven to be significant factor in trying to diagnose ovarian cancer at an earlier stage.

Of course, these symptoms are minor and can easily be associated with other issues. However, the results are proving the survey effective so far. Of 60 women who submitted the survey with positive indication, one was diagnosed with ovarian cancer. Of the 1,140 women who did not claim to have the symptoms, none tested positive for ovarian cancer over the course of the following year.

The survey will also serve as a research tool for doctors. Women who take the short survey and indicate that they have all of the symptoms will also be asked to write any additional symptoms. If those women screen positive for ovarian cancer, those additional symptoms will be analyzed, and common additional symptoms might be added to the survey to further screen patients.

Early detection is extremely important in treating ovarian cancer. If you have these symptoms, talk to your physician about ovarian cancer to rule out the possibility that you might have it. If he or she thinks you should get tested, do so, as it could save your life.

– Yvonne S. Thornton, M. D., M. P. H.

Posted in General health news, Women's health issues | 1 Response »
Tags: cancer screening, ovarian cancer, women's health

Drink Up Ladies!

Thursday, October 4th, 2012

If you were lost on a desert island, you would probably die from dehydration before you died of starvation. This is surprising for many people, since we all know how hungry we can get when we accidentally skip even one or two meals. The symptoms of dehydration are harder to pinpoint, but it’s extremely important that you get enough water every day. If hydration is so vital to our wellbeing on a regular basis, imagine the importance of it during pregnancy.

Women who are pregnant should be diligent in staying hydrated for the duration of their gestation. It is easier to become dehydrated when you are pregnant. For one thing, you are probably experiencing more nausea and vomiting than you ever have. Morning sickness is common, and every time you lose your lunch, you could become seriously dehydrated. The worst part is that you won’t have the desire to drink fluids after you’re sick, so the problem is not always remedied.

I recommend to my patients that they should drink, at least, two quarts of pure water per day. Not soda, not tea, not coffee, but good old-fashioned water. In the summer months, that amount should increase by a quart in order to compensate for the increase in perspiration and insensible loss. With the recommended quart of skimmed milk per day, I really don’t understand why there is a need for any more fluids in the form of soft drinks, etc. Becoming dehydrated during your pregnancy, even temporarily, puts your baby at risk for serious complications. When a pregnant women is dehydrated, that fluid restriction is thought to decrease the production of amniotic fluid in your womb. Particularly, in the second or third trimesters, dehydration can lead to premature labor because it triggers the same hormone that causes uterine contractions (oxytocin), not to mention the typical pains of dehydration such as headaches and muscle cramping.

The best way to prevent dehydration during your pregnancy is to drink more than enough water and stay out of the extreme heat and direct sunlight. If you experience symptoms such as dark urine, infrequent urination, headaches, dry mouth, chapped lips, and dry skin, contact your doctor immediately. It might be too late for water to solve the problem, and hospitalization might be required.

In a perfect world, we could all relax during our pregnancy and focus only on our health. Unfortunately, we are all busy people and our daily lives are often full of other concerns. If you find it difficult to keep track of how much water you’re drinking, consider keeping a log to make sure you’re always getting enough. Dehydration can be serious, so make sure avoiding it becomes one of your top priorities.

– Yvonne S. Thornton, M. D., M. P. H.

Posted in Pregnancy, Women's health issues | No Responses »
Tags: dehydration, Pregnancy, women's health

Ditch the Itch——Are You at Risk for Obstetric Cholestasis?

Monday, October 1st, 2012

There are many reasons why you might feel itchy during your pregnancy. You might start to itch around your midsection because your skin is stretched. You also might itch because of your prenatal vitamins. The hormones released during gestation also make your skin more sensitive, so even something as simple as your perfume or fabric choices might have you scratching incessantly. However, if you’re experiencing severe, generalized itching (pruritus) all over your body (especially the soles of your feet) that won’t go away, it’s time to talk to your doctor. It could be a sign of a serious condition known as obstetric cholestasis.

Obstetric cholestasis (OC) or intrahepatic cholestasis of pregnancy is a disorder that affects the liver and develops during pregnancy. Ten percent of the affected women will develop jaundice. Essentially, it is caused by a buildup of bile salts that are supposed to be flowing to and from your liver in the digestion of food. You’re at a higher risk of OC if it runs in your family. So, if your mom had OC while she was pregnant with you, there’s a good chance you’ll get it, too. It is also more common in women in Pakistan, Sweden and Chile. Unfortunately, there is no cure for OC. Itching usually resolves within a few days of delivery, and subsequent liver problems are uncommon — although cholestasis is likely to recur with other pregnancies. Because the liver is involved and the liver is responsible for clotting factors, blood tests to check your clotting factors are done throughout the pregnancy and you may need to take Vitamin K supplements, depending on the test results. Although the condition may seem to be just a nuisance and annoying to the mother, it can lead to stillbirth. So, it is a very serious condition. Because most fetal surveillance studies, such as electronic antepartum fetal testing (nonstress test) are very poor at predicting stillbirth in this disorder, doctors recommend that women with OC with elevated bile salts need to have their labor induced at 37 weeks (after fetal lung maturity has been established) to make sure the baby makes it out healthy and happy.

If your physician determines that the cause of your itching is in fact OC, you’ll need to get regular tests to make sure your liver is functioning properly. For some women, the itching is unbearable, so you should talk with your physician if the itchiness is interfering with your daily activities. A medication, known as Actigall (ursodeoxycholic acid ) helps regulate cholesterol by reducing the rate at which the intestine absorbs cholesterol and consequently is effective in alleviating the itching. Aveeno^®oatmeal baths, topical steroid creams and other steroids have been used with some success. . You should also try to scratch your skin as infrequently as possible, as open cuts from scratches could become infected. Although, when you’ve got the pregnancy itch, not scratching is obviously easier said than done!

– Yvonne S. Thornton, M. D., M. P. H.

Posted in Pregnancy | No Responses »
Tags: itching, obstetric cholestasis, Pregnancy, women's health

Prepare for Pregnancy After-Pains

Thursday, September 27th, 2012

You already know about the pains associated with pregnancy. The discomfort you feel in the months leading up to your due date don’t end once you give birth though. This is where many women are caught off guard when they learn that a week or two of healing after their delivery doesn’t leave them completely pain free.

When you consider the dramatic shift your body has experienced throughout your pregnancy, it shouldn’t be too surprising that it will take it awhile to get back to normal. Your weight isn’t the only thing that will take a while to reset though. After all that tightness, stretching, and pulling, your muscles, ligaments, and skin have been through a lot, and that will make them sore for some time. As these areas adjust, so too will your uterus, as it contracts back up into its original size and location. This process can take up to six weeks, and during that time (especially during breast feeding), you may feel after-pains from this movement. Urinating regularly can help relieve some of this discomfort. If you received any stitches, these will obviously be a bother and will take time to heal. Your swollen breasts will also be sore, and the nipples will probably get even more painful as they adjust to your child’s frequent feeding schedule. Your entire body will need to rebalance, and the if you had back pain from carrying the baby the last few months of pregnancy, it may take a couple more to ease the discomfort . Getting in shape will help speed this along, but don’t push yourself too much. You’re allowed some time to recuperate.

If you’ve already discovered these lasting pains and are trying to find ways to endure, there are a few pain relieving strategies you can try. Sitz baths, ice packs, wash bottles, and massages are supportive measures for postpartum pain. However, a new mom should not deprive herself of effective pain medication, such as extra-strength Tylenol, ibuprofen or prescription pain medications given by her doctor, even if she is breastfeeding. If you’re in very intense pain though, speak with your physician to make sure there isn’t a more serious issue. They may have advice for other safe pain relieving methods too. Otherwise, welcome to the joy and pain of parenthood!

– Yvonne S. Thornton, M. D., M. P. H.

Posted in Childbirth & delivery, Women's health issues | No Responses »
Tags: after-pains, pain relief, Pregnancy, women's health

What Does Your Baby Bump Tell You about Gender?

Monday, September 17th, 2012

We’ve all heard a few old wives’ tales concerning the prediction of gender in a developing fetus. Some say that the position of your belly is an indicator of the gender. If your belly is protruding on the lower side, then it’s a boy, and if it has settled fairly high, then it’s probably a girl. If only it were this easy to tell. Unfortunately, it is not this easy, and now there is proof. When I was pregnant with my two children, I was carrying “high” both times and yet, I have a son and a daughter. If looking at a pregnant woman’s belly forecasts the gender, then we could do away with prenatal studies.

Some people rely on the lunar calendar and still others have come up with the curious baking soda test. While these supposed gender predictors might be fun and grandma might claim to be absolutely sure of their accuracy, these and the location of your belly simply have no correlation with the gender of your baby. Researchers in Australia who had been testing various methods for gender prediction decided to take on the baby bump test. Their test would try to correlate the position of the placenta with gender prediction. Using ultrasound to identify and record the location of the placenta, they observed 277 pregnant women. They found that the rate of males and females born was almost 50-50 and that there seemed to be no connection between the location of the placenta, and gender. Instead, they found that the assessment of the baby’s genital tubercle at 12-14 weeks as a prediction technique was much more useful, with an accuracy rate of more than 85%. This is the tiny little nub that starts to protrude as your baby develops. Doctors have found that the angle of this nub can tell them a great deal about the resulting genitalia.

Although it may be tempting to quote this study to grandma, it is a sad commentary on our culture when we seem to have an insatiable need to identify gender. There really shouldn’t be any need to identify the gender if we are going to treat little girls the same as little boys. But, we don’t. This obsession with trying to identify gender (often leading to feticide in many countries) only underscores the lingering sex discrimination that still exists in the 21^st century. What difference does it make whether the growing fetus is a boy or a girl——unless they are going to be treated differently? When someone asks, “Is it a boy or a girl?” They are knowingly or unknowingly perpetuating the idea that one gender is better or worse than the other. We should be asking, “Is the baby healthy?”

The next time people try to tell you that your belly looks like it’s holding a boy or girl, you can simply smile and nod and let them have their fun. Instead, rely on your doctor and hope you have a healthy baby. Even better, leave it up to fate and wait for the surprise.

– Yvonne S. Thornton, M. D., M. P. H.

Posted in Parenting, Pregnancy, Women's health news | No Responses »
Tags: gender, Pregnancy, women's health

Prepare for Pregnancy After-Pains

Thursday, September 13th, 2012

If you’ve already discovered these lasting pains and are trying to find ways to endure, there are a few pain relieving strategies you can try. Sitz baths, ice packs, wash bottles, and massages [http://www.webmd.com/parenting/baby/news/20041103/pain-after-childbirth-common-often-untreated] are supportive measures for postpartum pain. However, a new mom should not deprive herself of effective pain medication, such as extra-strength Tylenol, ibuprofen or prescription pain medications given by her doctor, even if she is breastfeeding. If you’re in very intense pain though, speak with your physician to make sure there isn’t a more serious issue. They may have advice for other safe pain relieving methods too. Otherwise, welcome to the joy and pain of parenthood!

– Yvonne S. Thornton, M. D., M. P. H.

Posted in Childbirth & delivery, Pregnancy, Women's health issues | No Responses »
Tags: after-pains, pain relief, Pregnancy, women's health

How Safe is Your Acne Medication?

Monday, September 10th, 2012

It seems that every teen goes through skin issues because of all those hormones. However, many women suffer from acne far into adulthood. This has them using a variety of treatments to keep their skin looking nice. Unfortunately, one acne medication has dangerous side effects, including birth defects.

If you are pregnant, breastfeeding, or planning to become pregnant in the next year, you will need to avoid medications, including acne treatments, that could be unsafe for your baby. One brand in particular, commonly known as Accutane, can cause birth defects like cleft palate, heart defects, hydrocephaly, and microcephaly. There have been warnings issued, but many women are unclear as to whether or not their medication is dangerous or not. Take the time to check the ingredients and warning label on your acne medication boxes and bottles. You’ve likely been using it for years, so you might not have thought to check these areas once you became pregnant. Don’t just look for Accutane when weeding out your products though. The drug is also found under the name Isotretinoin. If you see either of those words on the label, you’ll need to replace it with a safer brand. These particular ingredients are normally found in pills for treating nodular acne, so there are many other safe alternatives.

Getting a handle on skin care can be frustrating, but clear skin is not worth the price your child and your family will pay if you have a baby born with defects, some of which are life threatening. As soon as you think you might want to become pregnant, take a look through all of the products you put on and in your body, because very soon, you’ll be sharing it with a very delicate new life.

– Yvonne S. Thornton, M. D., M. P. H.

Posted in Women's health issues | No Responses »
Tags: Accutane, acne, birth defects, isotretinoin, Pregnancy, skin care, women's health

Legitimate Rape or Legitimate Ignorance?

Thursday, September 6th, 2012

In February, there was a hearing chaired by Daryl Issa for the House Committee on Oversight and Government Reform Hearing on the Contraceptive Coverage Rule. Unfortunately, the panel was entirely male. Talk about oversight! This prompted many female members of congress to walk out of the hearing in protest, much to the confusion of the chair. When asked about the walkout, Senator Kirsten Gillibrand said, “If our republican colleagues want to continue to take this issue head on, we will stand here as long as necessary.” In August, women received a fresh reminder of the Republican male’s perspective on rape when Representative Tod Akin proclaimed, “If it’s a legitimate rape, the female body has ways to try to shut that whole thing down.”

Women around the world are wondering what constitutes the difference between rape and legitimate rape. John C. Wilke, who is not an obstetrician, but a general practitioner of almost 90 years old, and who is the former President of the National Right to Life Committee is the only doctor who supports Akin’s remarks regarding whether or not the reproductive system of a woman shuts down during rape. With such credentials, it goes without saying that he may have a bias and outdated view of rape and the female body, and experts disagree with his supposedly medical explanation for his belief. In fact, one in 15 raped women become pregnant, no matter what definition of rape you choose. Are Akin and Wilke suggesting that those rapes were not legitimate? I doubt it seemed that way to the women when it was happening.

The most disconcerting part of all of this is that representative Akin has the power to influence laws in our country. In this day and age, we hope that men have at least the decency and empathy to listen to the voices of women in our country, and, heaven forbid, include us in panels and decision-making regarding our own reproductive rights. Hopefully, there are a lot of women and understanding men out there willing to make their vote count in order to make a positive change for all of us. I wonder, is it pure prejudice keeping men like Akin in the dark when it comes to women’s health issues and reproductive rights, or is it legitimate ignorance?

– Yvonne S. Thornton, M. D., M. P. H.

Posted in Childbirth & delivery, Contraception (birth control), Fertility & Infertility, General health news, Health care policy, Pregnancy, Women's health news | No Responses »
Tags: abortion, rape, reproductive rights, women's health

Pelvic Mesh Lawsuits are on the Rise

Monday, September 3rd, 2012

If you’re considering options for pelvic organ repair or stress urinary incontinence, there are a few to choose from. Each comes with its own set of benefits and risks. Not knowing these risks, could put your body unnecessarily in danger though, which is exactly what has been happening lately with women who chose pelvic mesh as their treatment method.

As a whole, pelvic mesh has been tested and studied and is considered a common option for treatment. However, that does not mean there aren’t risks involved. Those risks could include permanent physical harm. Some women have reported injury as a result of their pelvic mesh implants and are filing suit against the companies who made the product. These suits accuse companies of underreporting the risks of using pelvic mesh implants and seek damages for the pain and suffering and medical costs associated with the injuries. These women reported injuries such as physical deformity, mesh erosion, damage to the bladder and other pelvic organs, physical deformity, pain during intercourse and other actions associated with pelvic use, and related permanent injuries. The damage they are seeking will pay for surgeries, medication, treatments, and both physical and mental pain and suffering. While the companies themselves may not have made the risks clear, the FDA did put out a statement last year warning the public of risks, including those mentioned in the suit as well as bleeding, organ perforation, neuro-muscular issues, vaginal scarring, and vaginal wall shrinkage. Though transvaginal mesh devices are common treatments for pelvic organ prolapse and stress urinary incontinence, they are more risky than other treatment methods.

If you’re suffering from one of these conditions, you should consider an alternative treatment option before settling on a pelvic mesh device. If you already have one of these implants, pay careful attention to your body. If you feel prolonged pain or discomfort, speak with a physician immediately and don’t wait for any damage to become permanent.

– Yvonne S. Thornton, M. D., M. P. H.

Posted in Women's health issues, Women's health news | No Responses »
Tags: pelvic mesh, pelvic organ prolapse, stress urinary incontinence, transvaginal mesh implant, women's health

Chocolate is the Caffeine of Choice for Moms to Be

Thursday, August 30th, 2012

When you get pregnant, you want to do everything you can to ensure the safety of your developing baby. For this reason, most moms cut out foods, drinks, and chemicals that might have adverse effects on their baby. Caffeine is just one thing they often give up, which means no more tall daily lattes or espressos. Although high levels of caffeine can be dangerous, small amounts are fine, and one study found that the levels of caffeine found in chocolate are safe for moms and their unborn babies.

Many experts agree that moms should avoid taking in any more than 200 mg of caffeine per day. This allows for a small cup of coffee, but most women still choose to avoid it altogether, which is probably a good idea, unless you need it as a stimulant for bowel regularity. You never know how much caffeine a particular brew of coffee might hold, and it’s always better to be safe than sorry. When pregnancy has you craving something sweet though, you might forget that chocolate too contains caffeine.

Fetal heart rate reactivity is a medical term that describes how reactive the baby’s heart rate is when it is moving around in utero. With fetal movement, the fetal heart rate accelerates about 15 beats per minute and is a sign of fetal well-being. Fetal reactivity assessment is used as a surveillance tool when we are worried about the baby in a Mom who may have hypertension or diabetes (known as a nonstress test or NST). The more “reactive” the fetal heart rate is, the better. A study published in the Journal of Maternal-Fetal and Neonatal Medicine determined that eating chocolate can make the fetal heart rate more reactive . This increased heart rate did not appear to be from the caffeine in chocolate, but rather from the theobromine, which dilates blood vessels and decreases blood pressure. In order to make up for this physiologic change, your heart and also your baby’s heart have to pick up the pace in order to maintain adequate blood circulation, resulting in a more reactive fetal heart rate pattern, which is a good thing.

However, as with any chemical, food or supplement that alters your body function, it should be taken in moderation. In other words, don’t go overboard, but don’t feel the need to pass up on a “chocolate moment” to satisfy those cravings once in a while either.

– Yvonne S. Thornton, M. D., M. P. H.

Posted in Childbirth & delivery, Pregnancy, Women's health news, Your newborn baby | No Responses »
Tags: caffeine, chocolate, Pregnancy, women's health