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Teen Pregnancy May Be Associated With Obesity Risk in Later Life

Thursday, August 1st, 2013

Concern about the increased prevalence in teen pregnancies has raised a lot of questions societally as well as within the medical community. It is no secret that an event such as childbirth can play a large role in a woman’s health, and the potential changes that may take place are increased in a teenager, whose body is still growing and changing throughout adolescence. From very real concerns such as the potential for premature delivery to the psychological effects of becoming a mother at a very young age or giving a child up for adoption, there is much fodder for examination and research.

One study has even suggested that there is a potential association between adolescent pregnancy and obesity later in life. However, it is important to note that this association is still vague at best, and researchers have yet to uncover a cause for this heightened obesity risk.   While it is possible that the associations between adolescent pregnancy and obesity is caused by the physiological changes that take place in the female body (and in particular the adolescent female body) during pregnancy, there are also many factors –primarily psychological and sociological—to take into consideration in order to determine the underlying cause of this association.  I believe that these young women, obese or not obese, gain so much weight when they are pregnant that obesity is the result of the pregnancy and they cannot lose the weight postpartum, given the additional responsibilities of raising a child.

Demographically speaking, adolescent mothers are more likely to be from a racial minority, to have lived in poverty, or to have attained a lower educational level than many of their peers. Four out of five black women are either overweight or obese.  It is highly likely that at least part of the association between adolescent pregnancy and weight gain is due to this “crossover”, as women of these demographics are also those most likely to be classed as overweight or obese. This is part of the difficulty in determining whether or not there are other physiological factors to take into account.

My take on the conclusions of this study and the entire situation of pregnant adolescents  and future obesity is that these young women are looking for acceptance and have very low self-esteem.  Their feelings are exploited by their male counterparts, who have a biological imperative to be intimate and not be rebuffed. Consequently, sexual intercourse is a form of being “accepted” and “loved”, only to find out later that the girl is pregnant, has gained excessive weight during the pregnancy and is now alone being responsible for a new life.  Her old habits (no exercise and cheap fast food) with a low or nonexistent income lead to her obesity and that of her child.  Then, it becomes a vicious cycle.

Regardless of the reasons for the prevalence of overweight and obese women among those who were pregnant as teenagers, studies like these highlight the importance of increased contraceptive aid and sexual education among female adolescents. At present, it seems that the primary association between these two groups of women, i.e.,  those who become pregnant as teenagers and those who are classed as overweight or obese in adulthood,  is a lack of education or awareness about their bodies.

– Yvonne S. Thornton, M. D., M. P. H.

 

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.

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.

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.

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.

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.

 

Angelina Jolie News Raises BRCA Awareness

Monday, 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.

Technology in Medicine: Robotic Assistance in Surgeries

Monday, May 20th, 2013

“Robots” are being used to assist in surgeries throughout the world. It sounds like something out of a movie, doesn’t it? The use of this kind of technology in medicine is raising a lot of questions for patients. Some may believe that the more technology that is used during their surgery, the better—others may have problems with the idea of a “machine” doing a lot of the work during a surgery. Doctors and surgeons are divided in much the same way, which is why studies are currently being done to assess the differences between robotic-assisted surgeries and traditional surgery methods.

In one study, women who were scheduled to receive hysterectomies were divided into two groups. One group received robotic assistance during surgery and the other did not. Researchers found that there were no significant differences in the outcomes of the surgeries—however, the robotic-assisted surgeries did take longer to complete. It may not seem like much of a finding, especially for patients, but studies like these may help ease the mind of individuals who worry about advances in medicine and whether or not they will be safe during their own surgeries or medical procedures.

Surgery—especially gynecological surgery—is becoming increasingly sophisticated, and that is good news for patients. Procedures that were once much more invasive can now be performed via laparoscopic methods, with only a few small incisions. While the outcomes at present are still very much the same for surgeries that do and do not use robotic assistance, there is a strong likelihood that in the future, as the technology advances, robotic-assisted surgeries could actually be much more advanced, and have much better postoperative outcomes compared to traditional surgical methods.

On the other hand, robotic surgery is very expensive (The DaVinci system costs 1.3 million dollars) and is labor-intensive (increased operating time), which means the patient is under anesthesia for a longer period of time, which may have serious sequelae.  All this has to be factored into the equation.  As a surgeon myself, the only advantage I see is that the surgeon gets to sit down during the entire procedure.  As a Catch-22, using robotic technology also reduces the training of young surgeons in the traditional approaches to operations, and thus the skill and “tried and true” surgical techniques are lost because they are no longer taught and performed on a daily basis.  The robot may have to be the wave of the future, by default, because surgical residents will no longer be taught how to do surgery the traditional way, and thereby fulfilling the prophesy.

The reason I find this so important to point out is to ease the minds of patients who worry about new methodologies in medicine—the simple fact is that even though surgery is growing more complex, it is also constantly improving in its ability to treat patients with a wide range of problems. While some of the newest trends in medicine may seem like science fiction more than anything else, our surgeons need to know and to be comfortable with both forms of surgery in order to have outcomes most advantageous for the patient.

– Yvonne S. Thornton, M. D., M. P. H.

Are Your Vitamins Contributing to Your Life or Death?

Monday, April 15th, 2013

Remember the good old days of Flintstones vitamins?  We were taught to take one every day so we could grow up strong.  Most of us continued that practice into adulthood, though the types of vitamins and supplements we use have changed considerably from the fruity, chalky prehistoric characters we were used to.  Although your doctor may prescribe supplements and although commercials suggest their vitamins can improve your health, they can actually be detrimental to your health, especially in older women.

It is important to make sure you’re getting all of the vitamins and minerals your body needs to function properly.  However, as we age, our body chemistry changes, which means the types of vitamins and minerals we need most will change as well.  More than 38,000 women were the subject of an Iowa Women’s Health Study concerning vitamin and mineral supplements.  Their results showed that most supplements had no obvious affect, but there were a few that actually increased the mortality rate in older women.  The culprits included Vitamin B6, folic acid, iron, magnesium, zinc, and copper.  Specifically, Iron seemed to be the most dangerous, with 15% of study participants who used it regularly dyeing.  Calcium, on the other hand, seemed to have the opposite effect, meaning it actually decreased the mortality rate.

Although this information may seem frightening, it’s important to put it into context.  Women in particular need Iron, so you never want to cut it out of your regimen completely.  That said, it’s better to get in the form of red meat and green leafy vegetables than in a vitamin.  The same is true of pretty much all supplements.  Your body will do a much better job of processing and using vitamins and minerals that are in food form.  Vitamins, when used on top of your usual diet, will easily put your system out of balance, which is what leads to dangerous levels of one or the other.  Likewise with Calcium, although it is important in the fight against osteoporosis, supplements can be dangerous when not taken in moderation or without the coinciding vitamins your body needs to process it.  In short, unless your physician recommends it, stick to a balanced diet and forget the vitamin supplements.


– Yvonne S. Thornton, M. D., M. P. H.

It’s Ok to Be a Big, Beautiful, Black Woman in America

Thursday, April 11th, 2013

Although historically, eating disorders like Bulimia and Anorexia have been found to be more prominent among women of European descent, our American culture continues to evolve.  While the added diversity this brings can be a good thing, it also means we share some of the negative aspects of our heritages as well.

The Journal of Counseling Psychology published a study meant to find out if African-American women now suffered from eating disorders as much as Caucasian women.  They also wanted to find out if the sources behind those disorders were similar.  The study did show that eating disorders among African-American women are on the rise, and this is mostly due to the internalization of societal beauty ideals.  In other words, as more and more wafer-thin models and actresses of African-American descent are spotlighted in the media, more of the public ideal as to what makes a beautiful African-American woman is biased in that direction.  In fact, concern over body image due to societal beauty ideals had a 79% correlation with eating disorders in African-American women.

It’s sad to me, that even though more cultures and ethnicities are being accepted in the American way of life, new types of beauty are not part of that incorporation.  Instead, the media seems to reduce them all down to one, predictable body type.  Yes, they are showing a more diverse range of races on TVs these days, but only those that fit into the Hollywood body stereotype.  It’s up to the public to call for movies, shows, and music that proudly display real people.  Only then will producers realize that it’s ok to be a big, beautiful, black woman in America.  In fact, there are many types of people out there who can help Hollywood create more dynamic and engaging media simply by being themselves, and this, in turn, will help form a healthier society.


– Yvonne S. Thornton, M. D., M. P. H.