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Women Are Enduring More and So Are Their Hearts

Thursday, May 3rd, 2012

There was a time, when women stayed home to care for the children, did not vote, and did not make money of their own.  Luckily, we’ve since achieved a sense of equality as citizens.  Unfortunately, that equality has not come without a price.  As modern day women, we work just as hard as men, but on average, still earn less.  We parent just as much as men, and often as not, more because it is ingrained in us to try and be that Hallmark mom, but still must bear the burden of pregnancy.  We deal with the emotional, physical, and economic stresses just as much as men, but now, studies show that our hearts do not get as much help during these stressful times.

Researchers at Penn State conducted a study to find out how the heart and blood pressure of men and women differed when presented with mental stress.  All subjects were given the same problems and were monitored carefully to see how they dealt with the pressure.  The hearts of both men and women started working harder as the stress mounted, as was expected.  The amount of blood flow to the heart increased in men in order to make up for the extra work, but it did not increase in women.  This was a surprising discovery.  Professor Chester Ray, who led the study, believes this “shows women may be more susceptible to experiencing a cardiac event with mental stress compared to men.”  With heart attacks being much more common in women than in men, their results are helping doctors understand why.  Hopefully, these findings will encourage more women to seek a doctor’s advice when they feel stress that seems to be affecting their heart.

What does this boil down to? It boils down to the fact that women need to begin to realize that they need to demand the help that they deserve and need. We simply cannot be everything to everyone all of the time. We need to set priorities, and stick to them. My new memoir, “Something to Prove” chronicles my life as a woman who balances career, home and family; hopefully serving as a roadmap for other adventurous women.  Different times in our lives call for different priorities. Being a harried mother may be just as stressful as meeting an office deadline or being the sole caretaker of infirm parents or performing difficult surgery.  We are not superwomen, though if you look at what a majority of women accomplish on a day-to-day basis, we might as well be; even without the additional pressure that put on ourselves trying to “do it all”. All women who have children have one job, if she works outside the home, then she has two jobs, and if you are also cook, cleaner, and overall the “go-to” person, you might just have three jobs. And this is considered normal… It’s no wonder women are stressed.   

Although psychological studies have shown that women feel they are “expected to possess many diverse traits and behaviors, such as being both competitive and nurturing, compliant and assertive, and to appear in control without any signs of vulnerability,” they need to realize these expectations contradict themselves and are simply not realistic.  If your lifestyle has caused you to deal with inordinate amounts of stress, your mental, emotional, and physical health will suffer if you don’t make a change.  A study at the Chinese University of Hong Kong found that women who had more satisfying jobs and home lives were less likely to develop as much mental stress, even though they had the same amount of responsibilities as others.  I love ballroom dancing and I twirl around the dance floor each week with a cha-cha or tango in order to de-stress and have a creative outlet.  In other words, find something that you love doing and it won’t take quite as much of a toll on your health.  With this in mind, you can still be a modern day woman and take on numerous responsibilities, but you shouldn’t be afraid to ask for help when you need it.  As a physician, author, wife, and mother, I know that finding this balance can be difficult, but your heart is worth it.

— Yvonne S. Thornton, M. D., M. P. H.

When Did My Uterus Become Politicians’ Business?

Tuesday, May 1st, 2012

As a working mother, I have made many decisions over the years regarding my health and the health of my family.  Those decisions were always made after careful consideration that included years of education, the beliefs of my family, and my own personal needs.  Not once during those processes did I ever consult with or even consider that politicians should also be debating those decisions.  It is shocking how much interest the government is suddenly taking in women’s reproductive health.  What should be personal choices made by American women, have now become the focus of debates for men who are looking for political gains and who frankly don’t have the biological parts necessary to even consider these topics.

Because Rick Santorum felt the need to prove his belief in traditional family values, he mentioned that women who are the victims of rape, should, “make the best of a bad situation,” in regard to their unwanted pregnancies.  While this may have helped him get a few more conservatives on his side, it did nothing to stop the suffering of women who, if he had his way, would continue to live out their traumatic experience by carrying and delivering the children of their attackers.  Trying to prevent unintended pregnancies altogether is even too much for Committee Republicans to keep their hands off of these days.  They would like to eliminate $12 billion of healthcare funding that would otherwise go to preventive services.  This would reduce access not only to birth control, but also cancer screenings and other types of care and services, especially those used by low-income women.  Republican Candidate Mitt Romney would like to create tax cuts that would benefit millionaires, hoping to spur job growth, but those cuts would come at a cost to programs that help women.  Obama seems just as puzzled by this as many American women, saying, “These are folks who claim to believe in freedom from government interference and meddling. But it doesn’t seem to bother them when it comes to a woman’s health.” The absence of women in power has become very obvious because of these issues.  Hopefully, they will inspire more women to vote and maybe even to run for office.

No matter what her position, every woman has the right to make her own decisions regarding her health, including her reproductive health.  Pressure from politicians, employers, and religious organizations should have no influence on her decision.  It is up to each individual woman to decide what beliefs to follow.  That’s why it is so great to be American in the first place.  We have certain freedoms that allow us to live our lives the way we choose.  While talking points like women’s reproductive health can mean big business for bureaucrats, they’re interfering with the personal freedoms of women and decisions that are, frankly, none of their business.

— Yvonne S. Thornton, M. D., M. P. H.

Great Scores Don’t Necessarily Mean Great Doctors

Monday, April 16th, 2012

If you’re planning to go into the medical field like I did, then you’re probably aware of the strict application process most medical schools will put you through.  If you don’t have the right grades or MCAT scores, you might not get into the school of your choice, no matter how badly you want to help people.  Unfortunately, this means top medical schools are letting in bright students who are great test takers, but who can’t take care of patients.

Being a physician is about much more than memorizing information from medical encyclopedias and science classes.  I’ve found that a strong sense of empathy and compassion for others, as well as a generosity of spirit has been crucial to my success in medicine.  It allows me to put myself in my patients’ shoes, which in turn gives me a better sense of what to ask and what to look for.

Many aspiring doctors don’t have the grades to get them into the top schools, but they may have more emotional intelligence than the students who beat them out for those spots.  Eventually, the positions of physicians are filled with very smart people who just don’t seem to take the time or care patients need.  It takes patience to listen to everything a patient has to say and then to dig even deeper.  It’s not about solving a puzzle as fast as possible.  It’s about understanding underlying issues that may not be obvious at first glance and knowing how to uncover them tactfully. It all goes back to bedside manner, which seems to have disappeared in an absurd dichotomy of doctors having the attitude “I know it all and you know nothing”. Doctors must listen to patients. Our patients know their bodies better than their doctors do. After all, patients live in their bodies. We only visit those bodies.

Luckily, after three years of study, the American Medical Association has realized this and is encouraging medical schools to look deeper into their potential students than just their test scores.  As a result, many are adding comprehensive interviews that attempt to find out who the applicant is as a person, not just as a student.  The Association of American Medical Colleges has also announced that it will be changing the scope of the MCAT exam to include more emphasis on psychology, sociology, and biology.  President of the AAMC, Darrell Kirch, said about the changes, “Being a good doctor is about more than scientific knowledge.  It also requires an understanding of people.”  I couldn’t agree more, and I hope this changing philosophy will help bring patients more compassionate and effective doctors.

— Yvonne S. Thornton, M. D., M. P. H.

Baby’s tastebuds mirror Mom’s food choices?

Wednesday, November 30th, 2011

You’ve probably heard the claim that exposing a baby in the womb to Mozart will increase his or her IQ. Despite the hype, the research doesn’t support major leaps in smarts (but, if nothing else, it might improve your child’s musical taste, later on).

Now, there’s some evidence showing that you may be able to shape a yet-to-be-born child’s taste in food.

“The flavor and odors of what mothers eat show up in the amniotic fluid, which is swallowed by the fetus, and in breast milk. There is evidence that fetal taste buds are mature in utero by 13 to 15 weeks, with taste receptor cells appearing at 16 weeks, according to researchers.

“’With flavor learning, you can train a baby’s palate with repetitive exposure,” said Kim Trout, director of the nurse midwifery/women’s health nurse practitioner program at Georgetown University.

“Trout recently co-authored a paper that reviews the evidence on prenatal flavor learning and its implications for controlling childhood obesity and diabetes, among the country’s most pressing health problems…”

 

Although I’m just as skeptical of this claim as I am about the one for baby-and-Mozart, I see real benefit in giving this a try, whether it makes your baby want broccoli or not. That’s because, in my practice, I see too many women gaining too much weight during pregnancy, which can not only cause complications for mother and baby, but can be almost impossible to shed once your baby is born.

So, bring on the Brussels sprouts, and eschew the Twinkies. Pass by the apple pie and bite into a nice juicy apple instead. Whether it does a thing to change your baby’s mind about what tastes good later in life, it will do a world of good for you both right now.

– Yvonne S. Thornton, MD, MPH

Should you be worried about the blot clot risk with newer birth control pills?

Monday, November 21st, 2011

You might have read the news that YAZ and Yasmin, two newer birth control pills, are riskier to take than older contraceptives due to higher potential for blood clot formation.

But it’s important to put this into perspective. No matter what birth control pill you use, blood clots are a possibility, if an uncommon one. What you might not know is that blood clots are even more common in pregnancy. Fortunately, the vast majority of the millions of women who get pregnant and give birth each year don’t suffer blood clots. Just as millions of women take birth control pills with no such side effects.

So, is there a unique problem with YAZ? Yes, but not the one identified in the headlines. The problem is in the marketing.

YAZ was promoted to women as a pill for bloating and acne in addition to its contraceptive effects. While that might be a good marketing strategy, it’s not a good medical one. Contraceptives are for birth control, and the best one for you, based on your medical history, might have nothing to do with acne. People shouldn’t pick their birth control the way they pick their toothpaste—on the basis of consumer advertising. You should consult your doctor who will look at your history and decide what form of contraception meets your needs. If your family has a history of strokes, blood clots, or thrombophlebitis (a blood clot that causes swelling in a vein), your doctor will almost certainly order advanced testing due to the possibility that any birth control pill—YAZ, Yasmin, or older medicines—might be inappropriate for your condition.

But if your doctor has already determined that YAZ or Yasmin is a safe bet, and you’re on one of these now? Keep taking it unless your doctor says otherwise. The alternative could be unintended pregnancy. And pregnancy, ironically enough, is more likely to cause a blood clot than your birth control pills.

– Yvonne S. Thornton, MD, MPH

HPV infections usually resolve on their own

Thursday, October 27th, 2011

It’s become common practice among some OB-GYNs to test for HPV, the human papilloma virus, due to the association of some strains of this sexually transmitted infection (STI) with cervical cancer.

But testing of women under the age of 30 is inadvisable. Because, although at least half of all sexually active men and women will get genital HPV at some point in their lives, the immune system will fight off and remove most of these infections from the body with no treatment. Seventy percent are gone within a year and 90 percent within two years.

It’s that 10 percent of cases we have to watch for. Some of those will lead to precancerous lesions in the cervix which, if left untreated, can develop into cervical cancer. But this process takes from 15 to 20 years. So, testing women under 30 for HPV leads to false positives, more testing, and perhaps invasive procedures in women who are at little or no risk of developing cervical cancer from HPV.

The American College of Obstetricians and Gynecologists (ACOG) therefore recommends that women under 30 not be tested for this STI, and I agree. If a woman under 30 has one of the high risk types of HPV, and if it persists, there will be ample time to find it and treat it. If she has one of the lower risk strains, it will probably be gone with no intervention within a year or two.

– Yvonne S. Thornton, MD, MPH

There’s much more to an annual pelvic exam than a Pap smear

Tuesday, October 25th, 2011

You might have read that the U.S. Preventive Services Task Force now recommends that most women have Pap smears just once every three years instead of once per year.

Does that mean you can skip the OB-GYN appointment until 2014?

No, no, no, and no.

You must have a pelvic exam every year. Pelvic examinations save lives. A Pap smear, which can help identify cervical cancer, is just one part of that examination. Your OB-GYN does much more during your annual. She also looks for any evidence of ovarian cancer, vaginal cancer, myoma (fibroids) and other abnormalities of the reproductive tract.

And while it’s true that cervical cancer is typically a slow-growing cancer that takes an average 10 years to spread, sometimes these cancers “don’t read the books” and spread in a shorter period of time.

In my new health book, INSIDE INFORMATION FOR WOMEN, I tell you in greater detail what to expect when you have a gynecologic examination.

Don’t take risks with your health. Your “annual” is called that for a reason. Make sure you see your OB-GYN for your pelvic examination every year.

– Yvonne S. Thornton, MD, MPH

You are what you eat…and so is your baby

Thursday, October 20th, 2011

We’ve all been told how important it is to eat well in order to stay healthy. Now, new research shows that what you eat when you’re pregnant can be as important for your baby as it is for you.

A study published in the Archives of Pediatrics and Adolescent Medicine shows that when mothers-to-be ate healthful foods, such as those that make up the so-called Mediterranean diet, their babies had fewer birth defects such as cleft palates and neural tube defects.

The Mediterranean diet focuses on vegetables, beans, fruits, grains and fish, and is lower in meat, dairy and “empty” carbs.

Before you panic if you’re reading this while gorging on burgers and fries, no, your baby isn’t going to be born with birth defects just because you’re taking a vacation from your diet. The birth defects researchers looked at in the study are quite rare to begin with. It’s just that they are rarer still among women who eat well.

But the study does hint at something we know: your baby’s development depends, in part, on the nutrients you consume. So, give your little one a head-start on a good future. You’ll be doing a favor for both of you.

– Yvonne S. Thornton, MD, MPH

Learning Your Baby’s Gender at Seven Weeks –Test is Mixed Blessing

Tuesday, August 16th, 2011

For parents-to-be, impatient to know whether to paint the nursery blue or pink, a simple test can provide answers as early as seven weeks into the pregnancy.  These tests have been available for some time but weren’t widely used in the U.S., because their accuracy wasn’t known. Now, The New York Times reports, a new study in The Journal of the American Medical Association, has “found that carefully conducted tests could determine sex with accuracy of 95 percent at 7 weeks to 99 percent at 20 weeks.”

But is it really necessary to know your baby’s sex that early? For some parents, it can be.  The Times reports that European doctors routinely use such tests to:

… help expectant parents whose offspring are at risk for rare gender-linked disorders determine whether they need invasive and costly genetic testing. For example, Duchenne muscular dystrophy affects boys, but if the fetus is not the at-risk sex, such tests are unnecessary.

But the big downside, and one that concerns me greatly as a doctor and a mother, is that some cultures have such a bias against baby girls that the wide availability of such testing will result in ever more otherwise healthy female fetuses being aborted.

Several companies do not sell tests in China or India, where boys are prized over girls and fetuses found to be female have been aborted. While sex selection is not considered a widespread objective in the United States, companies say that occasionally customers expressed that interest, and have been denied the test. A recent study of third pregnancies in the journal Prenatal Diagnosis found that in some Asian-American groups, more boys than girls are born in ratios that are “strongly suggesting prenatal sex selection,” the authors said.
At least one company, Consumer Genetics, which sells the Pink or Blue test, requires customers to sign a waiver saying they are not using the test for that purpose. “We don’t want this technology to be used as a method of gender selection,” said the company’s executive vice president, Terry Carmichael.

Cultural preferences won’t be deterred by a signature on a form, but at least, it’s a start. At some point, all cultures will learn to value both genders equally. Until then, a test that holds promise for some, can be a terrible incentive for the ultimate act of bias against females in others.

– Yvonne S. Thornton, MD, MPH

Free Birth Control Coverage is Now the Rule

Wednesday, August 3rd, 2011

In keeping with the Institute of Medicine’s recommendations that free birth control be made available to all under their insurance policies, a new rule from the White House mandates birth control coverage without co-pays or deductibles. The new rules also cover domestic violence screening and breastfeeding assistance without co-pays or deductibles.

Starting Aug. 1, 2012, new health insurance plans will be required to cover women’s preventive care without charging a co-pay or deductible. The new guidelines require health insurers to provide FDA-approved birth control, including emergency contraception such as the morning-after pill, HIV screenings, and well-women visits, among other services.

The guidelines also include an amendment that allows religious institutions that offer insurance to their employees the choice of whether or not to cover contraception services.

– Yvonne S. Thornton, MD, MPH