June 6th, 2011 by Linda Burke-Galloway, M.D. in Health Tips
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Of the 4 million babies born in the U.S. each year, approximately 12.3 percent of them will be premature and 3.56 percent will occur before 34 weeks. Premature birth is one of the leading causes of severe handicaps and has an annual cost of approximately $26 billion dollars. Although risk factors for preterm labor have been identified, there is still no cure. As stated in a previous blog post, when the cervix becomes weak (a condition called cervical insufficiency), the patient is at risk for second trimester miscarriages and preterm labor. Also, if a patient has a previous history of premature birth then she needs her cervix measured in a future pregnancy. If her cervix is short and measures between 16 mm and 25 mm before 23 weeks, she is at risk for premature labor and delivery. The recommended treatment for a short cervix is either progesterone suppositories or injections. A few months ago, there was profound controversy over an FDA approved injection that would cost approximately $1500.00 if purchased by the manufacturer, K-V Pharmaceuticals. Bending under political pressure, K-V reduced their price to $690.00.
The more options that are available for treatment of premature labor, the greater the chances are of achieving a full term baby. In the past two months, a new study has emerged which describes a progesterone gel that reduced birth rates before 33 weeks by 45 percent and improved newborn outcomes. This is a significant result. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
May 31st, 2011 by Linda Burke-Galloway, M.D. in Opinion
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How does one teach compassion? Either you have it or you don’t. A recent article in the Los Angeles Times made me cringe. In South Florida, fifteen ob-gyn practices out of 105 polled said that would not take care of a pregnant woman who weighed more than 200 to 250 pounds. The article goes on to describe two ob-gyn business partners who cited malpractice issues and fear of being sued as a reason for excluding obese women in their practice. So, what’s next? Will pregnant women be denied access to care based on bank accounts or zip codes? Where their children attend school? Whether they own a pet? Where do we draw the proverbial line?
One of my most frustrated moments in clinical practice was dealing with an imaging center who had cancelled my patient’s ultrasound procedure because they were “afraid she was going to break their table.” The patient was excited about her first pregnancy and wanted to do everything in her power to have a healthy baby. The first time I met her, she was almost apologetic about her weight. Most obese patients are. My staff had to locate an imaging center that was not only willing to accept the patient but her Medicaid insurance as well. No one should not have to endure that level of humiliation.
Whether we like it or not, Americans are obese and as physicians, we have done very little to reverse that process. I learned more about nutrition from Weight Watchers® then I did in medical school. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
May 24th, 2011 by Linda Burke-Galloway, M.D. in Health Policy, Opinion
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“But for the grace of God go I.” My late aunt drilled that value into my six-year old head and it has never left. An article regarding a New York politician recently caught my attention. When New York State enacted a bill to ban the shackling of pregnant prisoners, a New York State Assemblywoman objected. The article goes on to discuss the case of Jeanna M. Graves, who, in 2002 was arrested on a drug charge and began a three year sentence. Graves was pregnant with twins and while in labor, was handcuffed during her entire C. Section. How utterly ridiculous.
Before a C. Section begins, a patient is usually given either an epidural or spinal anesthesia. On rare occasions, she is put to sleep with general anesthesia if the baby must be delivered emergently. On all accounts, the patient’s legs will either be numb from anesthesia or she will be sleeping. Why then does she need shackles? She’s certainly not in a position to run. Although I addressed this issue last August, it needs to be revisited again. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
May 18th, 2011 by Linda Burke-Galloway, M.D. in Health Tips
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At one time, a hospital would be called a 24-hour institution but now it’s a business. Within this business are shift workers that include nurses, technicians, clerical staff and even hospital employed doctors who are now called hospitalists. In a teaching hospital resident physicians also work in shifts so the responsibility of patient care is always being transferred from one group of healthcare providers to another. Do they always communicate effectively? Regrettably, “no.”
Sign-outs, handoffs, shift changes, nurses’ report. These are the multiple names for the process where a departing provider is responsible for letting the arriving provider know what’s going on with the patient. According to statistics, 80% of medical mistakes occur during shift changes and 50 to 60% of them are preventable. Listed below is an excerpt from The Smart Mother’s Guide to a Better Pregnancy that teaches pregnant moms what things should be known during a shift change. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
May 10th, 2011 by Linda Burke-Galloway, M.D. in Health Tips
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If a pregnant woman finds herself scratching and itching during the third trimester, these symptoms should not be ignored. Each year, approximately 0.1 to 15% of pregnant women are affected by a liver disorder called Intrahepatic Cholestasis of Pregnancy or (ICP). ICP patients tend to develop symptoms of itchiness of their hands and feet that becomes progressively worse and then spreads all over their body. The itchiness usually worsens at night and if untreated can cause jaundice and several life-threatening complications to the unborn fetus. When a pregnant woman complaints of itchiness (pruritus) all over her body, the first order of business is to determine whether a rash is present. If a rash is absent, ICP should be suspected.
The liver is the largest gland in the body and in addition to filtering harmful substances such as alcohol it is also responsible for processing fats, carbohydrates and proteins. To process fat, the liver makes bile salts. In ICP, bile salts are increased which contributes to the symptoms of itchiness. Affected women will not only be plagued by pruritus but their unborn babies are at risk for stillbirth, preterm labor, fetal distress and abnormal heart rates. South American women and especially those from Chile have a greater risk of developing ICD as do women from South Asia and Sweden. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
Of the 4 million babies born in the U.S. each year, approximately 12.3 percent of them will be premature and 3.56 percent will occur before 34 weeks. Premature birth is one of the leading causes of severe handicaps and has an annual cost of approximately $26 billion dollars. Although risk factors for preterm labor have been identified, there is still no cure. As stated in a previous blog post, when the cervix becomes weak (a condition called cervical insufficiency), the patient is at risk for second trimester miscarriages and preterm labor. Also, if a patient has a previous history of premature birth then she needs her cervix measured in a future pregnancy. If her cervix is short and measures between 16 mm and 25 mm before 23 weeks, she is at risk for premature labor and delivery. The recommended treatment for a short cervix is either progesterone suppositories or injections. A few months ago, there was profound controversy over an FDA approved injection that would cost approximately $1500.00 if purchased by the manufacturer, K-V Pharmaceuticals. Bending under political pressure, K-V reduced their price to $690.00.
