March 3rd, 2011 by Linda Burke-Galloway, M.D. in Better Health Network, Health Tips
Tags: Babies, Bleeding, Blood Clotting, Blood Loss After Childbirth, C-Section, Cesarean Section, Dr. Linda Burke-Galloway, Hemoglobin, Hemophilia, High Risk Pregnancy, Labor And Delivery, Maternal-Fetal Medicine, OB/GYN, Obstetrics And Gynecology, PHH, Placenta Previa, Postpartum Hemorrhage, Preeclampsia, Pregnancy and Childbirth, Pregnant Women, Uterine Bleeding, Women's Health
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Having a baby can be a beautiful thing until something goes wrong. The tragedy is that many high-risk conditions can be managed appropriately if the patient is cooperative and the healthcare provider is competent and well trained. Unfortunately, almost 600 pregnant women die in the U.S. each year from complications and the most common complication is significant blood loss after birth or postpartum hemorrhage (PPH).
PPH occurs when there is a blood loss of 500 cc or greater for a vaginal delivery and 1,000 cc after a cesarean section (C-section). Or, if you were admitted with a hemoglobin of 12 and it drops by ten points to 11, there should be a high index of suspicion for PPH as well. Therefore, if you feel lightheaded or dizzy, have palpitations or an increased heart rate after delivering a baby, inform the hospital staff immediately.
The most common cause of PPH is uterine atony or lack of contractions after the baby is delivered. Any pregnant condition that stretches the uterus significantly — such as having twins or a higher gestation, excess amniotic fluid (aka polyhydramnios), a prolonged induction of labor (greater than 24 hours) — increases the risk of PPH. Retained products of conception, such as the placenta, also places the patient at risk for developing PPH.
Other risk factors for PPH include:
- Women with a known placenta previa
- African-American women
- Hypertension or preeclampsia
- Mothers with infants weighing greater than 8.8 pounds (or 4,000 grams)
- Mothers with greater than seven children
- Women with a history of hemophilia
If you have any of the risk factors listed above, please be proactive and discuss the possibility of a PPH with your healthcare provider. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
March 2nd, 2011 by Jessie Gruman, Ph.D. in Better Health Network, Opinion
Tags: BMJ, British Medical Journal, Center for Advancing Health, Doctor Patient Relationship, Dr. Jessie Gruman, Healthcare Dance, Healthcare reform, Participatory Medicine, Patient-Doctor Partnership, Shared Medical Decision Making, The Dance Of Good Medicine, Two To Tango
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The other day I came across this photo of a couple clasping each other in a dramatic tango on the cover of an old medical journal — a special issue from 1999 that was focused entirely on doctor-patient partnership. The tone and subjects of the articles, letters and editorials were identical to those written today on the topic: “It’s time for the paternalism of the relationship between doctors and patients to be transformed into a partnership;” “There are benefits to this change and dangers to maintaining the status quo;” “Some doctors and patients resist the change and some embrace it: Why?”
Two questions struck me as I impatiently scanned the articles from 12 years ago: First, why are these articles about doctor-patient partnership still so relevant? And second, why did the editor choose this cover image?
I’ve been mulling over these questions for a couple days, and I think an answer to the second question sheds light on the first. Here are some thoughts about the relationship between patients and doctors (and nurse practitioners and other clinicians) evoked by that image of the two elegant people dancing together:
It takes two to tango. Ever seen one guy doing the tango? Nope. Whatever he’s doing out there on the dance floor, that’s not tango. Without both dancers, there is no tango. The reason my doctor and I come together is our shared purpose of curing my illness or easing my pain. We bring different skills, perspectives and needs to this interaction. When in a partnership, I describe my symptoms and recount my history. I talk about my values and priorities. I say what I am able and willing to do for myself and what I am not. My doctor has knowledge about my disease and experience treating it in people like me; she explains risks and tradeoffs of different approaches and tailors her use of drugs, devices, and procedures to meet my needs and my preferences. Both of us recognize that without the active commitment of the other we can’t reach our shared goal: To help me live as well as I can for as long as I can.
Each dancer adjusts to his or her partner. In tango, each partner has different moves; the lead shifts subtly and constantly between them throughout the dance. In a partnership, when I am really ill, I delegate more decisions to my physicians; when I am well we freely go back and forth, discussing treatment options and making plans. Read more »
*This blog post was originally published at CFAH PPF Blog*
March 2nd, 2011 by GarySchwitzer in Better Health Network, Opinion
Tags: Breast Cancer, CAM, Celebrity Patients, Complimentary and Alternative Medicine, Dr. Barron Lerner, Evidence Based Medicine, Gary Schwitzer, HealthNewsReview.org, Informed Patients, Irresponsible Medical Marketing, Medical Advice From Celebrities, New York Times Health Blog, Nontraditional Treatments, Oncology, Promoting False Hope In Patients, Science and Medicine, Science Based Medicine, Snake Oil, Suzanne Somers, Unconventional Beliefs About Cancer, Unorthodox Cancer Therapies
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Dr. Barron Lerner has written a book about breast cancer: “The Breast Cancer Wars: Hope, Fear, and the Pursuit of a Cure in Twentieth-Century America.” And he’s written a book about celebrity patients: “When Illness Goes Public: Celebrity Patients and How We Look at Medicine.” He wed the two topics in a blog post on the New York Times health blog entitled “Suzanne Somers, Cancer Expert.” Excerpts:
“Earlier this week, NBC’s “Dateline” devoted an entire hour on Sunday evening to allow the actress Suzanne Somers to express her rather unconventional beliefs about cancer.
It is not the first time a major media outlet has given air time to Ms. Somers, whose journey into the medical realm has been featured on a variety of news programs, talk shows and entertainment channels. A few years ago, Oprah Winfrey invited Ms. Somers on her show to share the secrets behind her youthful appearance — a complex regimen of unregulated hormone creams and some 60 vitamins and supplements.
But is it entirely outrageous that respected media organizations continue to give the “Three’s Company” sitcom star a platform to dispense medical advice? Not really, in a world in which celebrities have become among the most recognizable spokespeople — and sometimes experts — about various diseases.
…
…patients — especially those who want to explore every possible avenue — have the right to know that there are unorthodox cancer therapies that some people believe are helpful.
But not without several caveats, and that is where Ms. Somers, and many of those in the media who discuss her books and views, have failed. Ms. Somers says she is promoting hope, but false hope benefits no one.
Many people with end-stage cancer are, understandably, desperate, and thus potentially vulnerable to a sales pitch — even an expensive one. But here is a case when an informed patient may truly be a wiser patient. Perhaps if doctors were more willing to address the fact that these nontraditional treatments exist, and share what we do and don’t know about their effectiveness, an actress like Ms. Somers would have less influence, and science would override celebrity.”
There’s been quite an online response to Dr. Lerner’s blog post. One reader wrote, succinctly:
“From Thigh Master to Snake Oil.”
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
March 2nd, 2011 by Medgadget in Better Health Network, Research
Tags: Biomedical Research, Biomedicine, Cancer Detection, Cancer Research, Circulating Tumor Cells, Dr. Shuming Nie, EGFR-Targeting Gold Nanoparticles, Emory University, Georgia Tech, Head and Neck Cancer, Low Molecular Weight Peptides, Medgadget, Radiation Oncology, Wallace H. Coulter Department of Biomedical Engineering
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Our modern armamentarium for treating cancer is impressive, but sometimes despite our best treatments, tumor cells continue to lurk in the bloodstream, seeding metastases throughout the body. Researchers at Emory have developed a way to monitor for these circulating tumor cells using gold nanoparticles.
This technique has been used before, but difficulty was encountered because white blood cells are close to the same size as some tumor cells, so they would both be tagged, necessitating a laborious multi-antibody staining process.
“The key technological advance here is our finding that polymer-coated gold nanoparticles that are conjugated with low molecular weight peptides such as EGF are much less sticky than particles conjugated to whole antibodies,” says Shuming Nie, Ph.D., a professor in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory University. “This effect has led to a major improvement in discriminating tumor cells from non-tumor cells in the blood.”
Once these tumor cells are tagged with the gold nanoparticles, laser illumination reveals which cells are tumors in the bloodstream. This technique was tested on 19 patients with head and neck cancer, and showed excellent correlation with previous techniques. If this method can be validated in larger studies, it shows promise as a faster, more economical method to detect circulating tumor cells.
Full story: Nanoparticles May Enhance Circulating Tumor Cell Detection …
Abstract in Cancer Research : Quantification of circulating tumor cells in peripheral blood using EGFR-targeting gold nanoparticles
*This blog post was originally published at Medgadget*
February 27th, 2011 by Glenn Laffel, M.D., Ph.D. in Better Health Network, Research
Tags: African Americans, American Fatness, BMI, Body Mass Index, Cultural Factors, Diet and Nutrition, Dr. Glenn Laffel, Ethnic Differences In Healthcare, Family Practice, Fitness and Exercise, Internal Medicine, Johns Hopkins School of Public Health, NAMCS, National Ambulatory Medical Care Survey, Obese Adults, Obesity Counseling, Obesity Epidemic, Overweight, Pizaazz, Primary Care, Racial Disparity, Sara Bleich, Socioeconomics, Weight Reduction, Weight-Loss Counseling, Weight-Related Counseling
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Most people know that the U.S. is struggling to contain a surging epidemic of obesity, and that the problem is most acute among African-Americans. Whereas about 27 percent of all adult Americans are obese (defined as having a body mass index of 30 or more), fully 37 percent of African-American adults are obese, and that number jumps to an appalling 42 percent among African-American women.
Over the years, public health officials have provided evidence that socioeconomic and cultural factors drive this racial disparity. Now, a new study suggests there is another reason as well: Obese African-Americans receive less obesity-related counseling than their white counterparts, and it matters not whether the physicians they see are African-American or white.
To reach these conclusions, Sara Bleich and colleagues from the Johns Hopkins School of Public Health used clinical encounter data from the 2005–2007 National Ambulatory Medical Care Surveys (NAMCS). The sample included 2,231 visits involving African-American and white obese people who were at least 20 years old and who visited family practitioners and internists that were either African-American or white. Asian and Hispanic patients and physicians were excluded from the study because their numbers were too small to permit hypothesis testing.
For each encounter in the study, the scientists determined whether the patient received guidance on weight reduction, diet and nutrition, or exercise from his or her physician. Read more »
*This blog post was originally published at Pizaazz*
