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 17th, 2011 by Peggy Polaneczky, M.D. in News, Research
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In an article filled with speculation, misinformation and broad sweeping generalizations, the Wall Street Journal does its damned best to make the birth control pill seem to be the worst thing to have happened to modern civilization, implying that by interfering with ovulation, the pill impairs our natural ability to choose a mate, causes women to choose less masculine partners and then stray from them, and makes us pick genetically similar rather than dissimilar mates.
Women on the pill no longer experience a greater desire for traditionally masculine men during ovulation….Researchers speculate that women with less-masculine partners may become less interested in their partner when they come off birth control, contributing to relationship dissatisfaction…That could prompt some women to stray, research suggests. Psychologist Steven Gangestad and his team at the University of New Mexico showed in a 2010 study that women with less-masculine partners reported an increased attraction for other men during their fertile phase.
“Less masculine” men. What the heck does that mean? Less hairy? Less into sports? Less violent? Not into Nascar or big trucks?
How about more likely to engage in conversation? More likely to care about their partner’s satisfaction in bed than their own? More likely to accept a woman having a career? Read more »
*This blog post was originally published at The Blog That Ate Manhattan*
May 4th, 2011 by Peggy Polaneczky, M.D. in Health Tips, Research
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Two studies published in this weeks’ British Medical Journal, one from the US and the other from the UK, report that users of drosperinone containing oral contraceptives (Yaz, Yasmin and their generics) have increased relative risks for non-fatal blood clots compared with users of pills containing levonorgestrel.
While neither study is perfect, and indeed have some very major limitations, they add to a growing body of evidence that pills containing drosperinone may impart higher risks for blood clots than older pills. Yaz is not alone in this regard – other studies have suggested that pills containing the newer progestins gestodene and desogestrel also impart slightly high clot risks than the so-called first and second generation pills containing the older progestins norethindrone and levonorgestrel.
I won’t go into the studies’ limitations here, but will say that trying to get our hands around comparative data on clot risks between various pills is an extraordinarily difficult process given that the diagnosis of blood clots is not always straightforward (or correct), pill choices are not randomized and fraught with prescribing bias, and confounding risk factors for clotting are numerous and difficult to control for. I wish folks would stop trying to answer these questions on the quick and cheap using claims and pharmacy databases without requiring chart review and strict diagnostic criteria. But that’s the way these studies are being done, and that’s the data I am being forced to contend with in my practice, so let’s talk about it. Read more »
*This blog post was originally published at The Blog That Ate Manhattan*
April 29th, 2011 by Linda Burke-Galloway, M.D. in Health Tips, News
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The Federal Drug Administration (FDA) recently issued a new warning about a medication that has been used for years and it has sent shock waves throughout my specialty. Terbutaline is an FDA approved medication that is used for asthmatic patients or patients who have significant narrowing of the airways. However for years it has been used as an “off-label” medication to treat preterm labor but now that’s about to change. An off-label drug means it hasn’t been approved for that specific use by the FDA.
According to the FDA, the injectable form of Terbutaline should only be used for a maximum of 24 to 72 hours because the drugs association with heart problems and death. The FDA goes on to say that the oral version (pills) should not be prescribed to treat preterm labor because it’s ineffective and can cause similar problems. As an obstetrician, I feel utterly betrayed. The medication clearly had side effects that included shortness of breath and a racing heart. As resident physicians we were taught that the benefit outweighed the risks of having a premature baby and the patients should try to adjust to the medication. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
April 6th, 2011 by Linda Burke-Galloway, M.D. in Health Tips, True Stories
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When we hear about maternal death, we immediately think of a third world country but in reality, 2 to 3 women die every day in the U.S. from pregnancy and childbirth. Unfortunately, African American women are affected disproportionately and are four times more likely to die than anyone else. The tragedy is that at least half of these deaths are preventable.
In her article, Special Report: Black Women Die Nearly Four Times the Rate of White Women From Pregnancy Complications, Rita Henley Jensen, describes the dilemma of the acting chief of the maternal and infant unit of CDC, Dr. William Callaghan. Callaghan can’t sleep at night because he wants to know why pregnancy is more dangerous for U.S. African American women.
During my residency training, I witnessed a maternal death. Read more »
*This blog post was originally published at Dr. Linda Burke-Galloway*
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?
