In the August issue of OBG Management, NYU's Dr.Steven R. Goldstein penned an article suggesting that we stop relying on the standard 2D ultrasound for localizing an IUD. The reason: that 3D or volume ultrasound allows visualization of planes, specifically a coronal plane, not often seen on the standard sonogram. Why is this important? Read on.
Dr. Goldstein's article demonstrates several images from studies in which the IUD's location doesn't look unusual on the 2D image. However, in the coronal plane of 3D imaging, a problem is demonstrated. Benacerraf et al found that 75% of patients with abnormally situated IUD's presented with either pain or bleeding - more than twice the rate of women whose IUD's were found normally situated.
We recently saw a young woman who had been in the Emergency Department complaining of pelvic pain for whom the diagnosis of her problem was far from clear. Visualization of the IUD in the coronal plane of her 3D sonogram clearly showed that not only was the device malpositioned in the lower uterus but one of the lateral arms penetrated the wall as well.
So now that you know a 3D study is superior, where should it be done? My answer would be more shameless self-promotion.
For more information or to schedule a 3D ultrasound, please call (718) 925-6277.
Showing posts with label Women's Health. Show all posts
Showing posts with label Women's Health. Show all posts
Monday, September 8, 2014
Monday, August 25, 2014
Shameless Self-Promotion
Many patients, colleagues, friends and family have all asked me: "Who's the most qualified to perform Ob-Gyn ultrasounds?" So here is my unvarnished and completely biased opinion.
An ultrasound study can be performed by either a sonographer or a sonologist (a doctor who performs or supervises ultrasounds.) However, a doctor will have a more extensive background in both health and disease processes than someone who is not a physician as a general rule. A physician will have spent far more time on the clinical side of the equation so will be more able to formulate a better differential diagnosis.
Now while a radiologist and gynecologist can both perform a decent pelvic ultrasound study, a gynecologist is generally far more familiar with female pelvic physiology and pathophysiology than a general radiologist. When it comes to a vaginal ultrasound, this shouldn't even be a question. An old friend once remarked that if radiologists performed vaginal sonography, the transducer handle would be long enough to reach into the reading room. Instead, most if not all radiologists read the studies performed by sonographers. A gynecologist performs a vaginal sonogram in much the same way an old-fashioned pelvic exam is performed, even down to occasionally using the abdominal hand.
Also, when a sonographer performs a sonogram in the standard radiology practice, the patient usually has to leave without knowing the result. When a gynecologist performs the exam, the result, at least preliminarily, is available right away. This eliminates a great deal of anziety.
OK, so now we've agreed your pelvic sonogram is best performed by an Ob-Gyn, why should it be performed by THIS "Recovering Obstetrician?" The short answer is Experience. I have been performing Ob-Gyn sonography since the late 1970's and exclusively since 1986. Since that time, when I decided to limit my practice to consultative ultrasound, I have had a chance to learn what works, what doesn't work, and have climbed to the summit of a rather steep learning curve. I've also learned a great deal about how to deal with both anxious patients and concerned referring clinicians. Do keep all this in mind if and when you need an ultrasound.
Thanks for reading. This concludes my infomercial.
For more information or to schedule an ultrasound, please call 718-925-6277.
An ultrasound study can be performed by either a sonographer or a sonologist (a doctor who performs or supervises ultrasounds.) However, a doctor will have a more extensive background in both health and disease processes than someone who is not a physician as a general rule. A physician will have spent far more time on the clinical side of the equation so will be more able to formulate a better differential diagnosis.
Now while a radiologist and gynecologist can both perform a decent pelvic ultrasound study, a gynecologist is generally far more familiar with female pelvic physiology and pathophysiology than a general radiologist. When it comes to a vaginal ultrasound, this shouldn't even be a question. An old friend once remarked that if radiologists performed vaginal sonography, the transducer handle would be long enough to reach into the reading room. Instead, most if not all radiologists read the studies performed by sonographers. A gynecologist performs a vaginal sonogram in much the same way an old-fashioned pelvic exam is performed, even down to occasionally using the abdominal hand.
Also, when a sonographer performs a sonogram in the standard radiology practice, the patient usually has to leave without knowing the result. When a gynecologist performs the exam, the result, at least preliminarily, is available right away. This eliminates a great deal of anziety.
OK, so now we've agreed your pelvic sonogram is best performed by an Ob-Gyn, why should it be performed by THIS "Recovering Obstetrician?" The short answer is Experience. I have been performing Ob-Gyn sonography since the late 1970's and exclusively since 1986. Since that time, when I decided to limit my practice to consultative ultrasound, I have had a chance to learn what works, what doesn't work, and have climbed to the summit of a rather steep learning curve. I've also learned a great deal about how to deal with both anxious patients and concerned referring clinicians. Do keep all this in mind if and when you need an ultrasound.
Thanks for reading. This concludes my infomercial.
For more information or to schedule an ultrasound, please call 718-925-6277.
Friday, August 22, 2014
Vitamin D: Shedding Some Light on Infertility
I've posted on the present epidemic of low vitamin D previously. Now we find yet another association of low levels of Vitamin D - Infetility.
Publishing in the European Journal of Endocrinology, researchers Elizabeth Lerchbaum and Barbara Obermayer-Pietsch performed a systematic review of studies published until October of 2011. A short summary of their results from PubMed:
The vitamin D receptor (VDR) and vitamin D metabolizing enzymes are found in reproductive tissues of women and men. Vdr knockout mice have significant gonadal insufficiency, decreased sperm count and motility, and histological abnormalities of testis, ovary and uterus. Moreover, we present evidence that vitamin D is involved in female reproduction including IVF outcome (clinical pregnancy rates) and polycystic ovary syndrome (PCOS). In PCOS women, low 25-hydroxyvitamin D (25(OH)D) levels are associated with obesity, metabolic, and endocrine disturbances and vitamin D supplementation might improve menstrual frequency and metabolic disturbances in those women. Moreover, vitamin D might influence steroidogenesis of sex hormones (estradiol and progesterone) in healthy women and high 25(OH)D levels might be associated with endometriosis. In men, vitamin D is positively associated with semen quality and androgen status. Moreover, vitamin D treatment might increase testosterone levels. Testiculopathic men show low CYP21R expression, low 25(OH)D levels, and osteoporosis despite normal testosterone levels.
While more work needs to be done, the impact of Vitamin D on both the male and female reproductive systems is far-reaching and still poorly understood. Stay tuned.
For more information or to schedule a sonogram, please call 718-925-6722.
Publishing in the European Journal of Endocrinology, researchers Elizabeth Lerchbaum and Barbara Obermayer-Pietsch performed a systematic review of studies published until October of 2011. A short summary of their results from PubMed:
The vitamin D receptor (VDR) and vitamin D metabolizing enzymes are found in reproductive tissues of women and men. Vdr knockout mice have significant gonadal insufficiency, decreased sperm count and motility, and histological abnormalities of testis, ovary and uterus. Moreover, we present evidence that vitamin D is involved in female reproduction including IVF outcome (clinical pregnancy rates) and polycystic ovary syndrome (PCOS). In PCOS women, low 25-hydroxyvitamin D (25(OH)D) levels are associated with obesity, metabolic, and endocrine disturbances and vitamin D supplementation might improve menstrual frequency and metabolic disturbances in those women. Moreover, vitamin D might influence steroidogenesis of sex hormones (estradiol and progesterone) in healthy women and high 25(OH)D levels might be associated with endometriosis. In men, vitamin D is positively associated with semen quality and androgen status. Moreover, vitamin D treatment might increase testosterone levels. Testiculopathic men show low CYP21R expression, low 25(OH)D levels, and osteoporosis despite normal testosterone levels.
While more work needs to be done, the impact of Vitamin D on both the male and female reproductive systems is far-reaching and still poorly understood. Stay tuned.
For more information or to schedule a sonogram, please call 718-925-6722.
Thursday, August 7, 2014
Screening Guidelines And Ageism
Most of the controversy surrounding mammography involves when to start screening - 35? 40? 50? However, the US Preventative Services Task Force
has also suggested that the evidence for continued screening after age 75 is lacking. Now there may be some evidence for older women.
Malmgren et al from the Swedish Cancer Institute in Seattle reported on findings to suggest the benefit of continued breast cancer screening in older women.
The researchers recently looked at the impact of mammography detection on older women by studying data from an institutional registry that includes more than 14,000 breast cancer cases with 1,600 patients aged older than 75 years.
The majority of mammography-detected cases were early stage, while physician- and patient-detected cancers were more likely to be advanced stage disease. Patients with mammography-detected invasive breast cancer were more often treated with lumpectomy and radiation and had fewer mastectomies and less chemotherapy than patient- or physician-detected cases.
Mammography detection was associated with a 97% five-year disease-specific invasive cancer survival rate, compared with 87% for patient- or physician-detected invasive cancers.
“Mammography enables detection when breast cancer is at an early stage and is easier to treat with more tolerable options,” said Dr. Malmgren. “In this study, older women with mammography-detected invasive cancer had a 10% reduction in breast cancer disease-specific mortality after 5 years.”
This all has little to do with ultrasound but everything to do with the doctor patient relationship. Ultimately, the decision to screen or not to screen should properly rest with the patient and her doctor, based on medical evidence, not cost. Older folks are people too.
If you've any questions or need to schedule an ultrasound, please call (718) 925-6277.
Malmgren et al from the Swedish Cancer Institute in Seattle reported on findings to suggest the benefit of continued breast cancer screening in older women.
The researchers recently looked at the impact of mammography detection on older women by studying data from an institutional registry that includes more than 14,000 breast cancer cases with 1,600 patients aged older than 75 years.
The majority of mammography-detected cases were early stage, while physician- and patient-detected cancers were more likely to be advanced stage disease. Patients with mammography-detected invasive breast cancer were more often treated with lumpectomy and radiation and had fewer mastectomies and less chemotherapy than patient- or physician-detected cases.
Mammography detection was associated with a 97% five-year disease-specific invasive cancer survival rate, compared with 87% for patient- or physician-detected invasive cancers.
“Mammography enables detection when breast cancer is at an early stage and is easier to treat with more tolerable options,” said Dr. Malmgren. “In this study, older women with mammography-detected invasive cancer had a 10% reduction in breast cancer disease-specific mortality after 5 years.”
This all has little to do with ultrasound but everything to do with the doctor patient relationship. Ultimately, the decision to screen or not to screen should properly rest with the patient and her doctor, based on medical evidence, not cost. Older folks are people too.
If you've any questions or need to schedule an ultrasound, please call (718) 925-6277.
Monday, July 28, 2014
Vitamin D Is More Than Just Bones
Since someone close to me was recently diagnosed with Systemic Lupus Erythematosus aka Lupus aka SLE, I started thinking about the effect that being told to avoid the sun might have on both vitamin D levels and the impact on lupus.
Since the root cause of many diseases such as SLE remains elusive, I was intrigued to find that specialists in the field were asking similar questions. Abou-Raya and colleagues conducted a placebo-controlled trial of vitamin D supplementation in patients with lupus.
Their findings were interesting. First, the lupus patients tended to have lower baseline vitamin D levels when compared with the control group. Second, and more importantly, vitamin D supplementation for 12 months led to significant improvements in both markers of disease activity and in clinical disease activity as well.
From the discussion: ... The overall effect of vitamin D is enhancement of protective innate immune response, while maintaining self-tolerance by dampening overactive adaptive immune responses30. Amelioration of proinflammatory cytokines by vitamin D supplementation may be attributed to the antiinflammatory and immunomodulation effect of vitamin D.
Finally, they conclude: Vitamin D, a safe, inexpensive, and widely available agent, may be effective as a disease-suppressing intervention for patients with SLE. In addition to the potential benefit of vitamin D replacement on improvement of SLE activity, vitamin D seems to have an immune-inflammatory-modulatory role that may benefit musculoskeletal and cardiovascular manifestations of SLE. This role could also help maintain immune health, thus avoiding the excess morbidity and mortality associated with vitamin D deficiency. We recommend routine assessment of vitamin D levels and adequate supplementation of the vitamin in patients with SLE.
When it comes to knowledge about vitamin D, let the sunshine in.
I know this has little to do with ultrasound but a lot to do with our health and that of our loved ones. If you do need an appointment for an ultrasound, feel free to call (718) 925-6277.
Since the root cause of many diseases such as SLE remains elusive, I was intrigued to find that specialists in the field were asking similar questions. Abou-Raya and colleagues conducted a placebo-controlled trial of vitamin D supplementation in patients with lupus.
Their findings were interesting. First, the lupus patients tended to have lower baseline vitamin D levels when compared with the control group. Second, and more importantly, vitamin D supplementation for 12 months led to significant improvements in both markers of disease activity and in clinical disease activity as well.
From the discussion: ... The overall effect of vitamin D is enhancement of protective innate immune response, while maintaining self-tolerance by dampening overactive adaptive immune responses30. Amelioration of proinflammatory cytokines by vitamin D supplementation may be attributed to the antiinflammatory and immunomodulation effect of vitamin D.
Finally, they conclude: Vitamin D, a safe, inexpensive, and widely available agent, may be effective as a disease-suppressing intervention for patients with SLE. In addition to the potential benefit of vitamin D replacement on improvement of SLE activity, vitamin D seems to have an immune-inflammatory-modulatory role that may benefit musculoskeletal and cardiovascular manifestations of SLE. This role could also help maintain immune health, thus avoiding the excess morbidity and mortality associated with vitamin D deficiency. We recommend routine assessment of vitamin D levels and adequate supplementation of the vitamin in patients with SLE.
When it comes to knowledge about vitamin D, let the sunshine in.
I know this has little to do with ultrasound but a lot to do with our health and that of our loved ones. If you do need an appointment for an ultrasound, feel free to call (718) 925-6277.
Monday, July 14, 2014
Pelvic Exam for the 21st Century
The American College of Physicians (ACP) certainly stirred up a hornets' nest with their pronouncement on the value of pelvic exams.
...“Routine pelvic examination has not been shown to benefit asymptomatic, average risk, non-pregnant women. It rarely detects important disease and does not reduce mortality and is associated with discomfort for many women, false positive and negative examinations, and extra cost,” said Dr. Linda Humphrey, a co-author of the guideline and a member of ACP’s Clinical Practice Guidelines Committee.
As I have posted previously, perhaps it's time to think about replacing the pelvic exam with ultrasound.
...So how would ultrasound stack up? Tayal et al conducted a study of emergency patients who were being evaluated for pain. Patients underwent both a transvaginal sonogram and the clinical pelvic examination. The order of examinations was randomized. The group found the sonographic pelvic exam superior to the digital pelvic exam across all BMI classes. And remember, these were patients already in pain.
When it comes to the issue of screening for ovarian cancer, the pelvic exam has failed miserably. Dr. Nick Summerton writes in the Spectator :
In seeking to pick up ovarian cancer at an early stage — with an improved chance of cure — much better alternatives to the vaginal examination are trans-vaginal ultrasound and CA125 testing. CA125 is a chemical given off by cancer cells that circulates in the bloodstream and women with ovarian cancer tend to have higher levels.
In 2015, the UKCTOCS screening trial for ovarian cancer will publish its results. Preliminary findings look very promising but, of course, "it ain't over 'til it's over."
Stay tuned.
For more information or to schedule an ultrasound, please call (718) 925-6277.
...“Routine pelvic examination has not been shown to benefit asymptomatic, average risk, non-pregnant women. It rarely detects important disease and does not reduce mortality and is associated with discomfort for many women, false positive and negative examinations, and extra cost,” said Dr. Linda Humphrey, a co-author of the guideline and a member of ACP’s Clinical Practice Guidelines Committee.
As I have posted previously, perhaps it's time to think about replacing the pelvic exam with ultrasound.
...So how would ultrasound stack up? Tayal et al conducted a study of emergency patients who were being evaluated for pain. Patients underwent both a transvaginal sonogram and the clinical pelvic examination. The order of examinations was randomized. The group found the sonographic pelvic exam superior to the digital pelvic exam across all BMI classes. And remember, these were patients already in pain.
When it comes to the issue of screening for ovarian cancer, the pelvic exam has failed miserably. Dr. Nick Summerton writes in the Spectator :
In seeking to pick up ovarian cancer at an early stage — with an improved chance of cure — much better alternatives to the vaginal examination are trans-vaginal ultrasound and CA125 testing. CA125 is a chemical given off by cancer cells that circulates in the bloodstream and women with ovarian cancer tend to have higher levels.
In 2015, the UKCTOCS screening trial for ovarian cancer will publish its results. Preliminary findings look very promising but, of course, "it ain't over 'til it's over."
Stay tuned.
For more information or to schedule an ultrasound, please call (718) 925-6277.
Tuesday, July 8, 2014
Where's Waldo?
We've all seen Waldo, the guy with the striped shirt and matching cap.
Seems pretty easy to spot, right?
But what if Waldo is in a large, busy crowd - is he still easy to spot?
Sometimes, an early pregnancy is harder to spot than Waldo. Because pregnancy tests are so sensitive, women are getting that first ultrasound quite early on in gestation. There is a window of about 2 - 3 weeks after conception when an early intrauterine pregnancy might not be visualized. This creates a quandary - is she really pregnant, is there a problem with the pregnancy or a problem with the dates, and, worst case scenario, is the pregnancy ectopic. Doctors refer to this clinical situation as "Pregnancy of Uncertain Location" or PUL. The usual management consists of serial measurements of the blood pregnancy hormone or Beta HCG and repeating the ultrasound until the situation is resolved. The protocol had been that failure to see a normally-situated pregnancy on ultrasound at a critical level of Beta HCG was highly suspicious for an ectopic pregnancy or a failed intrauterine pregnancy. Unfortunately, as we all are aware, life is not always so neat.
Doubilet et al, writing in the New England Journal of Medicine reviewed the diagnostic criteria of pregnancy of uncertain location and failed pregnancy and found that previously utilized criteria were a set up for diagnostic error, resulting in administration of a powerful teratogenic drug, Methotrexate, in cases subsequently found to be normal pregnancy. Nurmohamed et al found 8 cases of intrauterine pregnancy in which methotrexate was administered for suspected ectopic. None of these cases had a happy outcome.
Doubilet's review offered new consensus guidelines for the diagnosis of both early pregnancy failure and pregnancy of uncertain location, nicely summarized Here.
So if you find yourself in this situation, please review this post again and perhaps ask your doctor to review it as well.
For more information or to schedule an ultrasound, please call (718) 925-6277.
Seems pretty easy to spot, right?
But what if Waldo is in a large, busy crowd - is he still easy to spot?
Sometimes, an early pregnancy is harder to spot than Waldo. Because pregnancy tests are so sensitive, women are getting that first ultrasound quite early on in gestation. There is a window of about 2 - 3 weeks after conception when an early intrauterine pregnancy might not be visualized. This creates a quandary - is she really pregnant, is there a problem with the pregnancy or a problem with the dates, and, worst case scenario, is the pregnancy ectopic. Doctors refer to this clinical situation as "Pregnancy of Uncertain Location" or PUL. The usual management consists of serial measurements of the blood pregnancy hormone or Beta HCG and repeating the ultrasound until the situation is resolved. The protocol had been that failure to see a normally-situated pregnancy on ultrasound at a critical level of Beta HCG was highly suspicious for an ectopic pregnancy or a failed intrauterine pregnancy. Unfortunately, as we all are aware, life is not always so neat.
Doubilet et al, writing in the New England Journal of Medicine reviewed the diagnostic criteria of pregnancy of uncertain location and failed pregnancy and found that previously utilized criteria were a set up for diagnostic error, resulting in administration of a powerful teratogenic drug, Methotrexate, in cases subsequently found to be normal pregnancy. Nurmohamed et al found 8 cases of intrauterine pregnancy in which methotrexate was administered for suspected ectopic. None of these cases had a happy outcome.
Doubilet's review offered new consensus guidelines for the diagnosis of both early pregnancy failure and pregnancy of uncertain location, nicely summarized Here.
So if you find yourself in this situation, please review this post again and perhaps ask your doctor to review it as well.
For more information or to schedule an ultrasound, please call (718) 925-6277.
Monday, June 23, 2014
It Ain't Over 'Til It's Over
This morning, I found this disturbing story from India.
A man upon finding his first born baby deformed created a ruckus in government women's hospital on Wednesday alleging that the administration had changed his baby after delivery. Dozens of villagers gathered in his support in the hospital and shouted slogans against the doctors. The man stated that he had twice got the sonography of his unborn baby done from a privated doctor who claimed that the baby was perfectly normal.
According to sources, Farhan of nearby Gagwana village, was very excited about his first child and he took his wife for sonography in her third and seventh months. "The doctor told me that the baby was perfectly alright and we were happy with it," said Farhan.
On Sunday, Farhan's wife delivered the baby in a government hospital and afterwards the baby was brought to the couple. "The child was deformed and we were shocked to see that. When I enquired the doctors, they said that the baby was born deformed," added Farhan.
Farhan again went to the same private doctor who had conducted the sonography of his wife, "The doctor claimed that it is not possible after looking at the sonography report that the baby would be born deformed," Farhan said.
Farhan on Wednesday came back to the hospital and returned the baby to the hospital administration demanding to return his real child, "They changed my baby with another and I demanded DNA test before taking the baby," said Farhan.
Dozens of villagers from Gagwana also gathered in the hospital and created ruckus. They shouted slogans against the hospital administration. Police was also called on the spot to control the situation.
Having a child with a birth defect is obviously difficult but when it's unexpected, it literally gut-wrenching for all concerned. At issue is the question: what are the reasonable expectations after an apparently normal 20 week scan?
In the Netherlands, Baardman et al reported on the introduction of a routine 20 week scan increased the detection rate for serious congenital heart defects. However, at best, 15% of the defects went undetected before birth.
Magriples and Copel analyzed a series of 901 patients who underwent ultrasound screening with referral for a targeted exam if an abnormality were suspected. The babies were then examined at birth. There were 28 abnormalities in total. Of these, 5 or 17.8% were missed. In general, the more severe were detected while some of those missed were more subtle.
So what's the take home message? Trying to perform a physical exam on someone who is inside someone else is often exceedingly difficult. Moreover, prenatally, the sonographer is not looking at the finished product.
As Yogi Berra once said in 1973, "It ain't over 'til it's over." To contact me or to schedule an ultrasound, call (718) 925-6277.
A man upon finding his first born baby deformed created a ruckus in government women's hospital on Wednesday alleging that the administration had changed his baby after delivery. Dozens of villagers gathered in his support in the hospital and shouted slogans against the doctors. The man stated that he had twice got the sonography of his unborn baby done from a privated doctor who claimed that the baby was perfectly normal.
According to sources, Farhan of nearby Gagwana village, was very excited about his first child and he took his wife for sonography in her third and seventh months. "The doctor told me that the baby was perfectly alright and we were happy with it," said Farhan.
On Sunday, Farhan's wife delivered the baby in a government hospital and afterwards the baby was brought to the couple. "The child was deformed and we were shocked to see that. When I enquired the doctors, they said that the baby was born deformed," added Farhan.
Farhan again went to the same private doctor who had conducted the sonography of his wife, "The doctor claimed that it is not possible after looking at the sonography report that the baby would be born deformed," Farhan said.
Farhan on Wednesday came back to the hospital and returned the baby to the hospital administration demanding to return his real child, "They changed my baby with another and I demanded DNA test before taking the baby," said Farhan.
Dozens of villagers from Gagwana also gathered in the hospital and created ruckus. They shouted slogans against the hospital administration. Police was also called on the spot to control the situation.
Having a child with a birth defect is obviously difficult but when it's unexpected, it literally gut-wrenching for all concerned. At issue is the question: what are the reasonable expectations after an apparently normal 20 week scan?
In the Netherlands, Baardman et al reported on the introduction of a routine 20 week scan increased the detection rate for serious congenital heart defects. However, at best, 15% of the defects went undetected before birth.
Magriples and Copel analyzed a series of 901 patients who underwent ultrasound screening with referral for a targeted exam if an abnormality were suspected. The babies were then examined at birth. There were 28 abnormalities in total. Of these, 5 or 17.8% were missed. In general, the more severe were detected while some of those missed were more subtle.
So what's the take home message? Trying to perform a physical exam on someone who is inside someone else is often exceedingly difficult. Moreover, prenatally, the sonographer is not looking at the finished product.
As Yogi Berra once said in 1973, "It ain't over 'til it's over." To contact me or to schedule an ultrasound, call (718) 925-6277.
Monday, June 16, 2014
Sunshine On Sunscreens
Once again, summer beach and pool days are upon us and we need to remind ourselves to deal prudently with exposure to the sun's rays. Sunscreens are the most widely promoted means of protection but there are more than a few caveats.
No Spray Ons - Too easy to miss a spot.
No super high SPFs - EWG advises avoiding products higher than SPF 50.
No oxybenzone - There can be significant absorption into the bloodstream, with an estrogen-like effect.
No retinyl palmitate - EWG recommends avoiding as research shows synergistic effect with sun exposure for tumor development.
No combined sunscreen/bug repellent - combining screens with repellent may increase repellent absorption.
No sunscreen towlettes or powders - FDA sunscreen rules bar these.
No tanning oils - products with SPF lower than 15 are worthless.
For more info, check out more useful info at EWG.org.
Let's be careful out there. H/T TotalBeauty.com Also, for more info or to schedule an ultrasound, call 718 - 925 - 6277.
No Spray Ons - Too easy to miss a spot.
No super high SPFs - EWG advises avoiding products higher than SPF 50.
No oxybenzone - There can be significant absorption into the bloodstream, with an estrogen-like effect.
No retinyl palmitate - EWG recommends avoiding as research shows synergistic effect with sun exposure for tumor development.
No combined sunscreen/bug repellent - combining screens with repellent may increase repellent absorption.
No sunscreen towlettes or powders - FDA sunscreen rules bar these.
No tanning oils - products with SPF lower than 15 are worthless.
For more info, check out more useful info at EWG.org.
Let's be careful out there. H/T TotalBeauty.com Also, for more info or to schedule an ultrasound, call 718 - 925 - 6277.
Monday, June 2, 2014
New Fertility Hope For Chemo Patients
From this weekend's New York Times:
A commonly used drug can help young women with breast cancer retain the ability to have babies, apparently protecting their ovariesfrom the damage caused by chemotherapy, researchers reported here on Friday.
The treatment could provide a new option for dealing with one of the painful dilemmas faced by young cancer patients — that doing the utmost to save their lives might impair or even ruin their fertility. Researchers said the drug, goserelin, which temporarily shuts down the ovaries, appears to protect women from the more permanent premature menopause that can be induced by chemotherapy. In a clinical trial, women who were given goserelin injections along with chemotherapy had less ovarian failure and gave birth to more babies than women receiving only the chemotherapy.
“Premenopausal women beginning chemotherapy for early breast cancer should consider this new option to prevent premature ovarian death,” the study’s lead author, Dr. Halle Moore of the Cleveland Clinic, said at a news conference here at the annual meeting of the American Society of Clinical Oncology.
This is wonderful news indeed for many young women awaiting chemotherapy. There is one catch, however. On the GoodRx website, Zoladex (Goserelin) is listed as:
This drug is considered a specialty medication, which means:
It is very expensive. A typical fill can cost $1,326 or more for 1 kit of Zoladex 10.8mg.
Patients in need of this drug will usually find most of the cost paid by an insurance company, government or non profit organization. If you are uninsured or need help with your co-pay, the manufacturer may also offer assistance.
Most retail pharmacies will not stock this medication. The manufacturer may offer more information on how to fill this prescription.
Physicians and patients considering this therapy as always should do some homework first.
For more information, or to schedule an ultrasound, please call: (718) 925-6277.
A commonly used drug can help young women with breast cancer retain the ability to have babies, apparently protecting their ovariesfrom the damage caused by chemotherapy, researchers reported here on Friday.
The treatment could provide a new option for dealing with one of the painful dilemmas faced by young cancer patients — that doing the utmost to save their lives might impair or even ruin their fertility. Researchers said the drug, goserelin, which temporarily shuts down the ovaries, appears to protect women from the more permanent premature menopause that can be induced by chemotherapy. In a clinical trial, women who were given goserelin injections along with chemotherapy had less ovarian failure and gave birth to more babies than women receiving only the chemotherapy.
“Premenopausal women beginning chemotherapy for early breast cancer should consider this new option to prevent premature ovarian death,” the study’s lead author, Dr. Halle Moore of the Cleveland Clinic, said at a news conference here at the annual meeting of the American Society of Clinical Oncology.
This is wonderful news indeed for many young women awaiting chemotherapy. There is one catch, however. On the GoodRx website, Zoladex (Goserelin) is listed as:
This drug is considered a specialty medication, which means:
It is very expensive. A typical fill can cost $1,326 or more for 1 kit of Zoladex 10.8mg.
Patients in need of this drug will usually find most of the cost paid by an insurance company, government or non profit organization. If you are uninsured or need help with your co-pay, the manufacturer may also offer assistance.
Most retail pharmacies will not stock this medication. The manufacturer may offer more information on how to fill this prescription.
Physicians and patients considering this therapy as always should do some homework first.
For more information, or to schedule an ultrasound, please call: (718) 925-6277.
Tuesday, May 27, 2014
Polycystic Ovarian Syndrome: A Silent Misery
From The Daily Star:
A young girl, 15 years old, struggles with acne ever since her periods started. And not too long ago, she noticed dark thick facial hair around her chin and over her cheeks, something that can be socially crippling in school. No amount of waxing, threading and bleaching helps and this 15-year-old is miserable.
A couple has been trying to conceive for nine months with no positive result. In a country with an over-population problem and a serious lack of understanding of infertility and sexual health, there are usually misunderstandings on the varied number of reasons as to why a couple may not be able to conceive. There are grumbling in-laws, a lot of finger-pointing and blaming, usually the women, which does little to help the situation.
A 27-year-old woman has very irregular periods. She has gained a lot of weight over a year or two. She feels bloated and uncomfortable with friends and family being rather insensitive to her recent weight gains. Not having periods regularly also makes her scared about her future, especially when she thinks about marriage and children.
A 22-year-old woman feels extreme pain in her lower abdomen. When she is rushed to hospital, the doctors suspect appendicitis but ultrasounds show that her appendix is fine. However, because she has a sexually active relationship with her boyfriend and does not want her family or even her doctor to find out, she provides limited information on her symptoms which leads to inconclusive diagnosis.
What do these women have in common? They have Polycystic Ovarian Syndrome.
For reasons that are not well understood, in PCOS the hormones get out of balance. One hormone change triggers another, which changes another. For example:
The sex hormones get out of balance. Normally, the ovaries make a tiny amount of male sex hormones (androgens). In PCOS, they start making slightly more androgens. This may cause you to stop ovulating, get acne, and grow extra facial and body hair.
The body may have a problem using insulin, called insulin resistance. When the body doesn't use insulin well, blood sugar levels go up. Over time, this increases your chance of getting diabetes.
The cause of PCOS is not fully understood, but genetics may be a factor. PCOS seems to run in families, so your chance of having it is higher if other women in your family have it or have irregular periods or diabetes. PCOS can be passed down from either your mother's or father's side.
For more information or to schedule an ultrasound, please call: (718)925-6277.
A young girl, 15 years old, struggles with acne ever since her periods started. And not too long ago, she noticed dark thick facial hair around her chin and over her cheeks, something that can be socially crippling in school. No amount of waxing, threading and bleaching helps and this 15-year-old is miserable.
A couple has been trying to conceive for nine months with no positive result. In a country with an over-population problem and a serious lack of understanding of infertility and sexual health, there are usually misunderstandings on the varied number of reasons as to why a couple may not be able to conceive. There are grumbling in-laws, a lot of finger-pointing and blaming, usually the women, which does little to help the situation.
A 27-year-old woman has very irregular periods. She has gained a lot of weight over a year or two. She feels bloated and uncomfortable with friends and family being rather insensitive to her recent weight gains. Not having periods regularly also makes her scared about her future, especially when she thinks about marriage and children.
A 22-year-old woman feels extreme pain in her lower abdomen. When she is rushed to hospital, the doctors suspect appendicitis but ultrasounds show that her appendix is fine. However, because she has a sexually active relationship with her boyfriend and does not want her family or even her doctor to find out, she provides limited information on her symptoms which leads to inconclusive diagnosis.
What do these women have in common? They have Polycystic Ovarian Syndrome.
For reasons that are not well understood, in PCOS the hormones get out of balance. One hormone change triggers another, which changes another. For example:
The sex hormones get out of balance. Normally, the ovaries make a tiny amount of male sex hormones (androgens). In PCOS, they start making slightly more androgens. This may cause you to stop ovulating, get acne, and grow extra facial and body hair.
The body may have a problem using insulin, called insulin resistance. When the body doesn't use insulin well, blood sugar levels go up. Over time, this increases your chance of getting diabetes.
The cause of PCOS is not fully understood, but genetics may be a factor. PCOS seems to run in families, so your chance of having it is higher if other women in your family have it or have irregular periods or diabetes. PCOS can be passed down from either your mother's or father's side.
For more information or to schedule an ultrasound, please call: (718)925-6277.
Monday, May 19, 2014
The New Pregnancy Test
When I began my career in medicine, pregnancy tests were relatively insensitive. You had to wait until about 4-6 weeks after the last menstrual period before the results could be regarded as reliable. Real time ultrasounds was a gleam in a few researchers' eyes. Most women with a tubal pregnancy had the diagnosis made when they arrived in the emergency room with serious intra-abdominal bleeding. The confirmative diagnostic test of choice was a culdocentesis - the insertion of a long needle into the abdominal cavity through the vagina. Aspiration of non-clotting blood was considered diagnostic of internal bleeding. An unruptured ectopic pregnancy was considered a reportable case. The treatment was removal of the affected tube at laparotomy.
All that has changed. Today, thanks to Dr. Yalow's development of radioimmunoassay, pregnancy can be diagnosed sometimes before a period is missed. Transvaginal ultrasaound can diagnose an ectopic pregnancy often prior to the onset of significant symptoms. Surgery is done, not via large incisions, but via small laparoscopes - the so-called "bandaid surgery." And often, tubal pregnancy is treated medically or even followed expectantly. These have been truly remarkable developments.
In fact, the new pregnancy test may well be the vaginal sonogram. The new protocol for a woman who is seeing her gynecologist for suspected early pregnancy to empty her bladder and save that specimen of urine for the lab. But today, the office doesn't run the urine test yet. Today, her gyn performs a vaginal sonogram. If pregnancy is seen, that's it - she's pregnant. Done! If a small embroy/fetus is seen, a measurement yields an estimated delivery date which is more accurate than that predicted by last period. Early diagnosis of twins can also be made. If a fetus is seen, so can the heartbeat be seen. Everyone is ahead of the game.
The flip side is if no evidence of pregnancy is found on the sonogram. Now, that urine test is crucial and should be run. Urine tests are far more reliable than they were in the 1960's and early 1970's. If the test is negative, pregnancy is doubtful. Conversely, if the test is positive, then blood should be taken right then and there to look for the level of pregnancy hormone - the Beta HCG. Further management would then depend on that level which could be available often in less than a day. An investigative work up which often took weeks can sometimes be compressed into a few days or less.
Of course, I am oversimplifying but the change in the investigation and treatment of suspected tubal pregnancy has been truly remarkable stuff.
For more information, or to schedule an ultrasound, call: (718) 925 - 6277.
All that has changed. Today, thanks to Dr. Yalow's development of radioimmunoassay, pregnancy can be diagnosed sometimes before a period is missed. Transvaginal ultrasaound can diagnose an ectopic pregnancy often prior to the onset of significant symptoms. Surgery is done, not via large incisions, but via small laparoscopes - the so-called "bandaid surgery." And often, tubal pregnancy is treated medically or even followed expectantly. These have been truly remarkable developments.
In fact, the new pregnancy test may well be the vaginal sonogram. The new protocol for a woman who is seeing her gynecologist for suspected early pregnancy to empty her bladder and save that specimen of urine for the lab. But today, the office doesn't run the urine test yet. Today, her gyn performs a vaginal sonogram. If pregnancy is seen, that's it - she's pregnant. Done! If a small embroy/fetus is seen, a measurement yields an estimated delivery date which is more accurate than that predicted by last period. Early diagnosis of twins can also be made. If a fetus is seen, so can the heartbeat be seen. Everyone is ahead of the game.
The flip side is if no evidence of pregnancy is found on the sonogram. Now, that urine test is crucial and should be run. Urine tests are far more reliable than they were in the 1960's and early 1970's. If the test is negative, pregnancy is doubtful. Conversely, if the test is positive, then blood should be taken right then and there to look for the level of pregnancy hormone - the Beta HCG. Further management would then depend on that level which could be available often in less than a day. An investigative work up which often took weeks can sometimes be compressed into a few days or less.
Of course, I am oversimplifying but the change in the investigation and treatment of suspected tubal pregnancy has been truly remarkable stuff.
For more information, or to schedule an ultrasound, call: (718) 925 - 6277.
Thursday, May 15, 2014
Lupus In Pregnancy - What Should I Know?
Continuing the lupus thread duing Lupus Awareness Month, let's look at lupus during pregnancy. First, you should know that having lupus does not preclude a successful pregnancy outcome. There are risks involved, however, for both mom and baby. The March of Dimes ists the following:
What problems can lupus cause during your pregnancy?
Lupus may increase the risk of these problems during pregnancy:
Lupus flares. You may experience flares during pregnancy or in the first few months after giving birth. If your lupus is in remission or under good control, you’re less likely to have flares.
Preeclampsia. This is a certain kind of high blood pressure that only pregnant women can get.
Premature birth. This is birth that happens too early, before 37 weeks of pregnancy.
Miscarriage. This is when a baby dies in the womb before 20 weeks of pregnancy.
Stillbirth. This is when a baby dies in the womb after 20 weeks of pregnancy.
If you’ve been in remission or had your condition under good control for at least 6 months before pregnancy, you’re less likely to have complications. Talk with your health care provider before getting pregnant about the safest time for pregnancy.
What problems can lupus cause in your baby?
Most babies of mothers with lupus are healthy. However, some babies may face health risks, like:
Premature birth. About 3 in 10 babies (30 percent) of mothers with lupus are born prematurely. Premature babies may need to stay in the hospital longer or have more health problems than babies born full term (39 to 41 weeks of pregnancy).
Neonatal lupus. About 3 in 100 babies (3 percent) are born with this temporary form of lupus. This condition causes a rash and blood problems but usually clear up by 6 months of age. However, up to half of these babies have a heart problem called heart block. This is a condition that causes a slow heartbeat. Heart block is often permanent. Some babies need a pacemaker to help make their heart beat regularly.
As you would expect, pregnancy for a lupus patient is hardly a walk in the park. However, there is ample evidence that remission in disease activity optimizes a woman's chances for a successful outcome.
During pregnancy, expect to see two consultants on a regular basis - the Maternal Fetal Subspecialist and your Rheumatologist. Expect to have many tests and frequent visits. Do keep your appointments to give yourself and your baby the best possible odds. And above all else, hang in there. You can emerge with a healthy, happy baby.
For more information or to schedule an appointment for an ultrasound, call: (718-925-6277)
What problems can lupus cause during your pregnancy?
Lupus may increase the risk of these problems during pregnancy:
Lupus flares. You may experience flares during pregnancy or in the first few months after giving birth. If your lupus is in remission or under good control, you’re less likely to have flares.
Preeclampsia. This is a certain kind of high blood pressure that only pregnant women can get.
Premature birth. This is birth that happens too early, before 37 weeks of pregnancy.
Miscarriage. This is when a baby dies in the womb before 20 weeks of pregnancy.
Stillbirth. This is when a baby dies in the womb after 20 weeks of pregnancy.
If you’ve been in remission or had your condition under good control for at least 6 months before pregnancy, you’re less likely to have complications. Talk with your health care provider before getting pregnant about the safest time for pregnancy.
What problems can lupus cause in your baby?
Most babies of mothers with lupus are healthy. However, some babies may face health risks, like:
Premature birth. About 3 in 10 babies (30 percent) of mothers with lupus are born prematurely. Premature babies may need to stay in the hospital longer or have more health problems than babies born full term (39 to 41 weeks of pregnancy).
Neonatal lupus. About 3 in 100 babies (3 percent) are born with this temporary form of lupus. This condition causes a rash and blood problems but usually clear up by 6 months of age. However, up to half of these babies have a heart problem called heart block. This is a condition that causes a slow heartbeat. Heart block is often permanent. Some babies need a pacemaker to help make their heart beat regularly.
As you would expect, pregnancy for a lupus patient is hardly a walk in the park. However, there is ample evidence that remission in disease activity optimizes a woman's chances for a successful outcome.
During pregnancy, expect to see two consultants on a regular basis - the Maternal Fetal Subspecialist and your Rheumatologist. Expect to have many tests and frequent visits. Do keep your appointments to give yourself and your baby the best possible odds. And above all else, hang in there. You can emerge with a healthy, happy baby.
For more information or to schedule an appointment for an ultrasound, call: (718-925-6277)
Monday, May 12, 2014
Cervical Cancer Rates Rising in Seniors
Recent changes in pap smear frequency suggest that pap smears may no longer be necessary for women 65 years of age or older. There are a few big IF's:
Those with three consecutive negative Pap tests in the last 10 years, or two consecutive negative Pap tests combined with negative HPV tests in the last 10 years, with the most recent test performed within the past 5 years.
Now comes this news.
Previous studies determined that the rate of cervical cancer was approximately 12 cases per 100,000 women in the U.S. The incidence of the disease peaks in women between 40 to 44 years, then tapers off. However, such estimates did not take into account women who had hysterectomies, and are therefore no longer at risk for developing cervical cancer. Once these women were factored out, the incidence of this type of cancer increased to 18.6 cases per 100,000 women. The rate steadily increased as women age, particularly in women between 65 and 69 years of age.
African-American women had a higher incidence of cervical cancer at nearly all ages compared to caucasian women, with the discrepancy becoming more pronounced at older ages.
The study’s lead author Anne F. Rositch, Ph.D., M.S.P.H., an assistant professor of epidemiology and public health at the University of Maryland School of Medicine and a researcher at the University of Maryland Marlene and Stewart Greenebaum Cancer Center, believes these findings are important when reevaluating the screening guidelines for cervical cancer in older women in the U.S. Appropriate interventions need to be initiated to lower the burden of cervical cancer in these women.
Will the abandonment of the annual pap snatch defeat from the jaws of victory in the fight against the cancer that killed Evita Peron? While we do not want to spend precious healthcare dollars on needless testing, we do not want to put women's lives at risk in the process. I would urge any woman to have these conversations with her doctor before choosing either to continue or to forgo pap smears. Choose wisely indeed.
For more information or to schedule an appointment for an ultrasound exam, call: (718)-925-6277.
Those with three consecutive negative Pap tests in the last 10 years, or two consecutive negative Pap tests combined with negative HPV tests in the last 10 years, with the most recent test performed within the past 5 years.
Now comes this news.
Previous studies determined that the rate of cervical cancer was approximately 12 cases per 100,000 women in the U.S. The incidence of the disease peaks in women between 40 to 44 years, then tapers off. However, such estimates did not take into account women who had hysterectomies, and are therefore no longer at risk for developing cervical cancer. Once these women were factored out, the incidence of this type of cancer increased to 18.6 cases per 100,000 women. The rate steadily increased as women age, particularly in women between 65 and 69 years of age.
African-American women had a higher incidence of cervical cancer at nearly all ages compared to caucasian women, with the discrepancy becoming more pronounced at older ages.
The study’s lead author Anne F. Rositch, Ph.D., M.S.P.H., an assistant professor of epidemiology and public health at the University of Maryland School of Medicine and a researcher at the University of Maryland Marlene and Stewart Greenebaum Cancer Center, believes these findings are important when reevaluating the screening guidelines for cervical cancer in older women in the U.S. Appropriate interventions need to be initiated to lower the burden of cervical cancer in these women.
Will the abandonment of the annual pap snatch defeat from the jaws of victory in the fight against the cancer that killed Evita Peron? While we do not want to spend precious healthcare dollars on needless testing, we do not want to put women's lives at risk in the process. I would urge any woman to have these conversations with her doctor before choosing either to continue or to forgo pap smears. Choose wisely indeed.
For more information or to schedule an appointment for an ultrasound exam, call: (718)-925-6277.
Friday, May 9, 2014
Miscarriage - Can It Be Lupus?
May is Lupus Awareness Month. Lupus is an autoimmune disease in which the immune system attacks the body's own tissues, causing inflammation, swelling, pain, and damage. Lupus symptoms include fatigue, joint pain, fever, and a lupus rash. But sometimes, adverse pregnancy outcomes such as repeated miscarriage are the first sign of this disease.
Although an uncommon cause, risk of miscarriage is higher in patients with an autoimmune disease such as lupus.
If you've had two or more miscarriages and are unsure, you should ask about a diagnostic investigation. Your health as well as a successful pregnancy outcome may depend on it.
For more information, or to schedule an ultrasound, please call: (718) 925-6277.
Although an uncommon cause, risk of miscarriage is higher in patients with an autoimmune disease such as lupus.
If you've had two or more miscarriages and are unsure, you should ask about a diagnostic investigation. Your health as well as a successful pregnancy outcome may depend on it.
For more information, or to schedule an ultrasound, please call: (718) 925-6277.
Monday, May 5, 2014
Five Prenatal Tests Women Over 35 Should Consider
The other day, this piece on prenatal diagnosis appeared in my inbox.
While the CDC reports almost 15 percent of all U.S. babies -- or 1 in 7 -- were born in 2010 to women 35 and over, much tongue-clucking persists about women waiting to have a baby at "advanced maternal age." The reason may stem from data that shows certain risks (such as having a baby with Down syndrome) can increase with age. However, many women are happily embracing motherhood later on.
That said, certain tests and procedures are often recommended for women over 35. Here, 5 prenatal protocols these expectant moms may want to consider and what "older" moms who've been through them say about their experience.
The article goes on to list the 5 tests -
1. amniocentesis
2. nuchal translucency screening
3. Noninvasive Prenatal Testing (NIPT)
4. chorionic villus sampling (CVS)
5. midtrimester ultrasound
While this is a useful article as it provides background prep for moms to be for conversatons with their OB's and midwives, it lumps screening tests together with diagnostic tests, losing some perspective.
So let's look at this issue in another way. Put simply, a screening test is one which is relatively noninvasive, provides odds and stratifies risk, but does not tell you yes or no. A diagnostic test is often more invasive with real risks and answers specific questions. For example, a screening test for Down's Syndrome would yield a risk in the form of odds. A diagnostic test for Down's would yield a definitive result.
Amniocentesis and CVS are diagnostic tests. While they usually provide definitive results (with a few, thankfully rare exceptions,) nuchal translucency, NIPT and midtrimester ultrasound are more screening tests.
Also, some of these are performed in the first trimester, others in the second. NIPT, nuchal scan, and CVS are first trimester tests. The advantage here is that the earlier this hurdle is jumped, the less stressful the longer remainder of the pregnancy is.
Finally, a few words about ultrasound. IMHO, both first and second trimester ultrasound will remain standard in prenatal care, similar to early newborn physicals and the more comprehensive baby visit a month or so after birth. Many abnormalities and syndromes do not have a basis in chromosome complement, thus a test designed to screen for a chromosome issue such as Down's would not find cases of spina bifida, for example.
Prenatal ultrasound is also more than just looking at structure. It keeps pregnancy real in a tangible way for not only mom but also for dad.
For more information, or to schedule an ultrasound, please call: (718) 925-6277.
While the CDC reports almost 15 percent of all U.S. babies -- or 1 in 7 -- were born in 2010 to women 35 and over, much tongue-clucking persists about women waiting to have a baby at "advanced maternal age." The reason may stem from data that shows certain risks (such as having a baby with Down syndrome) can increase with age. However, many women are happily embracing motherhood later on.
That said, certain tests and procedures are often recommended for women over 35. Here, 5 prenatal protocols these expectant moms may want to consider and what "older" moms who've been through them say about their experience.
The article goes on to list the 5 tests -
1. amniocentesis
2. nuchal translucency screening
3. Noninvasive Prenatal Testing (NIPT)
4. chorionic villus sampling (CVS)
5. midtrimester ultrasound
While this is a useful article as it provides background prep for moms to be for conversatons with their OB's and midwives, it lumps screening tests together with diagnostic tests, losing some perspective.
So let's look at this issue in another way. Put simply, a screening test is one which is relatively noninvasive, provides odds and stratifies risk, but does not tell you yes or no. A diagnostic test is often more invasive with real risks and answers specific questions. For example, a screening test for Down's Syndrome would yield a risk in the form of odds. A diagnostic test for Down's would yield a definitive result.
Amniocentesis and CVS are diagnostic tests. While they usually provide definitive results (with a few, thankfully rare exceptions,) nuchal translucency, NIPT and midtrimester ultrasound are more screening tests.
Also, some of these are performed in the first trimester, others in the second. NIPT, nuchal scan, and CVS are first trimester tests. The advantage here is that the earlier this hurdle is jumped, the less stressful the longer remainder of the pregnancy is.
Finally, a few words about ultrasound. IMHO, both first and second trimester ultrasound will remain standard in prenatal care, similar to early newborn physicals and the more comprehensive baby visit a month or so after birth. Many abnormalities and syndromes do not have a basis in chromosome complement, thus a test designed to screen for a chromosome issue such as Down's would not find cases of spina bifida, for example.
Prenatal ultrasound is also more than just looking at structure. It keeps pregnancy real in a tangible way for not only mom but also for dad.
For more information, or to schedule an ultrasound, please call: (718) 925-6277.
Tuesday, April 29, 2014
Can Ovarian Cancer Be Found Early?
Ovarian cancer is the deadliest of all pelvic cancers for a woman. Overall, about one in seventy-two women will develop this disease. Of these, over half will have died within five years of diagnosis. If ever a disease cried out for a screening test, this would be it. Unlike the breasts, for example, the ovaries lie deep within the body and are therefore less accessible to physical exam. The bimanual pelvic exam is also uncomfortable and the discomfort causes women to tighten the abdominal muscles, making detection that much more difficult. If you add factors such as obesity and scars from Cesareans, you find the examiner's ability to feel the ovaries decreases exponentially.
Ultrasound has been suggested as a screening technique since the 1980's. In the US, the leading proponent of transvaginal ultrasound for ovarian cancer screening has been Dr. Van Nagell's group at the University of Kentucky.
Some have tried utilizing blood markers such as CA-125. Most recently, the group at MD Anderson found that evaluating changes in the level of CA-125 over time and combining that with transvaginal ultrasound yielded promising results in finding more early ovarian cancers.
Others, however, have not met with similar success. The US Preventive Services Task Force, in fact, recommends not screening for ovarian cancer.
Later this year, The UKCTOCS,the largest randomized trial of screening will publish its results, hopefully shedding more light on this issue.
In the meantime, there are some women at significantly higher risk for ovarian cancer, those whose strong family history or genetic tests place in a high risk group. For this group of women, screening, with all its foibles, should be considered. For more information or to schedule an ultrasound, please call: (718) 925-6277.
Ultrasound has been suggested as a screening technique since the 1980's. In the US, the leading proponent of transvaginal ultrasound for ovarian cancer screening has been Dr. Van Nagell's group at the University of Kentucky.
Some have tried utilizing blood markers such as CA-125. Most recently, the group at MD Anderson found that evaluating changes in the level of CA-125 over time and combining that with transvaginal ultrasound yielded promising results in finding more early ovarian cancers.
Others, however, have not met with similar success. The US Preventive Services Task Force, in fact, recommends not screening for ovarian cancer.
Later this year, The UKCTOCS,the largest randomized trial of screening will publish its results, hopefully shedding more light on this issue.
In the meantime, there are some women at significantly higher risk for ovarian cancer, those whose strong family history or genetic tests place in a high risk group. For this group of women, screening, with all its foibles, should be considered. For more information or to schedule an ultrasound, please call: (718) 925-6277.
Monday, April 28, 2014
Dad's Magic Moment
Everyone knows that the prenatal ultrasound provides the opportunity for mom to bond with her baby to be. Even before she first feels movement, seeing that tiny heart's beating, watching those movements, makes it all real. There is ample literature to describe the maternal bonding experience. But what about dad? Few have studied his reactions to the process - that is until now. Dr. Tova Walsh and colleagues at the University of Michigan interviewed 22 expectant fathers after they viewed a midtrimester ultrasound.
They found that the ultrasound experience was an important moment for men, establishing the reality of the coming child, and reassuring them that all was going well with the pregnancy.
It also caused the men to reflect on their roles in the life of mother and child, making it an important practical and psychological preparation for parenthood. The study noted that the men’s “plans and dreams alike extended beyond the immediate future of infancy and across the child’s lifespan.”
One man told the researchers, “Now that we know that it’s a girl, you know, now I’m thinking about ... walking her down the aisle someday, you know, (I’m) thinking that far ahead ... which is crazy, but I mean, it’s like my brain went from bringing her into the world and taking care of her and making sure she is taken care of (as) to her future and everything ...”
Another had more immediate worries: “I need to make sure I have a steady job because my child eating depends on me. If I don’t work, he don’t eat. And I’d rather my child eat before I do.”
Dads have magic moments too.
Walsh is a Robert Wood Johnson Foundation Health & Society Scholar at the UW School of Medicine and Public Health. Her study, “Moving up the Magic Moment: Fathers’ Experience of Prenatal Ultrasound,” is being published in the winter 2014 edition of the journal "Fathering".
For more information, or to schedule an appointment for an ultrasound, call: (718) 925 - 6277.
They found that the ultrasound experience was an important moment for men, establishing the reality of the coming child, and reassuring them that all was going well with the pregnancy.
It also caused the men to reflect on their roles in the life of mother and child, making it an important practical and psychological preparation for parenthood. The study noted that the men’s “plans and dreams alike extended beyond the immediate future of infancy and across the child’s lifespan.”
One man told the researchers, “Now that we know that it’s a girl, you know, now I’m thinking about ... walking her down the aisle someday, you know, (I’m) thinking that far ahead ... which is crazy, but I mean, it’s like my brain went from bringing her into the world and taking care of her and making sure she is taken care of (as) to her future and everything ...”
Another had more immediate worries: “I need to make sure I have a steady job because my child eating depends on me. If I don’t work, he don’t eat. And I’d rather my child eat before I do.”
Dads have magic moments too.
Walsh is a Robert Wood Johnson Foundation Health & Society Scholar at the UW School of Medicine and Public Health. Her study, “Moving up the Magic Moment: Fathers’ Experience of Prenatal Ultrasound,” is being published in the winter 2014 edition of the journal "Fathering".
For more information, or to schedule an appointment for an ultrasound, call: (718) 925 - 6277.
Friday, April 25, 2014
Abnormal Bleeding - My Doctor Scheduled An Ultrasound
Abnormal bleeding is one of the most common reasons for a woman to seek medical attention. About ten to thirty percent of reproductive age women will experience some form of menstrual disturbance. There is a whole laundry list of causes, including stress, underlying hormone imbalance, tumors, clotting disorders and even cigarette smoking. While a disturbance in the normal hormone fluctuation may be the most common reason, it is not the only cause. For this reason, an ultrasound is often performed, usually with transvaginal views. The transvaginal approach obviates the need for that overly filled bladder and can often more easily see pathology such as submucus fibroids or endometrial polyps. The thickness of the uterine lining can also be measured as well.
Sometimes, a 3D sonogram is done to note the architecture of the uterine cavity and to further delineate suspected intracavitary pathology. Finally, if either there is the suspicion of focal pathology or to amplify the findings from the sonogram, a saline sonohysterogram can be performed.
Depending on the results of these tests, further evaluation and treatment can be discussed. For more information or to schedule an ultrasound, call: (718) 925 - 6277.
Sometimes, a 3D sonogram is done to note the architecture of the uterine cavity and to further delineate suspected intracavitary pathology. Finally, if either there is the suspicion of focal pathology or to amplify the findings from the sonogram, a saline sonohysterogram can be performed.
Depending on the results of these tests, further evaluation and treatment can be discussed. For more information or to schedule an ultrasound, call: (718) 925 - 6277.
Thursday, April 24, 2014
My Placenta Is Low-Lying. Now What?
Now that most pregnant women have a midpregnancy ultrasound, they are often alerted to findings of uncertain significance. One of the most common of these involves the placenta. A placenta is low-lying when the lower edge extends to within 2 centimeters of the internal cervical opening or os. This is different from a placenta previa which actually covers the internal os. A group of investigators at the Brigham and Women's Hospital in Boston reported on their experience with the eventual outcome of pregnancies complicated by these low placentas.
Here's the short answer: Most of these situations resolve by the end of the pregnancy.
In total, 1220 of 1240 low-lying placentas (98.4%) that had sonographic follow up resolved to no previa before delivery; 89.9% of placentas cleared the cervix by 32 weeks, and 95.9% cleared by 36 weeks.
A small minority were not so lucky.
Twenty patients (1.6%) had persistent sonographic placenta previa or a low-lying placenta at or near term, including 5 complete previas, 7 marginal previas, 5 low-lying placentas, and 3 vasa previas; all had cesarean deliveries.
So, about 98/100 times all turns out well. In about 2/100 cases, the situation persists. Moreover, a very few unfortunate women were found to have vasa previa, a condition in which fetal blood vessels actually cross that internal os in front of the baby. Think about that for a moment. If the baby descends toward the birth canal and puts pressure on these blood vessels, those vessels can tear, resulting in a fetal hemorrhage, often severe.
So what should be the plan if they do find a low-lying placenta during your ultrasound? The authors suggest a repeat sonogram after 28-30 weeks to confirm resolution, repeating again at 34-36 weeks if the situation remains the same. During those studies, a search for vasa previa can also be conducted.
So if you're told you have a low-lying placenta, you should be optimistic but should follow up. The late Ronald Reagan said it best: "Trust but verify."
For more information or to schedule an ultrasound, please call: (718) 925-6277.
Here's the short answer: Most of these situations resolve by the end of the pregnancy.
In total, 1220 of 1240 low-lying placentas (98.4%) that had sonographic follow up resolved to no previa before delivery; 89.9% of placentas cleared the cervix by 32 weeks, and 95.9% cleared by 36 weeks.
A small minority were not so lucky.
Twenty patients (1.6%) had persistent sonographic placenta previa or a low-lying placenta at or near term, including 5 complete previas, 7 marginal previas, 5 low-lying placentas, and 3 vasa previas; all had cesarean deliveries.
So, about 98/100 times all turns out well. In about 2/100 cases, the situation persists. Moreover, a very few unfortunate women were found to have vasa previa, a condition in which fetal blood vessels actually cross that internal os in front of the baby. Think about that for a moment. If the baby descends toward the birth canal and puts pressure on these blood vessels, those vessels can tear, resulting in a fetal hemorrhage, often severe.
So what should be the plan if they do find a low-lying placenta during your ultrasound? The authors suggest a repeat sonogram after 28-30 weeks to confirm resolution, repeating again at 34-36 weeks if the situation remains the same. During those studies, a search for vasa previa can also be conducted.
So if you're told you have a low-lying placenta, you should be optimistic but should follow up. The late Ronald Reagan said it best: "Trust but verify."
For more information or to schedule an ultrasound, please call: (718) 925-6277.
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