DC Medical Malpractice & Patient Safety Blog

That's all that a sick friend needs to hear from you. Two sentences. Nine words. Too often, what they hear instead is silence -- you don't know what to say, you're afraid to say the wrong thing, and so the friend winds up feeling abandoned in a time of need. Or, just as bad, friends will weigh in with unsolicited advice, or insensitive comments.

The best thing to do is to be present. And to listen. And respond.

More thoughtful comments and experiences from patients can be found in the NY Times blog piece on "When friends disappear during a health crisis."

Since the 1970’s, gynecologists would generally advise women who are hysterectomy candidates to also have their ovaries removed, along with the uterus. The idea was to prevent ovarian cancer, which is difficult to detect but often deadly. However, Roni Rabin reports in a New York Times story that a new study finds compelling reasons for women to keep their ovaries.

The study, published in the May issue of the journal Obstetrics & Gynecology, tracked almost 30,000 women over the span of 24 years. It found that women who had their ovaries removed were at a greater risk for heart disease and lung cancer, and were more likely to die of cancer than those who left their ovaries untouched. For women who had their uterus and ovaries removed before they turned 50 and did not take estrogen, these risks were even higher. Scientists believe the continued production of estrogen may be the reason why women who kept their ovaries tended to live longer.

The lead author of the study, Dr. William H. Parker of the John Wayne Cancer Institute in Santa Monica, CA, explained why women should consider keeping their ovaries because although ovarian cancer is difficult to detect and treat, it is much rarer than heart diseases. Every year, heart diseases kill more than 20 times the number of women than ovarian cancer.

Of course, there are women who will benefit from removing their ovaries, especially those who are at high risks of getting ovarian or breast cancer. A patient with strong family history of either cancer should definitely consult with their doctor to decide the best course to take.

If you are pregnant and experiencing fatigue, dry skin, sleep loss, or weight loss, it may be worthwhile to find out whether you are a candidate for a thyroid test – these symptoms, while common in pregnant women, may be caused by underactivity (hypothyroidism) or overactivity (hyperthyroidism) of the thyroid gland.

If untreated during pregnancy, both conditions have been shown to result in higher risks for miscarriage, premature birth, preeclampsia, and even impaired intelligence in the child (in the case of hypothyroidism). But does such risk necessarily warrant a universal recommendation for thyroid tests in pregnant women? Ingfei Chen explores an ongoing debate on this issue in a New York Times article.

The thyroid gland produces hormones that regulate many important aspects of our bodies, including metabolism, body weight and heart rate. When there is too much of this thyroid-stimulating hormone (TSH), the pregnant woman suffers from hyperthyroidism and experience poor sleep, weight loss, and nervousness after giving birth. On the other hand, when the thyroid gland is underactive, the resulting hypothyroidism causes fatigue, weight gain and dry skin. Both conditions are manifested in very subtle symptoms but are risk factors for dangerous pregnancy complications.

While both an overactive and an underactive thyroid spell trouble for pregnant women, hypothyroidism is the more common and worrisome condition. Hypothyroidism, affecting 10 to 20% of women of childbearing age, is often undiagnosed but hampers fetal brain development. A study done 10 years ago reports that 19% of children born to women with untreated hypothyroidism had an IQ of 85 or lower, whereas the same measure was only 5% for those born to mothers with a healthy thyroid.

Although risks of an imbalanced level of TSH are known, the medical field is currently split on whether there is sufficient existing evidence for the benefits of treating the condition, and subsequently, of recommending universal screening. Studies are underway to track pregnant women with healthy and underactive thyroids, and their children will be tested for IQ. Until scientists arrive at conclusive results, the general clinical policy is to recommend a thyroid test to high-risk women (for example, a woman with family history of thyroid problems). However, more doctors have begun recommending the test to normal-risk expecting mothers, and many think that evidence for universal screening will soon be available, according to Dr. Stagnaro-Green, an endocrinologist at Touro University College of Medicine in New Jersey.

A new LabCorp blood test called OvaSure is aimed at early detection of ovarian cancer, but OB-GYNs doubt its efficacy and safety, as false positives might lead to unnecessary surgery and extreme anxiety. Ovarian cancer often goes undetected until later stages, by which point it can be too late to treat it effectively. A test that makes early detection more feasible would therefore be a wonderful thing.

From the article:

The need for such a test is immense. When ovarian cancer is detected at its earliest stage, when it is still confined to the ovaries, more than 90 percent of women will live at least five years, according to the American Cancer Society. But only about 20 percent of cases are detected that early. If the cancer is detected in its latest stages, after it has spread, only about 30 percent of women survive five years.

But far from greeting the new test with elation, many experts are saying it might do more harm than good, leading women to unnecessary surgeries. The Society of Gynecologic Oncologists almost immediately issued a statement saying it did not believe the test had been validated enough for routine use.

“You’ve got industry trying to capitalize on fear,” said Dr. Andrew Berchuck, director of gynecologic oncology at Duke University and the immediate past president of the society. “We’d all love to see a screening test for ovarian cancer,” he added, “but OvaSure is very premature.”

The test is good news if it is indeed valid, but raising false hopes and causing unnecessary procedures and stress is an adverse consequence of all this hype.

Tara Parker-Pope has a blog post about how doctors will treat women of childbearing age as "pre-pregnant," focusing on their reproductive capacities to the detriment of their overall health. Obviously reproductive matters are an important part of overall health and can influence many other medical conditions. But so can a lot of other common issues: neurological and psychological problems, drug-related issues, alcohol and tobacco habits, gastrointestinal issues, and so on all have a huge effect on a person's overall health. Yet these issues do not command the same attention from many doctors, who focus on the potential for a pregnancy rather than on the woman as a whole patient. As a consequence, the woman's health suffers.

The comments section of the post is enlightening and makes it clear that this is an issue many women face and are extremely angry about. There are also a few dismissive comments telling women to "get over it," displaying the ignorance and foolishness that enable these attitudes in the first place.

A Spanish study, conducted on 250 participants of varied nationalities, shows that 24% of pregnant women feel poorly informed by their gynecologists and that nearly half do not take any pre-natal course.

Considering the medical, social and emotional importance of pregnancy and childbirth, it is especially vital for pregnant patients to be informed and in control of their health care during gestation and birth.

From the article:

The Head of the Obstetrics and Gynaecology Department at the Hospital Clínico San Carlos, Miguel Ángel Herráiz, who presented the results of the survey...explained that the aim of the study is to find out pregnant women's preferences during birth, with there currently being a tendency in administrations and the media in favour of a more natural birth. With regard to the high number of women who believe their gynaecologist does not inform them properly, the expert recognises that "we need to provide a birth plan and explain well and at all times how the process is going to be".

The survey asked about questions that have become more pressing in recent years, such as whether or not Cesarean sections and other medical interventions ought to be done as commonly as they are at present.