Monday, December 30, 2013

Personal Reflection: When The Doctor Becomes the Patient

By Winnie Natu, MSIV
While on clinical rotations, I had the good fortune of meeting a wonderful doctor, teacher, and woman. During our time together she shared a personal story that has truly affected me and the way I view the doctor-patient relationship.  As a physician, Dr. X was well aware that her mother dying at the age of 45 of breast cancer meant more than dealing with the grief that accompanies losing a parent at a young age; it meant she herself may have an increased risk of the disease. She was tested for the BRCA gene mutations that are associated with a greatly increased risk of developing breast cancer. Her test came back positive for one of the genes and without hesitation she had a preventative double mastectomy.  
She recalls only half hearing what her own physicians told her about the risks of the procedure and that there was in fact a chance that she might not develop cancer and that if she did, other treatment options may be available at that time.  Of course she was thinking about her children and husband as a motivating factor for getting the surgery but often, she thought of her mother and what her life became in the last years of her life. Dr. X could not let go of the feeling of not wanting to be the patient. After years of being in control of her education and training and later her patients’ health, she could not give up the autonomy and authority that came with that. After years of fighting other people’s illnesses, she could not face that an illness would dictate her own life and so she saw no option but to take control as she had all her life with the mastectomy. 
We as doctors want our patients to leave their WebMD facts and preconceived notions at the door and follow our advice.  Can we do the same? An article on the ACP internist recently posted results of a study that posed clinical scenarios to randomized groups of physicians. Both outcomes involved a choice between surviving a fatal illness but with sometimes crippling outcomes. Physicians were randomized to groups in which they imagined themselves as the patient facing the decision, or in which they were recommending an option to a patient. “The hypothetical scenario involved two types of surgery for colon cancer. The first type of surgery cures colon cancer without any complications in 80% of patients, results in death within two years in 16%, and 1% a piece would experience a colostomy, chronic diarrhea, intermittent bowel obstruction or a wound infection. The second type of surgery cures 80% without complications, or results in 20% mortality within two years. Among 242 respondents, 37.8% chose the treatment with a higher death rate for themselves but only 24.5% recommended this treatment to a hypothetical patient”.
These and results of other studies like this tend to highlight the same concept for me: it is imperative to get to know your patient. Doctor, lawyer, teacher, home-maker: each comes with their own set of personality traits, priorities, social/financial circumstance, and personal experiences. Knowing these characteristics as a physician allows for providing individualized medical care that will tend to have the strongest compliance and best long-term outcomes for the patient.  Our job after all, is not to always carry out what we think is right but often what is right for each patient. Moreover, what Dr. X described: the unwillingness to give up control, the thought that “I know what is best for me”, fear of vulnerability etc. is not restricted to physician patients! It is important to remind ourselves that our patients, regardless of profession, have at least some of these feelings every time they come to us and that it is a great privilege that we are entrusted with their care.

Friday, December 27, 2013

TGIF Quote of the Week

This is the last Friday in 2013! Hope everyone is able to make it a great one!
Here is the quote if the week:

"It always seems impossible until it’s done."
                            - Nelson Mandela

Think back...what did you do in 2013 that you thought was impossible? Keep on accomplishing the impossible as impossible things are happening everyday! 

Have a great weekend! 

Monday, December 23, 2013

Healthy Holidays!!

While the winter holiday season can be the most magical time of the year, it is also a time when many engage in not-so healthy behaviors. Large amounts of holiday treats, stress over holiday spending and being in large groups as cold and flu season hits can all have a negative effect on your health. The CDC has created a fun holiday song called "The Twelve Ways to Health" , providing a great way to remember all the things we sometimes forget in the rush of the holiday season. On the CDC's page, along with the lyrics, are resources to learn more about every topic are provided. Take some time to sing along and get information about a topic you may want to know more about. When you make the holidays healthy, the happiness come naturally!

Friday, December 20, 2013

TGIF Quote of the week!

Happy Friday everyone! Have a relaxing weekend! hopefully you are or soon will be having a holiday break! Here is our quote of the week, which is especially good for this time of year. While many are looking for holiday cheer; the stress of shopping, cooking and get-togethers can make people the opposite of what you would expect from this time of the year: 

A healthy attitude is contagious but don't wait to catch it from others. Be a carrier.-Tom Stoppard 

Choose the healthy many be the one to spread it!

Monday, December 16, 2013

Rheumatoid arthritis

By Justine Shum, MSIV

Rheumatoid arthritis (RA) is an autoimmune disease that most commonly presents as an inflammatory arthritis affecting the joints. Like many other autoimmune diseases, RA affects more women than men -- about 3x as many women have the disease.

RA is a chronic disease that cannot be cured, but there are now many medications that are effective in reducing symptoms and slowing the progression of the disease. These medications are classified as disease-modifying antirheumatic drugs (DMARDs), and can further be separated into conventional DMARDs such as methotrexate and sulfasalazine, and biologic DMARDs such as rituximab and adalimumab. Because of DMARD use, the severe RA that results in crippling joint deformities is fortunately becoming more rare.

Current recommendations call for treatment with DMARDs to begin once a diagnosis of RA is made. Many patients wish to delay treatment, however, recent studies have shown that early and immediate treatment of RA results in lower disease activity in patients. These studies also show that at 2 years following diagnosis, patients who received immediate treatment were less likely to have joint damage and resultant disability.

Patient education of the disease course of rheumatoid arthritis and the consequences of delaying treatment will likely make the difference in patients who are wavering on initiating DMARDs. See the links below for some basic patient education material provided by the American College of Rheumatology.


Wednesday, December 11, 2013

"Good" and "Difficult" Patients

Whether you work in healthcare, have been in the healthcare system or simply watch medical dramas on TV, many are aware of the concept of "good" and "difficult" patients. "Good" patients are simply compliant with what is happening to them, low maintenance and an have an agreeable family. "Difficult" patients may ask too many questions, insist that they need immediate care or suggest things that their providers do not agree with. The article "Good" Patients and "Difficult" Patients - Rethinking our Definitions, by Louise Aronson, M.D. Challenges these images that are bestowed on patients and families by sharing a personal sorry about an experience with her elderly father. This is a great read for physicians and patients alike. Check it out by clicking the link below!

Thursday, December 5, 2013

Wanna Get Away? - Great Exhibit in D.C.

Going to the D.C. area or wanting to plan a trip there? We have one reason you may want to get there soon! The National Geographic Museum is now hosting the exhibit, Women Of Vision, that features the works of 11 female photojournalists, whose amazing photos capture modern realities and what is means to be a human in the 21st century. 

Visit the Women of Vision Exhibit webpage  to learn more. It will be open until March 9th. Make sure to plan your next trip to D.C. around this great exhibit! 

Monday, December 2, 2013

IUDs: Myth Busters and Facts

By: Winnie Natu, MSIV

The intrauterine device (IUD) is a small plastic device that is inserted into the uterus and is one of the safest and most effective forms of reversible birth control for women. Currently there are two major options on the market: Mirena, a progestin-releasing IUD and ParaGard, a plastic T-shaped device partially wrapped in copper wire. 

Despite its safety, efficacy, and benefits, the US has one of the lowest rates of IUD use worldwide. The purpose of this blog is to resolve some common misconceptions about IUDs and to answer questions that several women, like you, may have!

Case 1: A 28- year-old female with no past medical history comes in to discuss her options for birth control. She is currently in a monogamous relationship with her boyfriend and uses Loestrin Fe for contraception. She does a lot of travelling for work and is inconvenienced by having to take a daily pill. She does not want to have children in the near future but definitely wants to have a family someday. She has heard about IUDs but is worried that getting one might prevent her from ever having children.

This is a common misconception however an IUD is a completely reversible contraceptive device: it begins working as soon as it is fitted and stops as soon as it is removed with no effect on future fertility.

Case 2: A 20-year-old college student comes in for concerns with her current birth control pills. She is experiencing spotting between periods and often forgets to take her daily pill. She has had 3 sexual partners in the past 6 months and uses condoms occasionally. She has never been pregnant or had an STI but is concerned about the possibility of both and wants more information about her contraceptive options. When you mention an IUD she says she doesn’t want that because it increases the risk of something called pelvic inflammatory disease.

The World Health Organization has done multiple studies that all conclude the same thing: overall, women using an IUD have no increased risk of pelvic infection or infertility compared with women who used other types of birth control. In fact, Mirena acts to thicken cervical mucus and suppress or reduce endometrial bleeding and may offer some protection against an already low risk of PID. However it is important to remember than neither an IUD nor birth control pills protect against STIs! Only barrier contraceptives such as condoms can achieve this. This young woman should be screened for STIs and have a pregnancy test and if negative, she would be a candidate for an IUD.

Case 3: A 39-year-old woman that has given birth to her second child 3 months ago is interested in long term but reversible birth control. She has heard about an IUD but is worried that it wont be as effective as the birth control pills she has used in the past.

A new study on perception of birth control has concluded that it's not clear whether women have an overly optimistic view of the effectiveness of the birth control pill or an overly pessimistic view of the IUD. However, the fact is that IUDs can be left implanted for years, and are more than 99% effective at preventing pregnancy. In contrast, the birth control pill has been found in real-world practice to be about 95% effective.

The Facts: 
IUDs are an excellent choice of contraception for women who are seeking a long-term and effective birth control method, particularly those wishing to avoid risks and side effects of contraceptive hormones.

  The progestin-releasing Mirena is now considered to be one of the best options for treating heavy menstrual bleeding

 The copper-releasing IUDs do not have hormonal side effects and may help protect against endometrial (uterine) cancer.

 Certain women may be poor candidates for IUDs including women with current or recent history of pelvic infection, women that may be currently pregnant, have had a recent abnormal Pap smear, have or have a history of untreated cervical or uterine cancer, and women with an anatomically abnormal uterus that is very small or large.
Please ask your doctor for information about IUD placement and review the following links for learning more about IUDs!

Thursday, November 28, 2013

Happy Thanksgiving!

Happy Thanksgiving! Have a warm and safe holiday!

Click here for important Thanksgiving safety reminders from the National Fire Protection Association!

Monday, November 25, 2013

Balancing Diabetes in the Holiday Season

The end of the year brings major holidays from a variety of backgrounds. And a large majority of these holidays will bring families around tables for some of the most impressive - and fattening - dinners of the year. While the high carb, calorie and sugary foods may be tempting and delicious, we should all limit our intake of holiday treats. This can be especially difficult for those with diabetes, as the typical holiday foods do not cater to dietary restrictions. However, you can still have a wonderful time eating with your family this holiday season. Here are some tips from the CDC to help you eat well during the holidays:

At parties and gatherings:
  • You can still enjoy some of your favorite foods, just watch the portion sizes. Load your plate with good things with very small portions of the more fatty foods! 
  • Watch out for "healthy" options with disguised added fats. Hams coated with glazes and vegetables packed with butter or sour cream can hide major calories. Instead, look for plain fresh vegetables and if there are no alternative options, cut the skin off of meats.
  • Choose no sugar added fruit over cakes and pies. 
  • In addition, if you do not know what options will be served, take the initiative to bring your own healthy options. Not only will you give yourself options, you will introduce your family to more healty choices!
In addition, If you are traveling, make sure to get a flu vaccine before you go.
Make sure travel with double your medication just in case there are traveling issues or delays. In addition, make sure you keep up with your exercise regime, and don't be tempted to skip out on them! A little management can go a long way, helping you to still fully enjoy the holidays in a healthy way!

Click here to read the full list of tips provided the CDC

Friday, November 22, 2013

How Organic Is Your Wine?

Organic beverage sales make up a significant portion of organic foods sales, with wine being a contributor. For those who prefer to shop organic, organic wine may be the logical choice, but did you know there are different levels of 'organicness' in wines?

100% Organic wine is made with organic grapes. In addition there is a strict limit on the additives that go into the wine. Non-agricultural ingredients cannot account for more that 5% of the total product.

Wine made from Organic grapes must contain grapes that are 100% certified organic. While there are also specific rules on additives, they are not required to be organic.

So how do you tell the difference? Wine that is 100% organic will have the the USDA organic label on them while those made only with organic grapes will not. To learn more about the specifics of what goes into each type of organic wine and decide which is best for you, visit the USDA page: Organic Wine: Oversight, Labeling and Trade for further information. Remember, organic or not... ALWAYS in moderation!

More Resources:
USDA, Organic 101: Organic Wine

~ Enjoy your weekend! And maybe try some organic wine! ~

Tuesday, November 19, 2013

Diabetes and Pregnancy

By Winnie Natu, MSIV

It is important to remember that diabetes can affect people in any stage of life, including  pregnancy! Termed ‘gestational diabetes mellitus’ (GDM), it is critical we raise awareness about this topic as it can have life changing effects not only on mom, but on baby too.

What is it?
GDM is a type of diabetes that is first seen in a pregnant woman who did not have diabetes before she was pregnant. It usually shows up in the middle of pregnancy.  Like other types of diabetes, it occurs due to resistance to insulin, which is increased because of the different hormones the body produces and balances during pregnancy.

Am I at risk for getting it?
The most important risk factors for developing GDM are:
  • Age over 30
  • Family history of Type 2 diabetes
  • Being overweight
  • Certain ethnic backgrounds—Indian, Vietnamese, Chinese, Middle Eastern, Polynesian
  • GDM in a previous pregnancy
  • Previous difficulty carrying a pregnancy to term
  • Previous birth of a baby weighing more than 4 kg.
How do I know if I have it?
Doctors test for GDM between 24-28 weeks of pregnancy with a glucose challenge test. One hour after drinking a glucose solution, you will have a blood test to measure your blood sugar level. If it is higher than 130 to 140 mg/dL, it means you are at risk of gestational diabetes and will need a follow-up test. This time, you will have your fasting blood sugar level measured and then you will drink another sweet drink. Your blood sugar level will be checked every hour for three hours and if at least two of the readings are higher than normal, you will be diagnosed with gestational diabetes.

How does it affect me and my baby?
GDM causes baby’s blood sugar to be very high, which means the baby is overfed and grows to be very large. This can cause problems for both mom and baby during delivery and it may be necessary to have a C-section. Because of baby’s size, he or she may be born with nerve damage or shoulder abnormalities. GDM can also raise mom’s blood pressure and cause “preeclampsia”, which might lead to the baby being born early, seizures, or a stroke. Lastly, if GDM is not well-controlled, baby can quickly develop low blood sugar after birth which can be very serious, even fatal. 

How can I prevent it?
Follow a healthy diet including foods high in iron (fully cooked red meat), folic acid (green leafys) and calcium (pasteurized dairy). Lots of fruits and veggies with only moderate carbohydrates (pasta, bread, etc.). It is crucial to maintain a healthy weight! Generally, you should gain about 2 to 4 pounds during the first three months and then 1 pound a week during the rest of your pregnancy. Engage in regular and safe exercises including walking, swimming, low intensity aerobics, or pilates.

For more user-friendly and complete information about gestational diabetes, please visit the following resources:

Monday, November 18, 2013

Affordable Care Act Policy Briefing: Presented By Women's Way

Want to learn more about what the affordable care act means for women? Take advantage of the unique opportunity to join a conference call presented by Women's Way. By simply calling in during lunch, you have the ability to be part of an informative discussion about key provisions, medicare and medicaid advantages and disadvantages, as well as the healthcare marketplace. Time at the end will be saved for questions.

The call will be on Thursday, November 21 from 12:00-12:45 pm

Click Here for event details and instructions on connecting

To learn more about Women's Way, visit their website at

Sunday, November 17, 2013

Women's Health and the AFA: Now and in the Future

By Justine Shum, MSIV

The Affordable Care Act has been getting a lot of negative press lately due to problems with its Marketplace website, but we remain hopeful that it will improve access to healthcare. The Affordable Care Act has made a lot of changes for women, particularly by increasing coverage of preventive services. With 2014 quickly approaching, here is a review of the expanded coverage that is specific to women:

  • 20.4 million women with private health insurance gained expanded coverage of preventive services including mammograms, cervical cancer screenings, prenatal care, flu and pneumonia shots, and regular well-baby and well-child visits
  •  Many health plans now provide full coverage of other preventive services including well-woman visits, screening for gestational diabetes, domestic violence screening, breastfeeding supplies and contraceptive services
  •  24.7 million women with Medicare received coverage of preventive services including an annual well visit, personalized prevention plan, mammograms, and bone mass measurement if at risk for osteoporosis
  •  Women between ages 19 and 25 who would have been uninsured now have coverage under their parent’s employer-sponsored or individually purchased health insurance plan

Coming up in 2014 & Beyond
  • Insurance companies in the individual and small group markets will no longer be permitted to charge higher rates due to gender or health status
  • An estimated 13.6 million women who would otherwise be uninsured will gain health coverage by 2016
  •  An estimated 8.7 million women who currently pay for individual insurance will gain coverage for maternity services

For a full list of preventive services covered under the Affordable Care Act:

Thursday, November 14, 2013

Journal Club: November

Looking for a good article to read? Our fourth year students recently shared some very interesting articles with us for WHEP Journal Club, and in addition created some great discussion.Check out these articles:

  • Characteristics Associated With Differences in Survival Among Black and White Women With Breast Cancer, By: Silber and colleagues.  
  • Risk of Cervical Abnormalities in Women With Inflammatory Bowel Disease: A Population-Based Nested Case-Control Study, By: Singh and colleagues 
  • Patient Knowledge and Beliefs as Barriers to Extending Cervical Cancer Screening Intervals in Federally Funded Centers, By Hawkins and colleges 
  • Food Security Maternal Stressors and Overweight Among Low-Income US Children- Results From the National Health and Nutrition Examination Survey (1999-2002), By: Gunderson and colleagues 

Tuesday, November 12, 2013

Diabetes & Heart Disease : Key Issues for Women

By: Justine Shum, MSIV

Patients with type 2 diabetes are more likely to die from heart disease compared to adults without diabetes. Adults with diabetes are also 2-4x more likely to have heart disease. In women especially, diabetes is a serious risk factor for heart disease.

Why does diabetes increase risk of heart disease?

Even patients with well-controlled diabetes are at an increased risk of heart disease. This is because patients with diabetes, especially those with type 2 diabetes, often have other comorbid conditions that increase their risk of developing heart disease. These conditions include hypertension, hyperlipidemia and obesity.

What does this mean for women with diabetes?

Women with diabetes are more likely to have heart disease. Even premenopausal women, who normally have  protection due to estrogen against heart disease, lose that protection once they develop diabetes.

Women with diabetes who have heart disease also have poorer outcomes after heart attacks. In the first year after a heart attack, women are more likely to die compared to men who have heart attacks. Women are also more likely to have a second heart attack compared to men.

What can women with diabetes do about their heart disease risk?
  • Control your diabetes: A1C - measure of your average blood glucose control for the last 3 months. Measure at least twice a year. ADA recommends a A1C of 7% although your doctor will may recommend more or less stringent goals
  •  Quit smoking!
  • Maintain a healthy weight: Obesity is associated with insulin resistance
  •  Exercise: In addition to helping to maintain a healthy weight, exercise
  • Control your blood pressure: The American Diabetes Association (ADA) recommends lowering your blood pressure to 130/80 or lower
  •  Lower your LDL (bad cholesterol) level and raise your HDL (good cholesterol) level: The ADA recommends a LDL level less than 100, and with therapeutic lowering agents, a goal of 70 is recommended for patients with multiple risk factors. An HDL level greater than 45 is recommended, although the higher the better!
  •  Know the atypical presentation of a heart attack: Heart attack symptoms in women often are different from those experienced by men. Although chest pain remains the most common symptom, women often also experience a burning sensation in their upper abdomen as well as lightheadedness, upset stomach or sweating.

And always be sure to talk with your doctor about concerns and changes you may need to make. Remember, taking control is the first step toward prevention!

For healthy tips and resources, visit:

Friday, November 8, 2013

Warning: May Contain Sexism

When going to the movies, we are used to the ratings warning us of explicit language, sexual images and violence. Now, movies in Sweden are rating movies on the basis of sexism. While this rating is meant to say nothing about the quality of a movie, it is used to display sexism in movies and promote the creation of more strong, female roles. The criteria for pass or fail is simple: Movies need to include at least two female characters that talk to each other about something other than a man. Sounds simple, but you'll be surprised what movies don't make the cut. The criteria to pass is a bit light on substance, but can make you think when it comes to your favorite movies.While some feel this is a good way to raise awareness about women's roles in films, others feel that Sweden should start making the movies it is promoting instead of rating movies that have already been released. What do YOU think?

Read the Full story

Visit to view a database of ratings for over 45,000 movies

Wednesday, November 6, 2013

A Great Visual for Pregnancy Nutrition.

MyPlate is a visual for nutrition designed by that shows the ideal composition for a meal. It can be a useful tool for people of all ages, in helping them to understand what a healthy meal looks like. Now, Oregon Health and Science University has come out with "My Pregnancy Plate" to help pregnant women visualize their recommend intake of each food group. In addition, they also answer questions and give suggestions about snacks, sweet and food safety. Check out this great resource!

To see the full version Click Here

See the original MyPate at , the site also includes many resources for healthy living and eating!

Friday, November 1, 2013

TGIF Quote of the Week!

Happy Friday Everyone!
Here is the Quote of the Week:

Learn to be what you are, and learn to resign 
with good grace all that you are not
-Henri Frederick Amiel

This puppy is obviously not quite there yet...

Have a great weekend! Have fun and be safe if
you will be dressing up! 

“Your Diabetes To-Do List”

Written By: Renee E. Amori, MD

November is Diabetes Awareness Month, and it’s a good time to review your diabetes list of “Things to Do.”  Taking your medications, having diabetes education classes, and checking blood sugars are very important, but not the only things that people with diabetes need to remember.  Whether you have type 1 or type 2 diabetes, you have to do some regular “maintenance” to reduce your chance of having complications develop. 

Here are a few things that you should be doing as part of your regular diabetes care plan:

Have you had you had your eye exam?
Diabetes is a leading cause of vision loss.  You should have a dilated eye exam once a year

Do you check your feet daily or see a Podiatrist?
Daily foot care decreases the chance of infections, which can lead to amputations.  If you don’t know how to care for your feet, then seeing a Podiatrist for care is helpful.

Have you seen the dentist?
Regular dental visits reduce the chance of gum disease and tooth loss from high blood sugars.

Did you get your flu vaccine?
We recommend everyone with diabetes get the flu vaccine yearly.

Are you do for any other vaccine?
You may benefit from vaccines against other medical conditions.  Check with your doctor or health care provider to see if this applies to you.

It is important not only to do these things in November but all year long. Make sure your are keeping up with all of these and continue living a healthy life! 

Thursday, October 31, 2013

Getting Assistance Can Make All The Difference

For the last day of breast cancer awareness month we wanted to share some great advice for women who have undergone surgery for their breast cancer. This is to seek out a breast cancer assistance programs to help you in the next stage of your battle. Assistance programs offer useful services that can help you connect with and adhere to recommended treatment such as chemotherapy. A recent study found that when using an assistance program, 80% of participants were able to get some or all of their needs met compared to 35% of those who did seek out these services. While it has been shown that women nationwide have problems finding services after surgery for breast cancer, seeking early assistance can be the key to a full and successful recovery!

Read the full story here 

America Breast Cancer Foundation: Breast Cancer Assistance Program

For Philadelphia locals: Cancer Support Community 

Tuesday, October 29, 2013

Women's Health Seminar Series

Join us on Tuesday, November 5 for the seminar "Living With HIV: Issues for Women" presented by Dr. Amy Baranoski and invited panel members. Our guests will be sharing life experiences so this session will not be recorded. Make sure you are present for this seminar!

Monday, October 28, 2013

Brewing Controversy

A Dallas beer company is receiving  much heated criticism over a slogan for the beer "Dallas Blonde" after images of the new promotion truck were circulated online. The beer displays a blonde doll and reads that it "goes down easy". While the company owner claimed that is is just a fun play on words, many are saying that it is yet another promotion of rape culture in the United States. Alcohol is often involved in many sexual assault cases and some feel that a slogan like this on a can of beer is both inappropriate and insulting.

The owner did apologize for the offense the slogan may have caused anyone and has decided to remove it from the Dallas Blonde promotion truck.

What do you think? Is the can a representation of American society saying it is okay to sexually objectify women? Or is it just fun crude humor? Let us know!

Read the full story here.

Friday, October 25, 2013

TGIF Quote of the Week

Happy Friday Everyone! 
Here is the quote of the week: 

It's a fine thing to rise above pride, but you must have pride in order to do so.
~Georges Bernanos

Have a good weekend !

Wednesday, October 23, 2013

New "Terms" for Term Pregnancies

For some time now 37 weeks of pregnancy and beyond has been coined "term" pregnancy meaning it is an ideal time for the baby to be born. That was up until yesterday when new designations were given to the final terms of pregnancy by the American College of Obstetrics and Gynecology and the Society for Maternal-Fetal Medicine. Beginning at 37 weeks, the new terms are as follows: 

  • Early Term:  Between 37 weeks 0 days and 38 weeks 6 days
  • Full Term:    Between 39 weeks 0 days and 40 weeks 6 days (Ideal)
  • Late Term:   Between 41 weeks 0 days and 41 weeks 6 days
  • Postterm:     Between 42 weeks 0 days and beyond

The two groups created these new terms to discourage women and doctors from deciding on elective births before 39 weeks. Studies have shown that there is a significant difference in outcomes when comparing babies born at 37 weeks with those born just 2 weeks later. They hope to prevent births before 39 weeks of gestation that are not natural or medically necessary. In the immediate future, it is possible that we will see an increase in healthy births and a gradual reduction in the expense of newborn care. Let us know what you think! Do you think these new terms will have an impact?

View the original story here: Ob-Gyns Redefine Meaning of "Term Pregnancies" 

Monday, October 21, 2013

Why Can't I Get Enough Sleep pt. II - Insomnia

If you have difficulty with falling or staying asleep which results in problems with functioning during the day, you may have insomnia. It is a common and frustrating problem that affects up to 4 out of 10 people. In addition to poor and unrefreshing sleep, insomnia has been associated with decreased quality of life, difficulty at work, heart disease, and mood disorders.

Insomnia may occur on its own (primary insomnia) or be associated with other problems, such as:
  •  Psychiatric disorders, such as depression or anxiety
  •  Medical conditions, including heart burn, cardiovascular disease, sleep apnea and chronic pain
  • Medications or substances such as alcohol
  • Poor sleeping habits (aka sleep hygiene)
  • Acute life stress, such as starting or losing a job

Because many conditions affect insomnia, it is important to identify causes or contributing factors. To start the process towards managing insomnia and getting a good night of sleep, a thorough evaluation by a sleep specialist is indicated. After this, strategies to treat insomnia may be determined.

Depending on the causes or conditions associated with insomnia, treatment ranges from non-medication related therapy (implementing good sleep hygiene, bright light therapy, cognitive behavioral therapy) to the use of prescription or non-prescription drugs (melatonin).

For more information on insomnia:


Mai E, Buysse DJ. Insomnia: prevalence, impact, pathogenesis, differential diagnosis and evaluation. Sleep Medicine Clinics. 2008;3:167-174.

Friday, October 18, 2013

TGIF Quote of the Week

Happy Friday everyone, have a great weekend!
Here is the quote of the week:

"An once of prevention is worth a pound of cure"
-Benjamin Franklin

Good Luck to our students with upcoming exams! Hang in there!

Thursday, October 17, 2013

A Partnership Worth “Liking” – Facebook and NNEDV

The National Network to End Domestic Violence and Facebook have partnered up in an effort to keep survivors of domestic violence safe when using social media. In many stages of the domestic abuse cycle, using social media can be dangerous to the victim. Things an abuser finds online can cause further abuse, violence and stalking. Once the victim and abuser are no longer together, social media also can still allow an abuser access to the survivor’s life. 

Some say that abusers should simply stop using social media if they are worried about abusers following their activities. However, NNEDV and Facebook feel that this solution is unacceptable and isolating.  Survivors should have the same safety as anyone else when using social media. To help survivors, NNEDV and Facebook have created a guide to Facebook privacy and security settings. They hope that this guide will serve as a valuable resource for survivors who want to continue to connect with individuals who care about them. This guide could also be useful for those who are currently experiencing cyber bullying or other forms of virtual abuse.


If you or anyone you know could benefit from reading this, please share it and help combat domestic violence! 

Tuesday, October 15, 2013

Our Blog goes Pink! - Breast Cancer Awareness Month

Whep has gone pink for the second half of October in support of Breast Cancer Awareness Month! October is the one month where pink water shoots from fountains, tall city buildings display bright pink lights and NFL players trade their traditional colored gear for hot pink. And of course, you see the very popular pink ribbon more than ever on people, buildings and special merchandise.

However, it is important to remember the significant of breast cancer  not only in October but everyday of the year. In the U.S., 1/8 or 12% of women are estimated to develop breast cancer. It is the also the second leading cause of cancer deaths in women, with over 39,000 women dying every year.

For all women, and especially those who are at higher risk, it is important to screen for breast cancer. Early detection is one of the best ways to combat cancer. Women 50-79 should have a mammogram every two years. If you are younger with a family history, consult your doctor on the best time you should start having a mammogram. Clinical and self breast exams can also detect suspicious lumps. If you don't like the feel of something you find, get examined!

Today, there are over 2.8 million breast cancer survivors in America. With all the money and research going in to the cause, hopefully we will continue to see the number of survivors increase and the diagnosis and death rates fall. How will YOU support breast cancer awareness? Don't forget your pink this month!

For more information on Breast Cancer:

Ways to get involved:
- Many stores are now giving the option to donate when you make a purchase at the register
- Walks are being held all around the country:
Making Strides Against Breast Cancer Schedule 
Susan G. Komen 3-Day Walk
Walk with Avon

- If you would like to donate directly to any organization, simply type "Breast Cancer donation" into Google and choose an organization that you like. Remember to do your homework, as some companies take advantage of the charitable implication of the pink ribbon. Read more here.

Monday, October 14, 2013

Why Can't I Get Enough Sleep pt. I - Sleep Apnea

After a long, hard day at work, we all look forward to kicking off our shoes, winding down for the evening, and getting a good night of sleep. Sleep is as natural to us as breathing, and is easy to take for granted…until it becomes a problem.

Why is it difficult to get a good night of sleep, even though your body and mind want to rest? There are many explanations, and sleep apnea, a common sleep disorder, will be discussed in this blog entry. Additional causes of poor sleep, such as insomnia, restless legs syndrome, periodic limb movements, and circadian rhythm disorders, and will be addressed in future entries.

Sleep apnea is characterized by difficulty with breathing while asleep. This breathing difficulty is called an apnea, and may range in quality, from using more effort to breathe (obstructive sleep apnea) to complete absence of breathing effort (central sleep apnea). Sleep apnea may make it hard to fall or stay asleep. On top of this, sleep apnea affects your health in the long-term if left untreated. Sleep apnea increases your risk of diabetes, high blood pressure, stroke and death, among others.

Unfortunately, we are often not aware of having sleep apnea because we can’t observe ourselves while sleeping. However, if someone sleeps with you at night, he or she may have seen you stop breathing, or heard you snoring, both of which are signs suggestive of sleep apnea. Other risk factors for sleep apnea include male gender, being overweight, and older age.

How can you figure out whether you have sleep apnea? If you have a sleeping partner, ask him or her whether they have witnessed you snoring or stop breathing while asleep. You can also take the following questionnaire, called the STOP BANG questionnaire, to determine whether you are at increased risk for obstructive sleep apnea, the most common type of sleep apnea. Answering “YES” to three or more questions indicates that you are at higher risk for obstructive sleep apnea, and should see a sleep specialist for further evaluation.

STOP BANG Questionnaire
Have you been told that you Snore?                                                             YES                NO
Are you often Tired during the day?                                                             YES                NO
Do you know if you stOp breathing or has anyone witnessed you                 YES                NO
stop breathing while you are asleep?                                                            YES                NO
Do you have high blood Pressure or are you on medication to                      YES                NO
control high blood pressure?
Is your Body mass index greater than 28?                                                    YES                NO
Are you 50 years old of Age or older?                                                         YES                NO
Are you a man with a Neck circumference >17 inches, or                            YES                NO
a woman with a neck circumference > 16 inches?
Are you of male Gender?                                                                            YES                NO

For more information on obstructive sleep apnea:
En Espanol: