Wednesday, March 29, 2017

Pushing Away the Pelvic Exam

Going to the gynecologist can sometimes be a scary thing, especially when many women don't know what to expect. However, the major reason is because of the infamous pelvic exam that many of us dread. Pelvic exams are a way for physicians to look for illness in organs of the body such as the vulva, uterus, cervix, etc. This exam has traditionally been conducted annually (though this may be changing), when a woman is pregnant, or if she has an infection. Generally, this test should not be conducted during one's menstrual period, or post douche, use of birth control cream, or sex. Further, this examination can often be uncomfortable because of its invasive nature and use of hands. Often times, cultural or social barriers may be the root cause of a patient's hesitation to get this examination.

Pelvic exams can detect diseases ranging from ovarian cancer to STIs like bacterial vaginosis, genital herpes, trichomoniasis.  In fact, the United States has been shown to conduct twice as many cystectomies and hysterectomies compared to European countries because of findings on bimanual examinations.

However, often times, these exams may reveal benign conditions that can cause anxiety due to the need for further testing. Moreover, these tests are not the most effective screening tool to detect cancer, and additional measures are needed.

Therefore, considering these pros and cons, patients should have a say in and understand why their pelvic exam is being conducted.  Their awareness and understanding about its utility will help make them more comfortable with the exam. To ensure this sense of partnership between patients and physicians, medical evidence and personal support must be given to women to assure them that they are empowered in their decision making.

Meghana Pisupati

IMS 2017

Thursday, March 23, 2017

Not So Stoked about these Stroke Treatment Disparities

One second has the potential to change a life. Never has this been truer than for patients who suffer from a stroke, an unpredictable condition which may occur at any time or place. Strokes are the fifth major leading cause of death within the United States, and the increase in survival rate post incidence can be attributed to the immense medical advances.

There are two types of strokes, an ischemic stroke and hemorrhagic one. Hemorrhagic strokes are caused by a blood vessel that has broken open, creating a rupture, and is treated by stopping the bleeding. In contrast, majority of the strokes are ischemic or when there is a blood clot in a vessel that goes to the brain. These are treated by removing the clot with medication such as tissue plasminogen activator (tPA was approved by the FDA in 1996).

tPA, or Alteplase is administered via IV through the arm and works to dissolve a clot and improve blood flow after a CT or MRI. This form of treatment must be given within 3-4.5 hours in eligible patients, and often times, has full recovery in many patients. Often times, the administration of tPA may prevent 1 out of 6 patients from death or long term disabilities and other brain injuries.

So what's the problem with this drug you ask? Recent studies conducted by Dr. Archit Bhatt and colleagues at the Providence Brain and Spine Institute identified three factors that affected disparities amongst patients who were able to receive ultrafast door-to-needle times. Of the three are arrival time, day, and surprisingly, sex. Men were 2.2 times more likely to receive this treatment compared to women. These staggering results prompt me to ask why these disparities exist.

Similar results were observed by Dr. Tracy Madsen at Brown's Warren Alpert Medical School, where of 563,087 stroke patients from 2005-2011, only 3.8% had received tPA. What appears to be even more appalling was the fact that there were racial as well as gender biases in concerns to the receiving of tPA. Moreover, the type of insurance seemed to play a role in treatment, since 29% private insurance holders were more likely to receive this drug compared to those on Medicare, even though treating stroke patients with tPA may save payers $25,000 per patient in a lifetime.  Certainly, more research needs to be conducted on the reasoning, both economical and social, behind why more people who need this form of treatment and are within the 3 hour time slot are not in fact receiving.

Comment below to let us know how to achieve this!

Meghana Pisupati
IMS 2017

Thursday, March 9, 2017

A Day Without a Woman and Why It Matters

Image result for A day without a WomanYesterday we celebrated ourselves, women and all gender oppressed people of all backgrounds, race, nationality, immigration status, age or disability, religion, sexual identity, gender expression, and economic status.  

On January 21st over 5 Million US demonstrators joined the Women’s March worldwide and over 1 Million in DC to make our voices heard. But it’s not over. We stood united yesterday in solidarity making March 8th A Day Without a Women to speak against for inequity, injustice and for the human rights of women.
The first International Women’s Day took place in 1911 in Denmark, Switzerland, Germany and Austria (According to the International Women’s Day website).  On March 8th we reflect on the courageous acts of ordinary women, who have and continue to play an extraordinary role to eradicate the inequities that continue to plague women today: receiving lower wages, discrimination, sexual harassment and job insecurity (to name a few).
Why does it matter? According to the Economist Gender Equality Scale: Glass Ceiling Index, a metric that demonstrates where women have the best chance of equal treatment at work, categorized the US below average in significant areas, when compared to 28 other Countries. The Organization for Economic Co-operation and Development OECD performs an international biannual analysis of the economic trend to promote policies that will improve the economic and social well-being of people. The US, when compared to other Countries, was below the OECD average on wage gap equity, child care cost, paid maternity leave and women employed in parliament and government; and barely above average on gender equality for higher education.  Although the OECD has showed improvements on the gender equity on an international scale, Finland scoring the highest among 28 Countries, the wage gap continues to widened, furthering the notion that there is much work to be done.  This is among other women rights issues that have stemmed from the current administration, further jeopardizing our reproductive rights: the defunding of Planned Parenthood and overturning Roe vs. Wade. 
Yesterday, united in love and in the spirit of liberation, women:
  1. took the day off from (UN) paid labor
  2. avoided shopping for one day (unless from women or minority owned businesses)
  3. wore RED in solidarity with A Day Without a Women
We won’t stop until we close the doors to discrimination, gender injustice and all acts of oppression. Women’s rights are human rights.

For more information:

Lidyvez Sawyer, MPH, Director
Office of Diversity, Equity & Inclusion
Drexel University College of Medicine