Wednesday, July 25, 2012

Top Ten Reasons to Avoid Your Doctor by Dr Mercola

By Dr. Mercola
I've long said that the best strategy for achieving health is avoiding a visit to your doctor in the first place. Why? Because in many cases you will simply leave the office with a prescription or two, which will rarely solve your health problem. Most doctor visits result in "solutions" that only suppress your symptoms, often causing other side effects and problems.
Rather than advise patients about the true underlying conditions and real solutions that lead to health, they are left putting toxic Band-Aids on gaping wounds. As shown in the slideshow above, and as I detail in depth below, there are actually many reasons why avoidingyour doctor may be in the best interest of your health …

1. Annual Pap Smears

Many physicians still advise women to receive yearly pap smears, but the newest guidelines from the U.S. Preventive Services Task Force specifically recommend against this. The new recommendations call for women to undergo PAP screening only once every three years, beginning at age 21 and ending around age 65.
When testing is more frequent, or started before age 21, there's a chance of detecting human papillomavirus (HPV), and associatedlesions, more frequently. If a physician detects such lesions, they will assume they are "pre-cancerous" and treat them accordingly. However, most HPV infections and associated low grade squamous intra-epithelial lesions clear up on their own without treatment,while the treatment itself can lead to cervical incompetence and/or miscarriage in the future. Since most cases of HPV clear up on their own, this is a case where the treatment may do more harm than good.
That said, PAP smears (which screen for cervical cancer typically associated with HPV) are one of the best tools for preventing cervical cancer deaths – but getting one every year is likely unnecessary. 
Evidence shows that screening women for cervical cancer more frequently than every three years does not detect more cancer. Women who have not been exposed to HPV are not at risk for cervical cancer. Further, even if you are exposed and the infection does not clear up on its own (which is not common), it can take 10 years before it progresses to cancer. Cervical cancers are very slow growing, which is why less frequent PAP screens are still effective.
Despite the new PAP screen guidelines, most physicians continue to recommend annual PAP screening to their patients, mostly because they (and their patients) are in the habit of doing so. Some physicians also fear their patients will not come in for annual exams and other screening if the PAP is not required every year.
There is also a good deal of evidence that the revised PAP guidelines are part of a plan to rescue Gardasil (HPV) vaccine sales, which are embarrassingly low. The HPV vaccine is a heavily promoted and very expensive vaccine, but it has been a flop, with less than 27 percent of women opting to receive it, and reports of serious adverse effects continuing to pour in.

2. Mammograms

Only about 1 in 8 women whose breast cancer was identified during a routine mammogram actually had their lives "saved" by the screening, a recent analysis estimated– and this does not accurately account for how many women will fall victim to mammogram-induced breast cancer.
Using breast cancer data from The National Cancer Institute and The Centers for Disease Control and Prevention, researchers calculated a 50-year-old woman's likelihood of developing breast cancer in the next 10 years, the odds the cancer would be detected by mammography, and her risk of dying from the cancer over 20 years.
They found that a mammogram has, at best, only a 13 percent probability of saving her life, and that the probability may actually be as low as 3 percent. No matter what analyses they used, including considering women of different ages, the probability of a mammogram saving a life remained below 25 percent. Researchers concluded:
"Most women with screen-detected breast cancer have not had their life saved by screening. They are instead either diagnosed early (with no effect on their mortality) or overdiagnosed."
This bears repeating:
Mammograms often diagnose lesions or tumors that may never threaten a woman's life. They also often result in false positives that lead to over-treatment, i.e. misdiagnosed women often undergo unnecessary mastectomies, lumpectomies, radiation treatments and chemotherapy, which can have a devastating effect on both the quality and length of their lives. Plus, a mammogram uses ionizing radiation, which in and of itself can either induce or contribute to the development of breast cancer.

3. Cold and Flu 

Think it's wise to go to a conventional physician for these?  Think again.  Thanks to routine over-prescription of antibiotics, and the prescription of inappropriate antibiotics, you're likely to walk away after being told to take a drug you don't actually need.
Antibiotics do NOT work against viruses, hence they are useless against colds and flu's. Unfortunately antibiotics are vastly over-prescribed for this purpose. If you have a cold or flu, remember that unless you have a serious secondary bacterial pneumonia, an antibiotic will likely do far more harm than good, because whenever you use an antibiotic, you're increasing your susceptibility to developing infections with resistance to that antibiotic -- and you can become the carrier of this resistant bug, and can spread it to others.
The first thing you want to do when you feel yourself coming down with a cold or flu is to avoid ALL sugars, artificial sweeteners, and processed foods. Sugar is particularly damaging to your immune system -- which needs to be ramped up, not suppressed, in order to combat an emerging infection. This includes fructose from fruit juice, and all types of grains (as they break down into sugar (glucose) in your body).
Ideally, you must address nutrition, sleep, exercise and stress issues the moment you first feel yourself getting a bug. Getting plenty of high quality sleep will be crucial to your recovery. This is when immune-enhancing strategies will be most effective. In addition, the research is quite clear that the higher your vitamin D level, the lower your risk of contracting colds, flu, and other respiratory tract infections. I strongly believe you could avoid colds and influenza entirely by maintaining your vitamin D level in the optimal range.

4. Cholesterol

Many doctors are unaware that a high-fat diet is NOT the cause of heart disease. They are fooled into believing that total cholesterol is an accurate predictor of heart disease. If you visit your physician and you have high cholesterol, you're likely to be told two things:
  1. Take a statin cholesterol-lowering drug and
  2. Don't eat saturated fat.
While statin drugs do lower cholesterol very effectively, cholesterol is not the culprit in heart disease. Plus a report by the Massachusetts Institute of Technology claims that no study has ever proven that statins improve all-cause mortality-- in other words, they don't prolong your life any longer than if you'd not taken them at all. And rather than improving your life, they actually contribute to a deterioration in the quality of your life, destroying muscles and endangering liver, kidney and even heart function. The best ways to optimize your cholesterol levels and your heart health have to do with lifestyle measures, including eating healthy minimally processed fats and avoid highly processed vegetable fats and oils that are loaded with toxic omega-6 fats.

5. Depression

Once again, you're more likely to leave the doctor's office with a prescription for a drug that could be more dangerous than the problem itself. Every year, 230 million prescriptions for antidepressants are filled, making them one of the most prescribed drugs in the United States. The psychiatric industry itself is a $330 billion industry—not bad for an enterprise that offers little in the way of cures.
Despite all of these prescriptions, more than one in 20 Americans are depressed.Of those depressed Americans, 80 percent say they have some level of functional impairment, and 27 percent say their condition makes it extremely difficult to do everyday tasks like work, activities of daily living, and getting along with others.
The use of antidepressant drugs—medicine's answer for depression—doubled in just one decade, from 13.3 million in 1996 to 27 million in 2005.
If these drugs are so extensively prescribed, then why are so many people feeling so low?
Because they don't work at addressing the cause.
Research has confirmed that antidepressant drugs are no more effective than sugar pills. Some studies have even found that sugar pills may produce BETTER results than antidepressants! Personally, I believe the reason for this astounding finding is that both pills work via the placebo effect, but the sugar pills produce far fewer adverse effects.
Many people forget that antidepressants come with a slew of side effects, some of which are deadly. Approximately 750,000 people attempt suicide each year in the US, and about 30,000 of those succeed. Taking a drug that is unlikely to relieve your symptoms and may actually increase your risk of killing yourself certainly does not seem like a good choice. In addition, since most of the treatment focus is on drugs, many safe and natural treatment options that DO work -- like exercise, the Emotional Freedom Technique (EFT), vitamin D, and proper nutrition -- are completely ignored.

6. High Blood Pressure

The definition of what constitutes high blood pressure expanded greatly in 2003, so that drug companies could sell drugs loaded with side effects to 45 million extra people. Because the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (rife with drug industry conflicts of interest) decided that what were in actuality relatively low blood pressure readings were a risk for heart disease, millions more over the years, were suddenly labeled abnormal, and in need of "treatment" for a condition that didn't exist in medical literature until that panel met.
Uncontrolled high blood pressure is a very serious health concern that can lead to heart disease and increase your risk of having a stroke. The good news though is that following a healthy nutrition plan, along with exercising and implementing effective stress reduction techniques will normalize blood pressure in most people.

7. PSA Tests for Prostate Cancer

These tests actually reveal very little, and an irrelevant positive result will likely lead to a biopsy that comes with infection risk. The prostate-specific antigen test (PSA test), analyzes your blood for prostate-specific antigen (PSA), a substance produced by your prostate gland. When higher-than-normal levels of PSA are detected, it is believed that cancer is present. However, PSA screening barely has any impact on mortality rates from prostate cancer. As a result, the U.S. Preventive Services Task Force will soon recommend that men not get screened for prostate cancer.
Today, many experts agree that PSA testing is unreliable at best and useless at worst for accurately diagnosing prostate cancer. Many also agree that routine PSA blood tests often lead to over-diagnosis of prostate cancer, resulting in unnecessary treatments. Similar to mammograms, the PSA screen has become little more than an up-sell technique. The false positive rate is high, and the bulk of the harm is a result of subsequent unnecessary treatments.
Diet is actually a factor that can greatly impact your prostate health and help prevent enlarged prostate and prostate cancer, but many physicians fail to address this.
You'll want to eat as much organic (preferably raw) food as possible, and liberally include fresh herbs and spices, such as ginger. Make sure to limit carbohydrates like sugar/fructose and grains as much as possible to maintain optimal insulin levels, which will help reduce your cancer risk in general. Highly processed or charcoaled meats, pasteurized dairy products, and synthetic trans fats correlate with an increased risk for prostate cancer and should also be avoided.

8. Inappropriate and Unwise Dietary Advice

Most doctors are clueless about what constitutes a healthy diet. As such, they will recommend health catastrophes like artificial sweeteners, vegetable oils in lieu of butter, and fat-free pasteurized dairy products. Most will also neglect to tell you about the foods you could be eating more of to optimize your health, like fermented vegetables, raw dairy products, healthy fats (like saturated and animal-based omega-3s), grass-fed beef and more.
In addition, most are ignorant about the importance of how to cook your food – most foods are best consumed when raw or only lightly cooked, and this includes animal proteins like eggs and meat. A discussion about food quality is essential to health (i.e. getting your meat from a small local farmer instead of a confined animal feeding operation (CAFO)) but you will almost never hear this from your family physician. Wondering how to truly eat healthy? See my nutrition plan for a comprehensive (and free) guide.

9. Prescription Drugs Might Kill You and They Don't Address the Cause of the Problem

A drug prescription is usually a Band-Aid that gets nowhere near the root cause of illness.  And many drugs are dangerous.   Last year an analysis of data from the U.S. Centers for Disease Control CDC) revealed that deaths from properly prescribed drugs now outnumber traffic fatalities in the United States! And when you add in deaths attributable to other medical care modalities, like hospital admissions and surgery, the modern medical system becomes the leading cause of death and injury in the United States.
Authored in two parts by Gary Null, PhD, Carolyn Dean, MD ND, Martin Feldman, MD, Debora Rasio, MD, and Dorothy Smith, PhD, the comprehensive Death by Medicine article described in excruciating detail how everything from medical errors to adverse drug reactions to unnecessary procedures caused more harm than good. That was in 2003. In 2010, an analysis in the New England Journal of Medicine found that, despite efforts to improve patient safety in the past few years, the health care system hasn't changed much at all.5
For one of many examples, the birth control pills Yaz and Yasmin, which have been endorsed by a U.S. Food and Drug Administration (FDA) advisory committee, contain a drug called drospirenone that makes women who take it nearly seven times more likely to develop thromboembolism. This is an obstruction of a blood vessel that can lead to deep vein thrombosis, pulmonary embolism, stroke, heart attack and death.
Why did the FDA approve this dangerous drug? It turns out that at least four members of the advisory committee have either done work for the drugs' manufacturers or licensees, or received research funding from them. According to the Alliance for Natural Health:
"Each of those four panelists who received money from the pill's manufacturer voted in favor of the pill. Interestingly, the committee's ruling that the drug's benefit outweighs the risks was decided by a four-vote margin. Ironically, while the FDA allowed voting by advisors with business connections to drospirenone, the agency barred ... Sidney M. Wolfe, on the grounds that he ... had advised his readers not to take Yaz based on several years of data."

10. Your Doctor Might Not Even Tell You the Truth

A U.S. telephone survey found that 79 percent of Americans trust their doctor.But a recent survey of 1,900 physicians revealed thatsome are not always open or honest with their patients The results were less than impressive, to put it mildly:
  • One-third of physicians did not completely agree with disclosing serious medical errors to patients
  • One-fifth did not completely agree that physicians should never tell a patient something untrue
  • Amazingly 40% believed that they should hide their financial relationships with drug and device companies to patients
  • Ten percent said they had told patients something untrue in the previous year
When making health care decisions, you should certainly get your physicians' advice -- that's what you're paying them for, after all. Hopefully you have chosen a health care provider who has similar philosophies about health as you do, and whose expertise you can trust. But remember that when making health care decisions, you must be your own advocate; it's important to ask questions before opting for tests, procedures or treatments, and it's your decision if you'd rather opt for less medical intervention while choosing a more natural way of healing your body.
Ultimately, the more you take responsibility for your own health -- in the form of nurturing your body to prevent disease -- the less you need to rely on the "disease care" that passes for health care in the United States. If you carefully follow some basic health principles -- simple things like exercising, eating whole foods, sleeping enough, getting sun exposure, reducing stress in your life, and nurturing personal relationships -- you will drastically reduce your need for conventional medical care, which in and of itself will reduce your chances of suffering ill side effects.
But in the event you do need medical care, seek a health care practitioner who will help you move toward complete wellness by helping you discover and understand the hidden causes of your health challenges ... and create a customized and comprehensive -- i.e. holistic -- treatment plan for you.

Friday, July 20, 2012

Extra risks associated with cesarean section

Extra risks associated with cesarean section: Current research suggests that cesarean section has the following disadvantages in comparison with vaginal birth:
  • Physical problems in mothers: Compared with vaginal birth, cesarean section increases a woman's risk for a number of physical problems. These range from less common but potentially life-threatening problems, including hemorrhage (severe bleeding), blood clots, and bowel obstruction, to much more common concerns such as longer-lasting and more severe pain and infection. Even after recovery from surgery, scarring and adhesion tissue increase risk for ongoing pelvic pain and for twisted bowel.
  • Hospitalization of mothers: If a woman has a cesarean, she is more likely to stay in the hospital longer and is at greater risk of being re-hospitalized.
  • Emotional well-being of mothers: A woman who has a cesarean section may be at greater risk for poorer overall mental health and some emotional problems. She is also more likely to rate her birth experience poorer than a woman who has had a vaginal birth.
  • Early contact with, feelings toward babies: A woman who has a cesarean usually has less early contact with her baby and is more likely to have initial negative feelings about her baby.
  • Breastfeeding: Recovery from surgery poses challenges for getting breastfeeding under way, and a baby who was born by cesarean is less likely to be breastfed and get the benefits of breastfeeding.
  • Health of babies: Babies born by cesarean are more likely to:
    • be cut during the surgery (usually minor)
    • have breathing difficulties around the time of birth
    • experience asthma in childhood and in adulthood.
  • Future reproductive problems for mothers: A cesarean section in this pregnancy puts a woman at risk for future reproductive problems in comparison with a woman who has a vaginal birth. These problems may involve serious complications and medical emergencies. The likelihood of experiencing some of these conditions goes up sharply as the number of previous cesareans increases. These problems include:
    • ectopic pregnancy: pregnancies that develop outside her uterus or within the scar
    • reduced fertility, due to either less ability to become pregnant again or less desire to do so
    • placenta previa: the placenta attaches near or over the opening to her cervix
    • placenta accreta: the placenta grows through the lining of the uterus and into or through the muscle of the uterus
    • placental abruption: the placenta detaches from the uterus before the baby is born
    • rupture of the uterus: the uterine scar gives way during pregnancy or labor.
  • Concerns about babies in future pregnancies: A cesarean section in this pregnancy can affect the babies of future pregnancies. Studies have found that they are more likely to:
    • be born too early (preterm)
    • weigh less than they should (low birthweight)
    • have a physical abnormality or injury to their brain or spinal cord
    • die before or shortly after the birth
  • Planned cesarean compared with unplanned cesarean: A planned cesarean offers some advantages over an unplanned cesarean (a cesarean that occurs after labor is under way). For example, there may be fewer surgical injuries and fewer infections. The emotional impact of a cesarean that is planned in advance appears to be similar to or somewhat worse than a vaginal birth. By contrast, unplanned cesareans can take a greater emotional toll.
  • Planned cesarean compared with vaginal birth: A planned cesarean still involves the risks associated with major surgery. And both planned and unplanned cesareans result in a uterine scar and internal scarring and adhesions. This means women with planned and unplanned cesareans face similar risks in future pregnancies and for problems related to scarring and adhesions at any time

What are some concerns about physical effects of cesareans on mothers around the time of birth?

Having a cesarean section rather than a vaginal birth increases risk for the following problems: 

  • maternal death: some studies found that cesarean surgery itself, not any problems that led to surgery, appeared to cause additional maternal deaths compared with vaginal birth.
    Added likelihood for a woman with a cesarean: LOW to VERY LOW for maternal death
  • emergency hysterectomy: a woman with a cesarean is more likely than a woman with vaginal birth to have emergency surgery to remove her uterus (hysterectomy) in the early weeks after birth.
    Added likelihood for a woman with a cesarean: MODERATE for emergency hysterectomy
  • blood clots and stroke: a woman with a cesarean appears to be more likely than a woman with vaginal birth to have blood clots, including clots blocking blood vessels in the lungs (pulmonary embolism) and blocking blood flow to the brain (stroke).
    Added likelihood for a woman with a cesarean: LOW for blood clots and stroke
  • injuries from surgery: all women who have a cesarean have a wound; a woman with a cesarean may also be injured from accidental cuts to nearby organs such as the bladder or bowel or ureter (the tube that carries urine from the kidney to the bladder), especially if the surgery is done in haste.
    Added likelihood for a woman with a cesarean: VERY HIGH for abdominal wound
    Added likelihood of accidental cuts from surgery cannot be determined from studies examined
  • longer time in hospital: a woman who has a cesarean usually stays in the hospital a day or two longer than a woman who has a vaginal birth for post-operative monitoring and care, and this stay may be extended if she has complications.
    Added likelihood for a woman with a cesarean: VERY HIGH for a longer time in the hospital
  • going back into the hospital: a woman who has a cesarean is more likely than a woman with vaginal birth to be readmitted to the hospital in the weeks after birth.
    Added likelihood for a woman with a cesarean: MODERATE for going back to the hospital
  • infection: a woman with a cesarean is at risk for wound infection and may be much more likely than a woman with vaginal birth to have an infected uterus; women with a cesarean generally receive routine antibiotics to try to prevent infection.
    Added likelihood for a woman with a cesarean: HIGH for infection
  • pain: in the first days and weeks after birth, a woman who has had a cesarean is likely to have more intense and longer-lasting pain than a woman with vaginal birth; most women with a cesarean use pain medication after birth and consider pain at the cesarean wound to be a problem.
    Added likelihood for a woman with a cesarean: VERY HIGH for more severe and longer-lasting pain

What are some concerns about psychological effects of cesareans on mothers around the time of birth?

Having a cesarean section rather than a vaginal birth increases risk for the following problems: 

  • poor birth experience: a woman with a cesarean tends to give lower ratings to her birth experience than a woman with a vaginal birth, both early on and over time; she may be less likely to have her partner or other support people present; and to feel that she had control.
    Added likelihood for a woman with a cesarean: VERY HIGH to HIGH for poor birth experience (unplanned cesarean is worse than planned cesarean, vaginal birth with vacuum extraction or forceps is worse than vaginal birth without these procedures)
  • less early contact with her baby: a woman with a cesarean is less likely to see and hold her baby soon after birth than a woman with vaginal birth.
    Added likelihood for a woman with a cesarean: VERY HIGH for seeing and holding the baby later
  • unfavorable early reaction to her baby: early on, a woman with a cesarean is more likely to have negative feelings about her baby and to evaluate her baby less favorably than a woman with vaginal birth.
    Added likelihood for unfavorable early reaction to babies cannot be determined from studies examined
  • depression: a woman who has had a cesarean may be at higher risk for depression than a woman with vaginal birth.
    Current evidence is mixed on whether cesarean increases likelihood of depression
  • psychological trauma: a woman who has an unplanned cesarean during labor is at higher risk than other mothers for having traumatic symptoms (such as fear and anxiety) and for meeting criteria of Post-Traumatic Stress Disorder (PTSD).
    Added likelihood for a woman with an unplanned cesarean: HIGHfor having traumatic symptoms and for meeting criteria of PTSD (unplanned cesarean or vaginal birth with vacuum extraction or forceps pose HIGH extra risk in comparison with planned cesarean or vaginal birth with no vacuum/forceps)
  • poor overall mental health and self-esteem: a woman who has a cesarean section may be at greater risk for poorer overall mental health and lower self-esteem than a woman with vaginal birth.
    Added likelihood for poor overall mental health and self-esteem cannot be determined from studies examined
  • poor overall functioning: a woman who has a cesarean section may face greater challenges than a woman with vaginal birth for physical and social functioning and carrying out daily activities in the early weeks after birth.
    Added likelihood for poor overall functioning cannot be determined from studies examined

What are some concerns about ongoing effects of cesareans on mothers?

Having a cesarean section rather than a vaginal birth increases risk for the following problems: 

  • ongoing pelvic pain: a woman who has had a cesarean may have ongoing pelvic pain, possibly due to scarring and the growth of adhesion tissue.
    Added likelihood for ongoing pelvic pain cannot be determined from studies examined
  • bowel obstruction: a woman who has had a cesarean may develop twisted and blocked intestines in the years after surgery as a result of scarring and adhesion tissue in the abdomen.
    Added likelihood for a woman with a cesarean: MODERATE for bowel obstruction

What are some concerns about effects of cesareans on babies?

When mothers experience physical or emotional problems as a result of a cesarean birth (see above), it may interfere with their ability to take care of their babies. In addition, having a cesarean section rather than a vaginal birth increases risk for the following problems in babies: 

  • surgical cuts: a baby born by cesarean section may be accidentally cut (usually minor) during the surgery.
    Added likelihood for a baby born by cesarean: HIGH for accidental surgical cuts
  • respiratory problems: a baby born by a planned cesarean before the 39th week of pregnancy is at higher risk for mild to serious lung and breathing problems than other babies born at the same time.
    Added likelihood for a baby born by cesarean: HIGH to MODERATE for respiratory problems with a planned cesarean before 39 weeks
  • not breastfeeding: a mother who has had a cesarean faces extra challenges in getting breastfeeding under way, and her baby is less likely to be breastfed than a baby born vaginally.
    Added likelihood for a baby born by cesarean: VERY HIGH to HIGH for not breastfeeding
  • asthma: a person who is born by cesarean section appears to be at higher risk than a person born vaginally for asthma, both in childhood and in adulthood.
    Added likelihood for a person born by cesarean: HIGH for greater risk for asthma

What are some concerns about effects of cesareans on mothers in future pregnancies and births?

All pregnant women should be aware of these risks. Many women who do not expect to have more children change their mind or decide to continue with an unplanned pregnancy. 

In future pregnancies, the placenta, embryo and fetus that grow in a uterus with a cesarean scar may not function as well as those that develop in an unscarred uterus. The likelihood of the following problems may increase as the number of previous cesareans increases. Having a cesarean section rather than a vaginal birth increases risk for the following problems for in future childbearing: 

  • infertility: a woman who has had a cesarean is more likely than a woman with a previous vaginal birth to have difficulty conceiving another baby and is less likely to ever have another baby.
    Added likelihood for a woman with a previous cesarean: VERY HIGH to HIGH for infertility (not by choice)
  • reduced fertility: a woman who has had a cesarean is more likely than a woman with a previous vaginal birth to have negative feelings and attitudes about childbirth, to decide not to have additional children, and to point to these feelings and attitudes as the reason for this decision.
    Added likelihood for a woman with a previous cesarean: HIGH for reduced fertility by choice
  • maternal death: in future pregnancies and births, a woman whose uterus has a cesarean scar is more likely than a woman with a previous vaginal birth to have life-threatening problems with the placenta and the scar (see next points).
    Added likelihood for a woman with a previous cesarean: has not been measured well, may be VERY LOW for maternal death related to scar
  • ectopic pregnancy: a woman whose uterus has a cesarean scar is more likely than a woman with an unscarred uterus to have an embryo grow outside her uterus, including a cesarean scar pregnancy; in such cases, the pregnancy must be ended to save her life, and she may have severe bleeding, emergency surgery, which may include emergency removal of her uterus (hysterectomy), and other complications.
    Added likelihood for a woman with a previous cesarean: MODERATE for ectopic pregnancy
  • placenta previa: a woman whose uterus has a cesarean scar is more likely than a woman with an unscarred uterus to have a future placenta attach near or over the opening to her cervix; this increases her risk for serious bleeding, shock, blood transfusion, blood clots, planned or emergency delivery, emergency removal of her uterus (hysterectomy), placenta accreta (see next), and other complications.
    Added likelihood for a woman with a previous cesarean: MODERATE for placenta previa in a future pregnancy after having one cesarean;HIGH for placenta previa in a future pregnancy after having more than one cesarean
  • placenta accreta: a woman whose uterus has a cesarean scar is more likely than a woman with an unscarred uterus to have a future placenta grow through the uterine lining and into or through the muscle of the uterus; this increases her risk for a ruptured uterus (see below), serious bleeding, shock, blood transfusion, emergency surgery, emergency removal of her uterus (hysterectomy), and other complications.
    Added likelihood for a woman with at least one previous cesarean: MODERATE for placenta accreta in a future pregnancy
  • placental abruption: a woman whose uterus has a cesarean scar is more likely than a woman with an unscarred uterus to have a future placenta detach from her uterus before the baby is born; this increases her risk for severe bleeding, shock, blood transfusion, blood clots, planned or emergency cesarean delivery, and other complications, and it may reduce oxygen and nutrients to her baby
    Added likelihood for a woman with a previous cesarean: MODERATE for placental abruption
  • rupture of the uterus: a woman whose uterus has a cesarean scar is more likely than a woman with an unscarred uterus to have the wall of the uterus give way in a future pregnancy or labor, especially at the site of the scar; this increases her risk for severe bleeding, shock, blood transfusion, blood clots, planned or emergency cesarean delivery, emergency removal of the uterus (hysterectomy), and other complications; whether a woman plans a repeat cesarean or a VBAC (vaginal birth after cesarean), she is at greater risk for a ruptured uterus than a woman with no previous cesarean.
    Added likelihood for a woman with a previous cesarean: MODERATE for rupture of the uterus

What are some concerns about effects of cesareans on future babies (when a baby grows in a uterus with a cesarean scar)?

A placenta that grows in a uterus with one or more scars from a previous cesarean section may not do as well at providing oxygen and nutrients to the developing fetus compared with a placenta growing in an unscarred uterus. This may cause life-threatening problems. The likelihood of the following problems may increase as the number of previous cesareans increases. 

In comparison with a baby that develops in a uterus with no cesarean scar, a baby that develops in a uterus with a cesarean scar is at increased risk for the following problems: 

  • death: a baby who develops in a uterus with a cesarean scar appears to have an increased risk of dying before (stillbirth) or shortly after birth compared with a baby who develops in an unscarred uterus.
    Added likelihood for a baby who grows in a uterus with a cesarean scar: MODERATE for death of the baby
  • low birthweight and preterm birth: a baby who develops in a uterus with a cesarean scar may be at higher risk for being born too small (low birthweight) and for being born too soon (preterm birth) than a baby who develops in an unscarred uterus.
    Added likelihood for low birthweight and preterm birth cannot be determined from studies examined
  • malformation: a baby who develops in a uterus with a cesarean scar may be at higher risk for having a physical malformation that develops before birth than a baby who develops in an unscarred uterus.
    Added likelihood for malformation cannot be determined from studies examined
  • central nervous system injury: a baby who develops in a uterus with a cesarean scar may be at higher risk for having a brain or spinal cord injury than a baby who develops in an unscarred uterus.
    Added likelihood for central nervous system injury cannot be determined from studies examined

Potential Risks of Epidurals during Labor and Delivery

Potential Risks of Epidurals during Labor and Delivery

What Is an Epidural?

Epidural anesthesia or analgesia refers to total or partial loss of sensation in the trunk between the fundus and the pubis or lower. An anesthetic agent (such as Marcaine, Lidocaine or Carbocaine), a narcotic (such as Demerol, Morphine, or Fentanyl), or a combination of the two, is injected in the lower back in the epidural space between lumbar vertebrae two and five (L-2 andL-5).Some use the terms anesthesia and analgesia to refer to the agents used: anesthetic agents or analgesics (narcotics). Anesthetic agents numb the area; epidural narcotics, if used alone, diminish but do not completely eliminate labor pain. Others use the terms to describe the amount of pain relief. Anesthesia, as with a standard epidural, is the total loss of the sensations of labor. Analgesia, as with a light epidural is the partial loss.Epidural narcotics are being used for labor in some centers, but are presently less available than the anesthetics.1 Today, epidural narcotics are more often used for post-cesarean pain; a single dose administered in the delivery room provides approximately 24 hours of pain relief. The cost of an epidural, including the anesthesiologist and hospital fees, ranges between $700 and $1,200.

Potential Risks
Epidural blocks carry some risks to the mother, fetus and newborn. Undesired effects tend to be greater with larger doses of medication, a longer interval during which the medication is in effect and immaturity or distress in the fetus.

Undesired effects on the mother:
  • Inadequate pain relief (up to 10%)4
  • Rise of the mother’s oral and vaginal temperature 5, beginning within one hour after administration of the epidural, which may lead to treatment of the mother and baby for non-existent infection. This effect may be dose-related. This recent finding from England is being investigated in the United States.6
  • Drop in the mother’s blood pressure treated with position changes, oxygen and possible vasopressors (less likely if a bolus of IV fluids is given before the epidural).
  • Short or long-term postpartum backache from bruising caused by the injection or from ligament strain caused by prolonged time spent in a damaging position or inappropriate movement (for example, extreme passive flexion of the mother’s trunk, hips and knees during the second stage, or sudden vigorous movements of the mother) while her muscles are relaxed and her back is numb (up to 19%). Long-term backache is almost twice as likely to occur with an epidural than without.7
  • Possible unintentional spinal block and resulting spinal headache requiring days of bed rest and a blood patch.
  • Shivering may be reduced with lower doses, by warming of the anesthetic before administration, or by adding narcotics to the anesthetic.8
  • Mild to severe itching of the skin (with narcotics)
  • Retention of urine, requiring a bladder catheter1
  • Mother feels detached from the process and becomes an observer; others may reduce emotional support. The nurse can no longer assess labor progress by observing the mother and must rely more on the monitor and vaginal exams.9
  • Problems caused by human error or maternal structural anomaly, such as inability to place catheter properly; inadvertent injection of anesthetic into a blood vessel; or too much anesthesia, affecting respiration and swallowing (rates vary with skill of the practitioner and anatomy of the mother).
  • Rare complications, such as residual numbness or weakness from needle injury to nerves (almost 1 in 10,000)10, delayed respiratory depression with epidural narcotics (up to 12 hours later)8, and brain damage and death (extremely rare)11.
Undesired effects on the labor:
  • May slow labor, requiring Pitocin; and has been found to increase the chances of a cesarean delivery in primigravidas by two or three times.12
  • Often slows second stage by reducing or eliminating the normal surge of oxytocin; and by reducing pelvic floor muscle tone, which may lead to more deep transverse arrests or persistent occiput posteriors. In addition, forceps or vacuum extractor are required more often (20-75%). Delaying pushing until the fetal head is on the perineum reduces the need for forceps. Even though this approach lengthens the second stage, it does not increase the incidence of fetal distress.13
Undesired effects on the fetus:
  • Abnormal heart rate patterns, requiring oxygen to the mother, position changes and possible cesarean delivery.
  • Increased likelihood of newborn septic workup, IV antibiotics and isolation in the nursery if the mother develops an “epidural fever” that causes fetal tachycardia or newborn fever.
  • If the fetus is already stressed greater amounts of the medication are “trapped” in the fetal circulation, leading to more pronounced newborn effects (see below).
Undesired effects on the newborn:
  • Short-term (six weeks or less) subtle neurobehavioral effects, such as irritability and inconsolability and decreased ability to track an object visually or to shut out noise, bright light.4 There are no data on potential long-term effects.
  • Possible less efficient or less organized initial rooting and suckling behavior. Nurses have reported more difficulties in feeding babies whose mothers had an epidural when compared to unmedicated babies.6
  • Decreased infant responsiveness may lead to long-term consequences for the parent-infant relationship.14 Parents should be counseled to give their babies time to recover from the birth and medication and should avoid a label of “difficult child” or “incompetent mother.”
    1Dickersin, K. “Pharmacological Control of Pain During Labor.” In: Chalmers, I., Enkin, M., Keirse, M., eds, Effective Care in Pregnancy and Childbirth. New York: Oxford University Press, 1989.
    2Shnider, S.M., Abbound, T.K., Artal, R., Henriksen, E.H., Stefani, S.J., Levinson, G. “Maternal Catecholamines Decrease During Labor After Lumbar Epidural Anesthesia.” American Journal of Obstetrics and Gynecology147(1):13-15, September 1983.
    3Ramos-Santos, E., Devoe, L., Wakefield, M., Sherline, D., and Metheny, W. “The Effects of Epidural Anesthesia on the Doppler Velocimetry of Umbilical and Uterine Arteries in Normal and Hypertensive Patients During Active Term Labor.” Obstetrics and Gynecology, 77(1):20-25, January 1991.
    4Avard, D.M., and Nimroof, C.M. “Risks and Benefits of Obstetrical Epidural Analgesia: A Review.” Birth 12(4):215-225, Winter, 1985.
    5Fusi, L., Maresh, M., Steer, P., and Beard, R. “Maternal Pyrexia Associated With the Use of Epidural Analgesia in Labour.” The Lancet, 1250-1252, June 3, 1989.
    6Reinke, C., Clinical Nurse Specialist at Virginia Mason Hospital, Seattle Washington,Personal communication, June 1991.
    7MacArthur, C., Lewis, M., Knox, E.G., and Crawford, J.S. “Epidural Anesthesia and Long-Term Backache After Childbirth.” British Medical Journal, 301:9-12, July 7, 1990.
    8Lui, W.H.D., and Luxton, M.C. “The Effect of Prophylactic Fentanyl on Shivering in Elective Cesarean Section Under Epidural Analgesia.” Anaesthesia 46:344-348, 1991.
    9McKay, S., and Roberts, J. “Obstetrics by Ear,” American Journal of Midwifery 35(5):266-273, Sept/Oct 1990.
    10Scott, D.B. and Hibbard, B.M. “Serious Non-Fatal Complications Associated With Epidural Block in Obstetric Practice.” British Journal of Anaesthesia, 64:537-541, 1990.
    11Chadwick, H., Posner, K., Caplan, R., Ward, R., and Cheney, F. “A Comparison of Obstetric and Nonobstetric Anesthesia Malpractice Claims.” Anesthesiology, 74(2):242-249, February 1991.
    12Thorp, J.A., Parisi, V.M., Boylan, P.C., Johnston, D.A. “The Effect of Continuous Epidural Analgesia on Cesarean Section for Dystocia in Nulliparous Women.” American Journal of Obstetrics and Gynecology 161(3):670-675, September 1989.
    13Maresh, M., Choong, K.H., and Beard, R.W. “Delayed Pushing with Lumbar Epidural Analgesia in Labour.” British Journal Obstetrics and Gynaecology 90(7):623-627, July 1983.
    14Lester, B.M., Als, H., Brazelton, T.B. “Regional Obstetric Anesthesia and Newborn Behavior: A Reanalysis Toward Synergistic Effects.” Child Development 53:687-692, 1982.

Thursday, July 19, 2012

Wednesday, July 18, 2012

Owning Your Health

Owning Your Health

Chiropractic Care and Lifetime Health
Regular chiropractic care is a key ingredient in the mix of activities that result in lifetime health. A healthy diet - consistently eating balanced, nutritious meals with plenty of fresh fruit and vegetables during the day - is very important. Regular vigorous exercise - three to five times per week for at least 30 minutes a session - is another important component. Getting sufficient rest, more often than not, is another critical piece of the health puzzle. If you're doing all these things, you're doing a lot. When you add regular chiropractic care to your weekly, biweekly, or monthly schedule, you're substantially enhancing the value of all your other health activities.
In a word, by helping to maintain the health and proper functioning of your body's master system - your nerve system - regular chiropractic care helps you get the most out of your diet, your exercise, and your rest. Regular chiropractic care helps make it possible for you to function at your maximum, and when that's happening you are likely to be enjoying peak health and well-being.
Recent discussions in the scientific literature are focusing on monitoring and possibly improving cardiovascular health in children. There's been a lot of conversation and a lot of controversy. An article in the Journal of the American Medical Association1 argued that universal screening of children could result in young people being put on cholesterol-lowering drugs such as statins. And, according to certain experts, there just isn't sufficient medical evidence to justify such prescriptions.

These are not new proposals. In July 2008 the American Academy of Pediatrics recommended that some children as young as 8 be treated aggressively with cholesterol-lowering drugs.2 Soon thereafter, in November 2008, researchers recommended that statins be prescribed for millions of healthy people with normal cholesterol levels.3

What's going on here? Healthy adults and healthy children should take drugs? How can we make sense of these medical controversies and how can we take action that is actually appropriate to the health and well-being of ourselves and our children?

First, it's very important to take responsibility. That's difficult, because it seems that we live in a culture of denial. No one is responsible for anything. "Twinkies made me do it." "I have bad genes." "It's not my fault."

A person's health is usually evaluated in the same way. Who is responsible for a lifelong two-pack-a-day smoker developing lung cancer? The tobacco company, of course. Who is responsible for someone gaining 50 pounds in a year? Well, the fast food chain is responsible. Who is responsible for hundreds of thousands of Americans developing diabetes each year? Candy manufacturers, naturally. Throw in doughnut-makers, too.

But, people are actually responsible for their own actions. Going further, in many cases people are partly responsible for the diseases and disorders they develop. It's not that I'm a bad person, but I may be making choices that aren't in my own best interests.

"Lifestyle health" is a relatively new term being used by many researchers and health practitioners. From a lifestyle perspective, many cases of diabetes, overweight and obesity, and high cholesterol are caused by lifestyle choices. High-fat diets, high-sugar diets, lack of daily fruits and vegetables, and lack of exercise will cause people to develop diabetes, obesity, and high cholesterol.

Lifestyle health is directed at causing people to choose healthy behaviors.4

So taking statins when you're healthy to prevent high cholesterol and associated cardiovascular and inflammatory disorders is highly questionable. Giving medicines - whose long-term effects are largely unknown - to children makes even less sense.

Am I going to choose risky behaviors for myself and recommend risky behaviors for my children, causing us to possibly need medications down the road, or am I going to choose and recommend healthy lifestyles and take responsibility for my health and well-being and that of my children?

Statins like Crestor and Lipitor have certainly helped millions of adults with serious health problems. Still, taking these medications is like slamming the barn door after the horse has run away.

Let's see. If I'm healthy now, will I choose to maintain my good health by regular exercise, a consistent healthy food plan, and sufficient rest? The choice seems clear.

1Psaty BM, Rivara FP: Universal screening and drug treatment of dyslipidemia in children and adolescents. JAMA 307(3):257-258, 2012
2Daniels SR, et al: Lipid screening and cardiovascular health in childhood. Pediatrics 122(1):198-208, 2008
3Ridker PM, et al: Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. NEJM 359:2195-2007, 2008
4Chan AT, Giovannucci EL: Primary prevention of colorectal cancer. Gastroenterology 138(6):2029-2043, 2010

Interval Training and Cardiovascular Health

Interval Training and Cardiovascular Health

Chiropractic Care and Cardiovascular Exercise
Regular chiropractic care supports all your exercise activities. The converse is true as well, Regular exercise helps support chiropractic care.
In order to get the most out of the valuable time we spend exercising, we want to ensure that our musculoskeletal system is working effectively and efficiently. Bones, joints, and muscles need to be able to go through a full range of motion in order to exercise properly. Any limitation of mobility might cause an injury, which would not only be painful but would set back our normal exercise schedule.
By helping make sure that your muscles, bones, and joints are working at their best, regular chiropractic care helps you enjoy a full exercise program and reap all the benefits that exercise brings.
Interval training is an important part of aerobic exercise. If you're a walker or a runner, run intervals once a week. Walking and running build endurance by strengthening your cardiovascular system. Doing interval training once a week enhances your endurance by dramatically increasing the amount of blood your hear pumps every time it beats.1 (This is known as your cardiac stroke volume.) Interval training also increases the amount of oxygen you can take in on each breath.2 (This is known as your respiratory vital capacity.) The result is that you have noticeably increased speed and increased reserves when you need a prolonged burst of energy.
The same principles apply for any type of aerobic activity. . The interval system is easy to apply. For example, if you're a swimmer, you can do interval training with laps. If you ride a bike, you can do intervals with timed sprints.
There many books and magazine articles available to help you add interval training to your aerobics program. If you're doing aerobics exercise three times per week, you could use one of those sessions for interval training. Interval training is very powerful and the most important thing is to build up gradually.
To begin, you need to have a good base, meaning you do aerobic activity for at least 30 minutes. Using running as an example, you might be running 10-minute miles in at a fast "race pace". Ten minutes per mile is 2.5 minutes per quarter-mile. On your interval day, warm up by lightly jogging 1 mile. Then run four quarter-miles at a pace a bit faster than your race pace. In this example, you could run four quarter-miles at 2:25 or 2:20 per quarter. Then finish by lightly jogging for another mile.
Over time, your interval pace gets faster. You could do intervals with half-miles, three-quarters of a mile, or even a mile, if your weekly mileage supports such an interval distance. Most of us will see remarkable benefits by doing quarter-mile or occasional half-mile intervals.
One obvious result is that your resting pulse drops like a stone, because your heart is being trained to pump more blood each time it contracts. In this way, you save wear and tear on your heart. Owing to your heart's stroke volume, your heart beats less during the course of the day to provide the amount of blood you need flowing to your tissues.3 The takeaway is that your heart will last longer because you're doing intense vigorous exercise. That's a pretty remarkable result.
The bottom line is that interval training makes you stronger and faster. Your heart and lungs get a terrific workout with each interval training session. There's a big payoff for this once-a-week activity.
1Molmen HE, et al: Aerobic interval training compensates age related decline in cardiac function. Scand Cardiovasc J 2012 Jan 24 (Epub ahead of print)
2Dunham C, Harms CA: Effects of high-intensity interval training on pulmonary function. Eur J Appl Physiol 2011 Dec 23 (Epub ahead of print)
3Hwang CL, et al: Effect of aerobic interval training on exercise capacity and metabolic risk factors in people with cardiometabolic disorders: a meta-analysis. J Cardiopulm Rehabil Prev 31(6):378-385, 2011

Deep-Dish Cookie Pie! I think I need to try it!

Deep-Dish Cookie Pie

What’s black and white
And even better than a warm chocolate chip cookie?
chocolate chip cookie pie
If you answered, “Katie, nothing is better than a warm chocolate chip cookie,” you’ve obviously never met a cookie pie. (Above, topped with a super-healthy ice cream recipe I’ll post next week.)
Warm. Chocolate. Gooey.
This pie is everything you’d want in a cookie.
Except, oh yes, it happens to be five times thicker!
I could sit here and tell you about how I was in charge of dessert for our neighborhood Memorial Day party. I could tell you about my desire to wow the neighbors with a sinful-tasting finale and then surpriseshock them by revealing said sinful dessert was really not so sinful after all. I could tell you how this desire became reality when my dessert was the hit of the party, with everyone raving about it and one neighbor even hiring me to make a pie for her husband’s birthday in June.
But really, you don’t want to know all of this, do you? You just want the recipe.
deep dish cookie pie
Side note: If you make 1/4 of the recipe, you can put it in a mini springform pan for a baby pie, like the one above. And if you make a half recipe in a shallow pan, you can have… a healthy cookie cake!! (You know, like the ones at the Great American Cookie Co in the mall?)
Deep-Dish Cookie Pie
  • 2 cans white beans or garbanzos (drained and rinsed) (500g total, once drained)
  • 1 cup quick oats (or certified-gf quick oats)
  • 1/4 cup unsweetened applesauce
  • 3 tbsp oil (canola, veg, or coconut)
  • 2 tsp pure vanilla extract
  • 1/2 tsp baking soda
  • 2 tsp baking powder
  • 1/2 tsp salt
  • 1 and 1/2 cups brown sugar (EDIT: click for a Sugar-Free Version.)
  • 1 cup chocolate chips
Blend everything (except the chips) very well in a good food processor (not a blender). Mix in chips, and pour into an oiled pan (I used a 10-inch springform pan, but you can use a smaller pan if you want a reallydeep-dish pie.) Cook at 350F for around 35-40 minutes. Let stand at least 10 minutes before removing from the pan. (Some commenters have had success with a blender, but I did not. Try that at your own risk, and know the results will be better in a high-quality food processor such as a Cuisinart.)
Inspired by this popular recipe:
(Calorie Note: I haven’t calculated the calories for this recipe, but a few of the commenters did. According to their calculations, the pie will have around 200 calories per slice, as opposed to 700 in a slice of traditional deep-dish cookie pie.)
cookie pie unblurred
Perhaps calling it “healthy” is a stretch. After all, there’s still sugar, and there are still chocolate chips. But in comparison to your standard cookie pie—with its plethora of butter, eggs, and white flour—the above version is a much healthier alternative, while still tasting just as naughty. Plus, you get lots of fiber and protein from the oats and chickpeas.
And I promise no one can tell that these ingredients are in there. (For proof: just read all of the comments on this post!) This dessert is a real crowd-pleaser, even with people who aren’t used to eating healthy desserts.
cookie pie
Imagine cookie dough in the form of a pie.