Archive for the 'Medical' Category

Happy Birthday to “The Pill”

Tuesday, August 10th, 2010

Happy Birthday to “The Pill”—5-2010

© Richard Grossman MD, 2010

It was fifty years ago that the Food and Drug Administration approved “the pill”. What a half-century it has been!

The birth control pill made it possible for couples to have sex without concern about pregnancy. True, before hormonal contraceptives there were other contraceptives—but the condom, diaphragm and spermicide took away much of the spontaneity of sex. One of the advantages of the pill is that it separates contraception from intercourse.

Shortly before getting married in 1966 my wife visited a doctor to get on birth control pills. I remember that she brought home a bottle of tablets. Packaging has changed since then with the package helping the woman to remember to take her pill. There is even a pill pack with a reminder alarm!

The amount of hormone in each tablet has also changed; it has decreased immensely. The estrogen in today’s low dose pill is one seventh that of the first pill. If you have wondered why pills are different colors for different days, it is because many of today’s oral contraceptives vary the dosage during the month to get good cycle control with a very low level of hormones.

One formulation is not optimal for all women. Although all of today’s combined pills contain the same estrogen, the dosage varies between 20 and 50 micrograms. They also have different progestins (hormones similar to the other major hormone the ovary produces, progesterone). Some are excellent in controlling menstruation, others excel at helping with acne and others are best in alleviating PMS.

Initially every woman took active hormone pills for three weeks then stopped (or took placebos) for a week, then went back on the active pills again. That pattern has changed. Some pill formulations are designed so that the woman only menstruates every three months, and one prevents any bleeding at all. Suppressing periods is especially helpful for women who have problems such as heavy bleeding or bad cramps. We now recommend against a “vacation” from hormonal contraception—this only increases the risk of pregnancy.

“The pill” is one of several ways a woman can take hormones. In China the hormones are available as little dots on rice paper. We have patches that women wear; the hormones are delivered through the skin. There is also a plastic vaginal ring that slowly emits the hormones.

Of the two hormones, the progestin is the one most responsible for controlling fertility; the estrogen is added for cycle control. Unfortunately, the estrogen also increases the chances of blood clots, stroke and heart attack, especially in older women and those who smoke.

Progestin-only contraception without estrogen is available in “the minipill”, in a shot that is effective for 3 months, as an implant that goes under the skin of a woman’s arm, and in an IUD. All of these methods have the advantage of safety, but they often cause erratic bleeding.

We prescribe “the minipill” for women who are breastfeeding and for older women and those who are at risk of blood clots. This pill carries a very low risk of blood clots, but has a higher pregnancy rate and many users have irregular bleeding. It is important to take it at the same time every day, preferably at night.

Emergency contraception is a high dose of progestin that can prevent pregnancy when taken after unprotected intercourse. Although it can cause nausea, it has no serious risks and is up to 90 percent effective.

Birth control pills are safe for almost all women despite the slightly increased risk of blood clots. There are many beneficial side effects, including less bleeding and pain with periods, more predictable periods, and fewer ovarian and breast cysts. They also decrease the risk of developing several types of cancer. Overall, studies show that women who use “the pill” live longer than women who are “pill-free”.

“The pill” caused a revolution. This was the first widely available family planning method, and allowed women to have a sexual relationship without fear of pregnancy. It also has been a large part of programs that have slowed the growth of the human population. Historically, our growth was controlled by high mortality rates, especially by the deaths of children. It is much better to prevent undesired pregnancies than to rely on high mortality rates.

We just spent Mother’s Day with our son Dave, who was conceived after we had been married several years. Gail, my wife, took “the pill” and it was a blessing that we could wait before starting our family.

This article may be copied or published but must remain intact, with attribution to the author. I also request that the words “First published in the Durango Herald” accompany any publication. For more information, please write the author at: richard@population-matters.org.

Feminize Medical Care

Tuesday, August 10th, 2010

Feminize Medical Care—4-2010

© Richard Grossman MD, 2010

May God bless you with discomfort at easy answers, half truths, and superficial relationships, so that you may live deep within your heart;

May God bless you with anger at injustice, oppression, and exploitation of people, so that you may work for justice, freedom and peace;

May God bless you with tears to shed for those who suffer pain, rejection, starvation, war and loss, so that you may reach out your hand to comfort them and turn their pain into joy;

May God bless you with enough foolishness to believe that you can make a difference in this world, so that you can do what others claim cannot be done;

May God bless you with God’s comforting presence now and in your journeys through each day.

Franciscan blessing

Read by Reverend Ginny Brown at Dr. Leanne Jordan’s memorial service

My first year medical school class had 125 students in it; only six were women. Now half of medical students are women.

I did my specialty training at the University of New Mexico and was surprised that several other residents in obstetrics and gynecology came from medical school in Denver. The former chair of the OB-GYN department excluded women from his program. Imagine not letting women learn to care for women! Fortunately that has changed; now only two of thirty-six OB-GYN residents at the University of Colorado are male.

A friend studied the culture of operating rooms for his doctorate in sociology. He noted a huge change from the 1960s to the present. Men initially dominated—both figuratively and literally—and many OR nurses lived in terror of the behavior of surgeons. As more women became surgeons the ethos improved. The OR became a kinder, gentler place, and patients benefited as well as the staff. Worldwide, empowerment of women is one of the most important steps we can take to slow population growth.

Women in medicine often take off time to have children and to raise their family, so female doctors may take longer to finish their training. I am proud of our daughter-in-law, Dr. Stephanie Shrago, for excelling in med school and family practice residency and having two wonderful daughters. Of course, I also have to thank our son Dave who does a lot of our granddaughters’ care.

Another remarkable physician with whom I practiced for almost twelve years just died. Dr. Leanne Jordan’s memorial service was held earlier this month with an overflow crowd of admirers. Speakers at the service recalled Leanne’s talents: an amazing athlete, empathetic friend and an outstanding doctor. When we worked together in the operating room I felt as though I were energized with a second cup of coffee, because she was always so quick—but careful—during surgery.

One friend said that Leanne’s smile would light up a whole room. I knew about many of her accomplishments and numerous athletic skills that were mentioned during the service. I will never forget the story of her skinny-dipping with a friend after rowing practice when some guys moved their clothes away from the river’s bank.

Leanne died of the breast cancer that she fought valiantly for years. I admire her for being the “poster child” for cancer treatment. She did not hide the fact that she was battling the disease. This openness was a source of solace for others with serious illnesses, and an encouragement to get screened for cancer.

Early detection of breast cancer is key to its cure, as with many other diseases. Breast self exam is good, but mammograms can detect disease long before it can be felt.

Mercy has just opened its state-of-the-art Breast Care Center. It has the latest equipment for the diagnosis of breast problems. In addition, it is beautiful. Stunning art, a fireplace and the dragonfly motif help to soften the usual medical atmosphere.

In the past I heard complaints about pain caused by mammograms, but I don’t any more. That may be because the new digital machines are faster. They are safer, too, since they use less radiation.

Regrettably, not all women have health insurance to cover mammography. There are programs to help women older than 40, so finances shouldn’t be a reason to avoid this important test. The criteria are confusing for the different programs, so it is best to call B.J. Boucher at the American Cancer Society local office, 259-3527.

We have benefitted from more women participating in medical care. It is sad that we recently lost one of the finest, Dr. Leanne Jordan.

This article may be copied or published but must remain intact, with attribution to the author. I also request that the words “First published in the Durango Herald” accompany any publication. For more information, please write the author at: richard@population-matters.org.

No on Amendment 48

Saturday, February 21st, 2009

The article below may be copied or published but must remain intact, with attribution to the author. I also request that the words “First published in the Durango Herald” accompany any publication. For more information, please write the author at: richard@population-matters.org.

 

No on Amendment 48

© Richard Grossman MD, 2008

 

 

“Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof….” First Amendment to the Constitution of the United States

 

            “I am sorry, Mrs. Folk. There is nothing I can do.” I am in my office, holding ultrasound pictures. The Folks are sitting in front of me, looking dumbfounded. Two of their three children are present; the oldest is at school.

            “These pictures show a tubal pregnancy. It is very early, but we can still see the fetal heartbeat. It is clearly outside of your uterus.” Mrs. Folk is crying now.

             “In the past we used to treat ectopic pregnancies with surgery, or even just medicine. That is not possible now. Your chances of dying from this pregnancy are about fifty-fifty.”

            Approximately one pregnancy in 200 is in the wrong place. Although a woman’s uterus is wonderfully adapted to nourishing a developing fetus, her tubes are not. When a pregnancy grows in the tube, it tears the fragile tissue, causing pain and internal bleeding. Women still die of tubal pregnancies.

            Is the above scenario some sort of science fiction, set in some remote hard-hearted future? No, not if proposed Amendment 48 passes this November election. This scenario could happen right here in Colorado next year.

            Clearly 48 was drafted to stop all abortions in Colorado (even after rape or incest). It is short—and extremely deceptive. Nicknamed the “Personhood Amendment”, 48 reads: “As used in sections 3, 6, and 25 of article II of the State Constitution, the terms ’person’ or ‘persons’ shall include any human being from the moment of fertilization.”

            Section 25 of the Colorado Constitution states: “Due process of law. No person shall be deprived of life, liberty or property, without due process of law.” If a developing fetus (or even a newly fertilized egg) is defined as a person, then anyone who interrupts a pregnancy, no matter if it is potentially lethal to the mother, could be punished. The woman herself would be an accomplice. This would mean that anyone, including a physician who does surgery to save a woman’s life because of a tubal pregnancy, would be subject to the same penalties as a first degree murderer. Would the police have to investigate women who have miscarriages, too?

            The proposed amendment is so extreme that, if 48 were to pass, it would create legal havoc in our state. It would take years and millions of dollars to work out the legal implications.

            This amendment would not only prevent abortion, but it might also prevent many forms of contraception. Antiabortion people claim that hormonal birth control and IUDs cause abortions. Their evidence for this is weak, and is at odds with the majority of medical experts including the American College of Obstetricians and Gynecologists—my professional organization.

            The sad fact is that the amendment would probably increase the number of abortions! Making abortion illegal doesn’t stop women from trying to interrupt pregnancies—it makes them use desperate means. For instance, when abortion became legal in Norway, the abortion rate didn’t increase. Women did get better care, however. Remember that the best way to prevent abortions is with access to good contraception.

            Moreover, proposed Amendment 48 would prevent couples from taking advantage of many infertility treatments. In vitro fertilization would be banned because of the risk of losing an embryo—defined as a person.

            The people who wrote this proposed amendment (and the 131,245 people who signed petitions to put it on the ballot in November) appear to be honest, God-fearing Coloradoans. Their website lists physicians who support the amendment, but very, very few live in Colorado! In fact, they are outsiders testing the waters in our state to see how they can control women’s reproductive lives. Because of their efforts to impose their strict religious beliefs on everyone, they are the closest thing we have in the USA to the Taliban.

            This proposed amendment would punish parents and physicians who believe that all children should be planned and loved. It has been centuries since people were punished so severely for trying to help women control their fertility. There is strong evidence that the motivation to seek out and kill “witches” in Colonial times was to eradicate women who held the secrets of contraception. This was one way men could retaliate against women who knew more than they did.

            Don’t let religious zealots control women’s lives in Colorado. Vote “NO” to proposed Amendment 48. Go to www.protectfamiliesprotectchoices.org for more information.

 

Published October, 2008

Creative Commons Attribution 3.0 United States
This work is licensed under a Creative Commons Attribution 3.0 United States.