Durango Herald Medical


One morning last month I was on my back with a needle in my arm donating blood when my cell phone rang. It was news that my sister had been hospitalized in New Jersey with internal bleeding. She had received four units of blood.

Fortunately I was able to head east a couple of days later to be with her and her husband, David. Clara had had bad health all her life. She had spent much time sick as a child, often in the hospital. She developed a disease of her muscles that caused gradual but serious weakening over the past decade. This is in addition to other health problems, including asthma and two types of painful arthritis.

We spent a few days last June with Clara and her husband in Princeton. It was clear that her health was deteriorating and that she needed hospital care. I stayed with her a couple of hours while the admissions clerk searched for a room. Finally I had to leave to catch a plane to Europe where we sang with the Durango Choral Society.

Clara did not live at her home in the intervening months. She spent weeks in the hospital, then a rehabilitation center, then assisted living center. She was fortunate to find a wonderful woman who stayed with her during this time as her aide. Lidiya, an immigrant from Ukraine, entertained Clara with stories of her past, her family and her culture. Clara told me joyfully about the longest trip that she had taken for months to visit Lidiya’s home in northern Jersey. Lidiya took her mind off her pain and misery—what an angel of mercy she is! Lidiya wrote about Clara: “She really was a gracious lady and very interesting person. Also lovely, sunny and sweet.”

What I feared was true. Clara’s husband, David, and I were walking into the hospital when we encountered one of her doctors. This kind man showed us on the CT where the blood had collected, and also how damaged her lungs were. The scan also showed other signs of deterioration caused by the aging process and disease. She was not the beautiful older sister I had known as a kid growing up.

Surprised to see me (she didn’t know that I was visiting), Clara smiled briefly, but her energy and strength were short-lived. I could see marked decline since we were last together in the fall. Clara was bedridden and barely moved except to turn her head to talk. At mealtime she needed both hands to lift the small bowl of soup. She ate very little. She was in a private room at the end of a hall, she said, because the pain was so severe that at times she screamed out loud. I didn’t need to be a doctor to know that her condition was dreadful.

David told me that Clara had asked about hospice care a year and a half ago. Hospice was not appropriate then, but the time had come. David and I talked it over, and then I suggested to Clara that it might be appropriate. She agreed.

Her doctor agreed that Clara’s condition was hopeless, and that comfort was the best that he could offer. He talked it over with her, determined that she was alert enough to be able to make the decision, and started her on narcotics. The next day I received a call that my dear sister had died.

Writing runs in our family. Our mother decided in third grade that she wanted to be an English teacher. Our father wrote dentistry texts and Clara was a freelance writer. She wrote many articles for magazines and newspapers, as well as two published novels. I was always interested in science and did ok in English in school. Clara gave me a remarkable opportunity twenty-five years ago: did I want to try writing for a new magazine, Women’s World? I submitted a trial article and was selected to compose some of the Gynecologist Columns. She occasionally offered suggestions to improve my writing. Soon I realized that with the word processor I could reach many more people than by just seeing patients in the office. In other words, the pen is mightier than the speculum!

On Clara’s suggestion I approached the Herald with an idea for a book, which turned into this column. Sixteen years later people are reading it both here and outside of Durango.

Please join me in thanking my sister for empowering me to write. Please also join me in mourning her years of illness and recent death.

© Richard Grossman MD, 2011

Contraception Family Planning Medical Reproductive Health

Happy Birthday to “The Pill”

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: