11.09.09
How Will The New Health Reform Bill Benefit Pregnant Women?
“In difficult situations, when hope seems feeble, the boldest plans are safest” said the Roman historian, Titus Livy. On November 7, 2009, 220 members of the U.S. Congress took one of the boldest steps of their political careers and changed the course of history. They voted to pass HR Bill 3200, America’s Affordable Healthcare Act of 2009. I never imagined that doing the right thing could be so difficult.
Memories of tea parties, name-calling-hysteria, gross distortions of truth, gun-toting “patriots” and lobbyist payoffs still haunt me. The ugliness of fear still saddens me however the courage of the “Bold-220” inspires me. I am proud to be an American.
The bravest of all, was perhaps, Louisiana Representative Joseph Cao, a Vietnamese American who represents the New Orleans community. Cao broke ranks with his party to do what “was best for his constituents.” It’s refreshing to see a man of integrity within the midst of political hooligans. Perhaps there’s hope after all.
So, how will this new bill help pregnant women?
- Pregnancy will no longer be considered a pre-existing condition that allowed insurance companies to discriminate and refuse coverage to pregnant women
- You can keep your present healthcare provider and insurance company
- It helps low and middle-income individuals and families purchase insurance through “affordability credits”
- It provides a public health insurance option that breaks up insurance monopolies
- It provides preventive services with no share of cost for mental health services, oral health and vision for children and limits the amount of money you have to spend per year
- It expands Medicaid services to families at or below 133 percent of the poverty level
And most important, it allows me to return to the healing art of medicine. The BUSINESS of medicine will hopefully be dead. And I will not shed one solitary tear.
11.06.09
The Betrayal by Congresswoman Kosmas
No, I’m not psychic, but I can spot a snake-in-the grass when I see one. The procrastination and fence-sitting of Congresswoman Suzanne Kosmas regarding healthcare reform were red flags that she clearly had another agenda. She never had intentions of fulfilling the “will of the people” and “represented” no one but herself.
The Orlando Sentinel reports that Kosmas said: “It was a difficult decision” to vote against her party regarding healthcare reform. She would have preferred the “Senate” version and not “tax the wealthy.” Suzanne, who are you kidding? Please do not insult our intelligence. You rode into Washington on the coattails of a popular presidential candidate and had no intention of serving anyone except your checkbook and bank account. How much did Big Pharma pay you? What under-the-table deals were made? You are spineless, shameful and an embarrassment to the decent citizens of our District. And we WILL have the memory of an elephant. The only reason that I am not picketing your office is because I’m too busy taking care of the medically underserved; the uninsured and the voiceless patients of our community. However, when the campaign begins to boot you out of office, I’ll be the first in line to offer my wholehearted support.
Please do not sign a long-term residential lease in the District of Columbia or its outlying communities because your days are significantly numbered. I intend to support anyone (along with a check) who plans to challenge (and rightfully so) your elected position be it a Republican; another Democrat (hopefully); heck — I’ll even support Daffy Duck or the Cookie Monster.
My late aunt once said: “When the snake bites you once, it’s an accident. When the snake bites you twice – it’s YOUR fault.
Congresswoman Kosmas, I do NOT intend to get bitten again.
11.04.09
FDA Gives Green Light for Unapproved H1N1 Meds!
The panic continues. The FDA had granted the use of unapproved drugs in the treatment of the 2009 H1N1 Influenza virus. Through an Emergency Use Authorization (EUA), the experimental drug, Peramivir has been allowed to treat hospitalized patients with H1N1 influenza that includes pregnant women, babies and children up to age 17. Peramivir is not approved by the FDA for use in the U.S. because its patient safety has not been established.
Peramivir is an antiviral medication, similar to Tamiflu® and Relenza® but is given in the veins. It is helpful for patients who are unable to swallow meds, have an allergy to Tamiflu® or Relenza® or are not responding to oral or nasal medication. However, treatment with Peramivir should be considered a “Hail Mary Pass.” It is used when all else has failed. While the FDA believes that known and potential benefits of Peramivir outweigh its known and potential risks, a closer look at the FDA’s statistics is on order.
According to the Emergency Use Authorization of Peramivir IV Fact Sheet for Health Care Providers the following statistics are enlightening:
• Only 1,891 clinical trials patients in the US were given any form of the drug
• Out of 1,891 patients tested, NONE were children, pregnant women or nursing mothers
• Out of the 1,891 clinical trial patients, only 478 received a “single-dose” regimen similar to what might be given in a hospital setting
• Out of 1,891 patients, only 33 patients received a 600 mg dose for five days or greater
It is not surprising that the drug cannot be deemed “safe” with such a small patient sample.
The FDA also reports that 10 percent of all human subjects experienced adverse events including four percent who received the 200 mg dose and seventeen percent who received the 400 mg dose. The most frequent adverse reaction was pneumonia. The FDA recommends a 5-to-10 day treatment of Peramivir 600 mg given once per day.
Let’s hope we will remain healthy and never have the need for Peramirvir. However knowledge is power. At least we now have the facts.
11.02.09
Drowned Pregnant Woman Brought Back to Life!
Every day we look in the mirror, see our reflections but are not astute enough to recognize that we are viewing a miracle. However, Sade Davis knows otherwise because she is pregnant and was technically dead. (See Paramedics Bring Drowned Pregnant Woman Back to Life, NBC News, Keith Garvin and Matthew Stabley).
Davis is a 23-year-old pregnant mom from Prince George County, Maryland whose car veered off the road and ended up in a nearby creek. Miraculously someone saw what happened and moved into quick action. People from Fire Station 825 were on their way to another call when the eye-witness jumped in the middle of the road and flagged them down for help. Firefighter David Wilson and Lieutenant Dale Giampetroni pulled Davis out of the car and found her breathless and without a pulse. They performed CPR and brought Davis back to life. Both mom and unborn baby are alive and awaiting the baby’s delivery. Someone told Davis that it was obvious her baby was meant to be here which brings me to my next point.
There are no accidents, coincidences or “chance occurrences” in the human experience. And there certainly are no “accidents of birth.” Millions of sperm are given the assignment of fertilizing an egg that resides outside of the uterine cavity in the ovary. The uterine cavity is a hostile environment to the well-meaning sperm and yet it somehow overcomes the adversity of the uterus, travels inside the fallopian tube where it drills through the protective covering of the egg in order to gain entrance for fertilization. That’s not an easy task my friends, just ask any infertility patient.
Our presence on this planet is nothing short of a miracle. We are ALL supposed to be here to share our special gifts during the human experience.
The story of Sade Davis inspires all of us to recognize that you do not need to have a near-death experience to in order to experience miracles. Just look at your reflection in the mirror, and then give your Creator some praise.
10.28.09
Pregnancy and Insurance Discrimination: Turn Up the Volume
Do Insurers Discriminate Against Women?
The ABC story, Pregnancy and Discrimination, was repulsive. A previous cesarean section is now considered a pre-existing condition that prevents women from receiving insurance. Women must pay higher premiums or have a mandatory sterilization if they choose to be insured. No, you didn’t misread the statement. The Golden Rule Insurance Company had the temerity to become “Big Brother.” What a blasphemous name.
Contrary to misinformation and propaganda, there are very few cesarean sections that are done based on maternal request. Most are done because of fetal distress when the baby is not receiving adequate oxygen and faces the possibility of death. Once an emergency is detected, the physician has thirty precious minutes to perform the procedure in order to save the baby’s life.
Do you recall the miraculous landing of US Air Flight 1549 on the Hudson River in New York City? We commended Captain “Sulley” for his heroic feat without hesitation. However, would his passengers now have a “pre-existing condition” because they were involved in an airline emergency? Of course not. Why so for women? Why are women charged up to 48 percent more for insurance than men?
According to ABC, there are only eleven states that prohibit health insurers from gender discrimination regarding the cost of premiums. The remaining thirty-nine states are fair game for continued exploitation. Healthcare reform is not a lofty ideal with a partisan agenda. The future of our humanity lies within sacred wombs.
After the ABC interview and article became public, The Golden Rule Insurance Company changed their ruling and will now insure women with previous cesarean sections.
Thank you, Senators John Kerry and Barbara Miluski for not only bring this issue to the forefront but for introducing legislature to bring these egregious practices to a screeching halt. Let’s keep beating the drums and greasing the wheels. Sometimes when the volume is turned up high, people eventually listen.
10.26.09
An H1N1 PregnancyTragedy
The New York Times story of Aubrey Opdyke, Flu Story: A Pregnant 
Woman’s Ordeal (Donald G. McNeil Jr.) is a compelling example of why obstetricians get sued. Opdyke’s calamity could have been avoided, if someone had not been sleeping at the wheel.
As an expert medical reviewer, reading this case was an exercise in frustration. What on earth was her obstetrician thinking?
Opdyke is a 27 year-old waitress who had one previous delivery and was 27 weeks pregnant when she developed mild “flu-type” symptoms. Although she was a former high school swimmer, she was also a smoker – and that is the operative word. Smoking in pregnancy is a risk factor for multiple complications and has a direct effect on the lungs.
She called her obstetrician with complaints of “flu-like symptoms” and was advised to take acetaminophen. It didn’t work. She called the obstetrician AGAIN and was prescribed an antibiotic. She never developed a high fever but continued to experience body aches and exhaustion. One week later, she became delirious. Opdyke had H1N1 Influenza.
She subsequently developed pneumonia, spent four months in the hospital on a ventilator, suffered six collapsed lobes of her lungs, had a seizure, and an emergency cesarean section. Her baby lived for seven precious minutes then expired. However through Divine intervention and meticulous hospital care, Opdyke miraculously went home but remains extremely exhausted and now walks with the aid of a walker. She didn’t sue her obstetrician. She was simply grateful to be alive.
There were fundamental mistakes made in the management of Opdyke’s case that warrant discussion:
- Patients CANNOT be diagnosed over the phone. The second call from Opdyke should have alerted her obstetrician that an emergency appointment was warranted. Her smoking history placed her at risk for developing lower respiratory infections.
- She was inappropriately given an “antibiotic” without the benefit of receiving a physical exam. What was her obstetrician treating? What was the diagnosis?
- A stethoscope placed on her back and chest might have altered the patient’s outcome dramatically.
- Unless one has recently arrived from another galaxy, any practicing physician should have their antennas upright for the possibility of detecting H1N1 influenza.
Opdyke’s case is a tragedy that should not have happened. These are the types of preventable medical errors that inspired me to write The Smart Mother’s Guide to a Better Pregnancy. Pregnant women must learn how to become vigilant during their pregnancies, even when their providers aren’t paying attention.
Let’s all pray for Opdyke’s continued recovery and that she never encounters this nightmare again.
10.21.09
H1N1 Symptoms and Your Pregnancy!
It’s been approximately six months since the 2009 H1N1 virus was detected, yet the conversations continue to flourish. The gravity of the subject matter keeps the discussions flowing and much can be learned by pregnant women who not only have to protect themselves but their unborn children as well.
When a human face is placed on the name of a disease, it takes on a completely new meaning. Such was the case when one of my pregnant patients showed up at the receptionist’s window requesting an emergency appointment.
She was in her mid-thirties, had two children and was in her early third trimester. She reported having a headache, no fever but was coughing for the past four days. Despite taking Tylenol® and over-the-counter medicines, her cough still persisted and she “felt bad”. The receptionist asked if I could see her because the clinic was extremely busy. My instincts immediately said “yes” despite her not having a tell-tale fever.
When the patient walked into the exam room, I immediately requested protective masks. She looked extremely lethargic and was coughing uncontrollably. She stated that her 9 year-old-son had caught “it” first, and now she was affected. I tested her for H1N1 based on CDC’s recommendation but did not wait to get results back before I treated her for what was a presumed diagnosis of a seasonal flu and possible Bronchitis.
Two weeks later, her tests confirmed the 2009 H1N1 virus but she had fully recovered. I was very grateful that we all wore masks and that the medication worked. I advised her that because she’s already had the flu a vaccine was not necessary. Her body has produced antibodies that should protect her as well as her unborn child from any future infections.
There are lessons to be learned from every patient:
- A pregnant woman can have the H1N1 virus despite not having a fever
- Older pregnant moms are probably more susceptible to developing pneumonia and should be treated with an antibiotic in addition to antiviral medication
- Treatment should NOT be delayed until the lab results are available
- Pregnant women should see their healthcare practitioner immediately if they have a persistent cough, running nose, body aches and/or headaches
- Most infections resolve if given the proper treatment and attention
- Check with your local pharmacy to make certain that Tamiflu® is available in the event that you need it
For more information on H1N1, please visit http://www.flu.gov and look for my in-depth article regarding the H1N1 flu and pregnancy on LifeScript.com in the immediate future.
10.19.09
The Gift. A Day in the Life of An OB-GYN
During a routine prenatal visit, I noticed a nineteen year old pregnant mom had lost weight which is unusual in the second trimester. When I asked why, she lowered her head, said that she had paid a traffic ticket and hadn’t been eating well because there wasn’t much food in her freezer. She presently lived with her brother and sister and I’m not certain what happened to her parents. She was on a fixed income, receiving a monthly disability benefit and the traffic ticket affected her budget for the next two months.
I inquired whether she had visited any food pantries or applied for food stamps. Yes, she had applied the previous week and was waiting to receive a response. I offered to write a letter to expedite the process but knew I had to make a deeper decision. Do I passively listen to her complaint or become a pro-active physician?
I reflected on the fragility of my own life at age 19 and my difficult navigation into adulthood. I glanced at her pregnant belly and told her that before her exam was over, she’d have some money for food. My medical assistant of thirteen years rolled her eyes, sucked her teeth and muttered a sigh of frustration in Spanish. “You know she’s playing you,” she mumbled underneath her breath. “You’ve got a kind heart Dr. Galloway but you’re too nice. Let her go to a pantry. Somebody will help her.”
I’m a native New Yorker so I know the drill quite well. Yes, there are people who mistake kindness for weakness. And yes, there are patients who tell lies. However, I couldn’t ignore the patient’s weight loss or her unborn baby who needed nutrition, so I bought her a $30.00 gift card from the local supermarket.
Was it a scam? Who knows for sure? All I know is that the true gift is what comes from our heart.
*A Day in the Life© is a copyright series written to illustrate the challenging cases of pregnancy and the importance of receiving quality care. No part of this blog may be copied or reproduced without the express permission of the author, Linda Burke-Galloway, M.D.
10.14.09
Twin Pregnancies and IVF: Not a Benign Act
Stephanie Saul’s New York Times’ article, The Gift of Life, and Its Price, affected me on a personal level. As an obstetrician and a victim of infertility, I am well versed with the inherent risks of IVF. Saul describes the exorbitant costs of fertility treatments and the increased complications of multiple births. We are still recovering from the aftermath of Nayda Suleman’s controversial delivery. It’s miraculous that neither Suleman nor her eight babies died.
In Saul’s article, we follow the Mastera family who conceived twins through in Vitro Fertilization after four failed attempts using artificial insemination. The twins subsequently delivered prematurely at 32 weeks and were in the neonatal intensive care unit for approximately 51 days at a cost of $1.2 million dollars. The average cost of an IVF cycle ranges from $12,000 to $25,000. Is there any wonder why there is a low compliance to follow the prescribed guidelines and attempt conception with just one embryo when the chances of a live birth are improved with two? Unfortunately, the greater the number of embryos, the greater the risk of preterm deliveries, therefore having a twin pregnancy is not a benign act. Even WITHOUT the benefit of IVF, a twin pregnancy is a high risk condition.
Twins are notorious for delivering prematurely, have an increased risk of the placenta separating too soon, increase the mother’s chances of developing hypertension and 30% end up in the NICU. Twin pregnancies should be managed by high-risk obstetricians (aka maternal fetal specialists), yet I am amazed at how many of my OB colleagues attempt to manage these pregnancies alone.
Coping with infertility is an emotional roller coaster, a ride I know all too well. In the end, my husband and I chose adoption and are the proud parents of two rambunctious little boys.
For those who are considering IVF, less is sometimes better than more. Should you opt to use more than one embryo and successfully conceive, PLEASE place your pregnancy in the hands of a skilled maternal fetal medicine specialist. I promise you won’t regret it.
