October 5, 2011
It’s a sad commentary when human beings have to be reminded how to act like human beings, especially when they’re in the helping profession. Loni Hildebrandt was a 29 year old certified nursing assistant who was pregnant with her first baby. Make that two babies because she was pregnant with twins. Hildebrandt considered her pregnancy miraculous because she had infertility and was a diabetic since the age of one. Together, she and her boyfriend saved their money and obtained fertility treatments. Her mother, Jo Novtny, a nurse of 30 years was ecstatic when she saw the ultrasound of her two grandbabies but her happiness was short-lived. One day after the procedure, Hildebrandt began to bleed so they went to Sarasota Memorial Hospital in Florida.
Sarasota Memorial Hospital has an excellent maternal fetal medicine (aka high-risk obstetrics) department but Hildebrandt never made it there. She got as far as the hospital’s emergency room where she was attended to by one of its physicians. Despite repeated requests to have her blood sugar checked, Hidebrandt had to wait six hours before it was done. An ultrasound at the hospital revealed a blood clot that was causing the contractions and the ER doctor told her that he could probably save one by “suctioning the clot so the labor would stop.” According to The Herald Tribune, the physician suctioned the clot and one of the twins as well. Hildebrandt allegedly began bleeding more, passing bright red blood clots. They called for help but no one came. According to the newspaper report, a nurse put the afterbirth in a bedpan and left it near Hildebrandt’s head where she was lying. Her mother moved it and placed it under her daughter’s bed. Novtny ultimately delivered the second twin because no one else was around. The ER doctor returned to the room saw the fetus in Novotny’s hand took it from her and put it in a bucket.
Novtny states her daughter did not receive proper treatment until her personal physician arrived and remained in a pool of blood for over 10 hours. Hildebrandt’s iron count was dangerously low because of the bleeding. Her mother’s request to speak with the hospital administrator was met with no response so she wrote a letter to the governor instead. An investigation was done, gross negligence was found, the ER doctor resigned and Hildenbrandt’s nurse was cited for “lack of critical thinking skills.” The hospital will now have unannounced federal inspections in order to keep their Medicare payments. The hospital administrator issued a public apology.
Perhaps one day hospitals will do the right thing, even when no one is watching. Hopefully, Hildebrandt will become pregnant again and have a better outcome.
September 26, 2011
Three young mothers under the age of 40 are dead because they wanted to be beautiful. Kellee Lee-Howard wanted a slimmer body. Ditto Maria Shortall and Rohie Kah-Orukatan. Shortall worked as a housekeeper; Lee-Howard was the mother of six kids and Kah-Orukotan died at the same place where she received manicures. What do these women have in common besides being minorities? They had liposuction procedures performed by men who offered a discounted price for an elective surgical procedure. These men professed to be competent in performing the procedures but never had accredited training.
I knew this day was coming. I saw the storm long before the clouds emerged. As the insurance payments for professional medical services decreased and declined, physicians began to look for alternative ways to earn money. But was it ethical? Gynecologists began to do liposuctions. General surgeons did breast augmentations. Some primary care physicians abandoned seeing patients altogether and opted to do chemical peels and weight loss treatments. Medical spas were added to traditional medical practices. Everyone wanted to cash in on a woman’s desire to be beautiful. Physicians were now business owners and entrepreneurs. However, could they attend a weekend seminar and returns to their offices on Monday ready to do the procedures? Were they really as competent as a plastic surgeon who had five years of training?
Jayne O’Donnell recently published an expose about these doctors in USA Today entitled Lack of Training in Cosmetic Surgery Can Be Deadly. It reads like a litany of horror. The physician who performed Kah-Orukotan’s liposuction was an Occupational Health physician. He didn’t have the proper equipment in his office nor was the procedure approved for office surgery. Shortall and Lee-Howard’s physician did an internship in pediatrics, another internship and residency in general surgery but never got board certified in the 27 years that he has practiced medicine. Had these ladies accessed the Florida Board of Medicine website and looked up their physician, they would have noted the $350,000 settlement in 2004. They would have also noted the absence of board certification, the absence of plastic surgical training and the absence of privileges to admit to a hospital.
All three women died from complications of anesthesia. They had received too much lidocaine which is a numbing medicine given by injection prior to a surgical procedure. Too much lidocaine can also stop the heart. These deaths should have never happened.
In Part 2 of this blog, you will learn what can be done to avoid becoming a victim of a preventable medical mistake. The life you save could be your own.
September 19, 2011
In 2007, Melanie Jaggard went to the hospital for a punctured ear drum and was given the shock of her life. She had cancer; a very rare form that was located at the base of her brain.
Adenoid cystic carcinoma (ACC) is the second most common cause of salivary gland cancer but can affect other areas of the body. Melanie is one of only 20 to 25 people in the United Kingdom to have ACC and had a 2-inch tumor was removed from her head following a delicate 10-hour operation. She was single at the time, cancer free and one year later met the love of her life, Charlie Jaggard, on an online dating site. Charlie proposed three months after their first date and life was good, until she received the news that the cancer had returned, this time metastasizing to her lungs. Surgery was not an option because the tumors were too numerous and radiation was too risky to the lungs. However the couple was not discouraged. They married in January 2009 and Melanie decided to be a victor rather than a victim. Although 89 % of people with ACC survive after 5 years only 40% survive after 15. Melanie has a life-span of 15 years and she and Charlie have both decided to look at the glass as half full rather than half empty. After careful consideration regarding Melanie’s condition and prognosis, they decided to start a family.
Melanie is now pregnant with twins and is very optimistic about her future. While there may be people who will criticize her for starting a family, the Jaggards are convinced that 10 to 15 years will give them time to raise money for a cure or at least discover medicines that can shrink the tumor. Approximately 1 in 1500 pregnancies is affected by cancer. Melanie holds the distinction of being the only pregnant woman to have ACC in the medical annals thus far. She is treading in unchartered water but optimism will be her guide.
Lucius Annaeus Seneca once said: “Sometimes even to live is an act of courage.” Hopefully one day her twins will thank her.
September 7, 2011
Although Kathryn Stockett’s novel, The Help, had been a New York Times bestseller for months, somehow it had escaped me. However after hearing all the buzz about the movie, I was determined to see it even if I had to go by myself which ultimately happened.
Set in rural Mississippi during the turbulent sixties, on the surface, the movie appears to be about race relations between African American housekeepers and their Caucasian female employers, but as the lens sharpens, it becomes evident that the deeper meaning of The Help addresses issues regarding motherhood, fear, courage and trust. The characters are memorable such as Aibileen, an African American maid who has raised seventeen Caucasian children during the course of her domestic career. She becomes disturbed when the 2 year old that she cares for is emotionally neglected by her mother who is buckling under peer pressure from Hilly, the alpha woman who organizes the annual charity ball and spreads her unique brand of ignorance in the form of fear and intimidation. Hilly convinces her female counterparts that they all need to build outside toilets specifically for “the help” in order to avoid contracting mythical diseases. The discussion of Jim Crow segregation laws is nothing new in America. But what was unique about The Help is that we meet Skeeter, a young Caucasian college graduate who was raised by an African American maid whom she credits for giving her confidence. Skeeter looks beyond the occupation of the maids and seeks to discover their humanity. She asked Aibileen the very poignant question: “How does it feel to raise someone else’s children when yours are often left alone?” Aibileen diplomatically asks Skeeter to ask another question perhaps because it conjured up too much pain.
There are thousands of children left in the care of extended relatives or friends each year while their mothers work as domestic housekeepers taking care of someone else’s children. Some even leave their own country. I have met these women. I have been their physician. Their hopes and dreams for the future of their children are just as strong and vivid as mine. And if the truth be told, many housekeepers become an integral part of the family. What The Help demonstrates is that it is not easy to identify “them” versus “us.” The lines of those relationships are often blurred.
What we learn from the movie is that when women come together as a collective force, expect nothing short of triumph. The bond that unites us is far greater than the distractions that keep us apart.
July 20, 2011
When we think of skin changes in pregnancy, what immediately comes to mind are stretch marks or Striae Gravidarum . Stretch marks occur because of a breakdown of collagen, a substance that holds the skin together and is responsible for its stretching. Teen pregnant patients are more at risk for having stretch marks. Why is that important? Because, according to medical literature, stretch marks can increase the risk of having lacerations (or tears) during birth.
Another fairly common skin condition during pregnant is called Pruritus gravidarum or generalized itching during pregnant without the presence of a rash. Approximately 14% of pregnant women are affected by this condition and it is associated with twin pregnancies, fertility treatments and diabetes. As stated in my previous blog, itching during pregnancy should not be ignored, especially in the third trimester because it could signify a condition called Cholestasis of Pregnancy that involves an increase in bile or liver enzymes. This condition is also associated with preterm labor.
Hormonal changes of pregnancy that involve estrogen or progesterone can produce skin lesions called spider angiomatas. Although spider angiomatas are associated with pregnancy, they can also be seen in men who are alcoholics.
If you are a pregnant woman who has palms that are red, especially at the fingertips than you have a condition called Palma Erythema. Palma Erythema occurs because of an increase in blood flow in the body and is a way of eliminating heat that comes from the fetus and disappears after the baby is born.
The most common rash that is associated with pregnancy is called PUPPPs (Pruritic Urticarial Papules and Plaques of Pregnancy). It usually develops in the third trimester and has a distinct look. It usually begins in the abdomen, involving the stretch marks and then spreads to the legs, buttocks and thighs. It is extremely itchy and is usually treated with topical steroids. Fortunately, it does not have a negative effect on the fetus.
The most serious skin disorder in pregnancy is called Pemphigoid Gestationis which is a rare, autoimmune disease. The rash begins around the belly button and then spreads to the trunk, buttocks and extremities. It is intensely itchy, can occur at any time of the pregnancy including the post partum period. It is often associated with premature labor, small babies and can recur in women who take birth control pills. It is usually treated with steroids.
Skin rashes during pregnancy should not be ignored or self-treated. At least three skin disorders that are associated with pregnancy can have an adverse effect on the fetus. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
July 4, 2011
Independence Day always reminds me of my mother whose birthday fell two days prior to the holiday. My mom made her transition almost ten years ago but in her honor, I’d like to share a page or two from my journal that describes my own experience of becoming a mother.
I’m presently flying on Ethiopian Air across the Atlantic Ocean. The plane dropped 10 to 20 feet because of turbulence and my husband became embarrassed because I started calling on Jesus; loud and in living color. He tried to force me to listen to some Ethiopian music via red, antiquated looking head phones but I emphatically say no, I prefer to have a conversation with God instead. I’ve never been one who suffered in silence and when it appears like we’re headed straight for the ocean, of course I’m going to pray. I’m not a religious zealot but calling out God’s name in the time of trouble is like using a password to enter a safe haven in the midst of a chaotic world.
The pilot lowers the altitude and the plane is peaceful again. Back to the boys. I often wonder how did I arrive at this junction called international adoption? Twenty years from now when my sons are in their late twenties, I’ll be a three-quarter of a century. How will they respond to me when we finally meet? We appear to be getting closer to Ireland and Paris.
August 24, 2008. Seven whole days after my birthday and my life has changed dramatically. We stopped in Rome for fuel and a change of airline crew. The new crew was tougher, a little more no-nonsense but still professional and polite. I looked out the window and saw the demarcation between night and day; the dark, black sky giving way to a pale blue sky with orange hues. It was beautiful. I look at the flight monitor and watched our plane fly over exotic places such as Khartoum and Sudan. My former life seemed millions of miles away as the plane ventured towards my unknown future.
We finally approach Addis Ababa and as the plane was descending into the city, I observed the beautiful mountains and virgin landscape. It was breathtaking and of course, I cried. We had to obtain an entry visa that proved to be painless. They didn’t ask us to declare money nor the prerequisite pictures we were so careful to remember to bring. They only seemed concerned about the $40 visa fee and quickly snatched the two crisp $20 bills out of my hands and stuffed it into their pockets. Most of the immigration workers were 20-something year olds whose families probably bought their positions through backdoor deals and old political ties.
(To be continued. Please see Part 2 on Wednesday.)
May 4, 2011
Gaby Rodriquez will have her fifteen minutes of fame in the national media because she faked a pregnancy for 6 ½ months as a “social experiment” in her Yakima Valley high school. Only her high school principal, her mother and 20-year old boyfriend were aware that Rodriguez was not pregnant, her teachers, high school peers and even her best friend were all fooled. Rodriguez staged this charade because she wanted to make a point: “You have to take control of your life and not live your life in the shadows of stereotypes and rumors.” I’m sorry but I’m still confused. Was there a hypothesis? Did she want to know how people would treat her if she became pregnant? Was she acting out a fantasy? Is this why prime time television and media outlets from the east and west coast, as well as Canada and the BBC in London have all pursued Rodriguez with baited breath? There’s even talk about a movie and hiring an entertainment attorney.
Rodriguez lives in a town of approximately 9,000 people where 33% of the population lives below the poverty level and the median income is $26,950. Her high school is 85 percent Hispanic. These are the demographics of a community who is not surrounded by power and luxury. The irony is that the media now wants to speak to Rodriguez because she wasn’t pregnant. She didn’t perpetuate a stereotype and successfully pulled off a hoax. But is that a reason to gain notoriety? The U.S. has the highest rate of teen pregnancy of all developed countries. About 82 percent of pregnant teens are unmarried and 74-95 percent of their pregnancies are unintended. Only 33 percent of pregnant teens will graduate from high school. They are also at risk for several pregnancy complications including an increased risk of pre-eclampsia, Down syndrome, poor weight gain, premature labor and low birth weight babies. These are the facts that should be discussed in the media but I will not hold my proverbial breath and wait.
My media coaches so aptly advised me that the media’s job is to entertain and if you receive some noteworthy information in the process, consider yourself lucky. I hope the media also noted the fact that Rodriguez was taking an advanced placement course in biology. This young lady is obviously intelligent.
Wearing a prosthetic pregnant belly is now an entree to prime time television. Let’s hope it doesn’t become a trend.
May 2, 2011
If a pregnant woman finds herself scratching and itching during the third trimester, these symptoms should not be ignored. Each year, approximately 0.1 to 15% of pregnant women are affected by a liver disorder called Intrahepatic Cholestasis of Pregnancy or (ICP). ICP patients tend to develop symptoms of itchiness of their hands and feet that becomes progressively worse and then spreads all over their body. The itchiness usually worsens at night and if untreated can cause jaundice and several life-threatening complications to the unborn fetus. When a pregnant woman complaints of itchiness (pruritus) all over her body, the first order of business is to determine whether a rash is present. If a rash is absent, ICP should be suspected.
The liver is the largest gland in the body and in addition to filtering harmful substances such as alcohol it is also responsible for processing fats, carbohydrates and proteins. To process fat, the liver makes bile salts. In ICP, bile salts are increased which contributes to the symptoms of itchiness. Affected women will not only be plagued by pruritus but their unborn babies are at risk for stillbirth, preterm labor, fetal distress and abnormal heart rates. South American women and especially those from Chile have a greater risk of developing ICD as do women from South Asia and Sweden.However, North American born women in the U.S. have also been affected as well as women with Hepatitis C. Female hormones such as estrogen and progesterone contribute to the development of ICP as does genetics. The diagnosis of ICP is made by specific laboratory tests. Once the diagnosis is confirmed, the patient should be referred to a maternal fetal medicine specialist for further management. ICP is a high risk condition and the baby usually has to be delivered early because the mother cannot tolerate the intense itching. There is a special medicine that can be prescribed to reduce the elevated bile acids but it should be given under the supervision of a high risk physician.
A complaint of severe itching that develops during the third trimester should not be ignored or given Benadryl if the symptoms have lasted for more than 3 business days. At minimum, lab work should be ordered. Remember, a healthy baby doesn’t just happen. It takes a smart mother who knows what to do.
April 6, 2011
In the wee hours of the morning, Patricia Garcia took her last breath and made her transition. Her death was not a total surprise, she had almost died before. Garcia was 39 years old and the mother of an 11-month old son name Josiah who had made his entrance three months earlier than expected because he had stopped growing in his mother’s womb. During her pregnancy, Garcia was concerned that she might die before Josiah was born because of her complications of having a stroke, obesity and failing kidneys. At barely 5 feet, Garcia weighed 261 pounds and was decidedly obese with a basal metabolic index (BMI) of over 40.
Obese pregnant women are plagued with almost every type of complication imaginable from miscarriages, higher rates of cesarean deliveries, birth defects, pre-eclampsia and sometimes death. Garcia received general anesthesia during the cesarean birth of Josiah. It would have been technically challenging to attempt to give her an epidural or spinal anesthesia. Because she was put to sleep, the surgical team had to move quickly to remove the baby so that it would not receive excessive amounts of the anesthetic. Garcia’s procedure was unfortunately prolonged by several minutes, again due to technical difficulties.
Obesity is a national epidemic with 26.7% of our population affected. Garcia was considered the smallest person in her family because her brother weighed 700 pounds prior to receiving a gastric bypass. Obese patients often face discrimination and humiliation from within the medical community. Diagnostic procedures have been cancelled when it is determined that the patient is over a certain BMI for fear that their equipment would not sustain the additional weight. Patient safety experts propose that “obesity centers” for pregnant women be established to provide nutritional counseling, emergency cesareans as necessary and neonatal intensive care units.
Garcia promised her physician that she’d lose weight after she was discharged home. She didn’t. Although Josiah is now more than a diminutive 1-pound-11 ounce baby, he is still very small and was recently diagnosed as having dwarfism. He will be raised by his sixty-something year old grandmother who is also taking care of Garcia’s mentally disabled brother. Obesity is not a benign disorder. Until Americans make better lifestyle choices, tragedies like Patricia Garcia’s will continue.
March 30, 2011
I read an article in my local newspaper the other day that gave me reason to pause. The State of Florida intends to hand over 3 million Medicaid patients to managed care companies who will reduce payments to physicians and hospitals. In exchange for accepting these low payments for professional services, doctors are guaranteed through pending legislation that no matter what egregious errors they make, the patient will only receive a maximum of $250,000 in a medical malpractice lawsuit. This is definitely a “lose-lose” situation for patients.
Managed care is bad news for pregnant women. Extremely bad news. Every ultrasound, lab test and hospital admission that your physician or midwife orders on your behalf will have to be pre-approved by a gatekeeper who is on a mission to increase the profits of their company by reducing the amount of money that is spent on you. So you must therefore be on a mission to keep both you and your unborn baby out of harm’s way. How do you do that? Here are a few suggestions that are taken from The Smart Mothers Guide to a Better Pregnancy:
- Research your prospective healthcare provider through your State Board of Medicine’s licensing department to make certain they do not have any 7-figure malpractice suits settled or pending
- If you’ve had a previous high-risk pregnancy, request a referral to a Maternal Fetal Medicine high-risk specialist for your prenatal care
- If you delivered a preterm baby in the past, chances are likely you will do it again. Ask to have your cervix measured when you have an ultrasound and if it’s short , request a referral to a high-risk specialist
- If you have vaginal bleeding and are pregnant, do not leave a doctor’s office or an emergency room without someone doing an ultrasound to confirm that (a) the fetus is alive and (b) the pregnancy is not in the fallopian tubes (aka) ectopic pregnancy. An undiagnosed ectopic pregnancy could rupture and cause havoc.
- If you complain of a vaginal discharge, do not leave your healthcare provider until someone gives you a diagnosis and treatment. Untreated vaginal infections can lead to preterm labor. Bacteria is not your friend when you’re pregnant
- Back and lower abdominal pain should not be ignored, especially if you are less than 36 weeks. It could represent signs of premature labor
- Become familiar with fetal tracings. Flat lines and “u-shaped” curves during labor could mean your baby is in trouble and needs to be delivered quickly
- Try to deliver in a hospital that has a level 3 nursery and/or a NICU (neonatal intensive care unit)
- If a hospital mistreats you, contact its administrator. If you’re still not satisfied, file a complaint with the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) http://www.jointcommission.org/
- Trust your instincts. I can’t emphasize this enough.
Prevention is the key to reducing medical injury, not taking away someone’s right to sue.
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do. Check out the video below for my information and pick up a copy of The Smart Mother’s Guide