On Christmas Eve in 1981, my father died of a heart attack in a Brooklyn emergency room while waiting for a hospital bed that never manifested.  Dad died because he didn’t have private insurance or a cardiologist who would have advocated on his behalf.

Christmas Eve of 2009 marks an historical moment and a first-hand view of American politics. The Senate and House of Representatives will convene to decide whether to pass a unified bill on healthcare “reform”. To vote on Christmas Eve is not a coincidence: there will be pressure to simply gloss over the bill so that everyone can rush home for Christmas. 

The House had the mettle to include a public health option. However, sixty dealmakers in the Senate did not. They plan to have the foxes continue to watch over the chickens, then had the temerity to call it reform.

Thank you, Victoria Kennedy. I desperately needed to know how your wonderful husband would have responded. I was so despondent at the shenanigans of both Democrats and Republicans that I was ready to relinquish my voter’s card.

No, it is not practical to abandon this grossly imperfect healthcare bill and start anew but we definitely need to have protective measures in place. Sui Generis (self-regulation) will not and should not be the order of the day. It didn’t work in the past and it certainly won’t work in the future. Insurance companies are NOT going to do the right thing once politicians stop looking. If Americans are forced to remain with private insurers then we need an enforcer of strict regulation.  An Insurance Czar is definitely needed; an Elliot Ness or an Elliot Spitzer will do just fine. We also need answers to the following questions:

1. Will the premiums for people with pre-existing conditions be higher and by how much?
2. Will there be some outside regulatory agency to govern the insurance companies in the event of misdeeds?
3. Will there be co-pays and deductibles and by how much?
4. Will there be a limit of services provided by these so-called state regulated insurance plans, i.e., will the poor receive less services based on the type of insurance they have?
5. How much assistance will the middle class receive regarding insurance premium payments? 10%, 20%, or 30%?
6. Is there a cap on how much an insurance CEO can earn?
7. Will there be reductions in payments of Medicare and Medicaid to physicians?
8. Will these plans be taxed to people who earn above a predetermined income?

No one wants a perfect plan, just a fair one. That is not too much to ask. President John F. Kennedy said it best: “If a free society cannot help the many who are poor, it cannot save the few who are rich”.

 I hope the politicians are listening.

 The holiday season is usually a joyful time for pregnant women but in many cases, also a time of potential stress. Not only are you preparing for family celebrations but also for one of the most important and memorable occasions of your life. As a means of enjoying this holiday season to its fullest extent, the following tips are suggested:

1. Because most medical practices schedule fewer patients and have less physicians and healthcare extenders available during the holiday season, make sure you obtain the names of physicians or healthcare extenders who will be on-call in the event of an emergency

2. Traveling is not recommended for pregnant women after 32-weeks gestation. However if you must, then please, make certain that you stand-up after two hours of sitting for fifteen minutes to reduce the chances of developing a blood clot to your legs. This rule applies whether you’re flying driving or traveling by train.

3. If you are less than 32-weeks and travel for the holidays, make certain that you have a copy of your prenatal record in the event you encounter an unexpected emergency in another town or community. Try to research hospitals in advance of your travel so that you might become familiar with their facilities, services and payment requirements.

4. Because the winter is notorious for inclement weather, try to stay indoors as much as possible in the case of bad weather. The last thing you need is to develop contractions or go into labor in the midst of a snow storm.

5. Do not lift anything greater than 10 pounds and certainly do not shovel or offer to shovel snow. The bending movements (especially in the third trimester) place you at increased risk of a having a placental separation.

6. Avoid last minute shopping if possible to minimize exposure to crowds and unintended bumps to your belly. Excessive walking can also increase the risk of developing premature contractions.

7. Prepare dishes in advance if possible to avoid all day on your feet. The pregnant uterus compresses the veins and prevents the return of blood back to the heart. This contributes to varicose veins and swollen ankles.

8. Avoid wearing heels any higher than 2 inches. Anything higher places undue stress on your back and place you at risk for encountering preventable falls.

9. Takes lots of pictures of yourself during the holiday season to capture the historical moment of your pregnancy.

10. Check out some food safety tips from CDC http://www.cdc.gov/Features/HolidayFoodSafety/

I’m a physician, a Columbia University graduate, and I supported you for President. However, this watered-down “healthcare” bill is TRAGIC!! Not only is this a gift to the insurance companies but I will now have to pay triple premiums because I have a “pre-existing condition.” I’m extremely disappointed in you! Our House of Representatives had more courage than all of you.

You’ve heard the horror stories of American people held hostage by insurance companies. As a public health physician, I’ve witnessed it first-hand. I can’t order a diagnostic test without first providing an ICD Code and the name of the patient’s insurance  company. It’s all about getting paid.

I have to fight for the dignity and health of my patients on a daily basis. I had a pregnant patient with uncontrolled Diabetes denied a hospital admission because she had Medicaid. This is NOT change that we can believe in. I’m sitting at my computer wailing with grief. You’ve given the insurance companies everything that they wanted. Regretfully, I will NOT be voting for you or any other Democrat in the next election. I will sit home instead and pray for the day when compassion outweighs money, egos and politics.

The Democratic Senators are nothing but a pack of dealmakers dedicated to vested self-interests. You have made me ashamed to be a Democrat. You have failed the American people.

May God have mercy on your misguided souls.

While we’re aware that obesity in developed countries is approaching epidemic levels, I’m not certain whether the strategy in the Healthy Moms study is the correct approach.

The federal government is paying researchers $2.2 million dollars over a 4-year period in an attempt to prevent obese pregnant women from gaining any weight during the course of their pregnancy.  If the participants gain weight, it is to be limited to 3 percent of their baseline weight.  While this appears to be a noble endeavor, the goal of zero weight gain during pregnancy is unrealistic. The average pregnancy requires 80,000 additional calories over pre-pregnancy requirement which amounts to approximately 300 additional calories per day. The study recommends an intake of 100 to 300. If we take the lower recommendation of 100 additional calories per day, that would amount to an 8 pound weight gain during pregnancy because 3500 calories equals one pound. The Institute of Medicine’s recommendation is a total weight gain of eleven pounds for obese pregnant moms. This appears to be more practical.

The greater concern is what effect will calorie restrictions have on the fetus and newborn? The additional 300 calories is needed for proper fetal development and growth. Will there be risks of fetal growth restriction (the baby not growing properly)? Nutritional deficits based upon increased fetal demands and less calories? The majority of pregnant women complain of having an increased appetite when taking prenatal vitamins which is necessary for proper fetal development. How will that issue be addressed?

We are well aware of the adverse consequences that obesity can have on pregnancy outcomes. However, zero prenatal weight gain is pushing the envelope.  What long-term neurological or developmental effects will this diet have on babies? Let’s keep a close eye on the developments of this study as they unfold.

There is no silver lining in the healthcare bill that Senator Joseph Lieberman proposes. Special interests have won once again. The late Senator Ted Kennedy is probably rolling over in his grave and I sit in front of my TV in stunned silence. Why are people so fearful of change? And why are Senators sacrificing the health of innocent American people for the sake of money? Is money that darn important? More important than human life?

I was brimming with optimism after hearing President Obama’s State of the Union Address regarding healthcare reform. The insurance companies would finally be held in check and the reign of healthcare returned to the skillful hands of nurses and physicians. We had finally matured as a nation who was willing to reach out and assist the “least among us.” I envisioned

 • forty-eight million uninsured Americans finally entering the rolls of our healthcare system and receiving life-saving medical treatment

 • A dear colleague finally being able to insure both herself and family members through the Public Health Option because she, despite being a physician, cannot AFFORD healthcare insurance

• The ability to find obstetricians willing to do tubal ligations because they were being reimbursed appropriately

 • New moms finding Pediatricians willing to do circumcisions because they would be compensated fairly

• Hospital schedulers would ask for a patient’s diagnosis FIRST and NOT the name of her insurance plan or billing codes

However, my vision ended prematurely. Our lawmakers were not ready for Prime Time.

Rest assured we are now headed down a perilous path and political gluttony has struck again. And when China and India emerge as new world leaders because America is bankrupt, you can place the blame squarely on Joe Lieberman. For thirty pieces of silver, he sabotaged the health of our Nation. Can you imagine what he would have done as our Vice President?

An IVF patient posted a blog complaining about the possibility of only receiving two ultrasounds during her pregnancy and I could feel her pain. Quite recently I had a protracted discussion with an imaging center that kept denying my patients an ultrasound based on Medicaid’s rule of only one ultrasound per pregnancy.

Medicine has become a BUSINESS and many clinical decisions are now based on whether or not someone will be paid. Those who know me or read The Smart Mother’s Guide to a Better Pregnancy know that I abhor “keepsake” ultrasounds that are done for gender determination and entertainment. However, I value legitimate fetal ultrasounds that are reviewed by radiologists because they have saved lives. The earlier the fetal ultrasound is done, the more accurate the fetal dates. This could become an issue if you unexpectedly need an induction of labor.

An ultrasound done at 20 weeks provides information regarding the anatomy of the baby. Is there a 4-chambered heart? Are the baby’s intestines normal? Has the brain developed properly? Everything’s okay? Great, but what happens at the end of the pregnancy? The real-time information that ultrasounds provide to determine fetal well being is priceless. This year alone at least seven of my patients’ were spared stillbirths because we detected poor fetal growth, abnormal placentas, low amniotic fluid and umbilical cords wrapped around their babies necks, thanks to a third-trimester ultrasound.

So how do you get around the only-one-ultrasound-per-pregnancy rule? Your physician must write an order as a “follow-up” of a condition previously detected or diagnosed. Did you have previous abdominal pain or bleeding? Was there a suspicion that your baby wasn’t growing properly? Was the placenta in the correct position? These conditions justify obtaining a follow-up ultrasound. If you have a high-risk condition, don’t hesitate to request a referral to a high-risk specialist who can monitor your baby using 3-D ultrasounds.

Visual access of your baby is extremely important. The one-ultrasound-per pregnancy rule is total nonsense.

The tragedy of Roshunda Abney, (Las Vegas Review, Woman Says She Was Ignored in ER, Paul Harasim ) occurs much too often. She went home after a six-hour hospital wait, and returned with a dead baby.

Abney was a part-time customer service rep in Las Vegas who lived with her high school sweetheart. They had relocated from Mississippi for a better life.

 Abney had irregular menstrual periods, so she didn’t know that she was pregnant. For the past two days she had experienced menstrual-type cramping that wouldn’t go away despite taking over-the-counter painkillers. When the pain became unbearable, Abney went to a hospital-affiliated urgent care center. A nurse requested a urine sample but Abney was not able to supply one. Thirty minutes later a decision was made to transfer Abney to the hospital ER because she needed “higher care.” She was also uninsured.

Abney’s vital signs were taken upon her arrival to the hospital ER and then she proceeded to wait. And wait. And wait. Her pain became worse and she unsuccessfully attempted to receive medical attention. When she told a certified nursing assistant that her pain was getting worse, he told her that if she endured it for two days, “another 45-minutes wouldn’t make a difference.”

Sympathetic patients who were present in the waiting room offered to allow Abney to go ahead of them. They were subsequently informed to “mind their business or they would never see a doctor.” After a six-hour wait without being seen, she went to another hospital where she was also not seen and went home thinking she had gallstones. Twenty minutes after she reached home, her membranes ruptured and the feet of a baby was emerging. Paramedics were called and subsequently delivered a 24-week breech baby girl who was lifeless.

Abney’s case illustrates why hospitals and physicians get sued. She had to contend with layers of arrogance and calloused gatekeepers.

I strongly encourage all pregnant women to read The Smart Mother’s Guide to a Better Pregnancy. If you think the story of Roshunda Abney is an isolated incidence. Please, think again.

When Padma Lakshmi, the celebrity host of the cooking show, Top Chef, declined to reveal the gender of her unborn baby on a talk show, she represented an exception to the rule among pregnant women: most want to know what they’re having and share the news with the rest of the world.

 Women under age 30 still have a difficult time believing that pregnant women once had children without knowing the gender of their baby until birth. In the age of 4-D ultrasounds performed in strip malls, and genetic home DNA testing, such a thought appears to be obsolete. Baby showers and baby room preparations are the most common reasons for ultrasound requests by patients although these reasons are not FDA approved. However, most non-medical ultrasound companies have convenient amnesia when it comes to adhering to this rule.

Well now the “home gender DNA test” has made things even more confusing for vulnerable expectant families. These tests assert to have the ability to predict the sex of the unborn child as early as ten weeks gestation and within ten minutes of taking the test. The companies claim that the test has a special secret formula (aka proprietary mix of chemicals) that turns the urine green if it’s a boy and orange if it’s a girl. The accuracy alleged from various companies is between 80 to 90 percent but most recommend obtaining an ultrasound for final confirmation.

Karen Kaplan of the Los Angeles Times wrote an informative article Old Wives ’Tale Redux  regarding the challenges and effects home gender DNA tests had on expectant mothers including the class action suits that ensued because of incorrect results. The tests are expensive with a wide margin for error and exploitation.

So, what’s a mother to do? The use of the colors yellow, white or mint green still works well. Learning whether you’re having a boy or girl should not be nearly as important as safeguarding the health of your unborn child.

Someone should have taught Tiger Woods how to do the media dance; I had to learn the hard way. Although our Florida neighborhoods are only 30 miles apart, our paths will certainly never cross.

However, what Woods and I DO have in common is our public visibility. As a public health employee, my life is an open book.

A few years ago I had to report a former boss for inappropriate behavior based on several patients’ complaints. The case “blew up” because of his notoriety as both an elected official and a physician and I ended up with the media on my doorstep.  The reporter, camera crew and satellite truck remained parked in front of my home for almost three hours, reported the 11:00 o’clock news and then finally left. Although I didn’t speak with them that night, I knew that I would have to do so the next day. “Never say ‘no comment’” was the advice that I had been given from a law enforcement agent who was investigating the case.               

When I reported to work, a public information officer suggested that I participate in an elaborate scheme to avoid the media. And when I flatly refused, she told me that “I was on my own.”

The maintenance man and a secretary accompanied me as I walked out the door and faced the paparazzi. It was one of the most difficult days of my life. However, I was polite, non-judgmental and advised them that I was leaving the matter in the hands of the courts. My former boss lost his medical license and was removed from political office by the Governor. He faced criminal charges and the case dragged on for years.

In the court of public opinion Tiger, a lie unchallenged becomes the truth. The media is NOT going to go away.

I wish I could click my heels three times and be transported back to a time when healthcare was not a business and patients were more than a commodity. I am NOT a healthcare provider. I’m a physician who was taught to heal.

I wish pregnant moms had time to bond with their babies before being booted out of a hospital. And I didn’t have to threaten billing clerks for not admitting my patients for emergency tests because they didn’t have the “right” insurance.

I wish the ob hospitalists hadn’t sent a patient home inappropriately with low fluid and no further follow-up. The patient thought everything was “okay”, traveled to another state on vacation and had to be tracked down. She was advised to go the nearest hospital where she had an emergency c/section that saved her baby’s life.

I wish I could have avoided the hassle with a local hospital when I attempted to send a patient for a diagnostic test and they said they were “too full and too busy.” I ultimately sent the patient to a specialty hospital that was further away where she immediately had a cesarean section because the baby had stopped growing at 33-weeks. Both mom and baby are fine.

I wish the triage department at a local hospital had performed an ultrasound on a patient who complained of bleeding at 27-weeks. They listened to the baby’s heartbeat, said everything was fine and sent her home. When I sent her for an ultrasound, the radiologist contacted me emergently. The patient’s placenta completely covered the opening to her womb and there was a cord wrapped around the baby’s neck three times. I referred the patient to a specialty hospital where she remained for the next nine weeks until she delivered her baby with the cord still wrapped around its neck. However, both mom and baby are fine.

I wish I could run interference for ALL pregnant moms when somebody drops the proverbial ball . . . but I can’t. So I wrote The Smart Mother’s Guide to a Better Pregnancy instead.

“A healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.”