Finally, Good News if You've had a Miscarriage

Here is another medical topic that you probably think is uncommon until it affects you or someone you love- miscarriage. Despite the fact that statistics show somewhere between 5-10% (or higher) of all conceptions miscarry, you don't hear about it. 80% of miscarriages take place in the first trimester, and most of those occur very early-before eight weeks.

What I'd like to share, though, is a new study that brings some good news. Doctors have traditionally told patients who have a miscarriage to wait six months before trying to conceive again. A study published in the British Medical Journal (BMJ) looked at over 30,000 women who had miscarried, then had a subsequent pregnancy. Happily, women who conceived their next pregnancy within six months actually BETTER medical outcomes (less recurrent miscarriages, fewer ectopic pregnancies, and even less c-sections, low birth weight babies or pre-term deliveries) than women who's next pregnancy began six to twelve months after their miscarriage.

Why is this news important? Well, if you've had a miscarriage, I don't have to explain. The significance is not that you should rush to get pregnant again, but more that there is NO NEED TO WAIT. Many women (and men) have anxiously waited to get pregnant the first time, only to miscarry and then be told to wait for half a year before trying to conceive. That's tough for any age, but if you are already in your late 30s (and therefore already have an increased risk of complications associated with having kids), waiting six months is not only emotionally draining, but increases your other risks as you "age". (Mind you, I have MANY friends who had babies even in our early forties, so I'm not judging, here!)

By the way, please recognize that miscarriage can be very emotionally painful- express sympathy but try to avoid phrases like "what happened?" that the mom may hear as "what did YOU do?" We think most early miscarriages are due to chromosome issues, not from something the mom did, didn't do, ate, drank or otherwise initiated.

BOTTOM LINE: New medical evidence shows that there is no physical need to wait six months after a miscarriage before trying to conceive again, so go right ahead whenever you are emotionally ready!

Need a Vitamin B 12 Shot?

Why DO people get B 12 shots? As always, the answer is not exactly straight-forward. Many people get them because, well, they ask for one! There is a myth out there, quite popular with the entertainment industry, that getting a B 12 injection gives you a "shot" of energy. This idea has been around for many decades, and there are patients who absolutely swear it works. Additionally, many people believe if they are really stressed and run down- say at finals time in college- then a B 12 shot seems to keep them from getting sick. Is this true?
There are not any current evidence-based medical studies that support this theory. There is one recent study that showed high intake of Vitamin B12 (and of B6) is protective against depression in older adults living within the community. (Longitudinal association of vitamin B-6, folate, and vitamin B-12 with depressive symptoms among older adults over time.)
What we primarily use B 12 shots for, however, is the obvious- true B 12 deficiency. Why do people get this? A few get it as a side effect from bariatric surgery (a stomach bypass), but most get B 12 deficiency from making antibodies to B 12 receptors in your stomach. When this happens, you can no longer ABSORB B12 from your diet, so the only ways to get B 12 is from a shot or from a medicine that can be absorbed under your tongue, or more recently, a medicine you squirt in your nose (in the same manner as allergy nose sprays.) When you bypass the stomach receptors, the B12 can then enter your body effectively. Who is prone to getting B 12 deficiency? Anyone with other auto-immune diseases, where the body starts making antibodies to other organs or receptors. This includes adult onset diabetes, vitiligo, thyroid disease and other diseases in the rheumatic family such as lupus.
How about symptoms of B 12 deficiency? There may be none. In severe cases, the patient develops anemia. Often, we see nonspecific symptoms such as brittle fingernails, fatigue, and forgetfulness.
If you have a family history of true B 12 deficiency, that is also a risk factor.
The good news is that B12 is easily replaced, and though it will take a few months to get tanked back up, you should completely recover with time as long as you are consistent about your method of B 12 replacement. Additionally, extra B12 should not be harmful to anyone, as it is a water soluble vitamin (which means you may have lovely, expensive, bright yellow/green urine if you over-replace, but no other worries!)
BOTTOM LINE: B 12 replacement is only really necessary if your levels are low- check with your doctor if you are concerned!

The $7 Million Case of Herpes

Before I leave the topic of STD transmission and lawsuits, I want to share another case. This one took place in California last year, and involved a 56-year old woman catching genital herpes from a 77-year old man. Basically, he had a twenty five year history of genital herpes outbreaks, yet did not disclose this history nor did he wear a condom. He is a very wealthy man, king of a hair product empire, and well-off enough to give his girlfriend a BMW as a gift (which she was allowed to keep, along with the $7 million.)

Now, I do not know all the details of this case. Was his quarter of a century battle with herpes recent, or in his remote past? If he had worn a condom, would that have made a difference? If you get herpes from someone who is a college student (rather than a multi-millionaire business man), how much will you be awarded?

Here is what I think is important:
1. Please note the AGES- 77 and 56!
2. Note that he had a recurring disease for over 25 years- these are not trivial infections...
3. This is a smart, educated, very successful man with full knowledge of his disease, yet he chose not to disclose.
4. Condoms cover only part of the anatomy, and herpes is spread through direct skin-to-skin contact, so condoms HELP but do not 100% prevent herpes.
5. He was indeed, held LIABLE.

BOTTOM LINE: To REPEAT YET AGAIN, STDs can occur across any age, race, gender, or socio-economic boundaries- Buyer BeWARE!

Kiss and Tell?

Yesterday's post (regarding how a dentist was successfully sued for $1.5 million for giving his girlfriend a sexually transmitted disease) apparently generated quite a bit of water cooler discussion. What if he didn't KNOW he had HPV? Should he still be held liable? How can you PROVE someone gave you a specific disease?
The truth is that the only way to KNOW 100% for sure that someone gave you an STD is if you have never been physically intimate with any other person before your current partner- and that includes any form of intimacy that can occur with your pants off. Kissing on the mouth can certainly pass herpes, but in general, kissing, hugging, holding hands and other forms of intimacy that occur with your pants on are "safe".
Viral and bacterial infections often show up within a few days to weeks of exposure, but the sneaky part is that many of them can silently hang around for weeks, months, and even years in some cases. Obviously, if you are with partner A today, and with partner B several months later, then break out with an STD a few weeks into the second relationship- the picture is cloudy. Certainly, odds are better that it is the recent partner, but bacteria and viruses don't come with identification labels (though that would be so helpful!)
The other confounding feature is that symptoms from these infections tend to come and go until the infection is diagnosed and properly treated. In the interim, many people assume they are "cured" because their blister or discharge or discomfort goes away. Unfortunately, that is exactly when they are likely to pass the disease along to another partner.
So, the jury in this case had much to ponder, but the preponderance of evidence strongly suggested this man did, in fact, give his girlfriend BOTH genital warts AND HPV that caused pre-cancerous changes to her cervix. And, for the record, the evidence was strong enough to hold up under appeal.
I hope this high profile case will generate more honest discussions between partners, as well as make people think twice (on both sides) before they kiss and do NOT tell!
BOTTOM LINE: STDs are often SILENT, so expect your partner to get tested before he or she can "prove" his or her disease-free status!

GLAMOUR Reports $1.5 Million Lawsuit for STD!

Have you seen the September issue of GLAMOUR? Well, look closely at the article: "I Sued My Ex for Giving Me an STD- and I WON!" It's a fascinating case, actually. In short, a guy and gal got together. The girl had done "due diligence" in revealing her past sexual history, and had asked him about his. He reported NO history of STDs and said he, in fact, was in a "dry spell" and hadn't been with anyone in a long time. What's next?
Girl believes guy. Girl sadly develops genital warts AND abnormal Pap smears that are pre-cancerous. (To be clear, these are both caused by HPV, the Human Papilloma Virus, but represent infections by TWO DIFFERENT strains of HPV, as warts do not turn into cancer.) Back to the story- meanwhile, guy has-oops- impregnated another girl during the not-so- dry spell...
Now, the girl who caught the HPV is in law school, and not only knows her rights, but wants to be certain to protect any future women this guy chooses to be less than honest with, so...voila! Lawsuit.
Here is the best part: Girl WINS lawsuit, including an appeal, for $1.5 MILLION!
You can read part of my opinion about the case on page 338 of the magazine, but here are a few more thoughts:
1. People LIE about having STDs- it's embarrassing, they don't want to be rejected, and they think they wont get "caught."
2. Completely HONEST people may not actually KNOW that they have a disease, because so many are SILENT.
3. Perhaps we need some new media-worthy "catch phrase" for people to ask to see proof that their potential partner has been recently tested for ALL STDs- "Show me the papers"? "Papers before clothes?" "Proof, not promises?" "Reality before Romance?"
4. You cannot tell by LOOKING who has an STD. (This guy was a medical professional- a dentist- perfect case in point!)
5. IF you give someone else an STD, you CAN be found liable in a court of law. KNOW YOUR OWN STATUS as well as asking potential partners their status.
6. STDs are COMMON and cross all racial and socio-economic boundaries- don't be fooled into thinking that beautiful, rich, popular people are disease-free!

BOTTOM LINE: You CAN and WILL be held liable for giving someone a sexually transmitted disease. If you are not practicing abstinence, GET TESTED and swap results with any future partners BEFORE you are intimate.

Still Can't Sleep?

Insomnia. We've all had the occasional night or two when no matter what we try, we simply cannot fall sleep. Usually those sporadic nights have an identifiable stressor- a test, a job interview, or a change in time zones. For theses occasional situations, I have no problem with my patients taking a sleep aid (prescription or over-the-counter.)
Chronic insomnia, however, is a whole different ball game. Every night becomes a challenge and by 2:00am you're beginning to panic about how you'll be able to function in the morning. Patterns emerge of heavy caffeine intake in the morning to "get going", then an afternoon "pick me up" coffee or soda, followed by a glass or two of alcohol to "relax and wind down" from the day. Most people know caffeine is a stimulant, but did you know even morning coffee can impair your quality of evening sleep? Alcohol, though a sedative, may help people relax and fall asleep, but realize that it,too, disturbs the quality of sleep. So how can you break this pattern? Here are a few ideas that might help.
1. Start your day with exercise. Even a quick fifteen minutes of brisk walking will release adrenaline and help decrease your need for caffeine. Did you know exercising 30 minutes daily yields the same amount of mood enhancement as a low dose of an antidepressant? (Don't exercise just before bed, though, because as noted above, that adrenaline release will keep you up!)
2. Create a bedtime routine. If you have children, you know how important this is, and it works for adults as well. Take a warm bath or shower, appeal to your senses with relaxing aromatic bath soaps or gels, and then GO TO BED. Do not pass GO and collect $200. This means no stopping to unload the dishwasher, fold clothes, check email or watch television. If you want to read or watch t.v., do it before your shower. Get in bed, close your eyes, and consider some form of relaxing breathing or meditation.
3. Cover your alarm clock. Check it three times before you cover it if you need to, but if it's covered, you'll break that habit of waking up at exactly 2:17am each night. Yes, you might still wake up, but if you're not seeing the clock, it's easier for your brain to go back to sleep because you're not gearing up all the emotions that come with seeing that dreaded early morning time.
4. Consider an underlying medical issue.Medical causes of chronic insomnia include an underlying issues such as sleep apnea, restless leg syndrome, thyroid disease, anemia or depression. Make an appointment with your doctor to discuss it!

BOTTOM LINE: For the occasional sleepless night, go ahead and use a sleep medicine if you'd like, but if you're taking a sedative every night and stimulants every morning, recognize the habits that are aggravating the problem and make some healthy changes!

Just for the Women- Period.

Okay, today I want to talk about periods- menstruation- so this is for the women. Periods, like bowel movement patterns, are unique to each individual. In the textbooks, periods occur every 28 days, and last for a week. In reality, there is more variation. When an adolescent starts having periods, they are often very unpredictable for the first six months to a year. At that point, most young women establish a pattern that they can recognize and therefore predict when their next period should arrive. Some may be as short as 21 days, others beyond 30, but what is important is recognizing what your pattern is. Consider the modern calendar- a period tracker app- for your phone to figure out your cycle.

Are terrible cramps okay? Well, no- absolutely not! First of all, we have several medicines that might help, from ibuprofen and its cousins to using the contraceptive pill to help decrease the amount of cramping and blood loss. Additionally, for women who have pain outside the range of "normal", we begin to be concerned about endometriosis, a condition where extra tissue that belongs inside the uterus may have migrated outside of the uterus into the pelvis, and be stuck on the intestines or fallopian tubes, causing pain especially at ovulation (mid-cycle.)

Please do not suffer in silence! If you have "terrible periods" that make you miss school, work or fun stuff, make an appointment with your doctor! There are many ways your doctor can minimize your pain and help your life to NOT revolve around your menstrual cycle. Additionally, if it's PMS symptoms that drive you nuts (bloating, headaches, mood swings, and breast tenderness), there are simple behavioral modifications like quitting caffeine, increasing your calcium intake and increasing aerobic exercise that will help.

BOTTOM LINE: TALK to your doctor if you have questions about your period, and know we have many more answers beyond Midol or "the Pill".