Daily Archives: May 7, 2010

Miscarriage or Stillbirth Should be a ‘911 Call’ for Churches and Healthcare Professionals

Many of you know that Barb and I have lost four children during pregnancy. Both of us were surprised at the depth of emotion we went through — that only escalated with each loss. Now, come a new study the reports relationships often founder after failed pregnancy. When the researchers controlled for known risk factors, women who experienced miscarriages had a 22 percent greater chance of their marriage ending, while women who experienced stillbirths had a 40 percent had a significantly greater hazard of their marriage ending — in both cases, compared with women whose pregnancies ended in live births.

In our practice we consider a miscarriage or a stillbirth a 911 emergency for the marriage. I recommend to healthcare professionals and pastoral professionals that they be interactive in getting these families (parents and siblings) into preventive counseling. I only can wish someone had done that for us.

Here’s the full report from HealthDay News:

Wendy Becker already had three daughters when she miscarried at 14 weeks. That she was already a mother didn’t lessen her grief.

“What people didn’t understand was that having my other children and realizing how unique they are made it harder for me,” said Becker, who lives in Highland Ranch, Colo.

At first, her husband was understanding of her need to talk through the loss and the hours she spent online searching for support groups. But as the months wore on, he became frustrated at what seemed to be her inability to get over it.

“At a time you would think you would be able to help each other, we were going totally separate directions,” Becker said. “I was grieving. He was moving on.”

The Beckers aren’t alone in experiencing strain in a relationship in the aftermath of miscarriage; their marriage remains intact. New research finds that couples who have experienced miscarriage or stillbirth are more likely to break up even years after the loss than couples whose pregnancy ended with the birth of a child.

For miscarriage, or pregnancy loss prior to 20 weeks, the likelihood of breaking up is 22 percent higher than for couples who have a successful pregnancy. The rate of splitting up peaks between 18 months and three years afterward, before falling back to rates similar to that of other couples, according to the study.

For stillbirth, or pregnancy loss at 20 weeks and beyond, the risk of breakup or divorce is heightened by as much as 40 percent for as long as a decade after the loss, according to the study.

The researchers say this is the first nationwide study of the fallout on relationships, both among married partners and couples living together, from miscarriage and stillbirth. The study analyzed the results of 7,770 pregnancies using data from the National Survey of Family Growth.

“The findings were quite surprising at how strong they were and how long they lasted,” said study author Dr. Katherine Gold, an assistant professor in the departments of family medicine and obstetrics and gynecology at the University of Michigan, in Ann Arbor.

The study is published in Pediatrics.

Miscarriage can cause grief, anger and guilt, Gold said. Those feelings may fade in time, but not nearly as quickly as friends and family may expect them to, and can crop up again on the anniversary of the due date or the loss itself.

Becker, whose miscarriage occurred three years ago, remembers feeling alone in her grief. “No one else is grieving with you,” Becker said.

The impact of stillbirth can be even worse, with some women becoming depressed or suffering from symptoms of post-traumatic stress or anxiety disorders, Gold said.

Yet pregnancy loss by no means dooms a relationship. Most women are resilient, Gold said.

“Most women after miscarriage actually do quite well, and most couples do well after miscarriage,” Gold said. “But there is this subset of people who may be at higher risk for their relationship breaking up.”

Researchers said it was possible that having a baby could help sustain relationships, rather than a miscarriage heightening the risk of a breakup. In addition, it’s possible unknown factors could contribute to both risk of miscarriage and risk of divorce, such as mental illness or other chronic physical conditions.

After a miscarriage, men and women also experience the loss differently, said Dr. David Keefe, chairman of obstetrics & gynecology at New York University Langone Medical Center.

For women, the sense of loss lasts longer. While men can certainly bond emotionally with the fetus and the idea of being a father, women have also experienced physical changes that can intensify the attachment, Keefe said.

Men and women tend to grieve differently, with women wanting to discuss the loss and men tending to want to “close up and go play golf,” Keefe said, though there are always exceptions.

For couples going through infertility treatment, who may have already heavily invested themselves in the pregnancy financially and emotionally, the loss can be especially difficult to bear.

“The study provides evidence scientifically of what a lot of us sensed was an issue, which is that following a major disappointment of a miscarriage or stillbirth, that marriages can fall apart,” said Keefe, a fertility specialist who has also trained as a psychiatrist.

After the miscarriage, Becker had trouble sleeping, became depressed and wanted to “talk about what had happened to anyone who’d listen,” she said.

Though she and her husband of 22 years never seriously considered divorce, “it did affect our relationship,” Becker said.

Gradually, Becker found her own way of coping. Now 44, she started a Web site, miscarriagememories.com, where she offers support to other women going through similar loss and sells silver charms to memorialize the baby that could have been.

“People e-mail me all the time and say, ‘Thank you for telling me I am not crazy for feeling this way,'” Becker said. “I would rather have the baby, but if I couldn’t have that, I am happy that something positive has come out of this.”

Doctors, Listen Up: Have a Seat and You’ll Have Happier Patients

For years, when I teach young healthcare professionals about caring for patients, I teach them to sit down to talk. Why? Not only do patients warm up more quickly to physicians who sit down, they say they are more satisfied with doctors who sit, as opposed to those who stand for the entire visit. Now, a new study shows patients also estimate that physicians stay 40 percent longer than they actually do. That’s huge! The details are in this report from HealthDay News:

When it comes to doctor-patient relationships, new research suggests that patients would be happier if their doctors would just sit down and stay awhile.

And for doctors, taking a seat doesn’t necessarily have to add time to their day. The researchers found that when doctors sat down during a hospital visit, patients thought the doctors had stayed longer than they actually had.

“Patients perceived that sitting physicians were in the room about 40 percent longer than they were,” said the study’s senior author, Dr. Paul Arnold, director of the Spinal Cord Injury Center at the University of Kansas Medical Center in Kansas City.

“And, after a while, we started noticing that the patients had almost no negative comments about the physicians who would sit down,” Arnold added. “So, there was both a quantitative and qualitative difference in patients’ perception.”

Dr. Ronald Epstein, director of the Rochester Center to Improve Communication in Healthcare at the University of Rochester Medical Center in New York, said he wasn’t surprised by the finding.

“This is in the lore of medical training,” Epstein said. “During school, we’re told that it really changes the dynamic of interactions.” But until now, he said, there’s hasn’t really been any research to support the idea.

“It’s important to put yourself at the same level as your patient,” he said. “For a patient, it can be a frightening, disempowering feeling to have a group of people standing over you,” referring to what can happen in teaching hospitals when a group of doctors enters a patient’s room.

“Sitting down is a gesture of accommodation, similar to smiling,” Epstein said. “I think patients do appreciate it, and that it allows them to express their concerns more openly.”

For the study, which has not been published, Arnold and his colleagues followed physician interactions with 120 adult, post-operative, neurosurgical patients. All of the patients had an established relationship with their doctor.

One group of patients was visited by a doctor who stood, and patients in the other group were seen by a doctor who sat during the visit. Visit times were measured with a stop watch.

On average, standing doctors spent 1 minute 28 seconds at their patients’ bedsides. Sitting doctors actually spent slightly less time in the room, averaging 1 minute 4 seconds.

But whether the doctors stood or sat, their patients’ perception was significantly different from reality.

Patients whose doctors stood thought the doctor spent about 3 minutes 44 seconds in the room. Those with sitting doctors believed their doctor was present for an average of 5 minutes 14 seconds, the study found.

The researchers then asked a smaller group (38 patients — 20 who had a sitting doctor and 18 with a standing doctor) about their feelings regarding the bedside meetings. For a physician who sat down, 95 percent of the comments were positive, compared with 61 percent positive comments for doctors who stood.

Patients said they felt that doctors who sat down took time to listen and that all of their questions had been answered. When describing doctors who stood, patients said such things as, “He was in and out of my room before I even knew what was going on” and “I didn’t have time to ask the doctor any questions.”

“I think physicians should try to sit down when they can,” Arnold said. “It puts the physician and the patient face-to-face, and it seems like you’re willing to stay a little longer. If you’re standing, it seems like you’re in a rush.”

For More information: The American Academy of Family Physicians has some great advice on communicating with your doctor.

Survey: Most Baldness Treatments Don’t Work

A new survey is out and confirms what I see in the office: more than half of men say that their hair loss treatments are not effective. In other words, most baldness cures just don’t cut it, at least according to a new Consumer Reports magazine survey of more than 8,000 men and women who have personal experience with hair loss. Here are the details from WebMD:

Of the respondents, nearly 40% of women and 27% of men said they had tried a treatment or product to help stop or reverse their hair loss. More than half of the men polled said that the benefits of the baldness remedies were overplayed. Most of them said they reached for over-the-counter baldness remedies, but 20% of men opted for Propecia, a prescription pill for men only.

In the survey, 27% of the men who used Propecia said it was “very” effective. Propecia is a member of the class of medications called 5-alpha reductase inhibitors, which block the body’s production of a male hormone. This drug is also used to treat enlarged prostate glands.

Alternatives to Propecia for Hair Loss

Other remedies did not fare quite as well. Over-the-counter minoxidil (Rogaine) is applied directly to the scalp and is the only hair regrowth drug approved for use by women. Just 4% of respondents said it was very effective, with 43% of users saying it was not effective at all.

Dietary and herbal supplements touted as baldness cures were rated very effective by 6% of those polled. When medications that target the underlying cause of the hair loss were used, 12% of the respondents thought they were very effective.

Only 2% of men surveyed underwent hair transplants; but of these, 49% were either very or completely satisfied with the results of their surgery, the poll shows.

Accepting Hair Loss

It may be time to adopt the mantra that bald is beautiful, the editors say. The available treatments — even those that were viewed as very effective — do have pronounced downsides.

“It’s a deeply personal, devastating issue to many who desperately want to believe that there’s a panacea out there. Sadly, there is no magic bullet.  At the end of the day, the best remedy may actually be acceptance,” Tod Marks, senior editor at Consumer Reports, says in a news release.

Close to 60% of women and 67% of men said they sought treatment for their hair loss because they had nothing to lose, but that may not be true, according to the survey.

For example, Propecia needs to be taken for at least three months, and when you stop using it, it may stop working. It can only be used by men, and infrequent side effects may include depression and impotence. Minoxidil also stops working after you stop taking it, and side effects include dry, itchy, or irritated scalp and increased facial hair.  Hair transplants can be pricey, and sometimes the procedure must be repeated.

So what is a balding man or woman to do?

Men were also asked about ways to help mask their baldness, and 65% said wearing a wig or toupee was a very or somewhat effective technique. In addition, 46% said shaving their head works, 46% said dressing better was a good strategy, and 44% said exercising to improve their body helped keep eyes off of their heads.

For now, “the best advice is to use proven entities for hair loss,” Neil Sadick, MD, a dermatologist in private practice at Sadick Dermatology in New York City, tells WebMD. “This includes Propecia, minoxidil, and hair transplantation.”

Advances in Hair Loss Treatment

Stay tuned, Sadick says. Basic science is revealing new ways to address — and potentially reverse — hair loss. Some research is pointing toward an inflammatory process that underlies hair loss, suggesting that anti-inflammatory therapies such as steroids may help.

Sadick wrote a book on this topic 10 years ago: Your Hair: Helping to Keep It. What has changed since then?

“Propecia was introduced along with advances in hair transplantation and the use of light sources to stimulate hair growth,” he says. Today’s hair transplants are much more natural looking than the bulky hair plugs of yesteryear, he says. Surgeons can now use individual hair micrografts as opposed to clumps of hair.

“Some men are also looking more positively at baldness,” he says.

Then and now, “the best bet to prevent getting taken advantage of is to see a doctor who specializes in hair loss, and who will do a thorough evaluation to determine the cause of the hair loss before recommending a treatment,” he says.

Some doctors who are on the front lines of the war against hair loss are surprised by the survey results.

“Our experience continues to show minoxidil to be the most effective medication,” says Robert V. Mandraccia, MD, a plastic surgeon in Fort Myers, Fla.

It is not a quick fix, he says. “It takes time; we suggest nine months to a year to see if it works.”

Manufacturers Speak Out

WebMD contacted Merck & Co., the makers of Propecia, regarding the new survey findings.

“The survey conducted by Consumer Reports, which showed Propecia was the most successful with respondents, supports what has been shown in clinical trials,” says Pamela L. Eisele, a spokeswoman for Merck. “Men who are experiencing male pattern hair loss should talk with a doctor, who can help separate fact from fiction when it comes to hair loss products.”

Joy Pasqualoni, a spokeswoman for Rogaine, which is manufactured by Johnson & Johnson, tells WebMD, “In clinical testing of men’s Rogaine foam, we know it regrew hair in 85% of men after four months of twice daily use.”

The Myths and Bald Facts About Hair Loss

Hair plays a huge role in many people’s sense of physical beauty, and losing hair can be devastating for many. The emotions surrounding hair make men and women vulnerable to all sorts of false notions about hair loss or balding, particularly those that offer hope – such as the host of miracle cures hawked on the Internet. Here’s a rundown of some of the most common myths about hair loss from an excellent article by Consumer Reports:

Myth: Men who lose their hair have more testosterone than other men and are better lovers.

Reality: The fact that eunuchs never become bald may have spawned this myth. They keep their hair because they lack the male sex hormone that causes male-pattern baldness, the common kind. But that hormone isn’t testosterone-it’s DHT, a testosterone derivative that causes hair follicles to shut down. Bald men don’t have more testosterone than men with more hair; instead, their follicles are genetically more susceptible to the effects of DHT. (Women have small amounts of DHT, which causes hair loss for them, too.) The experts we consulted say there’s no evidence linking baldness with sexual potency.

Myth: Hair loss is inherited from the mother’s side of the family.

Reality: Hair loss can be inherited from either side. A 2004 study of 254 men found that those whose father or maternal grandfather had substantial hair loss were 3.8 and 2.7 times more likely, respectively, to have hair loss than men with a dad or maternal granddad who kept his hair. We found no comparable studies in women, but our consultants think that hair loss can be similarly passed down to women from either side of the family.

Myth: Emotional stress can accelerate the normal loss of hair with age.

Reality: Our search of the literature and interviews with hair-loss experts turned up no evidence linking the most common type of baldness with emotional stress. However, stress can trigger another type, alopecia areata, an autoimmune disease that causes hair loss in circular patches. Moreover, the physical and emotional stress produced by a prolonged illness or major operation can also cause hair loss.

Myth: Massage can stimulate hair growth.

Reality: We found no studies showing that temporarily boosting blood flow by massaging the scalp can increase hair growth. That notion is particularly implausible for treating common baldness, which is unrelated to circulation. In fact, hair loss can be worsened by overly vigorous massage, which can break hairs or yank them out.

Myth: Shampooing your hair every day can increase hair loss.

Reality: Shampooing might appear to cause such loss because it can make loose hairs fall out. But those hairs would soon fall out anyway. And shampooing doesn’t increase the actual number of loose hairs. Avoid vigorous towel drying, however, since hair is more fragile when wet and may break.

Myth: Tight hats can cause hair loss.

Reality: This myth may have arisen in part because people often wear hats to cover their balding heads. Some people also believe that tight hats curtail the flow of air and blood to the hair follicle. But follicles don’t “breathe,” and air can’t reach them since they’re under the skin. And tight hats do not restrict blood flow in the scalp sufficiently to harm the hair follicles.

Myth: Shaving your hair will make it grow back fuller.

Reality: This is no truer for your head than for any other part of your body. Budding hair may look fuller, since shaving removes the naturally tapered end of the shaft. But shaving does not thicken hair, stimulate the creation of new follicles, or accelerate hair growth.

Myth: There’s no point in seeing a doctor about hair loss since it’s a normal result of aging.

Reality: Hair loss can signal a systemic disorder, such as diabetes or hypothyroidism, or a localized scalp problem such as ringworm. And it’s a common side effect of many medications, including antidepressants, anti-inflammatory drugs, beta blockers, birth-control pills, blood thinners, cholesterol reducers, and thyroid inhibitors.

See your doctor if you experience hair loss that:

  • Is sudden and severe.
  • Occurs when there’s no family history of the condition.
  • Is accompanied by itching or burning of the scalp.
  • Occurs after you start taking a drug.

For common hair loss in men, physicians may also prescribe drugs like finasteride (Propecia and generic), if over-the-counter minoxidil (Rogaine) doesn’t work. You could consider hair transplants as well.

Myth: Hair will never return to normal after cancer treatment.

Reality: Hair lost after chemotherapy will almost always grow back within 6 to 12 months after the treatment ends, though it may have a different texture or even color at first. Radiation treatment does tend to cause permanent hair loss, but it’s generally confined to skin in the irradiated field.