People you would like to know: It is now just after midnight on the beginning of Thanksgiving day. I am trying to catch up on my labs and reports for patients.  I am looking at a report from a Neurologist consultation for a 26 year old nurse who has terrible migraines and some painful disk disease in her back.  So I am thinking of her personality and her character strengths. I know her well.  She also has two small children that I have delivered for her. She is in the late stages of nursing her second baby now.  Despite having these medical and life challenges, this is a ..read more

International Medicine, British-isms, and "Melting Pot" medicine I just did a checkup for a 35 year old woman who had a very nice cockney accent. This means she is from a central neighborhood of London. I think that means she grew up within listening distance of a certain cathedral's bells. Or maybe Big Ben. I am not sure which cathedral, but it is a somewhat small area. The cockney accent is unique in the English language. Once you understand what it sounds like, you probably won't forget it. I delivered her baby about two years ago. Having a nice conversation with her was really ..read more

AntiMullerian Hormone (or Mullerian Inhibiting Factor)  I would like a share a story about the perils of believing that all that is new and modern is better.  I have a patient who is about 42 years old. She had one child about 4 years old and she desperately wanted another. I took her through the basic infertility workup that I have described on these pages and we found that she had nearly run out of her supply of eggs. So try as she might, and push fertility meds as far as she can (Follistim, Perganol, Menotropin, Menopur, Repronex, urofollitropin, Gonal-F, Fertinex, and many more ..read more

I had a Light Schedule Today, and Pre Conception Counselling I had a light schedule today. It was a real treat for me. My usual Monday hours are 1 pm to 8 pm.  Lately I have been very busy and I need to work hard to keep up with the work. I book a checkup or Ob visit every 15 minutes, with time off for lunch, and I schedule a new patient for 45 minutes. I think that should be plenty of time, but obviously if I discover a major problem, or if the patient really needs some help with some problem, that won't be enough time. Lately my hours have been very full.  But today, there was pl ..read more

VBAC, and Bonding of new Dads It is now Saturday morning, about 10:30 AM. I just finished doing a repeat Cesarean Section of a 38 year old woman at 39 weeks. Her last baby was born by a different Ob. For her first baby she labored for days, eventually the labor obstructed, and she even got a fever. Then she got a section. That kind of a labor, with obstruction, and eventually infection, really stresses the mother and her baby. The risks to the mother and the baby increases over time. If those risks are not mediated and managed, then eventually there will be a catastrophic outcome. In those sit ..read more

Human Genetics Analysis Every day in the office I deal with the issues involved in human genetics. Making a human baby involves the union of the genetics of a mother and a father. A man and a women. Benjamin Franklin (one of the American Founding Fathers) used to like to say that only two things in life are certain. They were, in order of importance, Death and Taxes. Americans repeat that phrase often. We usually say it fast without any pause in between.  I would add that there are a few other certain things in life. At the beginning of life, there is Birth. One cannot have a death witho ..read more

Hyperemesis Gravidarum, or super vomiting  of pregnancy.  Right now our beloved Princess Kate is hospitalized with Hyperemesis Gravidarum.  The royal spokesperson has said that she is less than 12 weeks pregnant, but has not given us her due date yet. We can assume that she is past 8 weeks or so, or the HG would not be at this stage. So she is between 8 and 12 weeks. That means she is due near July 1st 2013.  HG happens when the pregnant women is so nauseous that she vomits nearly continuously.  Nausea and Vomiting are completely normal parts of the first trimeste ..read more

Stem Cells Everybody asks, "Should I have my umbilical cord blood stem cells frozen and stored?" Usually, by the time patient is asking me this question, she has been bombarded with advertisements from the stem cells storage companies. But, even if the patient doesn't ask me, I will ask the patient at about 20 weeks. In my practice, it  is a prenatal care checklist item for 20 weeks, along with the 20 week genetic and anatomy sonogram. So, I will make sure that the patient has the information that she needs to make a good decision. First of all, everybody should be aware that umbilical ..read more

Pre-eclampsia or Toxemia Toxemia is a big problem. Toxemia strikes about one in twenty pregnant women. It is usually mild, but sometimes is severe. Occasionally it will become life threatening. When it gets really bad, it develops into eclampsia (instead of pre-eclampsia). When it is super bad, it leads to a failure of the blood systems, then we call it HELLP syndrome. HELLP is an acronym for "Hemolysis, Elevated Liver Functions, and Low Platelets". About one out of 75,000 pregnant women will get toxemia so bad that they die of it.  The professors of Ob all call this pre-eclampsia. The ..read more

Influenza after Hurricane Sandy It is now Saturday November 10th, and it's my first weekend off since Hurricane Sandy came through. When I woke up today I was struck by the thought that I haven't had any phone calls for influenza yet this season. We are well into flu season. Usually, by now, there are a ton of calls. I wondered "what was up with that?" Why no calls for influenza? So I did what I usually do with these kinds of influenza questions. I opened my iPhone and surfed over to Google's flu tracking tool at http://www.google.org/flutrends/  Immediately I discovered that the United S ..read more