Women with Turner Syndrome (TS) are a distinctive group of women who require specialized medical and obstetrical/gynecological care. TS is found in approximately 1 in 2,500 pregnancies and is the result of the loss or partial loss of an X chromosome. Normally women’s chromosomes are 45XX and with TS it will be 45X. Because of this missing chromosome women with TS can look slightly different and can have an array of possible medical conditions such as:
cardiovascular disease which could be the result of a congenital anomaly
Pediatricians and pediatric endocrinologists usually follow these patients closely during childhood and adolescence, initiating estrogen to begin puberty and normal development. Conception and pregnancy offer unique conditions which will require individualized intense care by a team of specialists and preconception counseling is a must. Because of the higher risks for various medical conditions, TS patients need to be followed carefully throughout their lives.
The CDC (Centers for Disease Control and Prevention) recently updated its guidelines concerning the testing of pregnant women who have a possible Zika virus infection or exposure. It must always be noted that most people with the Zika virus infection are either asymptomatic or have mild clinical symptoms. Mild clinical symptoms can be an acute onset of a fever, a rash, joint pain, and/or conjunctivitis.
There is new data suggesting that the virus can be detected in the blood and urine for 2 weeks after the infection begins. This testing of the urine and blood for the virus should be performed for:
Symptomatic pregnant women in less than 2 weeks after the symptoms begin
Asymptomatic pregnant women in less than 2 weeks after a possible exposure
After this 2-week window, blood testing should begin for the Zika virus IgM antibody, which the body makes in response to a new Zika virus infection. If this is found to be positive, there was definitely an infection and close fetal evaluation should begin.
As always, you should discuss the Zika virus problem with your health care provider so you can get the best possible care.
Today, the Zika virus is on the mind of almost everyone; pictures of the children affected by the virus are seen constantly in the news. Beginning today, I will try to keep us up to date on the latest information available.
The virus is named after the Zika Forest in Uganda, Africa, where it was first discovered in the late 1940s. Since then it was not considered to be a major problem because it usually caused mild flu symptoms, which soon passed rather quickly. Then last year’s reports came from Brazil about a major invasion of the virus. There were pictures of the many affected newborns that had been infected, and the resulting congenital microcephaly was seen everywhere.
Why is this virus now causing all these problems? Where has it been the last 60-70 years? Some experts believe the virus has mutated, and some think it has always been there, but was quietly going unnoticed.
As the summer approaches and the mosquitoes return, the Zika virus will certainly be a concern in the mainland of our country. Puerto Rico already reported about a 1000 confirmed cases, including approximately 100 pregnant women. With the travel season upon us, the numbers of our family and friends who will be exposed to the virus is staggering, so being aware of the latest information is paramount in our quest to be safe.
If you are on a regular walking program as part of your exercise plan, the recent snowstorms may hold you back for a while. It may be time to revisit your stairs at home or at work to continue staying in shape.
Try to vary your ascent by speed and the number of steps taken. Before you begin each climb at home, you may want to add stretching and doing a plank or push-ups. Before your descent, consider 10 jumping jacks. Also, always remember to speak to your health care provider before beginning any exercise program!
A recent small study of menopausal women with frequent hot flashes may show a relationship between these flashes and an increased chance of developing heart disease. Frequent hot flashes meant that the women experienced these flashes 5-6 times per day.
In the study, changes were seen in the vessels of the cardiovascular system. This again points to the importance of menopausal women having regular visits with their health care professionals to assess their cardiovascular health!
The risk of suffering from a heart attack increases for women after going through menopause. It seems that estrogen is heart protective, and after the menses stops, estrogen production greatly decreases. Therefore, heart problems become more of a concern.
It is important to remember that more women die of heart disease each year than men. This may be attributed to the fact that women do not seek medical attention as quickly as men when possible heart concerns develop. When suffering a heart attack, most men will describe crushing or squeezing chest pain while women will have no chest pain or simply a fullness feeling in the chest. Many women during a heart attack may complain of dizziness, shortness of breath, nausea, and weakness.
Please be alert for a woman’s special signs of a heart attack, and do not delay a trip to the ER. Your family and close ones need you!
Over the past 50 years, more women are delaying childbirth for many reasons. Now obstetrical teams are seeing an increase in first births for women aged 40 to 44. Pregnancies can progress beautifully with these women but increased risks have been associated with later motherhood. Some of these risks include:
Abnormal fetal chromosomes
Diabetes during the pregnancy
High blood pressure before and during the pregnancy
Preterm labor and delivery
Increased chance of twins
The age of the father is also of concern here. Advanced paternal age is often thought of as being 40 or older at the time of conception. There are studies suggesting that advanced paternal age can be associated with a higher risk for autism spectrum disorders and some gene abnormalities.
If you or your partner is in this age group and are considering a pregnancy, begin a discussion with your health care provider.
Many women who are at an increased risk of developing breast cancer are not aware of their risk. If you are at an increased risk, a pharmacologic preventive therapy (chemoprevention) is a consideration you should discuss with your health care provider. It has been reported that the agents used can reduce the risk by 50%.
The Gail Breast Cancer Risk Assessment Tool is one of the models that has been developed to quantify a woman’s risk of developing breast cancer. By answering a series of questions about lifestyle, obstetric and gynecological history, and family history, a 5 year and lifetime risk can be calculated. If there is a moderate to high risk, lifestyle and pharmacologic interventions should be considered.
Tamoxifen (Nolvadex) and Raloxifene (Evista) are two agents that may be discussed to help in the reduction in breast cancer. There are risks and benefits to both medications, which need to be considered.
Last week, I spent the day attending a conference at the Icahn School of Medicine at Mount Sinai in New York City. It was called Lung Cancer Screening: A Paradigm Shift in Primary Care. The main focus was on the changing thoughts and new protocols for screening for lung cancer in high risk patients. Of course I looked at the course through my OB/GYN glasses, and here are some of the points I took home:
Lung cancer is the #1 cancer killer in the United States, and it is now found as often in women as it is in men.
Therefore, for women in the United States, lung cancer is the #1 cancer killer, and its numbers are greater than breast, ovarian, and uterine cancer combined.
Smoking and exposure to passive smoke are the main causes of lung cancer.
Finding lung cancer at an early stage and having it removed can give an overall cure rate of 80% at the Stage 1 level.
Low-dose lung screening CAT scans can pick up these early cancers, and the radiation exposure can be low, thus decreasing the radiation exposure risks.
With the new thoracic laparoscopic surgical techniques, post-op pain and recovery time have been greatly reduced.
The questions that need to be resolved are many. When do you start the screening process? In the high risk patient, do you screen yearly? How do you define who is the high risk patient? How are the scans paid for?
I left the conference more determined than ever to try to help my patients stop smoking and to help the younger ones not to start. If you do smoke and have been smoking for a while, please speak to your health care providers to see if these new developments may be of help for you. The lung cancer screening protocols are evolving so keep your eyes and ears open!