A common occurrence in early pregnancy.
Although it’s not often spoken about, miscarriage is the most common complication of early pregnancy. Miscarriages usually occur within the first trimester, by week 12.
Several medical conditions are typically included under the term miscarriage, including abnormally growing pregnancies, pregnancies that previously had a heartbeat but no longer show cardiac activity, and otherwise normally developing pregnancies that somehow become disrupted before week 20. Stillbirth is the term used for pregnancies that end after week 20 but before delivery.
While studies have shown that the rate of first trimester miscarriage is between 10 and 20 percent of all pregnancies, it’s thought that the true rate is closer to 25 to 30 percent, if the rates included pregnancies not yet clinically detected.
It’s important to remember that despite suffering a miscarriage, most women will find they can have a full-term pregnancy.
Symptoms: The typical symptoms of miscarriage are cramping and vaginal bleeding, although some miscarriages don’t show any symptoms. These signs can sometimes be difficult to interpret because many women with mild cramping or light bleeding in their first trimester go on to have normal pregnancies.
To help clarify the underlying cause of these symptoms, your obstetrician may order blood tests to monitor pregnancy hormone levels along with an ultrasound scan. Even though light spotting or mild cramping can be normal, any severe abdominal or pelvic pain and heavy vaginal bleeding should always be evaluated by a physician. These symptoms may indicate a more serious condition called ectopic pregnancy, which can be life-threatening to the mother if untreated.
Causes: Many women experiencing a miscarriage are concerned whether something they did or consumed may have contributed to this outcome. Was it that glass of wine? That big cup of coffee? That heavy box she lifted before she found out she was pregnant?
There are many misconceptions about what can cause a miscarriage. For example, some people believe stress, exercise, working, intercourse or a history of prior birth control use caused the miscarriage. But none of these are associated with increased risk of miscarriage.
The truth is that about 50 percent of miscarriages are thought to be caused by genetic abnormalities that happen at the time of fertilization. These are usually genetic problems that are considered lethal, or in other words, would prevent the fetus from surviving the pregnancy. Genetic abnormalities are more likely to be the cause of a miscarriage in early pregnancies and with mothers who conceive at an older age.
Other factors that have been shown to be associated with the risk of miscarriage are smoking, moderate-to-high alcohol consumption, and illicit drug use. Age, having prior miscarriages, and certain invasive prenatal tests (amniocentesis and chorionic villus sampling, (CVS)) are also associated with increased risk of miscarriage. Caffeine, although sometimes associated with miscarriage, has been found to be safe in low doses—meaning about one eight-ounce cup of coffee a day.
Things that can alter the shape of the uterine cavity also may cause an increase in miscarriage risk, such as uterine abnormalities (like a uterine septum or bicornuate uterus), scar tissue from previous uterine surgery, or uterine fibroids.
Some maternal medical problems—such as poorly controlled thyroid disease, diabetes or adrenal disease—may also be related to miscarriage. And some infections may have the potential to lead to a miscarriage—for example, Fifth disease, rubella and toxoplasmosis. For this reason, pregnant women with a fever greater than 100.3°F should see their doctor immediately.
Treatment: Because a miscarriage often happens in women who want to be pregnant, treatment is usually reserved for those who are medically unstable or have a serious condition, or those women who clearly have an abnormal pregnancy. For women with desired pregnancies who have no symptoms or very mild symptoms, some doctors will wait until the miscarriage or abnormal pregnancy is confirmed with certainty by either blood tests or ultrasound.
Treatment typically depends on the patient’s symptoms, preference and how far along the pregnancy is. Options for treatment include waiting for the pregnancy tissue to pass on its own (called expectant management), medication that causes the uterus to push out any remaining pregnancy tissue, or a surgical procedure called a dilation and curettage (or D&C) to remove this tissue.
After Effects: Most women will experience some bleeding and cramping for several days after their miscarriage. Cramping usually improves over two to three days, while bleeding may continue to be irregular until the woman’s next period. And the next period may also be heavier with more cramping than normal and may be delayed up to eight weeks after the miscarriage. Pelvic rest—avoiding use of tampons, douches or having intercourse—is usually recommended for one to two weeks after a miscarriage.
Many women are eager to try to conceive again after a miscarriage. Some physicians recommend waiting several menstrual cycles to allow some time to recover both physically and emotionally. While there’s no medical reason to wait beyond the initial recovery period, it’s helpful to verify that the current pregnancy has resolved completely, either by ultrasound or a negative pregnancy test.
Regardless of when a woman has physically recovered from her pregnancy and miscarriage, it’s important to wait until she has emotionally recovered before trying again. Many women grieve over their lost pregnancy, even if they were unaware they were pregnant prior to miscarrying.
Conclusion: As devastating as miscarriage can be, it’s important to remember that miscarriage is common and the majority have nothing to do with the actions of the mother. Most women will then go on to have normal, healthy pregnancies in the future.
Hopefully, by continuing to discuss miscarriage openly and accurately, women can feel less isolated about their experience and more hopeful about their chances of a normal pregnancy in the future, if and when they so desire.
Dr. Lindsay Odell is a physician at Penn Ob/Gyn Chester County, a practice of Chester County Hospital with offices in Exton, West Chester and Southern Chester County. Dr. Odell received her medical degree from Chicago Medical School-Rosalind Franklin University and completed her internship and residency at Thomas Jefferson University Hospital. She’s board eligible in obstetrics and gynecology and has a special interest in family planning and patient education.
You’ve seen them on TV—in “Royal Pains” and “Rush”—but what do concierge doctors do in real life?
Concierge medicine—sometimes referred to as personalized healthcare or retainer medicine—has gained significant momentum in recent years, with about 5000 doctors in the U.S. following this model.
As the Affordable Care Act took effect and newly insured patients began flooding medical offices, many doctors and patients grew frustrated with longer wait times for shorter appointments. Feeling squeezed and unable to serve their patients as comprehensively as they’d like, some doctors transformed their practices using the concierge approach, allowing them to lighten their caseload and offer more proactive care that better meets their patients’ needs.
What can patients expect to gain—and spend—on concierge care? It all depends on what you hope to get from your healthcare experience. There’s a spectrum of options, but here are a few key differences to consider to determine if this personalized approach is right for you and your family.
Membership Cost. Concierge membership costs are often based on an annual fee that can range from a few hundred to several thousand dollars per person, with some discounts for other family members. The fee largely depends on the level and amount of services included in the concierge program. In some practices, this may be in addition to other medical insurance premiums.
Some practices use a Fee for Care (FFC) model, in which a retainer fee covers all services, with some exceptions (e.g., lab work, x-rays) charged on a cash basis. Others offer a Fee for Extra Care (FEC) arrangement, similar to FFCs, but bill the patient’s insurance for these additional services.
In another model patients pay an annual membership fee for a comprehensive wellness program that includes extensive screenings and tests not normally covered by insurance, along with extra conveniences, like 24/7 doctor availability. In this model, standard medical services (e.g., sick visits, hospital care) continue to be billed to insurance.
Doctor Availability. Because most concierge doctors care for a fraction of the patients seen in conventional primary care practices—typically 300 to 600 patients as compared with 2000 to 3000—they’re able to offer increased availability, such as unrushed routine appointments, same-day or next-day visits, more out-of-office contact with patients via email and cell phone, and coordination of specialty care. Offerings like these are fairly standard among concierge practices.
What can be harder to find are doctors who offer the personalized care our parents and grandparents enjoyed—doctors who make house calls, serve as attending physicians for hospital stays and offer community events to be present in all aspects of their patients’ lives.
Preventive Services. Personalized medicine has given many doctors the time required to not only fully address patients’ immediate health issues, but also to focus on an often overlooked part of patient care: disease prevention.
To make prevention a priority, some concierge doctors perform comprehensive lab work to catch early warning signs that might not present themselves otherwise. This preventive approach has proven to be valuable and even life-saving when serious conditions like cancer and cardiac issues are uncovered early.
Wellness Services. Select concierge practices take preventive care a step further by working with you to develop an annual wellness plan that addresses your specific lab results and your individual needs and goals. This could mean concrete steps to help you lose weight the healthy way, better manage a chronic condition, or even reduce or eliminate medications.
If this is important to you, look for a concierge practice that prioritizes well care in addition to sick care.
A New Option. In today’s doctors’ offices, it’s sometimes easy to forget your healthcare is not a transaction; it’s an investment. The concierge medicine model allows you to prioritize aspects of your well-being that matter most to you: a middle-of-the-night phone call to your doctor, a comprehensive health screening, a customized weight-loss plan.
Like most worthwhile investments, you can’t know the long-term payoff upfront. But with a potential return of a longer, healthier life, more and more patients agree it’s worth a try.
Dr. Gary Cooperstein, D.O., a Board Certified Family Physician and Senior FAA Medical Examiner, founded Whitford Family Medicine, a full-service personalized healthcare practice in Downingtown, in 1989. Driven by his commitment to preventive health and wellness, he joined the MDVIP national network of primary care physicians in 2014. Learn more at MDVIP.com/GaryCoopersteinDO.
It’s common and treatable, and yes, your child can enjoy an active kid’s life!
Spring is in full bloom. For most kids, this means sun, fun and outdoor sports. But for a child with asthma, it also means exposure to seasonal allergens—pollens from trees, grasses and weeds. And if that weren’t enough to trigger an asthma attack, mold is a constant presence in warmer months.
Plus, all those young equestrians at the Devon Horse Show are exposed to horse dander and dust in the stables and ring—even more triggers.
What is asthma? Asthma is a chronic condition caused by inflammation and narrowing of the bronchial tubes (passageways that allow air to enter and leave the lungs). It’s the same disease for adults as for children, and affects about 7 million American children, according to the Centers for Disease Control. Untreated asthma is a leading cause of school absenteeism and the leading cause of kids’ visits to the emergency room.
There are two types of asthma. Allergic asthma is caused by exposure to an allergen, such as pollen, pet dander, dust, dust mites, milk, eggs, peanuts or ingredients in certain medications. There’s often a family history of this type of asthma. Non-allergic asthma is caused by exposure to something that affects normal breathing, especially a viral respiratory illness, like a cold or flu.
Either type can be triggered by irritants like smoke or perfume, strong emotions, intense exercise or weather changes.
What are the symptoms of childhood asthma? Three of the most common symptoms are: 1) a change in normal breathing, such as coughing or wheezing, often interrupting sleep or play; 2) shortness of breath, chest tightness or rapid breathing (signs like the belly pumping hard or the pulling in of the muscles between the ribs or skin at the base of the throat); and before difficulty keeping up with other kids when playing.
If your child has asthma symptoms and repeated episodes of what’s been diagnosed as bronchitis or pneumonia, or is not responding to treatment for asthma (for example, repeated doses of oral steroids)—and is unable to sleep well, regularly attend school, run and play—then see an allergist. Allergists specialize in diagnosing and treating allergies and asthma.
Undiagnosed and untreated, childhood asthma can worsen as the lungs work harder and harder to breathe, posing a danger to growing lungs.
How is asthma diagnosed? The allergist will begin with a detailed medical history, including symptoms, medications and family history of allergies and asthma. Next come questions about the child’s environment at home and school (identifying triggers like household or school pets, smoking, dust, etc.), sleep patterns, school attendance and activities.
The doctor will perform a physical exam and, depending on the child’s age, a peak flow meter test or full lung function study, which involves blowing into a tube connected to a computer. Don’t worry, it doesn’t hurt! Allergy skin tests (skin pricks testing sensitivity to dander, dust, mold) may be done to identify specific allergies so triggers can be avoided.
How is childhood asthma treated? An effective treatment plan has several parts and is designed to treat symptoms and prevent asthma attacks. The allergist will explain how to identify and eliminate or control asthma triggers.
For a child with mild, intermittent asthma (symptoms less than twice a week), the doctor typically will prescribe a rapid-acting broncho-dilator medication (an inhaler) to be used to prevent or relieve the symptoms before or during triggers, such as vigorous exercise.
If that’s not sufficient, and the child has more frequent, moderate, severe or persistent asthma symptoms, then the doctor will prescribe additional medications to control airway inflammation.
Will my child outgrow asthma? Children with non-allergic asthma triggered by viral infections typically outgrow it by age 6 or so. Children with allergic asthma—including kids with food allergies and eczema—typically continue to have asthma as adults.
In either case, children with well-managed asthma can sleep through the night, regularly go to school and, yes, enjoy a full, active kid’s life—including running, playing and riding.
Sandra M. Gawchik, D.O., is the Co-chief of Allergy/Immunology at Crozer-Chester Medical Center and a Clinical Associate Professor of Pediatrics at Thomas Jefferson University Hospital. A board-certified allergist and pediatrician, Dr. Gawchik treats patients of all ages who have asthma and allergic conditions. 610-876-1249; CrozerKeystone.org/Providers.
Start the conversation now to plan for this important part of your retirement.
Should it really come as a surprise that most of the traditional financial services and the brokerage industry either ignores or gives short shrift to healthcare in retirement? Three or four cable news networks are currently dedicated to stocks, bonds and global capital markets, yet there’s no mainstream focus on healthcare and healthcare costs, despite their importance to a family’s retirement and lifestyle.
Healthcare costs, and most significantly Long Term Care costs, have historically risen at a faster rate than inflation. According to Fidelity Benefits Consulting (2013), “the average 65-year-old couple retiring in 2014 will need an estimated $220,000 to cover healthcare costs during their retirement.”
What’s even more significant is this statistic assumes “average life expectancy” and does not include Long Term Care expenses. The advisors who are focused on it, and certainly the families that have experienced its potentially devastating impacts, are keenly aware of the healthcare challenge.
The Challenge. The retirement healthcare challenge can be presented as the Three “C’s”:
• The first hurdle to overcome is the Complexity of the overall healthcare marketplace, the resulting confusion created by new regulation, and an ever-shifting landscape for providers and consumers alike.
• The second obstacle is Cost and the ever-present debate: Can I afford it? Can I afford not to get it? Other costs to consider include the cost of not acting, cost of waiting too long to act, and cost of acting, including your research time and cost to implement the plan.
• The third consequence is emotional and financial strain on you, as well your loved ones and Caretakers.
In dealing with the Three C’s, many pre-retirees’ and retirees’ first healthcare decision will be to bridge the gap between employer-sponsored healthcare coverage and Medicare eligibility at 65. During this period, a person who’s not covered under a spouse’s employer plan would need to find coverage in the private market—either directly with an insurance provider or through the “Marketplace” created by the Affordable Care Act. In either case, it’s solely up to consumers to determine their best course of action, and many are surprised by the high, unsubsidized costs of private insurance.
Medicare Options. The second set of major healthcare decisions that most retirees face concern Medicare, Medicare Advantage and Medicare Supplemental Plans. The timing and importance of these decisions—made primarily during the three months before and after turning 65—can seem daunting. A bit of homework and planning can help retirees make choices with confidence.
Long Term Care Insurance. The 900-pound healthcare gorilla in the room is Long Term Care Insurance (LTC) and the debate that rages about the need for it. Remember, LTC steps in to cover custodial and unskilled healthcare costs that are not covered under Medicare or major medical insurance.
According to the U.S. Department of Health and Human Services, about 70% of those 65 or older will require some type of LTC services, either in their homes or an assisted living facility. Many retirees will have no trouble covering those costs from savings and retirement accounts.
There are, however, a significant and growing number of Americans who, despite good savings and retirement planning, are forced to liquidate assets and estates because of illnesses that require around-the-clock care. This can be extraordinarily expensive. According to MetLife, the average cost of a private nursing home is $90,000 a year, and in many states exceeds $100,000.
Plan Now. Contrary to popular belief, continued advancement in medical technology, life-saving procedures and increased life expectancy contribute to medical conditions that require significant long-term family and medical supervision; and it’s not cheap. The chances that it will affect you or someone close to you will go up in the next 25 years.
To avoid irreparable damage to a family’s financial plan, it’s imperative to make healthcare planning a front-burner family conversation. Even small measures and a continued open dialogue between advisors and the family can create a heightened sense of confidence and a definitive step toward being better prepared.
Owen Mulhern, IV, CFP®, is the President of Financial Coach, a comprehensive retirement planning and wealth management firm in West Chester. Through its Retirement Gameplan Process, the Financial Coach Team builds the plans and executes the tactics that seek to provide real-life retirement results. FinancialCoachGroup.com.
Disclosure: Securities offered through LPL Financial, Member FINRA/SIPC. Investment Advice offered though FC Advisory LLC, a registered investment advisor. Financial Coach and FC Advisory LLC are separate entities from LPL Financial.
For men, prostate cancer is the most common non-skin cancer and second leading cause of cancer death.
Over the past few years, prostate cancer screening has become a confusing topic for middle-aged men. Doctors have found an increasing number of patients with serious misinformation about prostate cancer screening and its implications. And, media coverage has prompted many men to forego most, if not all, testing for the disease.
Hopefully, this article will help clarify what prostate cancer screening involves and who should be tested.
How is prostate cancer screening done?
To begin, the prostate is a walnut-sized organ, deep in a man’s pelvis, resting on top of the rectum and attached to the bladder and urethra. Its simple function is to make semen, and, thus, it’s a non-essential organ. Because of its location, the prostate can be examined by a routine rectal exam in a physician’s office. A PSA blood test (prostate-specific antigen) may also be done as part of an exam.
If you’ve followed stories in the press, you know the PSA test is a useful, though not perfect, screening tool. Generally, the PSA test reading should be less than 4.0, but there are variations on how this result may be interpreted.
The difficulty with the PSA test relates to its lack of cancer specificity. While the reading may be elevated as a result of prostate cancer, it can also be abnormal because of other, non-cancerous reasons—such as prostate or urinary infection, benign prostate enlargement, or even recent ejaculation. It’s often difficult for a urologist to determine the basis for an elevated reading, and so additional testing—often including a prostate biopsy—may be recommended.
Most doctors agree that there’s been over- diagnosis and over-treatment of some clinically insignificant or non-life-threatening prostate cancers—small volumes of slow growing cancers, unlikely to shorten a man’s lifespan. However, it’s also noted that as a result of screening guidelines, prostate cancer deaths have declined in the U.S.
The National Comprehensive Cancer Network (NCCN) recently cited two important studies that looked at PSA screening over a 13-to-15-year period. The results showed not only significant reduction in mortality but also that only 98 patients need to be screened and five treated to save one life, paralleling breast cancer screening.
It’s also been shown that 30 to 50 percent of men detected with prostate cancer don’t require treatment, although a significant percentage harbor potentially aggressive disease. Because of this, an increasing number of patients elect active surveillance—continued close observation of their cancer—and understand that treatment could be recommended in the future.
What are screening guidelines?
To help clarify this issue, the American Urological Association (AUA) and National Comprehensive Cancer Network (NCCN) released guidelines citing the benefits of targeted PSA screening. All screening should be undertaken after thorough discussion with a physician.
The AUA recommends prostate cancer screening combining PSA blood test and prostate examination on a prescribed schedule. Men should not be screened until they are at least 40 years old, regardless of family history of prostate cancer or ethnicity. Men between 40-54 should be screened only if there’s a family history of prostate cancer or if they’re African-American. Between 55-69, screening is recommended every two years. Screening after 70 is currently not recommended. Again, these are general guidelines and a discussion with your physician is essential.
Is other testing recommended?
Research shows there are different genetic markers in prostate tissue and urine that can help clarify PSA results and prostate cancer diagnoses. The FDA has approved several available tests, and specialists are using these cutting-edge tests to ensure that patients get individualized evaluation and treatment.
Prostate cancer screening remains a controversial topic for men as they approach middle age. The most important advice is that men have clear discussions with their physicians and not ignore this critical topic. The future is likely to show exciting improvement in screening and treatment as new research on prostate cancer continues.
Thomas F. Lanchoney, MD, FACS, is a graduate of the University of Pennsylvania School of Medicine, where he did his internship and residency. A member of Urology Health Specialists, he specializes in da Vinci robotic and minimally invasive surgery. Find out more at UHSurology.com.
Whether you’re an expectant mother, recently relocated parent, or dissatisfied patient, looking for a pediatrician can seem like a daunting task.
How do you know if a pediatrician is well qualified? What questions should you ask the office and the physician to find the right match for you and your family? What factors should you consider?
Here’s some advice I share with my friends when they’re looking for a pediatrician.
Where to Begin? Keep your eyes open for pediatric offices in your community. Most pediatricians get the majority of their referrals from word-of-mouth. If there’s an office that comes highly recommended by multiple families, take this endorsement as a positive sign and add that office to your list to contact. But beware—you may have friends who give rave reviews to a pediatric practice that’s 45 minutes away. Do you want to drive that far to see your doctor when you have a sick child?
Also make sure the offices you’re considering accept your insurance. That may seem obvious, but if you don’t ask this up front, you may expend a lot of energy for nothing!
Some Preliminary Questions. Is the office independent or affiliated with a hospital system? Although affiliation doesn’t require you to use that hospital for specialists, admissions and the like, there are advantages to such a relationship. The pediatric practice often has access to technical resources, specialists and continuing medical education opportunities through its affiliated institution.
Is the office on electronic medical records (EMR)? This is helpful because prescriptions can be sent electronically to pharmacies from your doctor’s computer—very helpful for busy parents. Also, records are clear and accessible to multiple parties, so medical errors are reduced.
What are the hours of the practice? Are there weekend and evening hours? This could be especially important to working parents. Who covers calls to the practice overnight, on holidays and weekends? If you call with a question, will you get an answering service or a medical professional on the phone?
Once You Have a List, Start Calling and Visiting. What kind of reception did you get when you made your first call to the office? Is the office manager or a physician willing to sit down with you to answer questions and orient you to the practice? First impressions are important. Remember, it’s not just the physicians you’ll be dealing with; it’s the office staff as well. Are they kind, helpful and polite?
If possible, try to visit the office. Is the space clean and pleasant? Don’t be influenced by bells and whistles, though—toys harbor germs and may be banned for good reason. Also important, is there a separate “sick” and “well” entrance?
Consider Your Particular Needs. Would you feel more comfortable with a pediatrician who is a parent? Perhaps you have a teenage boy who would feel more comfortable with a male physician. Or you have a child with special needs and would like your doctor to be proactive in helping you coordinate care. Maybe you plan to breastfeed and want a pediatrician who’s knowledgeable and supportive of nursing.
Ask about the pediatrician’s credentials. Your pediatrician should be board certified by the American Board of Pediatrics.
Be vocal when you’re interviewing and trust your gut! Do you get a warm fuzzy feeling from your visit? Or do you have nagging doubts this isn’t a good fit?
Know that in an office of several physicians, there’s generally a personality fit for everyone! If you find the right office but the first pediatrician isn’t “the one,” don’t give up! Ask to see a different doctor the next time. Don’t worry—no one will judge you.
With a little research, your relationship with your pediatrician will be a long and rewarding one!
Bethany Kutz, M.D., currently practices general pediatrics at CHOP Care Network Chadds Ford in Glen Mills. Her interests include newborn care, breastfeeding support and asthma/allergies. She and husband Jason have a “working lab” at home, with their 8-year-old daughter and 10- and 12-year-old sons. Find out more at CHOP.edu; 610-358-2778.
Paoli Hospital celebrates its centennial and a history of community support.
Too often lost in current conversations on healthcare, which devolve into political posturing and worse, is the proud tradition of community hospitals and their essential role providing care to area residents. Our region is especially fortunate to mark a milestone for a patient-centered institution, as Paoli Hospital hits the hundred-year mark.
With a colorful history chronicled in a 300-page, 30-chapter, book—The History of Paoli Memorial Hospital, published in 1999 and written by former hospital board chair Marjorie H. Panitt—Paoli Hospital has great stories to tell. The hospital was kind enough to share its stories and photos from its archives, along with a copy of Panitt’s fact-filled book (there are even copies available on Amazon.com).
Want to know some of what we learned? Subscribe now.
Find out where you can get a free copy of County Lines, here.